Disparities and distrust: The implications of psychological processes for understanding racial disparities in health and health care

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Abstract

This paper explores the role of racial bias toward Blacks in interracial relations, and in racial disparities in health care in the United States. Our analyses of these issues focuses primarily on studies of prejudice published in the past 10 years and on health disparity research published since the report of the US Institute of Medicine (IOM) Panel on Racial and Ethnic Disparities in Health Care in 2003. Recent social psychological research reveals that racial biases occur implicitly, without intention or awareness, as well as explicitly, and these implicit biases have implications for understanding how interracial interactions frequently produce mistrust. We further illustrate how this perspective can illuminate and integrate findings from research on disparities and biases in health care, addressing the orientations of both providers and patients. We conclude by considering future directions for research and intervention.

Section snippets

The processes and consequences of racial bias

In the United States, Whites' obvious and blatant expressions of prejudice toward traditionally underrepresented groups, and toward Blacks in particular, have declined substantially over the past 50 years. As Bobo (2001) concluded in his review of racial attitudes, “The single clearest trend in studies of racial attitudes has involved a steady and sweeping movement toward general endorsement of the principles of racial equality and integration” (p. 269). Although more obvious acts of bias

Contemporary bias and health care

In this section, we attempt to connect research on the social effects of implicit and explicit attitudes with the literature on racial disparities in health care, drawing primarily on studies published since the Institute of Medicine Report (2003). We first focus on research that illustrates the role of subtle biases in treatment delivery and medical interactions. Then, we consider how racial distrust affects the behavior of Blacks within the context of health care.

Conclusion

The literature reviewed in this paper provides direct experimental evidence of the impact of racial attitudes and stereotypes on White–Black relations in the United States. In general, although explicit prejudice and stereotypes have declined over time, many Whites still harbor implicit, negative racial attitudes and stereotypes toward Blacks. These implicit biases are manifested in subtle, often unintentional forms of discrimination that produce less favorable outcomes for Blacks than for

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