Racial Bias in Healthcare: What You Need to Know

What is racial bias in healthcare?

Racial bias happens when attitudes and judgments toward people because of their race affect personal thoughts, decisions, and behaviors.

Whether implicit or otherwise, racial bias is evident in almost every area of healthcare, says Andrea Heyward, Director of the Community Health Worker Institute at the Center for Community Health Alignment. “Biases show up in many ways, including cultural and language barriers, and limited or no access to health insurance coverage, healthcare treatment, or social services due to immigration status,” Heyward tells Healthline.

Racial bias in healthcare also goes well beyond disparities that are perhaps easier to recognize, like the lack of multilingual staff at a medical facility, for example.

It also shows itself as disparities in statistics, clinical evidence, and more. “It’s the disproportionate mortality rate experienced by Black women in childbirth, [or the] historic and present-day evidence of racial bias in pain assessment and treatment,” continues Heyward.

Ultimately, racial bias appears in every corner of the healthcare experience for Black people and People of Color all across the United States.

What are the types of racial bias?

Implicit bias

Implicit bias is one of the most widely discussed forms of racial bias in healthcare. Implicit racial bias in healthcare happens when healthcare professionals make judgments and decisions about a person’s medical care that are fueled by their own unconscious stereotypes and prejudices.

In one recent analysis of available literature, researchers found that implicit racial bias from healthcare professionals can result in changes in both treatment and clinical judgment. For example, the analysis describes how racial bias can actually affect the way that certain medical interventions — such as pain management and intrauterine devices (IUDs) — are prescribed or recommended.

Algorithm bias

There’s also a lesser-known type of bias that can have a hugely negative impact on the healthcare experience for People of Color: algorithm bias.

Algorithm bias is the type of bias that occurs when a healthcare algorithm, like one that might be used for helping with a diagnosis, expands upon already existing inequalities.

Recent preprint research, meaning it has not been formally peer reviewed, describes multiple ways in which racial bias can show up in modern AI healthcare systems.

For example, an overrepresentation of non-minorities (people who are not members of communities that have typically and historically been marginalized) means that many datasets used to help aid in diagnoses may be less applicable to minority communities.

And many risk calculators in the past have been created based on biased statistics, which can greatly affect accurate information for People of Color.

Both implicit and algorithm bias — as well as other types of biases in healthcare — make it almost impossible for People of Color to receive equal health and healthcare outcomes.

How does racial bias affect People of Color in general and Black people specifically?

Racial bias in healthcare disproportionately affects Black communities. In fact, you only have to look as far as the recent pandemic to see the type of impact that racial bias has on Black people with COVID-19.

In one recent analysis of COVID-19 statistics in the United States, researchers discovered that severe racial and ethnic disparities have led to higher COVID-19 mortality rates in Black Americans. In fact, the disparity is so significant that Black people are over 3.5 times more likely to die from COVID-19 than white people.

And these disparities in COVID-19 hospitalization, death rates, and even vaccination rates, are only a small piece of the larger picture. We also know that:

• Black women are more likely to die from pregnancy-related complications, according to the Centers for Disease Control and Prevention.
• Black people are more likely to experience diabetes-related complications reports the American Diabetes Association.
• Black people — especially Black men — are more likely to be diagnosed with hypertension, according to the American Heart Association (AHA).
• Black people are more likely to be misdiagnosed or overly diagnosed with mental health conditions reports Mental Health America.

But it’s not just Black communities that have been disproportionately affected by healthcare disparities due to racial bias. “Other people of color experience biases that restrict access to quality care and services to address social determinants of health,” explains Heyward.

When it comes to COVID-19, research published in 2021, for example, has shown that Hispanic, Asian, and American Indian communities also experience higher rates of hospitalization and death from COVID-19 than white Americans.

“It is critical to understand how issues such as disparities in health outcomes, lower quality of life, and decreased life expectancies impact BIPOC communities and their full complexity,” says Heyward.

How to do better

Heyward explains that many of these issues are deeply rooted in structural, institutional, and systemic racism. She stresses that it’s important to not only understand the root causes of racial bias but also the extent to which they span beyond just the healthcare experience.

When we recognize just how pervasive racial bias is — not just in healthcare but also in education, employment, and other areas — we can see that the path to change isn’t as simple as just training our medical professionals. Instead, Heyward emphasizes that our approach to change should be multifaceted.

“We must take a hard look at the healthcare system as a whole and consider sustainable, system-wide changes such as long-term investment in nonclinical roles, diversity within integrated care teams, and the integration of community health workers into both clinical and community settings,” she says.

So what does reducing racial bias look like long term? Well, here are a few of the key areas that can potentially make the biggest impact right now.

Ensuring healthcare professionals are not only educated but diverse

Ultimately, reducing racial bias in healthcare starts by creating more equitable care at the source, which can be done in part by training and supporting culturally competent healthcare professionals. “The lack of cultural competency and true understanding of Black, Indigenous, and People of Color impacts not only the quality of care as patients but also access to healthcare and social services,” Heyward says.

But it’s not enough to just educate a population of healthcare professionals when they also lack diversity — having medical professionals from diverse racial and ethnic backgrounds is important, too.

“We know that cultural competency, racial, and implicit bias training is essential for healthcare providers; however, a step further is to ensure that there is also representation and diversity within care teams,” notes Heyward.

Integrating community health workers into more areas of healthcare

“We know that bias shows up well before a patient even schedules a medical appointment or is admitted to a hospital,” explains Heyward.

In fact, she says that one of the biggest barriers is no access to healthcare or social services at all. It’s something that especially affects people whose first language is one other than English or who don’t speak English at all.

So how can we address the racial bias that shows up from the moment someone seeks care? Well, this can be done through initiatives like the PASOs program at the Center for Community Health Alignment, which uses a community health worker model to help Latino and immigrant populations access healthcare and social services.

And these kinds of initiatives aren’t just recommended — they’re essential, says Heyward. “Having a trusted member of the community supporting patients helps people of color and immigrant populations to not only access and navigate healthcare services but also allows for advocacy on behalf of patients who are not always seen, valued, or heard,” she explains.

Creating more accessible healthcare services and funding

When it comes to creating sustainable change, it’s not necessarily enough to just help people access the services that exist now. It’s also important that we continue to expand the services that we have available.

Recent literature highlighting the disparities related to COVID-19 emphasizes that one of the most important ways we can address these disparities is to start investing in healthcare facilities that serve marginalized and low income communities.

And expanding access to Medicare and other social healthcare programs can help more individuals in these communities have access to the care they need.