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Recently, growing calls for health equity and social justice have raised awareness of the impact of implicit bias and structural racism on social determinants of health, healthcare quality, and ultimately, health outcomes.
Feb 17, 2021 · An Insights Council survey shows disparities in care delivery at health care organizations and interpersonal racism affecting clinicians and staff, but also many programs and training to...
- Lisa A. Cooper
- 2021
Sep 1, 2023 · Family physicians, like other health care providers, make health care decisions that, without acknowledgment and conscious effort to address personal racial bias, can adversely affect racialized patients.
- Overview
- What is racial bias in healthcare?
- What are the types of racial bias?
- How does racial bias affect People of Color in general and Black people specifically?
- How to do better
When we seek medical care, we all hope that we’ll be provided the best care possible, regardless of our individual circumstances. We expect that the treatment we receive will be equal to that of anyone else’s, and we trust that the people on our care team will also be on our team — regardless of any personal thoughts or feelings.
Yet, history has shown that not everyone is afforded this type of treatment when it comes to healthcare. In fact, one survey found that over 10 percent of Black adults, and an even higher percentage of Black women and Black adults living in low income households, reported being unfairly discriminated against or judged by a healthcare professional.
Racial bias happens when attitudes and judgments toward people because of their race affect personal thoughts, decisions, and behaviors.
Whether implicit or otherwise, racial bias is evident in almost every area of healthcare, says Andrea Heyward, Director of the Community Health Worker Institute at the Center for Community Health Alignment. “Biases show up in many ways, including cultural and language barriers, and limited or no access to health insurance coverage, healthcare treatment, or social services due to immigration status,” Heyward tells Healthline.
Racial bias in healthcare also goes well beyond disparities that are perhaps easier to recognize, like the lack of multilingual staff at a medical facility, for example.
It also shows itself as disparities in statistics, clinical evidence, and more. “It’s the disproportionate mortality rate experienced by Black women in childbirth, [or the] historic and present-day evidence of racial bias in pain assessment and treatment,” continues Heyward.
Implicit bias
Implicit bias is one of the most widely discussed forms of racial bias in healthcare. Implicit racial bias in healthcare happens when healthcare professionals make judgments and decisions about a person’s medical care that are fueled by their own unconscious stereotypes and prejudices. In one recent analysis of available literature, researchers found that implicit racial bias from healthcare professionals can result in changes in both treatment and clinical judgment. For example, the analysis describes how racial bias can actually affect the way that certain medical interventions — such as pain management and intrauterine devices (IUDs) — are prescribed or recommended.
Algorithm bias
There’s also a lesser-known type of bias that can have a hugely negative impact on the healthcare experience for People of Color: algorithm bias. Algorithm bias is the type of bias that occurs when a healthcare algorithm, like one that might be used for helping with a diagnosis, expands upon already existing inequalities. Recent preprint research, meaning it has not been formally peer reviewed, describes multiple ways in which racial bias can show up in modern AI healthcare systems. For example, an overrepresentation of non-minorities (people who are not members of communities that have typically and historically been marginalized) means that many datasets used to help aid in diagnoses may be less applicable to minority communities. And many risk calculators in the past have been created based on biased statistics, which can greatly affect accurate information for People of Color. Both implicit and algorithm bias — as well as other types of biases in healthcare — make it almost impossible for People of Color to receive equal health and healthcare outcomes.
Racial bias in healthcare disproportionately affects Black communities. In fact, you only have to look as far as the recent pandemic to see the type of impact that racial bias has on Black people with COVID-19.
In one recent analysis of COVID-19 statistics in the United States, researchers discovered that severe racial and ethnic disparities have led to higher COVID-19 mortality rates in Black Americans. In fact, the disparity is so significant that Black people are over 3.5 times more likely to die from COVID-19 than white people.
And these disparities in COVID-19 hospitalization, death rates, and even vaccination rates, are only a small piece of the larger picture. We also know that:
•Black women are more likely to die from pregnancy-related complications, according to the Centers for Disease Control and Prevention.
•Black people are more likely to experience diabetes-related complications reports the American Diabetes Association.
•Black people — especially Black men — are more likely to be diagnosed with hypertension, according to the American Heart Association (AHA).
Heyward explains that many of these issues are deeply rooted in structural, institutional, and systemic racism. She stresses that it’s important to not only understand the root causes of racial bias but also the extent to which they span beyond just the healthcare experience.
When we recognize just how pervasive racial bias is — not just in healthcare but also in education, employment, and other areas — we can see that the path to change isn’t as simple as just training our medical professionals. Instead, Heyward emphasizes that our approach to change should be multifaceted.
“We must take a hard look at the healthcare system as a whole and consider sustainable, system-wide changes such as long-term investment in nonclinical roles, diversity within integrated care teams, and the integration of community health workers into both clinical and community settings,” she says.
So what does reducing racial bias look like long term? Well, here are a few of the key areas that can potentially make the biggest impact right now.
Although racial disparities in access to care, as well as in the quality and intensity of care, contribute to racial/ethnic disparities in the severity and course of disease, most racial disparities in the onset of illness occur prior to the presentation of patients to receive health care.
- David R. Williams, Ronald Wyatt
- 2015
Mar 21, 2024 · Delayed diagnoses, inappropriate levels of pain management or being denied care are negative experiences other Black people have faced there in the health-care system, says OmiSoore H. Dryden.
People also ask
What is racial bias in healthcare?
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What type of bias affects the healthcare experience for people of color?
Do health care organizations have a problem with interpersonal racism?
Jul 9, 2022 · A review of studies involving physicians, nurses, and other medical professionals found that health care providers’ implicit racial bias is associated with diagnostic uncertainty and, for...
