The Role of Implicit Bias on Health Equity

This week, STAT News published an interesting series on a report released in 2003 by the National Academies Press, titled Unequal Treatment: Confronting Racial and Ethnic Disparities in Health. The release was groundbreaking at the time, focusing on the realities of racial disparities for both the provider and patient sides of healthcare. However, as STAT News reports, over the last 20 years, not much has changed, as it pertains to racial health disparities and associated health encounter outcomes. Although the conversations have been more frequent and in-depth, and data now often examines race, improved health has not been achieved. 

As I review these articles and see the momentum, we are making in areas such as those covered by the social determinants of health (SDoH), it should be clear that poverty should never conceal racial health disparities that exist in our healthcare system. These racial disparities span all socioeconomic and education levels. On July 12, the New York Times published details from a United Nations report that concluded that racism and sexism were the primary attributes contributing to maternal deaths of Black women – not genetics or lifestyle choices. “Black women in the United States are three times more likely than white women to die during or soon after childbirth,” their article read. “Those problems persist across income and education levels, as Black women with college degrees are still 1.6 times as likely to die in childbirth than white women who have not finished high school.” Putting aside our overt racial issues (such as the recent U.S. Supreme Court ruling regarding affirmative action), I can’t help but continue to call attention to the subject of implicit biases and their impact on our progress. Implicit bias occurs automatically and unintentionally, passively influencing our judgments, decisions, and behaviors.

Last year, Forbes contributor Dana Brownlee wrote an op-ed piece that challenged one implicit bias concept in particular: a common refrain by white individuals that color does not matter (often said to appease our own sense of discomfort when it comes to race). Brownlee’s article, titled Dear White People: When You Say You “Don’t See Color,” This Is What We Really Hear (forbes.com), noted that when individuals say that “people can’t make an impact on what they don’t see … people can’t address what they don’t acknowledge. People can’t affect change around what’s already been dismissed. I can guarantee that if a person is holding on to an ‘I don’t see color’ worldview, they are not doing too much of anything to move the needle on racism.”

So, in my initial example regarding racial inequality for Black maternal health, what if we start by automatically flagging Black women as being at high risk in maternal care, requiring access to additional care and services to ensure that they receive the necessary support they need? This is a detour from our prior notion that we cannot flag patients, because this will lead to labeling. But in doing so, are we failing to acknowledge the role that race is playing in our poor health outcomes? Additionally, data pertaining to hospital health outcomes, nationally and locally, should not only include reference to poverty, but reviews should include examination for racial disparities across all indicators.

The first step to address race as a health inequity is to acknowledge its existence and take the necessary steps to represent it as a health risk factor that requires additional attention and treatment.