Implicit bias needs critical check in health care

Children of color have worse clinical outcomes, and it might be because of the way healthcare providers treat them — even if it is unintentional.

The scientific literature is full of studies showing that disparities in outcomes correlate to a patient’s race.

For example, a study published in JAMA Pediatrics in 2018 showed that black school-age youth were more likely to die by suicide than white youth, though that’s reversed for teens.

Among children with moderate to severe congenital heart disease, black children were less likely to continue follow-up care with a specialist, according to a 2018 study in Congenital Heart Disease. And disparities in outcomes for children with developmental conditions, such as Down syndrome, are documented.

Differences in care can be tied to socioeconomic factors. But even accounting for that, race matters in terms of outcomes.

Researchers across the country have been investigating why this happens and how to bring health equity to children, regardless of skin color, religion, gender, orientation or other factors tied to disparities in outcomes.

What they’ve found is this: Most of the time, health-care providers have no intention of treating a patient differently, but sometimes they do.

Why? Implicit bias. Implicit bias refers to the unconscious attitudes and stereotypes that affect our understanding, feelings and actions – whether it is in a positive or negative way. And it affects everyone.

For example, if you had a lot of great teachers who were female, you might subconsciously prefer female teachers. Or, perhaps you were raised in a white neighborhood with minimal interaction with people of color. Your only exposure to people of color was watching TV news showing violent behavior (an example of bias in the media). You might subconsciously expect all people of color to be aggressive.

What you see and hear in the news, on social media, in books and even in the classroom matters. Representation of different genders and races in media and the workplace can reinforce or challenge implicit biases.

So if implicit bias is subconscious, and harm is not intentional, what is to be done about it?

Researchers point to the success of care protocols and standards of care — treating every patient using the same set of steps and procedures — in minimizing differences in outcomes. This is a good step, but it’s not all that needs to be done.

Experts say there is a growing call for health-care professionals to examine implicit bias. Self-reflection, challenging assumptions and engaging in honest conversations can move biases from the subconscious to the conscious, where they can be proactively addressed.

Importantly, once you become conscious of bias, actions need to change. Implicit bias is unintentional. But once you become conscious of your bias, it becomes a choice. And conscious, deliberate racial bias — well, that’s racism.

Abbie Roth is managing editor of Pediatrics Nationwide and Science Communication at Nationwide Children’s Hospital.

abbie.roth@ nationwide childrens.org