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Black / African American Health Care: Implicit Bias

Implicit Bias and Racial Disparities in Health Care

Studies show providers are less likely to deliver effective treatments to people of color when compared to their white counterparts—even after controlling for characteristics like class, health behaviors, comorbidities, and access to health insurance and health care services.

 

Why are black people sicker, and why do they die earlier, than other racial groups? Many factors likely contribute to the increased morbidity and mortality among black people. It is undeniable, though, that one of those factors is the care that they receive from their providers. Black people simply are not receiving the same quality of health care that their white counterparts receive, and this second-rate health care is shortening their lives. (Source)
 

As a health care provider in America, it is imperative you understand the health disparities faced by the black / African American communities, your own implicit biases, and the importance of working towards equality in health care.  

Understanding Implicit Bias

What is Implicit Bias?

Implicit (subconscious) bias refers to the attitudes or stereotypes that affect our understanding, actions and decisions in an unconscious manner. These biases, which encompass both favorable and unfavorable assessments, are activated involuntarily and without an individual’s awareness or intentional control.

 

We All Have Implicit Bias:

We have all been exposed to "the negative narratives about racial minorities that circulate in society—discourses that become the stuff of unconscious negative attitudes about racial groups. [Health care providers], like the rest of the American public, have implicit biases. They have views about racial minorities of which they are not consciously aware—views that lead them to make unintentional, and ultimately harmful, judgments about people of color." (Source)

 

Why is it important to understand implicit bias?

When there’s a conflict between a person’s explicit and implicit attitudes—when people say they’re not prejudiced but give subtle signals that they are, for example—those on the receiving end may be left anxious and confused. Additionally, implicit bias against specifically the black / African American community leads to poorer care, less medicine prescribed, and large health disparities within this community. (Source)

 

How to overcome implicit bias?

Implicit bias in individual interactions can be addressed and countered if we become aware of our bias and take actions to redirect our responses.  (Source)

  • Stereotype replacement — Recognizing that a response is based on stereotype and consciously adjusting the response
  • Counter-stereotypic imaging — Imagining the individual as the opposite of the stereotype
  • Individuation — Seeing the person as an individual rather than a stereotype (e.g., learning about their personal history and the context that brought them to the doctor’s office or health center)
  • Perspective taking — “Putting yourself in the other person’s shoes”
  • Increasing opportunities for contact with individuals from different groups — Expanding one’s network of friends and colleagues or attending events where people of other racial and ethnic groups, gender identities, sexual orientation, and other groups may be present
  • Partnership building — Reframing the interaction with the patient as one between collaborating equals, rather than between a high-status person and a low-status person

Racism in Health Care

Black Pain Myths

“Black people’s nerve endings are less sensitive than white people’s.” “Black people’s skin is thicker than white people’s.” “Black people’s blood coagulates more quickly than white people’s.”

False ideas about black peoples’ experience of pain can lead to worrisome treatment disparities. A 2016 study found that "half of white medical trainees believe such myths as black people have thicker skin or less sensitive nerve endings than white people...These disturbing beliefs are not long-forgotten 19th-century relics" but realities within the United States health care system.

Due to explicit and implicit bias, black patients:

  • are less likely to be prescribed pain medication
  • are less likely to be believed about pain
  •  are less likely to receive pain reduction help after surgeries
  • are discharged earlier from the hospital
  • are more likely to receive less desirable treatments
  • less likely to receive medication or therapy for mental health issue