Racial Bias in Health Care and Health

Abstract

A landmark report from the Institute of Medicine (IOM) in 2003 documented that from the simplest to the most technologically advanced diagnostic and therapeutic interventions, African American (or black) individuals and those in other minority groups receive fewer procedures and poorer-quality medical care than white individuals. 1 These differences existed even after statistical adjustment for variations in health insurance, stage and severity of disease, income or education, comorbid disease, and the type of health care facility. Very limited progress has been made in reducing racial/ethnic disparities in the quality and intensity of care. 2 The IOM report concluded that multiple factors contribute to racial disparities in medical care and that unconscious bias by health care professionals contributes to deficits in the quality of care. This Viewpoint discusses the potential contribution of societal racial bias to disparities in health care and health status.

Determining the effects and challenges of incorporating genetic testing into primary care management of hypertensive patients with African ancestry

“…Yet, these populations have the poorest outcomes from common, chronic illnesses such as CKD, and are least likely to benefit from diagnostic and therapeutic advances [71, 72]. Translational genomic research also should take into account real-world primary care operations, and the need for real-time, point-of-care integration of test results with the EHR using CDS tools [73–75].…”

Palliative Care Teams as Advocates for Adults with Sickle Cell Disease

“…A 2003 Institute of Medicine (IOM) report showed that African Americans receive fewer procedures and lesser-quality medical care than caucasian Americans; this remained true even after adjusting for income, level of education, comorbid disease, and the type of care facility. 22,23 What's more, the quality of care and communication deficits between providers and people with SCD are even more marked than those between providers and African American patients, in a way that cannot be accounted for solely by age, race, education, or health status. 24 Improving relationships between health care providers in the medical system and patients with SCD may improve the trust that SCD patients have in medical professionals, which in turn may improve the overall quality of care among this underserved patient population.…”

“…31 (3) Higher levels of implicit bias among clinicians have been directly linked with inequities in treatment recommendations for African Americans and have been associated with poor quality of patientphysician communication. 23 (4) As a result, there can be a vicious cycle, as true or perceived discrimination from health care providers is associated with greater nonadherence to management regimens, 25 which is especially problematic for the nearly 30% of adults with SCD who report chronic pain. 2 Beyond pain, SCD is a complex condition that affects not only the patient's relationship with health care providers, but also their relationship with family and community.…”

Methodology of AA CRASH: a prospective observational study evaluating the incidence and pathogenesis of adverse post-traumatic sequelae in African-Americans experiencing motor vehicle collision

“…Finally and more generally, evaluating the pathogenesis of a disorder among a highrisk population using molecular and epidemiological methods is a valuable approach to gaining new insights into disease pathogenesis. [46][47][48][49] In this article, we describe the methods of a large-scale, NIH-funded, longitudinal study evaluating the incidence and pathogenesis of chronic pain and neuropsychological outcomes among African-Americans experiencing MVC.…”