Unconscious bias is creating a health crisis
The healthcare industry in the United States is one of the most consequential industries, proving relevancies from the wealthiest billionaires to the homeless on the streets. It is due to our heavy reliance on this industry that healthcare corporations have become the second largest revenue producing industry in the United States. Notwithstanding the impact that this $1.2 billion industry has on the day-to-day existence of American citizens, the truth remains that many people are unaware of the depths of inequality and discrimination that is present in healthcare; therefore, progress remains elusive in fixing these inequalities and creating an equitable healthcare system.
Prejudice is the “negative actions or lack of consideration given to an individual or group that occurs because of a preconceived and unjustified opinion” (Togioka et al., 2022). This prejudice in the healthcare environment can result in different qualities of treatments for groups, either explicitly or implicitly. However, not all prejudice is overt and intentional. Implicit prejudice, also known as “unconscious bias,” means that healthcare providers may be unaware of the unfairness that they are subjecting their patients to by indirectly judging them due to their race, disability, sex, and/or ethnicity. This implicit bias “can shape the way medical providers interact with patients” (PatientEngagementHIT, 2020). These bias-driven interactions are always to the detriment of the patients.
These implicit biases lead to negative outcomes for patients, especially members of marginalized communities. In 2012, the AHRQ conducted a study and reported that “black and Hispanic Americans received worse care than whites in 40% of quality measures, persons of American Indian and Alaskan Native descent received worse care than whites in 33% of quality measures and Asians received worse care than whites for 42% of measures…[It] was also found that the lesbian, gay, bisexual and transgender (LGBT) population was less likely to report getting prescriptions filled in a timely manner, less likely to report getting access to non-urgent care and less likely to report that is was easy to see a specialist” (Babyar, 2018). This shows that marginalized populations receive much worse care than white patients.
This bias not only has a negative impact on the patient’s level of care, it is detrimental to the patient’s confidence in the medical community. In a study published in the American Journal of Public Health, black patients indicated that their confidence in medical providers was lacking and rated their quality of care as poorer” (DeAngelis, 2019). It has been found that “black patients felt most negatively toward physicians who were low in explicit bias but high in implicit bias, demonstrating the validity of the implicit-bias theory in real-world medical interactions” (DeAngelis, 2019).
This implicit bias is having a real impact on patients who are members of marginalized communities. “Prejudice in healthcare negatively and disproportionately impacts stroke, cardiovascular, obesity, diabetes, hypertension, depression and anxiety among those discriminated against” (Togioka et al., 2022). While race is certainly one of the prime indicators of discrimination within a professional healthcare system, there is evidence that “‘providers’ communication is less-patient centered with members of… other stigmatized groups including patients with obesity” (Phelan et al., 2015).
Additionally, discrimination has been manifested within transgender people, where there is a disparity in transgender-focused education materials available to health professionals. Furthermore, there are a lack of policies necessary to accommodate transgender identities in medical documentations such as referral forms and prescriptions. (Bauer et al., 2009). While there are certainly overt prejudices against people in America that affect their quality of life, the implicit biases that they face from the healthcare industry are equally as troubling.
It is clear that there are recurrent themes in which healthcare discriminates primarily against color, weight bias, gender, and ethnicity. This discrimination can negatively impact a patient in which the patient does not get the same quality patient and physical time with their doctor or healthcare professional. Those who discriminate, even unknowingly, against certain groups or ethnicities may be harming the patients lives more than they realize and potentially putting them at a risk for death.
Babyar, J. (2018). Equitable health: let’s stick together as we address global discrimination, prejudice and stigma. Archives of Public Health, 76(1). https://doi.org/10.1186/s13690-018-0291-3
Bauer G et al (2009) “I don’t think this is theoretical; this is our lives”: how erasure impact health care for transgender people. Journal of the Association of Nurses in AIDS Care; 20: 5, 348-361
DeAngelis, T. (2019). How does implicit bias by physicians affect patients’ health care? Monitor on Psychology, 50(3). https://www.apa.org/monitor/2019/03/ce-corner
Health Disparities Examples. (2022). Patientnavigatortraining.org. https://www.patientnavigatortraining.org/chronic_disease/module1/2_healthdisparityexamples.htm
PatientEngagementHIT. (2020, October 16). What Is Implicit Bias, How Does It Affect Healthcare? PatientEngagementHIT. https://patientengagementhit.com/news/what-is-implicit-bias-how-does-it-affect-healthcare
Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews, 16(4), 319–326. https://doi.org/10.1111/obr.12266
Togioka, B. M., Duvivier, D., & Young, E. (2021, August 25). Diversity and Discrimination In Healthcare. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568721/
Vaanya is an alumnus of the Teen Think Tank Project’s 2022 Winter Research Cohort. The first year high school student played an integral role in the cohort’s health equity research. Outside of the TTTP, she is active in extracurricular activities, including: newspaper club, swim team, student council, chess tournaments, and guitar recitals. The honor student plans to pursue a career in the medical field.