Notes on Implicit Bias and Social Determinants of Health

Learning Objectives
  • Relate the determinants of health to inequity, disparities, and injustices.
  • Identify how implicit bias can lead to poor health outcomes for marginalized groups.
  • Recall assessment methods for social determinants of health in various settings.
  • Recognize evidence-based strategies for systemic change.
  • Identify ways educational institutions and health providers can address social determinants of health.
Key Concepts of Social Determinants of Health (SDOH)
  • Definition: Structural conditions in which individuals are born, grow, live, work, and age.
  • Impact: SDOH are crucial for understanding health disparities and inequities affecting different populations.
Implicit Bias in Health Care
  • Definition: Unconscious discrimination that can lead to biased healthcare outcomes for different demographic groups.
  • Mechanisms: Occurs in situations with ambiguity, stress, and time constraints.
  • Example: Health care providers often give lesser quality care to African American patients compared to white patients due to time restrictions.
  • Influencing Factors: Race, ability, gender, culture, language.
Examples of Implicit Bias
  • Hiring: Favoring male candidates over female candidates with equal qualifications.
  • Gender Pay Gap: As of 2021, men earned about 18% more than women on average.
Prevalence of Workplace Discrimination
  • Higher rates of discrimination reported in the U.S. (61%) compared to Germany (37%), UK (55%), and France (55%).
Types of Implicit Bias
  • Race and Ethnicity Bias
  • Age Bias
  • Gender Bias
  • LGBTQIA+ Community Bias
  • Ability Bias
Strategies to Overcome Implicit Bias
  • Awareness: Identify personal biases and reflect on negative stereotypes.
  • Actions: Proactively become more inclusive, learn about different cultures, take implicit association tests.
  • AAFP Tactics (IMPLICIT):
  • Introspection
  • Mindfulness
  • Perspective-Taking
  • Learn to Slow Down
  • Individualization
  • Check your Messaging
  • Institutionalize Fairness
  • Take Two
Assessing Disparities and Bias
Cross-Sectional Studies
  • Descriptive Studies: Evaluate disease prevalence and risk factors (e.g., asthma, elevated blood lead levels).
  • Example Studies: National Health and Nutrition Surveys (NHANES).
Ecological Studies
  • Evaluate relationships between environmental factors and health outcomes (e.g., air pollution and cardiovascular disease rates).
  • Helpful in assessing community-level interventions and their effects.
Evidence of Implicit Bias in Medicine
  • Study Example: Schulman KA, et al. examined race and sex influence on physician recommendations for cardiac catheterization.
  • Findings indicated inconsistent treatment recommendations based on patient demographics.
Conclusion and Considerations
  • It is critical to understand the impact of implicit bias in clinical settings and strive for equitable treatment across all demographies.
  • Data-driven assessments of health disparities can inform effective public health strategies and initiatives to improve outcomes across diverse populations.