Racial Bias Affects Trauma Outcomes
Dr. Adil Haider, a trauma surgeon at Harvard Medical School, has been studying disparities in emergency care outcomes for over 10 years. “People have always had this iconic image of emergency departments as the great equalizers,” Haider says. “There’s a perception that no matter who you are, if you have a trauma injury, you’re going to get picked up and receive the same level of care.” However, Dr. Haider's research identified large gaps in patient survival rates based on race. Compared to white patients with similar injuries, he found that black and Hispanic patients have a 20% and 50% greater chance of death, respectively. Socioeconomic factors, insurance status, and access to immediate emergency care all contribute to this disparity. But unconscious bias is also a likely culprit.
From the article:
“Bias from healthcare providers could also be an important factor,” [Haider] says. “There’s a perception that trauma happens to certain types of people, who deserve it because they’re from the wrong side of town, and even well-meaning, highly qualified people end up falling into that bias.”
Of the one million people who have taken the online implicit association test – a social psychology experiment designed by psychologists at Harvard University to detect the automatic associations between different races/genders and certain concepts which are stored subconsciously – approximately 70% showed preferences towards white people. Haider conducted similar tests on doctors, trainee surgeons and nurses using clinical vignettes. Once again, about 70% showed unconscious preferences towards white patients.
Do such biases affect how patients are treated? Multiple high-profile studies have suggested they do. In 2016, a paper in the journal Proceedings of the National Academy of Sciences surveying 222 white medical students and residents found that 50% of them believed black patients felt less pain than white patients, and so required less medication.
However in the trauma world, there remains a lack of acceptance, both that racial disparities exist and that bias is a problem at all. A survey published in 2016 of 536 surgeons found that 50% thought there was little evidence for disparities, and of the 50% who believed they did exist, 90% felt this was down to patient factors such as lack of compliance with treatment.
“People just don’t want to talk about it,” Haider says. “When it comes to their hospital, it’s a case of: ‘we treat everybody the same, no issues here.’”
Transgender Teens Fear Discrimination in Healthcare Settings
A new study published in Pediatrics finds that transgender and gender nonconforming (TGNC) youth are about half as likely to receive necessary medical care as their cisgender peers. This is in spite of a greater prevalence of physical and mental health problems in the TGNC population. Twenty-five percent of TGNC teens have chronic health conditions, and 60% have mental health issues. In comparison, only 15% of cisgender teens have chronic health problems, and 17% have mental health issues. Dr. Daniel Schumer, who wrote an accompanying editorial for the study, suggests that TGNC teenagers may avoid medical care due to fear that they'll be mistreated by healthcare providers, or experience subtle discrimination like being addressed by non-preferred pronouns.
From the study:
Consistent with gender minority and resilience theory, individuals perceived as gender nonconforming may be vulnerable to discrimination and have difficulty accessing and receiving health care compared with their cisgender peers. Perceived gender nonconformity may be a risk factor for minority stressors (eg, nonaffirmation, victimization, discrimination, or rejection), which may in turn elevate adverse health outcomes for these youth. Youth who are perceived or identify as gender nonconforming or nonbinary must also overcome unique barriers to accessing affirming health care compared with other TGNC adolescents, such as mistrust of health care providers because of fear of the youth’s own gender identity or expression being misunderstood. These barriers contribute to delays in seeking services, which may result in poorer health outcomes.
Health and Care Utilization of Transgender and Gender Nonconforming Youth: A Population-Based Study, from Pediatrics
African-Americans Bear the Burden of HIV/AIDS
African-Americans are disproportionately infected with HIV compared to other Americans. In 2016, African-Americans made up 12% of the U.S. population and 44% of all new HIV diagnoses. In 2015, African-Americans accounted for 52% of all AIDS-related deaths. While being far more likely to have HIV, a new CDC report finds that African-Americans are less likely than other Americans to have the virus under control with antiretroviral medications. In addition to improving outcomes, antiretroviral drugs constrain the spread of HIV. Addressing the needs of African-Americans living with HIV/AIDS will be critical to eradicating the disease. Likely causes of the disparity in viral supression include a lack of testing and outreach, less adherence to medical advice, and greater mistrust of healthcare providers.
From the article:
With 48 percent of HIV-infected Americans having achieved viral suppression, patients in the U.S. were on average slightly less likely than patients elsewhere to have the infection under control. But African-Americans in every category—regardless of gender or how they contracted the virus—were far less likely to have sustained viral suppression, the CDC report showed.
The report’s authors cite lack of health insurance, limited access to health services, stigma and distrust of health providers as possible contributors to racial disparities in American HIV care. “Addressing barriers to HIV care and treatment is critical to reducing health disparities,” a CDC statement said.