Implicit Bias in Healthcare: Why Black People are Dying at a Higher Rate than White People

Graphic: Brian Stauffer via Oprah Mag

Infant mortality and maternal mortality rates are two ways to measure a country’s overall health, but why has America consistently been one of the worst developed countries in these categories? In 2017, the US ranked 55 out of 225 in infant mortality. Infant mortality rate is the number of infant deaths under one year old out of 1,000 live births within a year. Our score was 5.9. This may not seem horrible, but the average score in developed countries is around 3 – our score is almost double that. So why is America’s infant mortality rate so high? Many researchers believe it is because of the implicit bias by healthcare workers in the country.

Implicit bias is the unconscious prejudices and stereotypes people have. Because of these, healthcare workers will often times treat black patients differently than white patients. A common practice used by doctors with black patients is using first-person plural pronouns such as “we”, “us”, “ours” in order to control the power dynamic. They may say phrases such as, “We’re going to take our medicine, right?” to talk down to or demean the black patients. Doctors will often also control the conversation more with black patients and not let them talk as much. If the patient is not able to communicate their issues, they will most likely not be taken seriously nor will they receive adequate and appropriate care.

There have been countless studies on implicit bias and they all prove that in America, black people and people of color, receive lesser care than white people. I have various studies cited at the bottom of this. The physicians are not always aware of their biases, but our country reinforces the ideas that white people are the most important. The media further perpetuates the racist and discriminatory stereotypes that get engrained in our heads. Whether we think we are unbiased or not, it is important to reflect on your actions and figure out if these implicit biases are coming out.

One way implicit bias affects our country’s health is infant and maternal mortality. Black women die from pregnancy-related causes at a rate over 3 times as high as white women and Native American women die at a rate 2.5 times higher than white women. It is a known fact that most pregnancy related deaths are preventable, yet black women are dying at a much higher rate than white women. It is clear that black women and women of color are simply not being listened to and are not receiving the proper care that they need. These biases in healthcare are contributing to our country’s high infant and maternal mortality rates.

Sixty percent of all pregnancy-related deaths can be prevented with better health care, communication and support, as well as access to stable housing and transportation, the researchers concluded. The fact that over half of these deaths can be prevented but black women die at a much higher rate, proves the biases and racism built into that industry.

An important fact to mention when discussing implicit bias is that white people make up 64.4% of the healthcare industry while black people only make up 11.6%. With over half of the workforce being white, there is just not enough representation by black people and PoC. Black patients are not being listened to and they have such a small chance of being able to see a black physician that might treat them with the respect and care they need.

A starting point to help combat implicit bias in the healthcare industry is to teach about it in medical school. If a student already has prejudices, implicit or explicit, they are putting the lives of their patients at risk. Learning about these biases that we all have, whether we know it or not, is of the utmost importance. Although it is important in the world of medicine, everyone needs to learn of these things to see how their actions and non-verbal cues may be affecting the people around them. Innocent people are dying because they are not receiving the proper care they need. This is just one of the aspects of systemic racism that our country is rooted in.

Resources

Caryn Rabin, Roni. “Huge Racial Disparities Found in Deaths Linked to Pregnancy.” The New York Times, 7 May 2019, www.nytimes.com/2019/05/07/health/pregnancy-deaths-.html. Accessed 22 June 2020.

Chapman, E.N., Kaatz, A. & Carnes, M. Physicians and Implicit Bias: How Doctors May Unwittingly Perpetuate Health Care Disparities. J GEN INTERN MED 28, 1504–1510 (2013). https://doi.org/10.1007/s11606-013-2441-1

Collins, Sara R., et al. “What Is Status of Women’s Health? U.S. vs. 10 Other Countries | Commonwealth Fund.” Commonwealthfund.Org, 23 May 2019, www.commonwealthfund.org/publications/issue-briefs/2018/dec/womens-health-us-compared-ten-other-countries, https://doi.org/10.26099/WY8A-7W13. Accessed 22 June 2020.

DeAngelis, T. (2019, March). How does implicit bias by physicians affect patients' health care? Monitor on Psychology, 50(3). http://www.apa.org/monitor/2019/03/ce-corner

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

“Implicit Bias in Health Care.” Www.Culturecareconnection.Org, www.culturecareconnection.org/communication/implicit-bias.html. Accessed 22 June 2020.

Mangan, Dan. “US Has the Worst Rate of Child Mortality among 20 Rich Nations.” CNBC, 8 Jan. 2018, www.cnbc.com/2018/01/08/us-has-worst-rate-of-child-mortality-among-20-rich-nations.html. Accessed 22 June 2020.

“Racial and Ethnic Disparities Continue in Pregnancy-Related Deaths.” Cdc.Gov, 2019, www.cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html. Accessed 22 June 2020.

Smooth, Jay. “What Is Systemic Racism? [VIDEOS].” Race Forward, 22 Feb. 2018, www.raceforward.org/videos/systemic-racism.

“The World Factbook — Central Intelligence Agency.” Cia.Gov, 2019, www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html. Accessed 22 June 2020.

“United States (USA) - Demographics, Health & Infant Mortality.” UNICEF DATA, data.unicef.org/country/usa/#maternal-health. Accessed 22 June 2020.

U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. 2017. Sex, Race, and Ethnic Diversity of U.S, Health Occupations (2011-2015), Rockville, Maryland.