Racial Disparities in Healthcare are Pervasive



the racist photo in the medical school yearbook page of governor Ralph Northam of Virginia has probably caused many physicians to re-examine their past we hope we're better today but the research is not as encouraging as you might think there's still a long way to go to improve how the medical field treats minority patients especially african-americans that's the topic of this week's healthcare triage a systematic review published in academic emergency medicine gathered all the research on physicians that measured implicit bias with the implicit association test and included some assessments of clinical decision making most of the nine studies used vignettes to test what physicians would do in certain situations the majority of studies found an implicit preference for white patients especially among white physicians to found a relationship between this bias and clinical decision making one found that this bias was associated with a greater chance that whites would be treated from myocardial infarction than african-americans that study was published in 2017 the implicit association test has its flaws although the authors maintained that it measures external influences it's not clear how well it predicts individual behavior another bigger systematic review of implicit bias in healthcare professionals was published in BMC ethics also in 2017 the researchers gathered 42 studies only 15 of which used the implicit association test and concluded physicians are just like everyone else their biases are consistent with those of the general population the researchers also cautioned that these biases are likely to affect diagnosis and care a study published three years earlier in the Journal of the American Board of Family Medicine surveyed 543 internal medicine and family physicians who've been presented with vignettes of patients with severe osteoarthritis the survey asked the doctors about the medical cooperativeness of the patients and whether they would recommend a total knee replacement even though the descriptions of the cases were identical except for the race of the patients african-americans and whites participants reported that they believed the white patients were being more medically cooperative than the African American ones these beliefs did not translate into different treatment recommendations in this study but they were clearly there in 2003 the Institute of Medicine released a landmark report on disparities in health care the evidence for their existence was enormous the research available at that time showed that even after controlling for socioeconomic factors disparities remained there's significant literature documenting that African American patients are treated differently than white patients when it comes to cardiovascular procedures there were differences in whether they received optimal care with respect to cancer diagnosis and treatment african-americans were less likely to receive appropriate care when they were infected with HIV they were also more likely to die from these illnesses even after adjusting for age sex insurance education and the severity of the disease disparities existed for patients with diabetes kidney disease mental health problems and for those who were pregnant or were children the report cited some systems-level factors that contributed to this problem good care may be unavailable in some poor neighborhoods and easily obtained in others differences in insurance access and coverage can also vary by race but the reports author spent much more time on issues at the level of care in which some physicians treated patients differently based on their race physicians sometimes had a harder time making accurate diagnoses because they seemed to be worse at reading the signals from minority patients perhaps because of cultural or language barriers then there were beliefs that physicians already held about the behavior of minorities you could call these stereotypes like believing that minority patients wouldn't comply with recommended changes of course there's the issue of mistrust on the patient's side as well african-american patients have good reason to mistrust the health care system the infamous Tuskegee Experiment is just one example and we covered that in a previous episode in its report the Institute of Medicine recommended strengthening health plans so that minorities were not disproportionately denied access it urged more underrepresented minorities be trained as health care professionals and that more resources be directed towards enforcing civil rights laws in practice it endorsed more evidence-based care across the board it noted the importance of interpreters community health workers patient education programs and cross-cultural education for those who care for patients all of this has met with limited success in 2017 the agency for Healthcare Research and quality issued its 15 fearly report on health care quality and disparities as called for by the IOM in 2002 it found that while some disparities had gotten better many remained the most recent data available showed that 40% of the quality measures were still worse for blacks than whites other groups fared worse as well measures were worse for 20% of asian-americans thirty percent of Native Americans and one-third of Pacific Islanders and Hispanics of the twenty one access measures tracked from 2000 to 2016 9 were improving 9 were unchanged 3 were worsening be easy to look at a racist photo from the 1980s and conclude that it was a different time and that things have changed many studies show that it's still pervasive today the recommendations from the IOM in 2003 still hold any fair assessment of the evidence suggests much work remains to be done hey II do like the show it really helps if you like the video and really if you subscribe right down there and another good way to support the show is at patreon.com go to patreon.com/scishow we'd especially like to thank our research associate joe sevenths and our surgeon Admiral Sam and if you love healthcare triage content get even more at the healthcare triage podcast it's great get it at iTunes or Spotify or wherever you download your podcast content you

23 Comments

  1. Do you happen to know if increasing the representation of minority groups amongst physicians is helping to combat this problem? I.e. black doctors treating black/minority patients have better outcomes than white with black? Thanks for what you do! Very interesting.

  2. Great ideas. However, can we agree that remains, on this Earth in 2019, there is ONLY ONE RACE of Hominid: Homo sapien sapien. The last concurrent “race” were the “Hobbit People” who went extinct 10,000 years ago. Neanderthals never truly went extinct, as they mated with Homo sapiens. Truth be told, African’s and Indians are purer Homo sapiens as they lack any Neanderthal DNA. There are different levels of melanin, oil produced by skin, size and shape of hair follicle, height advantages. There many ethnicities, cultural traditions, National Democratic identities, regional commonalities, etc. There remain but ONE RACE Homo sapien sapien.

  3. https://www.livinganthropologically.com/biological-anthropology/how-race-becomes-biology/ << Update April 2018: See the special issue of Social Science and Medicine, "The Role of Racism in Health Inequalities: Integrating Approaches from Across Disciplines" for a number of related articles to how “race becomes biology.” Thanks to Anna Zogas for her “In the Journals” highlight on Somatosphere. Of particular interest is the article "Area racism and birth outcomes among Blacks in the United States" (briefly discussed as a supplement below), and see also "Why America’s Black Mothers and Babies Are in a Life-or-Death" Crisis by Linda Villarosa in The New York Times. For especially intriguing future research, The effects of whiteness on the health of whites in the USA.

    Race Becomes Biology
    Using traditional notions of race to understand human variation is not accurate or productive. The findings of Race Reconciled enable anthropology to reiterate how Race is a Social Construction. It is a human idea about biology that does not correspond very well to the biology. But anthropology also demonstrates how race becomes biology, or the embodiment of racist inequalities. … >>

  4. I'd LOVE to see a video about a brief (or not so brief!!!) history of mistreatment of minorities within the healthcare system!!! Love your videos.

  5. What nonsense. Uses junk science with implicit bias tests sprinkled in with a handful of actual determinants, all to link it back to a racist yearbook photo. It’s troubling people buy the lazy and oversimplified excuse of racism at every turn.

  6. mike ehrmantrout 25 years ago

  7. The only thing I agree with in this video is enforcing civil rights laws. They were made to free all of us and therefore should be enforced

  8. One flaw
    Any research her can prove his beliefs no matter what the truth.

  9. I thought a black person only counted as 3/5 a person. Seems awkward to expect 1-1 treatment if they're less than 1. And before the trolls reply, obviously I'm being sarcastic…

  10. Do Black doctors also preferentially treat Black patients?

  11. I like that you site your sources in the video, but I would be lying if I said it would be useful if you repeated the practice in the description. The fact that they're not is somewhat of a surprise to me, as this show's executive producer, presides over another show which subscribes to the practice I have mentioned. Some people have time to go through the video again and find every source to verify, but in all other cases, this is more likely to compound mistakes made in the research phase.

  12. As a follow up to this video I recommend the book The Death Gap: How Inequality Kills by Doctor Ansell. Another point not highlighted in this video is the issue of epistemic injustice experienced by most minorities who access our healthcare system. If as a patient your narrative is not believed or just discounted this can also affect the quality of the care you will receive. Interestingly, your pain is also likely to not be adequately treated if you are African American compared to the white counterparts.

  13. is this of ethical concerns of providers/nurses ? Nursing fundamentals have taught me to have values such as altruism, social justice, providing cultural competent/sensitive care with human dignity, and so on.

  14. stop mispronouncing "biases"

  15. Who was reading comments while watching

  16. I'm glad there was other studies cited that did not use the Implicate Association Test. The IAT is severely flawed and any information from it should be regarded as highly unreliable. I wish people would just stop using it like it means anything.

  17. I thought Africans and Europeans were more/less likely to get certain disease, needed different treatments, and so on. So to me it would seem rather natural for medical professionals to treat people differently.
    Is this wrong?

  18. implicit bias tests are bullshit pseudoscience.

    Stick to real science please.

  19. Hey There! Since you covered the adverse effects of the DEAs crackdown on opioids and just published this video about the role race plays in patient outcomes amongst providers, do you think you could cover how the pain management opioid prescribing crackdown effects minorities when it comes to why there seems to be racial prejudice prior to initiating long-term opioids and systemically lower maximum titration levels amongst the African American demographic? I'm a member of a small social justice group in Paducah KY and this topic just came up coincidentally lol #healthcaretriage
    #scishow
    #scishowpsych

  20. THANK YOU for this well researched report. Many AA claim racism in healthcare but are made to believe that what they felt isn't real. These are great articles that show there is a problem, and it's real.

  21. This is pretty consistent with what's already established in the field of prejudice…

  22. Something I wonder about with compliance: minority patients often don't have the greatest insurance coverage, so perhaps having higher co-pays for prescriptions means they're not always able to afford the prescribed medications? Are the doctors assuming that systemic racism is making compliance more difficult for minority patients?

  23. I would argue that their are statistically significant differences genetically and culturally between groups of people even within the same country so treating everybody the same will either provide optimal care for only on group of people or suboptimal for all people. We ought to treat people as individuals taking into account heritage and living conditions when practicing medicine. If you are dealing with a situation where all you know about a patient is they have sudden pains in chest and low oxygen levels and that their black it is entirely more responsible to look into sickle cell anemia sooner than if your patient where Hispanic.

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