EARLY CHILDHOOD RESEARCH
roles, those who appear dangerous, those who are police officers and firefighters, those who are doctors, and so on. Inequities and biases in the broader society get incorporated into media, which gets consumed by children, whether intentionally or not. These portrayals then influence and shape unconscious associations in children of all ages. 13 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 that convey ideas about fairness and kindness toward all people, it’s also what children observe day to day in the behavior of those adult models. 14 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. 15 The viewing device also recorded who and what the teachers were looking at during the study. When teachers then 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 past 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 four 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. 11,12 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
ADULT RESEARCH
Within the racial history of America, the complexion of Black 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. 16 In addition, lighter-skinned Black people were sometimes viewed as slightly higher in status than darker-skinned Black people. Darker-skinned Black people often had fewer employment opportunities and were treated more harshly. Although the deliberate disparate treatment of light-skinned and darker-skinned Black individuals has significantly diminished, unconscious bias related to the complexion of people still exists in many sectors of American society. In the late 1800s Black women were often experimented on with little pain medication. Hiring and promotions of Black people can sometimes be significantly influenced by implicit racial bias related to complexion. 17,18 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 a Black 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, Case Study Exercise 1 You’ve just come from a meeting with a group of Black 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 Black 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 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?”
three images were darker-skinned 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. 19 Judgments about the worth or intellect of the Black man appeared to be unconsciously influenced by his complexion. Although not reported in the research, subjects would probably deny making judgments based on complexion. It should be noted that in recent generations, discrimination based on skin tone appears to be diminishing. 20 Excessive and biased focus on Black youths’ behavior in schools contributes to the disparate suspension rates for Black and White students in primary and secondary schools. 21 This does not appear to be the result of conscious discrimination. It appears that similar behavior is judged differently when carried out by a Black versus a White student. Blake and colleagues went a step further and examined race, complexion, and suspension rates. They found that Black teenage girls with darker complexions are suspended at a higher rate than those with lighter complexions. 22 Again, unconscious bias seems to be a major factor. Question 1: Why might the community members perceive a hospital or healthcare system as being racist? Commentary on Question 1: In addition to the history and present state of a particular hospital or healthcare system, the history of racism in America in general, as well as continuing racial health disparities, may contribute to some Black and Latinx community residents perceiving a hospital as being racist.
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Book Code: PCIL1525
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