Eliminating Explicit and Implicit Biases in Health Care: Evidence and Research Needs

Abstract

Health care providers hold negative explicit and implicit biases against marginalized groups of people such as racial and ethnic minoritized populations. These biases permeate the health care system and affect patients via patient–clinician communication, clinical decision making, and institutionalized practices. Addressing bias remains a fundamental professional responsibility of those accountable for the health and wellness of our populations. Current interventions include instruction on the existence and harmful role of bias in perpetuating health disparities, as well as skills training for the management of bias. These interventions can raise awareness of provider bias and engage health care providers in establishing egalitarian goals for care delivery, but these changes are not sustained, and the interventions have not demonstrated change in behavior in the clinical or learning environment. Unfortunately, the efficacy of these interventions may be hampered by health care providers’ work and learning environments, which are rife with discriminatory practices that sustain the very biases US health care professions are seeking to diminish. We offer a conceptual model demonstrating that provider-level implicit bias interventions should be accompanied by interventions that systemically change structures inside and outside the health care system if the country is to succeed in influencing biases and reducing health inequities. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Racial Differences in Patient-Reported Symptoms and Adherence to Adjuvant Endocrine Therapy Among Women With Early-Stage, Hormone Receptor–Positive Breast Cancer

“… 11 , 12 , 13 , 14 , 15 , 16 Differences in socioeconomic status, higher rates of exposure to environmental risk factors, lower access to health care, and explicit and implicit clinician bias driven by centuries of racism, oppression, and disinvestment, rather than biological differences, contribute to higher symptom burden among Black women. 11 , 16 , 17 , 18 , 19 , 20 , 21 , 22 Race is a social construct, 23 and observed differences in health experiences and outcomes by marginalized groups must be understood in the broader context of structural racism and other factors that differentially place minorities at increased risks for high symptom burden, enduring disparities in treatment adherence, and breast cancer outcomes. 24 , 25 …”

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