Racial biases and disparities in healthcare are significant issues that can impact the quality of care patients receive. These disparities often result from unconscious biases that healthcare professionals hold towards certain racial groups, which can manifest in various ways, such as condescending behavior towards patients or assumptions about patients' adherence to treatment. While there is no direct evidence linking implicit bias among healthcare professionals to clinical decision-making, this bias can still impact access to care, the quality of care, and health outcomes. Healthcare professionals and institutions must be aware of and address these biases to provide more equitable care to all patients.
Racial Bias in Healthcare
Racial bias in healthcare can lead to disparities in patients' quality of care. These disparities often result from unconscious biases healthcare professionals hold towards certain racial groups. These biases can manifest in various ways, such as condescending behavior towards patients, a lack of interpretation services, or assumptions about patients' adherence to treatment.
While there is no direct evidence linking implicit bias among healthcare professionals to clinical decision-making, this bias can still impact access to care, the quality of care, and health outcomes. For example, non-white patients may receive lower-quality care, are more likely to experience longer wait times, and be triaged to lower levels of care.
Racial disparities also exist in treating mental health disorders. Black patients are less likely to receive treatment for similar psychiatric conditions as white patients but more likely to have chronic diseases such as major depression.
These disparities in mental health treatment can contribute to poorer health outcomes for Black patients. Healthcare professionals need to be aware of their own biases and work to reduce their impact on patient care.
Racial Bias in the Utilization of Restraints
Racial bias in using restraints refers to the unequal use of conditions, such as physical restraints or sedation, on patients of different racial backgrounds. Research has shown that Black patients are more likely to be restrained in healthcare settings than white patients.
This racial bias in using restraints can be linked to healthcare professionals' unconscious biases toward Black patients, such as perceiving them as more aggressive or non-compliant. These biases can result in Black patients receiving a higher level of restraint use, even when their behavior does not warrant it.
Racial Disparities in Psychiatric Diseases
Racial disparities in psychiatric diseases refer to the unequal treatment and diagnosis of mental health disorders among racial groups.
Black patients are less likely to receive treatment for similar psychiatric disorders as white patients but are more likely to have chronic conditions such as major depression. Black patients may also be more likely to be diagnosed with more severe and chronic mental health conditions, such as schizophrenia, due to biases held by healthcare professionals.
These disparities in mental health treatment can contribute to poorer health outcomes for Black patients. Healthcare professionals need to be aware of their own biases and work to reduce their impact on patient care to address these disparities.
There are several ways that healthcare professionals and institutions can work to reduce racial biases and disparities in healthcare:
Implicit bias training:
Providing training on unconscious biases can help healthcare professionals recognize and mitigate their preferences to provide more equitable care.
Cultural competency education:
Ensuring that healthcare professionals are educated on the cultural backgrounds and needs of their patients can help reduce misunderstandings and improve communication.
Increasing diversity in the healthcare workforce:
A more diverse healthcare workforce can ensure that patients have access to care providers who share their cultural backgrounds and experiences.
Implementing fair and objective policies:
Ensuring that policies and procedures are fair and objective can help reduce unconscious biases' impact on patient care.
Collecting and analyzing data:
Gathering data on patient outcomes and care experiences can help to identify areas where disparities exist and target interventions toward addressing them.
Engaging in community outreach and partnerships:
Working with community organizations and leaders can help to build trust and improve the healthcare system's responsiveness to the needs of different racial and ethnic groups.
Increasing patient education and empowerment:
Providing patients with the education and tools they need to advocate for their health can help to reduce disparities in care.
Reducing racial biases and disparities in healthcare requires a multifaceted approach that includes implicit bias training, cultural competency education, increasing diversity in the healthcare workforce, implementing fair and objective policies, collecting and analyzing data, engaging in community outreach and partnerships, and improving patient education and empowerment. By addressing these issues, healthcare professionals and institutions can work towards providing more equitable care to all patients, regardless of their racial or ethnic background.
Smedley, B., Stith, A., & Nelson, A. (2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academy Press.
Hall, W. J., Chapman, M. V., Lee, K. M., Merino, Y. M., Thomas, T. W., Payne, B. K., Eng, E., Day, S. H., & Coyne-Beasley, T. (2015). Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. American Journal of Public Health, 105(12), e60–e76. https://doi.org/10.2105/AJPH.2015.302903
Bean, M. G., Stone, J., Moskowitz, G. B., Badger, T. A., & Focella, E. S. (2013). Evidence of nonconscious stereotyping of Hispanic patients by nursing and medical students. Nursing Research, 62(5), 362–367. https://doi.org/10.1097/NNR.0b013e31829e02ec
Dehon, E., Weiss, N., Jones, J., Faulconer, W., Hinton, E., & Sterling, S. (2017). A Systematic Review of the Impact of Physician Implicit Racial Bias on Clinical Decision Making. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 24(8), 895–904. https://doi.org/10.1111/acem.13214
Shah, A. A., Zogg, C. K., Zafar, S. N., Schneider, E. B., Cooper, L. A., Chapital, A. B., Peterson, S. M., Havens, J. M., Thorpe, R. J., Jr, Roter, D. L., Castillo, R. C., Salim, A., & Haider, A. H. (2015). Analgesic Access for Acute Abdominal Pain in the Emergency Department Among Racial/Ethnic Minority Patients: A Nationwide Examination. Medical Care, 53(12), 1000–1009. https://doi.org/10.1097/MLR.0000000000000444
Musey, P. I., Jr, Studnek, J. R., & Garvey, L. (2016). Characteristics of ST Elevation Myocardial Infarction Patients Who Do Not Undergo Percutaneous Coronary Intervention After Prehospital Cardiac Catheterization Laboratory Activation. Criticalathways in Cardiology, 15(1), 16–21. https://doi.org/10.1097/HPC.0000000000000069
Schrader, C. D., & Lewis, L. M. (2013). Racial disparity in emergency department triage. The Journal of Emergency Medicine, 44(2), 511–518. https://doi.org/10.1016/j.jemermed.2012.05.010
Aparicio, H. J., Carr, B. G., Kasner, S. E., Kallan, M. J., Albright, K. C., Kleindorfer, D. O., & Mullen, M. T. (2015). Racial Disparities in Intravenous Recombinant Tissue Plasminogen Activator Use Persist at Primary Stroke Centers. Journal of the American Heart Association, 4(10), e001877. https://doi.org/10.1161/JAHA.115.001877
(1999) Mental health: a report of the Surgeon General. [Rockville, MD.: Dept. of Health and Human Services, U.S. Public Health Service ; Pittsburgh, PA: For sale by the Supt. of Docs] [Web.] Retrieved from the Library of Congress, https://lccn.loc.gov/2002495357
Kessler, R. C., Demler, O., Frank, R. G., Olfson, M., Pincus, H. A., Walters, E. E., Wang, P., Wells, K. B., & Zaslavsky, A. M. (2005). Prevalence and treatment of mental disorders, 1990 to 2003. The New England Journal of Medicine, 352(24), 2515–2523. https://doi.org/10.1056/NEJMsa043266
Williams D. R. (2005). The health of U.S. racial and ethnic populations. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 60 Spec No 2, 53–62. https://doi.org/10.1093/geronb/60.special_issue_2.s53
Baglivio, M. T., Wolff, K. T., Piquero, A. R., Greenwald, M. A., & Epps, N. (2017). Racial/Ethnic Disproportionality in Psychiatric Diagnoses and Treatment in a Sample of Serious Juvenile Offenders. Journal of Youth and Adolescence, 46(7), 1424–1451. https://doi.org/10.1007/s10964-016-0573-4
Rosenfield S. (1984). Race differences in involuntary hospitalization: psychiatric vs. labeling perspectives. Journal of Health and Social Behavior, 25(1), 14–23.
Sleath, S. (1998). Patient race and psychotropic prescribing during medical encounters. Patient Education and Counseling, 34(3), 227–238. https://doi.org/10.1016/S0738-3991(98)00030-5
Whaley, A. (1998). RACISM IN THE PROVISION OF MENTAL HEALTH SERVICES: A Social-Cognitive Analysis. American Journal of Orthopsychiatry, 68(1), 47–57. https://doi.org/10.1037/h0080269.
Zun L. S. (2003). A prospective study of the complication rate of use of patient restraint in the emergency department. The Journal of Emergency Medicine, 24(2), 119–124. https://doi.org/10.1016/s0736-4679(02)00738-2
Schnitzer, K., Merideth, F., Macias‐Konstantopoulos, W., Hayden, D., Shtasel, D., & Bird, S. (2020). Disparities in Care: The Role of Race on the Utilization of Physical Restraints in the Emergency Setting. Academic Emergency Medicine, 27(10), 943–950. https://doi.org/10.1111/acem.14092
Cassie, K. M., & Cassie, W. (2013). Racial disparities in the use of physical restraints in U.S. nursing homes. Health & Social Work, 38(4), 207–213. https://doi.org/10.1093/hsw/hlt020