Implicit bias in healthcare

By Sally McMahon

In addition to focusing on social determinants of health, we are also exploring implicit bias within the healthcare system. We talked to Aja Barber from the Center for Health Equity to learn more about implicit bias and how it impacts healthcare professionals’ relationships with patients. Below are the highlights.

Medical News: What is implicit bias?

Aja Barber

Aja Barber: Biases are predeterminations and evaluations of one group in relationship to another that upholds artificial group power dynamics of inferiority or superiority. And, because power also shifts along the various characteristics of our identity, these biases have multiple intersections including race, class, dis/ability, body size, sexual orientation, gender identity, and more.

However, it is not the identity that causes inequity but the ongoing collective misunderstanding about bias coupled with the desire by some to maintain dominance and its material advantages over these identities. For those of us who grew up in the United States, we have all been conditioned to carry and express biases – both implicitly and explicitly.

Explicit biases are easier to identify as they are expressed directly while implicit biases are expressed indirectly and are more often seen through the impact of our decisions, rather than the intention. Implicit biases feel inherent to our culture but are actually conditioned by our experiences with the tangible and intangible realities of inequity. These biases become implicit and embedded deeper in our culture without healthy, collective conversation about transforming bias towards equity.

MN: How does it affect the relationship between healthcare providers and patients?

AB: Implicit biases can impact the healthcare system in several ways. Below are just a couple of examples:

  • Implicit biases are most well-known for impacting the treatment of patients by healthcare professionals. For example, Black, American Indian, and Alaska Native women are two to three times more likely to die from pregnancy related causes than white women. Other patients discriminated against are those with chronic illness or other disabilities, queer and/or trans patients and larger size patients. Identifying and addressing implicit bias in healthcare will improve patient-provider interactions, communications and health outcomes.
  • The implicit biases individuals hold are impacted by experiences with their surrounding community. One such experience is the way healthcare is designed and implemented. For example, the curriculum which trains healthcare professionals are biased in ways that prevent people from a robust learning about bodies that are not white and male as well as care practices that extend beyond western European practices. Other examples of bias in the healthcare field include the difference in perception of value for healthcare workers. Consider the difference in your mind between doctors, nurses, techs and janitorial crews – all of whom are vitally important to a safe, sanitary healthcare experience but experience the material realities of being valued very differently.

MN: Are there any initiatives in Louisville to educate the healthcare community on implicit bias?

AB: Because of the way biases are embedded into our culture, the impact they have on our decision making is a fast skill that our brains have developed. Building an alternate skill to interrupt these biases in our daily lives requires significant individual and collective unlearning.

One such resource for groups is the opportunity to receive implicit bias training. Several entities across Jefferson County provide training on implicit bias and/or advancing equity, including the Louisville Metro Department of Public Health and Wellness’ Center for Health Equity.

The Center for Health Equity (CHE) is an office within the Louisville Metro Department of Public Health and Wellness. We work to achieve health equity by examining power and its impact on our institutions and interpersonal relationships.

Across the country, healthcare practitioners recognize that their feelings, beliefs, and attitudes about others can negatively impact the care of patients. Our work at CHE can offer guidance around how the healthcare field can approach the important process of unlearning harmful biases in order to provide a more equitable standard of care.

Through discrimination, the inequitable power dynamics of racism, economic exploitation and ableism shaped the design and implementation of healthcare, health outcomes and the conditions of the communities where people live and work, also known as social determinants of health.

The institutions that determine how health is measured, and which types of care are available to those experiencing poor health outcomes often reflect the biases of the decision-makers, leading to inequitable investment and disparate health outcomes.

It is important to understand that, to transform the biases we hold as individuals, we must collectively transform the design of our institutions so everyone can thrive.

The Louisville Metro Department of Public Health and Wellness is working to end health inequity, particularly by expanding our collective understanding of the processes needed to reach our goals across the levels of society – individual, interpersonal, organization, community and policy.