Why your health isn't solely up to you
The reason we can't ignore the role of implicit bias and social determinants of health
I’d love to tell you my path toward advocating for healthcare equity began during my childhood. Still, it wasn’t even on my radar until my graduate studies, when I first encountered the concept of social determinants of health.
The U.S. Department of Health and Human Services defines social determinants of health (SDOH) as “conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”
I was unaware of the link between economic stability, education access, healthcare access, neighborhood environments, social support, and health outcomes, so I was unaware of SDOH's impact on people who looked like me. However, a saying that “once you see it, you can’t unsee it” rang true for me. Once I learned about SDOH, I became committed to understanding and addressing the underlying factors perpetuating healthcare disparities.
My journey took a significant turn during my tenure at Partners In Health (PIH), where I witnessed firsthand the profound impact of systemic inequalities on patient well-being. There, I sowed the seeds of Enhance Black Women's Health years before I knew what this business would become. But I’m getting a little ahead of myself, so let me take a step back to talk more about what fueled my deep-rooted desire to dismantle barriers preventing Black women from accessing quality care.
In the words of Alannis Morissette, “Isn’t it ironic” that my professional endeavors would intertwine with my healthcare journey when I was diagnosed with rheumatoid arthritis and Sjögren's syndrome? I didn’t realize it at the time, but these diagnoses would later underscore for me the critical importance of healthcare access and quality. Because I was blessed with insurance coverage, a supportive healthcare team, and financial means, I was able to navigate the complexities of managing chronic illness effectively. Yet, I couldn't ignore the stark reality that many others – especially Black women – faced insurmountable obstacles in accessing even essential healthcare services.
The Washington Post recently reported that in the District of Columbia (D.C.), almost half of Black residents live in medically underserved areas, meaning that they have a shortage of primary care services (Brice-Saddler et al., 2024). As chronic illnesses are prevalent in medically underserved areas, lack of healthcare access is a significant social determinant of health for Black D.C. residents. Even if you’re not a Black resident living in D.C., it’s essential to realize that in the U.S., healthcare access is a privilege, not a right. Coming to that realization fueled my determination to drive change.
However, it’s important to note that healthcare access is not the only factor in health outcomes. Healthcare quality is equally important. Through my graduate studies, my work at PIH as well as my own healthcare experiences, I began to recognize that implicit biases within the healthcare system played a significant role in perpetuating disparities, particularly for Black women. Thus, when I founded Enhance Black Women's Health in 2023, it came from a place of wanting to equip healthcare providers with the tools to confront and address their implicit biases so they can ensure equitable care for all patients.
Hall et al. (2015) define implicit biases as “thoughts and feelings outside of conscious awareness,” which can influence healthcare providers' behavior and treatment choices.
For this reason, we must recognize the insidious nature of implicit biases. I mean insidious because they often lurk beneath the surface and influence clinical decision-making in ways we may not even realize. If you’re not new to the community, you’ve heard this story, but it’s worth repeating. During a follow-up call with my optometrist, he admitted that he wrongly assumed I wasn’t following instructions during an examination that tested my peripheral vision. After reviewing my x-rays, he discovered that I had inflammation in the back of my eye, impacting my peripheral vision - the very thing that was being tested. It was because he chose to confront his biases head-on that I received the proper diagnosis of rheumatoid arthritis and Sjögren's syndrome. My optometrist serves as an example of why healthcare providers must confront their implicit biases to provide care that is not only medically sound but also culturally competent and equitable.
While many of us wouldn’t think we hold implicit biases, we all do to some extent. The healthcare providers who choose to equip themselves with the tools to identify and address these biases will transform the healthcare system for the better. As we embark on this journey, I invite you to join my Substack community to stay informed and engaged. Together, we can transform healthcare, one conversation and one patient at a time.
References
Brice-Saddler, M., Portnoy, J., Harden, J.D., & Kai Chen, J. (2024 January 3). Half of Black D.C. residents lack easy access to health care, analysis shows. The Washington Post.
Hall, W. J., Chapman, M. V., Lee, K. M., Merino, Y. M., Thomas, T. W., Payne, B. K., Eng, E., Day, S. H., & Coyne-Beasley, T. (2015). Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. American Journal of Public Health, 105(12), e60–e76. https://doi.org/10.2105/AJPH.2015.302903
U.S. Department of Health and Human Services, Office of Disease and Health Promotion. (n.d.). Healthy People 2030. https://health.gov/healthypeople/priority-areas/social-determinants-health