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Racial Bias in Healthcare

Healthcare is a crucial part of our society. Hospital visits ensure our health and well-being. However, prejudices against people of color (POC) in healthcare are often overlooked. Racial bias in hospitals is exceedingly common, causing mistreatment and discrimination to different ethnicities, particularly POC.


These biases have been categorized into two groups: implicit and explicit. Explicit biases are thoughts and feelings that we purposely perceive and are consciously aware of, while implicit biases are not consciously held and difficult to control, meaning that they can influence one’s behavior without their realization. In the general population, white Americans tend to associate black Americans with negative perceptions such as fear and distrust. These notions are especially prevalent during stressful or busy times, as the mental effort required to thoroughly evaluate a person’s individual characteristics is far greater than that needed to characterize them as part of a racial or ethnic group. Additionally, many white healthcare workers harbor explicit biases towards black and hispanic people, believing them to be unintelligent, unable to follow treatment regiments, and more likely to partake in risky behaviors.


In 2005, the National Academy of Medicine released a report proving that contrary to popular belief, disproportionate rates of poverty among Black people does NOT “account for their shortened lifespans and increased levels of sickness compared to whites.” In other words, poverty cannot be used as an excuse for surging illness-related mortalities in blacks. This report also showed that when taking factors such as insurance status, income, age, and condition severity into account, the quality of healthcare given to POC was notably lower than the service provided to white people. The fundamental structure of the American healthcare system makes it particularly difficult for minorities to receive equal benefits due to policies preventing undocumented immigrants and documented imigrants with under 5 years of residence to obtain public health insurance. Minority groups were also found to be less likely to receive proper cardiac care, kidney transplants, dialysis, stroke, cancer, and AIDS. Related studies have also shown that in many hospitals, black patients with heart disease were provided with older, cheaper treatments compared to their white counterparts and were less likely to receive important procedures such as coronary bypasses and angiography.


Black women especially, were found to be less likely than white women to receive radiation therapy and mastectomy. In addition, undesirable treatments are substantially more common in POC patients, resulting in a higher frequency of limb amputations seen in blacks than whites. Mental health treatments have also been proven to be disproportionate between races. Black people with bipolar disorder have a higher chance of being prescribed antipsychotic medication, despite several studies showing its negative side effects. Not only can these drugs be ineffective, but can put the patient at risk for several negative health effects.


Unfortunately, these racist stereotypes are no stranger to the world of healthcare. Danya Bowen Matthew, author of Just Medicine: A Cure for Racial Inequality in American Healthcare, stated that physicians have been exposed to racist stereotypes and beliefs on minorities throughout society, giving them, along with the rest of the American public, implicit biases against these ethnic groups. These implications cause healthcare workers to hold certain prejudices against other races without being aware of it. This claim is supported further by studies utilizing the Implicit Association Test (IAT). The IAT assesses these biases by having test-takers associate black and white faces with pleasant and unpleasant words under an intense time constraint. These studies showed that on average, physicians tend to hold a pro-white/anti-black implicit bias. Furthermore, physicians with these biases were less likely to prescribe pain medication to black patients when compared to white patients. A similar study, asking whether they would recommend thrombolysis, an effective treatment for coronary artery disease, found that black patients were less likely to be prescribed with this treatment by a doctor with anti-black biases.


Besides treatment types and prescription, subtle biases against POC can be expressed in a number of ways. These include “approaching patients with a dominant and condescending tone that decreases the likelihood that patients will feel heard and valued by their providers, failing to provide interpreters when needed, doing more or less thorough diagnostic work, recommending different treatment options for patients based on assumptions about their treatment adherence capabilities, and granting special privileges, such as allowing some families to visit patients after hours while limiting visitation for other families.” These preconceptions surrounding racial or ethnic groups can be difficult to recognize, as those who hold them are likely unaware of these subconscious biases.


In closing, during a time of severe racial bias against POC, it is important that we not only recognize the prejudices that exist in police forces, but begin to expand our efforts to all aspects of society that discriminate against certain ethnic groups.




Resources


https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/racial-disparities-in-health-care/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638275/

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