III. Racial Disparities in Health Status: Interpersonal Racial Bias

Ruqaiijah Yearby , Sick and Tired of Being Sick and Tired: Putting an End to Separate and Unequal Health Care in the United States 50 Years after the Civil Rights Act of 1964,  25 Health Matrix: Journal of Law-Medicine 1 (2015) (155 Footnotes)


Health care providers' explicit and implicit racial biases favoring Caucasians over African Americans illustrates interpersonal racial bias. According to presenter Dr. Michelle van Ryn, there is evidence that a patient's race can affect physicians' “question-asking in clinical interview, diagnostic decision-making, referral to specialty care, symptom management, and treatment recommendations.”  For example, contrary to evidence showing that African Americans are intelligent and compliant, some health care providers believe that African Americans are unable to adhere to treatment regimens, and thus providers give less than the medically recommended health care services to African Americans.  As a result, many African Americans die unnecessarily.

For instance, a study conducted by Harvard researchers found that African American Medicare patients received poorer basic care than Caucasians who were treated for the same illnesses.  Specifically, the study showed that only 32 percent of African American pneumonia patients with Medicare were given antibiotics within six hours of admission, compared with 53 percent of other *23 pneumonia patients with Medicare.  Also, African Americans with pneumonia were less likely to have blood cultures performed during the first two days of hospitalization.  The researchers noted that other studies had associated prompt administration of antibiotics and collection of blood cultures with lower death rates.  Nevertheless, almost twenty years of research shows that this disparate treatment is caused by health care providers' implicit racial bias against African American patients.

Empirical evidence of health care providers' implicit racial bias was first published in 1999 in the Schulman study. That study investigated primary care physicians' perceptions of patients and found that a patient's race and sex affected the physician's decision to recommend medically appropriate cardiac catheterization.  Specifically, African Americans were less likely to be referred for cardiac catheterizations than Caucasians, while African American women were significantly less likely to be referred for treatment compared to Caucasian males.

That same year, researchers found that African Americans were less likely than Caucasians to be evaluated for renal transplantation, and that African Americans were less likely to be placed on a waiting list for transplantation after controlling for patient preferences, socioeconomic status, the type of dialysis facility patients used, perceptions of care, health status, the cause of renal failure, and the presence or absence of coexisting illnesses.

In 2000, Dr. Calman, a Caucasian physician serving African American patients in New York, wrote about his battle to overcome his own and his colleagues' racial prejudices, which often prevented African Americans from accessing quality health care.  That same *24 year, Drs. van Ryn and Burke conducted a survey of physicians' perceptions of patients.  The survey results showed that physicians rated African American patients as less intelligent, less educated, and more likely to fail to comply with physicians' medical advice.  Physicians' perceptions of African Americans were negative even when there was individual evidence that contradicted the physician's prejudicial beliefs.

In 2006, Dr. van Ryn repeated this study using candidates for coronary bypass surgery. Again, the physicians that were surveyed exhibited prejudicial beliefs about African Americans' intelligence and ability to comply with medical advice.  The physicians acted upon these prejudicial beliefs by recommending medically necessary coronary bypass surgery for male African Americans less often than compared to male Caucasians.

More recently, a 2008 study found that physicians subconsciously favor Caucasian patients over African American patients.  In this study, physicians' racial attitudes and stereotypes were assessed and then physicians were presented with descriptions of hypothetical cardiology patients differing only in race. Although physicians reported not being explicitly racially biased, most physicians regardless of race or ethnicity held implicit negative attitudes about African Americans, and thus were aversive racists.  This is significant because research has shown that the stronger the implicit bias, the less likely the physician was to recommend the appropriate medical treatment for heart attacks for African American patients.  Therefore, in order to address racial bias within health care, there must be a transformative change within the United States that addresses all the forms of racial bias.