deeply held values, creating equitable healthcare environments requires physicians' conscious actions to build systems and processes that move them towards the elimination of disparities. It is not only the responsibility of those with particular titles,like a chief diversity officer, but all healthcare providers must be
“activists” in their own areas of work: in the treatment room, in the laboratory, or in the administrative suite. The focus on implicit bias does not absolve providers of conscious, focused,deliberate action, it simply highlights an important parallel process.
EARLY CHILDHOOD RESEARCH
appear dangerous, those who are police and fire people, those who are doctors, etc. Inequities and biases in the broader society get incorporated into media, which get consumed by children, whether intentionally or not. These portrayals then influence and shape unconscious associations in children of all ages (Williams & Steele, 2017). Children are also influenced by the behavior of parents, caregivers, and other significant adults in their life, noticing the complexion and gender of their close friends, as well as comments and jokes. It’s not only the things that parents and caregivers say to convey fairness and kindness for all people, but it’s also what children observe day-to-day in the behavior of those adult models (Pirchio et al., 2018). The process of unconscious associations can also be seen in the way adults begin to view and interact with children. In a study at the Yale Child Study Center in 2016, preschool teachers viewed videos of African American and White children walking around a classroom,talking and interacting with each other (Gilliam et al., 2016). The viewing device also recorded who and what the teachers were looking at during the study. When teachers were told that there might be challenging behavior, the device revealed that they began to look at and track the African American children. Further, their eyes tracked the African American boys more than the other children. The teachers did not have any conscious idea of their viewing behavior.
Did you Know? Much of the research on implicit bias has only occurred in the last 40 years. It has provided increasing support for theories related to the development of implicit biases and ways in which unconscious biases impact decision making. One of the important areas of implicit bias research focuses on the question, how early in one's development does implicit bias begin to show up? Recent research suggests that the foundation for what later shows up as implicit bias occurs in infancy. For example, if we track the eyes of infants, at about 4 weeks of age, they will stare longer and more frequently at female faces if a woman has been the primary caregiver. This is clearly not implicit bias, but it appears to reflect a differential association or a preference. This process of differential response in terms of what types of faces infants tend to stare at continues to evolve (Balaset al., 2011; Lee at al., 2017). Although care has to be taken to not infer bias from infant behavior, it appears that responsiveness to faces that are similar to the infant or the individual who provides nurturing/food may be a precursor to preferences later in development. As toddlers and older children begin to spend time online, watch television, and read books,they sense the race or gender of the people who tend to be in leadership roles, those who
ADULT RESEARCH
Within the racial history of America, the complexion of African American people has always been a complex dynamic. The One Drop Rule, in practice and then in law, has existed since Africans were forcibly brought to this country. Interracial relationships, both forced and voluntary, resulted in biracial children and adults. Essentially, any African ancestry (“one drop of African American blood”) classified an individual as African American (O’Connell et al., 2020). In addition, lighter-skinned African Americans were sometimes viewed as slightly higher in status than darker-skinned African Americans. Darker-skinned African Americans often had fewer employment opportunities and were treated more harshly. Although the deliberate disparate treatment of light-skinned and darker-skinned African Americans has significantly diminished, unconscious bias related to the complexion of people still exists in many sectors of American society. Hiring and promotions of African Americans can sometimes be significantly influenced by implicit racial bias related to complexion (Grant, 2020; Louie & Wilkes, 2018). In one experiment, subjects were sent to one of two rooms. In one room subjects saw the subliminal presentation of the word “ignorant” on a screen,followed by the subliminal presentation of the face of an African American male. In the other room, subjects saw the subliminal presentation of the word “educated” and the subliminal presentation of the face of the same man. In the next phase of the experiment, subjects in both rooms saw seven variations of the same man’s face: three images were lighter-skinned versions, three images were darker-skinned Case study exercise 1 You’ve just come from a meeting with a group of African American and Latinx community residents. They presented the committee, which you are a part of, with a list of demands related to what they perceive as a racist hospital environment. Your first patient is a 24-year-old African American male, dressed in a t-shirt and jeans. You greet him and before you can ask any questions, he asks you a few questions. “Where did you grow
versions, and one image was identical to the first subliminal presentation. From the seven photographs, subjects were asked to select the version that was identical to the subliminal presentation. Researchers found that subjects primed with the word “ignorant” selected a darker-skinned version of the man, while those primed with the word “educated” selected a lighter- skinned version (Ben-Zeev et al., 2014).Judgements about the worth or intellect of the African American man appeared to be unconsciously influenced by his complexion. Although not reported in the research, subjects would probably deny making judgements based on complexion. It should be noted that in recent generations, discrimination based on skin tone appears to be diminishing (Braniganet al., 2019). Excessive and biased focus on African American youth’s behavior in schools contributes to the disparate suspension rate for African American versus White students in primary and secondary schools (Erickson & Pearson, 2021). This does not appear to be the result of conscious discrimination. It appears that similar behavior is judged differently when occurring by an African American versus a White student. Blake and colleagues went a step further and examined race, complexion, and suspension rates. They found that African American teenage girls with darker complexions were suspended at a higher rate than those with lighter complexions (Blake et al., 2017). Again, unconscious bias seems to be a major factor.
up?” “Did you have any Black friends?” “Why are you looking at your watch?” “Is this going to be more than a 10-minute visit?” Question 1 Why might the community members perceive a hospital or healthcare system as being racist?
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Book Code: PYCA1423
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