The Impact of Implicit Bias in Healthcare

How to Promote Health Equity for Black Women

Although healthcare providers aim to provide equitable care, research has shown this is only sometimes true. Findings show that objective and subjective measures of group identity can predict implicit bias (Elran-Barak & Bar-Anan, 2018). Hence, a provider's identity may impact their patients' quality of care.

That is why understanding the impact of implicit bias is essential for ensuring providers promote health equity for Black women. In this post, we will discuss implicit bias in healthcare and shed light on its specific effects on the health of Black women. By understanding the dynamics of implicit bias, healthcare providers can identify and address these biases, ensuring equitable care for all patients. 

Implicit Bias and its Impact on Black Women in Healthcare

According to FitzGerald and Hurst (2017), implicit biases are unconscious negative associations that may affect judgments and behaviors towards a particular group. While these biases are dangerous in general, in healthcare, they can be deadly. Due to these biases, healthcare providers may engage in differential treatment, misdiagnosis, and disparities in access to care. As a result, implicit bias can lead to adverse health outcomes for Black women, such as: 

• Disparities in Maternal Health: Studies have shown that in the U.S., Black women are two to three times more likely to die from a pregnancy-related cause than White women (Levin, 2022). Thus, implicit bias can result in delayed or inadequate care, dismissal of symptoms, and a lack of trust between patients and providers.

• Misdiagnosis and Underdiagnosis: Research has shown that implicit bias can contribute to short-length medical examinations, leading to misdiagnoses or underdiagnoses of certain conditions, potentially compromising health outcomes (Palmese et al., 2020). For example, cardiovascular diseases are often underdiagnosed due to the stereotype that Black women are less susceptible to heart problems.

• Access to Reproductive Health: The unintended pregnancy rate is growing, with Black women having the highest unintended pregnancy rate among Black Indigenous People Of Color (Finer & Zolna, 2014). Therefore, limited access to reproductive health services is a severe issue as contraception and family planning are essential for supporting reproductive healthcare for Black women.

This illustrates that implicit bias disproportionately affects the health outcomes of Black women, and what’s even more troubling is that not enough has been done to address it (Cukier, 2021). However, this comes as no surprise as the origins of implicit bias can be traced to societal conditioning, cultural stereotypes, and historical inequalities. Therefore, providers must recognize their biases and how they may impact patient care.

Strategies for Addressing Implicit Bias in Healthcare

Despite the challenges, the one thing that we know at Enhance Black Women's Health is that we can address these issues. Whether we are healthcare providers or patients, our advocacy makes a difference. Here are specific strategies that can help: 

• Self-Reflection and Awareness: Recognizing that we all have implicit bias is essential to ensure proactive self-reflection. This can involve participating in implicit bias training, reading literature on cultural competence, and actively seeking patient feedback. By doing this, we can become more aware of the areas we can improve.

• Diversify the Healthcare Workforce: There is a tendency for providers to seek "culture fits" when creating a more diverse workforce requires us to seek "culture adds." Employing those that add to the workplace culture can help mitigate the effects of implicit bias. In addition, having a diverse workforce enables patients to interact with professionals who have a deeper understanding of their cultural experiences and healthcare needs.

• Implement Evidence-Based Protocols: It should go without saying that healthcare institutions should develop evidence-based protocols. Due to implicit bias, patients may feel judged, which can lower their trust in the healthcare system (Puhl et al., 2021). Thus, it is essential to standardize care so that individual biases are reduced and unbiased care can be delivered to all patients, regardless of their background.

• Promote Culturally Competent Care: We cannot dismiss acknowledging a patient's cultural values and beliefs when providing care. Providers can gain a deeper understanding and appreciation for their patients' diverse cultural backgrounds and experiences through cultural competence. In doing so, providers can learn how to avoid stereotypes and provide personalized care that accounts for individual needs.

• Engage in Community Partnerships: Developing relationships with community organizations and leaders is essential for gaining insight into the specific challenges. Black women face in accessing healthcare. Providers and community stakeholders can design interventions to address systemic biases and promote health equity by working together.

As implicit bias in healthcare perpetuates health disparities Black women face, it is crucial to recognize these biases to promote health equity. By fostering self-awareness, diversifying the healthcare workforce, implementing evidence-based protocols, encouraging cultural competence, and engaging in community partnerships, healthcare providers can begin to dismantle the barriers that impede equitable care. Our collective responsibility is to ensure that every patient, regardless of race or gender, receives the care they deserve. By understanding how implicit bias impacts healthcare, we can take intentional steps to promote health equity for all.

Sources. 

Cukier, A. (2021, October 28). Canada's dietitians are lacking in diversity - but things are changing. Best Health. https://www.besthealthmag.ca/article/dietetics-canada/ 

Elran-Barak, R. and Bar-Anan, Y. (2018). Implicit and explicit anti-fat bias: The role of weight-related attitudes and beliefs. Social Science and Medicine, 204, 117-124. 

Finer, Lawrence B., and Zolna, Mia R.: "Shifts in Intended and Unintended Pregnancies in the United States, 2001–2008." American Journal of Public Health, 2014, 104 (S1), S43,

FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC medical ethics, 18(1), 19. https://doi.org/10.1186/s12910-017-0179-8

Levin, B. (2022, May 20). Louisiana Senator Bill Cassidy: Our maternal death rates are only bad if you count Black women. Vanity Fair. https://www.vanityfair.com/news/2022/05/bill-cassidy-maternal-mortality-rates 

Palmese, F., Reggidori, N., Pappas, G. & Gramenzi, A. (2020). More than a "monstrous obesity"! Time to overcome the "anti-fat" bias. Clinical Obesity, 11(1), 1-3. http://dx.doi.org/10.1111/cob.12413