Health Disparities: The Ignorant and the Blind

Health Disparities: The Ignorant and the Blind

The inequity between health outcomes among different racial groups in health care settings is a disgusting dark side to what is typically portrayed as an upstanding pillar of society. The bias and prejudice which exists in the health care field is not only palpable, but measurable. The public is predominantly ignorant of the statistics and data which highlight the vast disparities in quality of care and overall outcome of health facility visits among these diverse groups. Others dismiss the claim that there exists institutionalized racism in our health care system, and disregard the studies as misguided or unfounded. To truly establish equal health outcomes following care and create an environment in our hospitals which allows the patient, regardless of color, to receive the highest standard of care which can be provided, we must accept this information for what it is, the truth, even though it may be uncomfortable. Embracing that discomfort will allow providers to realize their own biases and not allow any perpetuation of this issue affecting millions.

On the intrapersonal level, physicians’ personal biases, whether conscious or not, affects treatment speed and efficiency of patients with different racial backgrounds. According to studies referenced in the article Can Health Care Be Cured of Racial Bias? by April Dembosky, African-Americans who present with the same symptoms and chief complaints as whites receive on average less prescription pain medication. Dembosky also states, “Black patients with chest pain are referred for advanced cardiac care less often than white patients with identical symptoms.” This chasm between whites and blacks receiving proper care adumbrates the prejudice and racism which exists in ambivalence, griping minorities with anxiety who seek treatment, while not affecting whites entirely, and completely results from health care providers acting upon their implicit biases.

Interpersonally, a lack of community understanding or acknowledgement of controversial fact perpetuates the inequality of health care outcomes. Studies, such as one published in the National Institute of Health’s National Library of Medicine stating that blacks were less likely than whites to receive opioid analgesics for the same health conditions, rarely make headlines. It is an unpopular topic of discussion to propose that those in charge of saving lives may also be treating patients differentially due to race and biases, a topic which is uncomfortable perhaps for the reason that it may install worry, and rightfully so, in such affected populations who will call upon these care providers for treatment in the future. Those who do find information on this subject may dismiss it because, similar to climate change, it is easier to dismiss an issue as being untrue than it is to try and generate a plausible solution. Whether it is due to ignorance of fact or blindness of truth, the lack of community involvement preserves the biases which leave some recipients of care behind. Were there more news coverage of such disparities, the public would pressure health institutions in which the gap is most extreme and catalyze positive change.

In the broader scope of public policy, there exists no legislation or regulation which standardizes the clinical pathways, the ideal sequence of treatment and timing of such care for a particular diagnosis, which must be followed for any patient, regardless of race. A mandatory level of standardization ensures equality for treatment of all groups, indifferent to the biases of any particular health care provider. Perhaps if such a standardization was incentivized, such as a penalty on insurance payments to the institution for differential health outcome due only to a difference in race without other complications, there could be a positive impact on reducing the difference in treatment of varying ethnicities with the same diagnosis.

According to the International Consortium for Health Outcomes Management, “We believe outcomes are the ultimate measure of success in health care.” If this is indeed the case, then our current health care system is blatantly failing the needs of underrepresented populations, and it is not only our responsibility, but our duty as the future of health care to establish an equity so desperately missing from our care of individuals, regardless of cultural background or ethnicity. To truly call oneself a health care provider, one must do so without difference of color or creed, for to do so is a disservice to not only the patient, but the entirety of the health care community.

What do you think is a good way to help break the cycle of prejudice and bias in our health care system? Is it feasible to dream of a health care system without prejudice?

9 thoughts on “Health Disparities: The Ignorant and the Blind

  1. I personally think a good way to help break the cycle of prejudice and bias in the health care system is to first be made aware that these prejudices exist. The first step in fixing a problem is first acknowledging that there indeed is a problem. As you mentioned, many people, physicians even, are not aware that these biases exist and many acts of health disparities occur unconsciously. I think to decrease the likeliness that these instances occur, people have to be made aware that even though it may be unintentional, we all hold these certain biases about certain people because that is simply how our brains work.

    To complete eradicate prejudice within the health care system would be ideal, but it is easier said than done. Although I don’t think it’s possible to completely eliminate prejudice from the system, I think it’s possible to rid the system of conscious and intentional prejudice by reporting acts of discrimination when they occur so that those situations may be handled properly to be sure they don’t happen again.

  2. I think the increasing quantification of everything in our lives, including health related factors will be greatly beneficial towards achieving better health equality. With more sharing of this information, better conclusions and decisions can be made. When a doctor makes his decisions based on information measured from devices and conclusions made from a computer rather than more subjective sources of information, biases in treatment could be greatly reduced. With a large database of people, their traits, and outcomes, doctors and patients would also be able to make more informed choices based on their specific situations. Of course, a system like this would also have its own issues that need careful consideration. First, computer models, while likely an improvement on human judgement, oftentimes also contain their own inherent biases. This is sometimes because the population that the model is used on is different than the set that the model was trained with. For example, if a model was trained with only white people, predictions for other groups of people may not be as accurate. Security of the health information of individuals could also be an issue. Similar existing databases are already subject to attack from malicious groups, and centralizing all this information into one place would increase the incentive even more for attackers. I think a health care system without any prejudice at all will be impossible to achieve, but a system with more shared information could help reduce the biases in health care.

  3. In order to break the cycle of prejudice and bias in healthcare, people first need to realize that this is a real problem. Some people choose to ignore that bias is a real problem, while others do not see it as a problem because it has not happened to them. These two ways of thinking need to be changed in order to combat the cycle of prejudice that occurs in healthcare. I think doing exercises like the ones in class on Thursday would be very helpful to show people their unconscious biases. I know it opened my eyes to what I am initially drawn to and what turns me away. Helping people to be aware that they have predispositions to certain characteristics in people will help them to be aware of those behaviors and take actions to stop them. Paying attention to how our actions affect others, or how they could be interpreted is the first step to eliminating prejudice and bias.

    I think it is possible to dream of a healthcare system with no prejudice, but a lot of hard work would have to be done in order to achieve it. I am not sure if bias can be completely removed from healthcare, but I do think it can be minimized greatly from where it is now. People will always have some unconscious bias, but if they can recognize it and not act on it, healthcare will improve greatly.

  4. I agree when you say that creating standards for health care and then creating incentives for health care providers to actually adhere to those standards will help get better outcomes. In addition to bias training for healthcare workers at the intrapersonal level, there must be something done at the public level in the form of legislation that sparks change in the equity of healthcare for all. A bill that sets standards for health care equity and ensures equal outcomes would do much in the way of ensuring that disadvantaged groups would get the care they deserve. Such a bill would most likely face heavy opposition from health care providers, but it would benefit the public. By disciplining that continue to perpetuate health disparities, and rewarding those who ameliorate them, we can come closer to erasing health disparities. A combination of both bias training for healthcare workers and public policy that encourages equal outcomes would be powerful indeed.

  5. I agree that the unconscious racial biases among people can cause a disparity in health care. I would like to point out another way in which doctors risk the lives of their patience in response to biases. Of course, as you stated Mitchell, certain ethnicities are less likely to get referred to the proper health procedures than others. There is another main disparity however; this is how the patients are physically treated as opposed to whether or not treatment is received.

    Doctors will commonly acknowledge that black individuals are more likely to develop diabetes while whites will develop cancer. Doctors will recognize that the DNA in certain ethnicities makes one group of people more prone to one chronic illness than another. What the doctors normally do no do, is take a different approach in treating two different patients from two different ethnic backgrounds.

    In the health profession, we have recognized the differences in ethnic genes however; the health providers seldom consider these differences in order to better treat a patient. All patients are treated as if they have the same DNA as a white person. This approach is not adequate for anyone who is a racial minority. Different ethnicities may require different medical approaches to the same diseases because different ethnicities are affected by chronic illnesses differently.

    This is often overlooked when people discuss the disparities that ethnicities play in the medical world. Hopefully this will be noticed more often as time continues, and we can save more lives.

  6. I would have to agree with other HSSP students in saying the first step toward breaking the cycle of prejudice in our health care system is to recognize these biases. This, however, can be extremely difficult because many people, like me, do not know their personal biases but I am aware that everyone has them. Because these biases can be so subtle, I am unsure as to whether we can actually break the cycle of prejudice. I do believe we can improve, but the idea that we could demolish the cycle completely seems unlikely. Doctors definitely need more of a check and balance type system to ensure that they do not send home a patient simply because of skin color, religion, gender or any other form of discrimination. Analyzing health care biases on a larger scale can help bring awareness to what other doctors are doing. For example, training physicians could have some type of simulation in which multiple victims with the same symptoms come in for an examination and attending physicians could observe to see how the patients are treated differently. The training physicians would have to be oblivious to such practices so there can be reliable results. Doctors may also take a series of implicit bias tests just so they can get an idea of which situations could create a bias in diagnosis. Eliminating health care bias seems to only be true in a perfect world. Although unbiased judgement is what patients deserve, I do not think this a feasible dream. No biases would mean a world without discrimination, furthermore a world without “isms” such as sexism, racism, or ageism. Seeing as biases are unconscious, and some people simply grow up to believe different ideas, I do not believe there can be health care, or life, without bias.

    1. I also have to agree with the HSSPers above, in saying that the first step to eliminating prejudice in the health field is to acknowledge that we each hold our own biases towards others. Although it may differ from person to person, everyone has biases, whether it be bias towards different races/ethnicities, age, gender/sexual orientation, weight, etc. However, by acknowledging what biases we hold, we can more consciously approach people with a fair mind. While our unconscious biases may keep us from completely eradicating prejudice in the health system, acknowledging biases and working towards equality will definitely bring us far.

      Andrea, you did mention that you were aware that you had biases, but didn’t know which ones you held. I definitely agree that our specific bias towards others can be hard to see sometimes. The IAT can help more clearly see what unconscoius biases you may hold towards other groups of people. It may be a good idea for people in the health field to take the IAT as well. It would help them further acknowledge what biases they have in order to help prevent prejudice.

  7. I think I would have to also agree with the other HSSPers. Like the presenter noted on Thursday, people are not aware of their unconscious bias—whether in health or in other environments—I thought it was interesting how the doctors were surprised that they were more likely to offer white men knee replacement surgeries compared to black women. It will be a struggle every day to take note of the bias that we do, but it is worth just being aware. I think just having an awareness is a big step forward. While I do think it’s impossible to eliminate bias entirely, I think it’s worth trying to limit it as much as possible. I don’t have a personal experience regarding health disparity that happened to me—but I do not visit the hospital often regardless. Having taken the implicit association test before, I am aware that I do have a slight bias with regards to race. I think a majority of that is because of the influence media and pop culture had/has on my psyche. If pop culture can introduce a wider array of diverse individuals that play roles going against their stereotype, then it may limit the bias for coming generations. I can only hope that bias’ are not too ingrained within the minds of people so that it is possible to rehabilitate, so to speak.

  8. I agree completely with what you said. One of the biggest things I saw in your post was that before we have equality and no judgement in treatment we must see that there is something wrong there. This makes me think of the first step to solving really any problem in the world, Realizing there is a problem. I personally read the article on women not getting fair and equal treatment and I was totally shocked when I read it. It made me think of my sister. If my sister was going through that pain and was ignored simply because she’s a girl I would’ve been extremely mad. Also when you talked about physicians biases affecting their treatment it made me think of any biases I may have. And nobody is perfect we all have some sort of bias whether we know it or not. Your post made me wonder how I could eliminate these biases from my own life, and possibly from the healthcare field. The problem is society has put a huge negative thought process behind biases which simply scares people from admitting they have one. And if people can’t admit there is a problem they can never solve it.

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