Implicit Bias in Health Care ___________________________________________________________________
In response to this conflict, a systems-based practice has been proposed [59]. This type of practice emphasizes the role of sociocultural determinants of health outcome and the fact that health inequities stem from larger systemic forces. As a result, medical and health education and training should focus on how patients’ health and well-being may reflect structural vulnerabilities driven in large part by social, cultural, economic, and institutional forces. Health and mental health professionals also require social change and advocacy skills to ensure that they can effect change at the organizational and institutional levels [59]. Implicit bias is not a new topic; it has been discussed and stud- ied for decades in the empirical literature. Because implicit bias is a complex and multifaceted phenomenon, it is important to recognize that there may be no one single theory that can fully explain its etiology.
counterparts, even after controlling for medically necessary procedures [65]. This places African American and Latina women at greater risk of infection and maternal mortality. One of the most salient statistics that highlights racial health disparities is in maternal morbidity and mortality rates. In the United States, Black patients are 212% more likely than White patients to die from pregnancy- or childbirth-related causes [110]. In addition, during the COVID-19 pandemic, evidence of racial health disparities was widespread. People of color were hospitalized for COVID at 4.7 to 5.3 times the rate of White Americans [110]. Gender health disparities have also been demonstrated. Gener- ally, self-rated physical health (considered one of the best prox- ies to health) is poorer among women than men. Depression is also more common among women than men [66]. Lesbian and bisexual women report higher rates of depression and are more likely than non-gay women to engage risk behaviors such as smoking and binge drinking, perhaps as a result of LGBTQ+-related stressors. They are also less likely to access healthcare services [67]. Socioeconomic status also affects health care engagement and quality. In a study of patients seeking treatment for thoracic trauma, those without insurance were 1.9 times more likely to die compared with those with private insurance [68].
CONSEQUENCES OF IMPLICIT BIASES
HEALTH DISPARITIES Implicit bias has been linked to a variety of health disparities [1]. Health disparities are differences in health status or disease that systematically and adversely affect less advantaged groups [60]. These inequities are often linked to historical and current unequal distribution of resources due to poverty, structural inequities, insufficient access to health care, and/or environ- mental barriers and threats [61]. Healthy People 2030 defines a health disparity as [62]: …a particular type of health difference that is closely linked with social, economic, and/or environmen- tal disadvantage. Health disparities adversely affect groups of people who have systematically experi- enced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic sta- tus; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteris- tics historically linked to discrimination or exclu- sion. As noted, in 2003, the Institute of Medicine implicated implicit bias in the development and continued health disparities in the United States [1]. Despite progress made to lessen the gaps among different groups, health disparities continue to exist. One example is racial disparities in life expectancy among Black and White individuals in the United States. Life expectancy for Black men is 4.4 years lower than White men; for Black women, it is 2.9 years lower compared with White women [63]. Hypertension, diabetes, and obesity are more prevalent in non-Hispanic Black populations compared with non-Hispanic White groups (25%, 49%, and 59% higher, respectively) [64]. In one study, African American and Latina women were more likely to experience cesarean deliveries than their White
CLINICAL DECISIONS AND PROVIDER-PATIENT INTERACTIONS
In an ideal situation, health professionals would be explicitly and implicitly objective and clinical decisions would be com- pletely free of bias. However, healthcare providers have implicit (and explicit) biases at a rate comparable to that of the general population [6; 69]. It is possible that these implicit biases shape healthcare professionals’ behaviors, communications, and interactions, which may produce differences in help-seeking, diagnoses, and ultimately treatments and interventions [69]. For example, physicians have been shown to minimize Black patients’ pain, ignore their complaints, and spend less time in examination rooms with them [111]. In a 2021 study, physicians were more likely to expect Black patients would not adhere to an HIV pre-exposure prophylaxis medication compared with White patients [112]. As a result, physicians were less likely to discuss available regimens with Black patients. They may also unwittingly produce professional behaviors, attitudes, and interactions that reduce patients’ trust and comfort with their provider, leading to earlier termination of visits and/or reduced adherence and follow-up [7]. The adverse consequences of implicit biases between patients and practitioners emerge in the following areas [106]: • Communication • Relationship • Patient satisfaction and patient’s view toward provider’s patient-centeredness
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