Week 9: Bias and Discrimination in Healthcare Settings
Contents:
Part 1: Experiencing bias
Part 2: Institutional and personally-mediated bias
Part 3: Evidence it exists; explaining and reducing bias
Part 1: Experiencing bias
General Medical Council Principles
- “Doctors must not refuse or delay treatment because they think that a patient’s actions have
contributed to their condition”
- “Doctors mustn’t unfairly discriminate against patients by letting personal views affect
treatment”
- Most doctors enter profession out of desire to help others, and so aren’t deliberately biased.
Biases Experienced by Obese patients
However, biases are often expressed by doctors and healthcare professional, and also that patients
perceive that they are discriminated against due to social category membership. A key example of
this is people who are obese – patients will talk about consultations with doctors where, from their
perspective, the doctor will regard any condition they have through the lens of their obesity.
Definitions Central to Today
Stereotypes cognitive expectancies and associations about an outgroup
Prejudice Emotional reaction to someone on the basis of group membership
Discrimination Acting on the basis of stereotypes and prejudice; denial of equality of treatment
(biased behaviour)
Experiencing Bias
Identification and treatment of ill health is important, and there are negative health consequences
of not seeking treatment. We know that there are inqequalities in health, particularly amongsty
minority groups, and it is these people who need the most access to healthcare.
- E.g: Black people in the Ushave a higher rate of death due to heart disease, cancer, stroke,
diabetes etc.
- These inequalities cause fays lost from work, and a dip in productivity, as well as direct costs
on healthcare systems such as the NHS
The biomedical model cannot on its own explain these inequalities, so therefore, an explanation that
might cover these inequalities is through bias.
, Bias occurs across social groupings
Disability is one example, where bias and discrimination can be seem. When talking ot people with
disability, bias and discrimination is often described as the “greatest concern” they have.
Additionally, they also report social isolation, mental health problems, and even the close people to
the disabled person often report stigma by association.
Weight Bias
This is negative attitudes or stereotypes that [eople hold against people with onesity, resulting in
discrimination / prejudice.
It is common – the 4th most common form of discrimination in the US (Puhl et al., 2008). It has been
described as the “last acceptable form of discrimination.”
Health consequences of experiencing weight bias
- People with obesity often express weight bias, through internalising said bias.
- This internalisation has consequences for their health behaviour:
o Puhl et al., (2007) – those who believe negative stereotypes around weight are more
likely to engage in binge eating, refusal to diet.
o The research into consequences of stigma undermines the commonly held beluef
that stigma can be momtivating.
- Stigma is related to higher levels of mental health issues and lower self esteem.
Part 2: Institutional and Personally-mediated bias
Institutional Bias
There is the guiding principle that we should offer equitable treatment to people, regardless of race,
ethnicity etc. This doesn’t always happen at an institutional level:
- There has been evidence of denial of healthcare
- There is a requirement for people with obestity to lost weight before receiving bariatric
surgery – whilst there is evidence that losing weight can help to make outcomes better, and
surgery safer, but the 5% figure is arbitrary and not necessarily the right amount to reap the
benefits
- NICE recommends that we offer bariatric surgery more widely – but there doesn’t seem to
be much movement along that route.
Age: there is evidence that older adults are disproportionately disadvantaged. They are less likely to
be referred ot specialist services and less likely to get medication and tests they need.
Racism: BMJ editorial looked at link between racism and mental health. 21% of study population
was from minority groups, but this only representated 7% populations. Therefore they are over
represented in hospital samples. Conclusion is that minority groups are more likely to be admitted to
hospital involuntarily and to have the longest stay
Contents:
Part 1: Experiencing bias
Part 2: Institutional and personally-mediated bias
Part 3: Evidence it exists; explaining and reducing bias
Part 1: Experiencing bias
General Medical Council Principles
- “Doctors must not refuse or delay treatment because they think that a patient’s actions have
contributed to their condition”
- “Doctors mustn’t unfairly discriminate against patients by letting personal views affect
treatment”
- Most doctors enter profession out of desire to help others, and so aren’t deliberately biased.
Biases Experienced by Obese patients
However, biases are often expressed by doctors and healthcare professional, and also that patients
perceive that they are discriminated against due to social category membership. A key example of
this is people who are obese – patients will talk about consultations with doctors where, from their
perspective, the doctor will regard any condition they have through the lens of their obesity.
Definitions Central to Today
Stereotypes cognitive expectancies and associations about an outgroup
Prejudice Emotional reaction to someone on the basis of group membership
Discrimination Acting on the basis of stereotypes and prejudice; denial of equality of treatment
(biased behaviour)
Experiencing Bias
Identification and treatment of ill health is important, and there are negative health consequences
of not seeking treatment. We know that there are inqequalities in health, particularly amongsty
minority groups, and it is these people who need the most access to healthcare.
- E.g: Black people in the Ushave a higher rate of death due to heart disease, cancer, stroke,
diabetes etc.
- These inequalities cause fays lost from work, and a dip in productivity, as well as direct costs
on healthcare systems such as the NHS
The biomedical model cannot on its own explain these inequalities, so therefore, an explanation that
might cover these inequalities is through bias.
, Bias occurs across social groupings
Disability is one example, where bias and discrimination can be seem. When talking ot people with
disability, bias and discrimination is often described as the “greatest concern” they have.
Additionally, they also report social isolation, mental health problems, and even the close people to
the disabled person often report stigma by association.
Weight Bias
This is negative attitudes or stereotypes that [eople hold against people with onesity, resulting in
discrimination / prejudice.
It is common – the 4th most common form of discrimination in the US (Puhl et al., 2008). It has been
described as the “last acceptable form of discrimination.”
Health consequences of experiencing weight bias
- People with obesity often express weight bias, through internalising said bias.
- This internalisation has consequences for their health behaviour:
o Puhl et al., (2007) – those who believe negative stereotypes around weight are more
likely to engage in binge eating, refusal to diet.
o The research into consequences of stigma undermines the commonly held beluef
that stigma can be momtivating.
- Stigma is related to higher levels of mental health issues and lower self esteem.
Part 2: Institutional and Personally-mediated bias
Institutional Bias
There is the guiding principle that we should offer equitable treatment to people, regardless of race,
ethnicity etc. This doesn’t always happen at an institutional level:
- There has been evidence of denial of healthcare
- There is a requirement for people with obestity to lost weight before receiving bariatric
surgery – whilst there is evidence that losing weight can help to make outcomes better, and
surgery safer, but the 5% figure is arbitrary and not necessarily the right amount to reap the
benefits
- NICE recommends that we offer bariatric surgery more widely – but there doesn’t seem to
be much movement along that route.
Age: there is evidence that older adults are disproportionately disadvantaged. They are less likely to
be referred ot specialist services and less likely to get medication and tests they need.
Racism: BMJ editorial looked at link between racism and mental health. 21% of study population
was from minority groups, but this only representated 7% populations. Therefore they are over
represented in hospital samples. Conclusion is that minority groups are more likely to be admitted to
hospital involuntarily and to have the longest stay
