of Africans was maintained by a system of inhumane physical and psychological abuse, norms, accepted practices, and laws. As property , Africans weren't considered human. They were property to be purchased, sold,and even named in the will of individuals before they died, like one might leave a house or wagon to a spouse or children. Like the evaluation or assessment of a used car or house, enslaved Africans were evaluated and rated according to their fitness and/or physical defects. They were not viewed as human beings on par with Whites (Franklin & Higginbotham, 2011). The ingrained nature of this racist system afforded any White person the right to stop any African American individual, question them, search them, and even physically abuse them. These actions were accepted practice and, in many cases, were part of legal codes and regulations. Thus, the systemic and structural nature of racism in this country was not only built on the economic practice of enslaving African Americans for individual and family profit, but was built on the practices, beliefs, and laws that created and supported the belief that Africans were not fully human (Medical News Today, 2021). In the 18th and 19th centuries the support of this belief of inhumanity took the form of scientific racism or pseudoscience. Many people, both professionals and laypersons,thought that African American people had an innate tendency to want to run away from the confinement of the plantation, had thicker skin and skulls, and had fewer nerve endings and therefore could endure more pain. This rationale was often used for the extreme Definition Implicit bias can be defined as those attitudes, beliefs, and stereotypes that affect our understanding, behavior, and actions in an unconscious (implicit) manner. A relatively small portion of the information the brain processes is conscious. The majority of information is processed unconsciously, out of awareness. As people process this information, their unconscious association can reinforce stereotypes that most often differ from their conscious assessment of an individual or group. An act to amend Sections 2190.1 and 3524.5 of, and to add Section 2736.5 to, the Business and Professions Code, relating to healing arts. [ Approved by Governor October 02, 2019. Filed with Secretary of State October 02, 2019.] LEGISLATIVE COUNSEL'S DIGEST This bill would require the Board of Registered Nursing, by January 1, 2022, to adopt regulations requiring all continuing education courses for its licensees to contain curriculum that includes specified instruction in the understanding of implicit bias in treatment. Beginning January 1, 2023, the bill would require continuing education providers to comply with these provisions and would require the board to audit education providers for compliance with these provisions, as specified. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. The Legislature finds and declares all of the following: a. Implicit bias, meaning the attitudes or internalized stereotypes that affect our perceptions, actions, and decisions in an unconscious manner, exists, and often contributes to unequal treatment of people based on race, ethnicity, gender identity,sexual orientation, age, disability, and other characteristics. b. Implicit bias contributes to health disparities by affecting the behavior of physicians and surgeons, nurses, physician assistants, and other healing arts licensees. Assembly Bill No. 241 Assembly Bill No. 241 CHAPTER 417
brutalization and whipping experienced by African American men, women, and children (Gilder Lerhman Institute of American History, 2021). These beliefs contributed to the medical experimentation conducted on African American bodies, sometimes without any attempt to reduce the pain and suffering of African American patients or experimental subjects (Cohen, 2021; Dimuro, 2018). Although current laws, policies, and accepted medical practices have eliminated the horrendous abuses of African American bodies, it is important to recognize how deeply embedded many of the beliefs and perceptions of African American people are within American culture, both consciously and implicitly. A 2016 study revealed that almost half of the medical students and residents surveyed endorsed notions of pseudoscience, believing that African American people had thicker skin, less sensitive nerve endings, and experienced less pain than Whites (Hoffman et al, 2016; Skibba, 2019). In spite of conscious endorsements of equity, fairness, social justice, and providing the highest level of care, there is this parallel process of unconscious or implicit bias. It is not that providers are inherently bad. Rather, they are human and prone to internalize, to a greater or lesser extent, the beliefs and stereotypes resulting from centuries of systemic and structural racism. These beliefs and internalized stereotypes can cause physicians to behave in ways that violate their deeply held values of fairness and equity. The process is unconscious or implicit. These unconscious associations can contribute to the unequal treatment of people based on their race, ethnicity, gender, gender identity, age, disability, sexual orientation, etc. Although implicit bias and unconscious associations can be a subtle influence on cognition and behavior, their impact on decisions can be significant (DeAngelis, 2019; Edgoose et al., 2019). California is a leader in recognizing the criticality of implicit bias in healthcare (California Legislative Information, 2021). c. Evidence of racial and ethnic disparities in healthcare is remarkably consistent across a range of illnesses and healthcare services. Racial and ethnic disparities remain even after adjusting for socioeconomic differences, insurance status, and other factors influencing access to healthcare. d. African American women are three to four times more likely than White women to die from pregnancy-related causes nationwide. African American patients often are prescribed less pain medication than White patients who present the same complaints,and African American patients with signs of heart problems are not referred for advanced cardiovascular procedures as often as White patients with the same symptoms. e. Implicit gender bias also impacts treatment decisions and outcomes. Women are less likely to survive a heart attack when they are treated by a male physician and surgeon. LGBTQ and gender-nonconforming patients are less likely to seek timely medical care because they experience disrespect and discrimination from healthcare staff, with one out of five transgender patients nationwide reporting that they were outright denied medical care due to bias. f. The Legislature intends to provide specified healing arts licensees with strategies for understanding and reducing the impact of their biases in order to reduce disparate outcomes and ensure that all patients receive fair treatment and quality healthcare. The process of implicit bias in no way diminishes the importance of conscious, deliberate behavior. Physicians’ conscious endorsements of the values of equity and fairness can be an important element of their service to patients. In addition to
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