Discrimination has been a universal issue in the United States, especially for people from certain ethnicities and races. Racial discrimination has long been rooted deep in society to the extent of impacting healthcare services delivery, thus interfering with the quality of healthcare, access to care, and above all, leadership and workforce in this sector. Sometimes the quality of healthcare people receive is associated with misperceptions and stereotyping instead of who they are. Statistical profiling is a theoretical principle that has led to unending racial discrimination. It can be defined as cases of discrimination based on beliefs that reveal the actual distributions of attributes of different clusters (Tilcsik, 2021).
The theory of statistical discrimination is a necessary social background to comprehending racial discrimination in healthcare. The literature has used this theory as an ideal example to analyze people’s attitudes (Tilcsik, 2021). Some organizations have a prejudiced culture where people use the overall beliefs about certain ethnic groups to make decisions about a person from that ethnicity. In healthcare, service providers have found themselves at one point or another using race attributes to profile patients or a co-worker, which most of the time change the attitude of the caregiver toward them. This paper aims to analyze the theory of statistical profiling on the bases of races and ethnicities that led to prejudice in healthcare settings. It will also evaluate the impacts of profiling as an issue in the healthcare sector on quality and access to healthcare services, workforce, and leadership in this sector. In addition, the paper discusses ways in which the issue can be eliminated and embraces diversity, equity, and inclusion practices in this sector.
Keywords: healthcare diversity, statistical profiling theory, statistical discrimination, race, and ethnicity.
Introduction
Members from minority ethnic groups in the United States have faced discrimination in various healthcare departments. A recent report by PhRMA has highlighted how insurance obstacles impact innocent communities due to a lack of equitable health coverage for people of color. The foundation admits that racial discrimination contributes to the aggravation of health inequalities resulting in existing gaps in dominance and severity of illness across racial groups. Racial profiling is an issue in healthcare that has prevented people of color from accessing doctors’ prescriptions and insurance departments, causing health disparities among the population.
Nong et al. (2020) studied patients’ experiences of discrimination in the healthcare system. They found that 21% of 2137 adult respondents reported having experienced discrimination in the system, and 72% were said to have experienced it more than once. Discrimination based on race or ethnicity was the most reported type of discrimination experienced. Racial discrimination is a more significant issue in this system that needs to be addressed in every dimension.
Literature review
The increasing diversity in the United States population is evident in the patients’ healthcare professionals treat (Marcelin et al., 2019). Patients from underrepresented groups in the United States can experience the effects of statistical discrimination that originate from cultural stereotypes in ways that propagate health inequities (Marcelin et al., 2019). As Marcelin et al. (2019) note, this discrimination also affects healthcare professionals in various ways, such as patient-clinician relations, hiring and promotion, and inter-professional relations.
Discrimination originates from an individual’s perceptions, preferences, and attitudes are essential contributors to a person’s reaction (Bertrand & Duflo, 2017). In the health care system, a caregiver may decline to treat or care for patients simply because they are members of certain racial or ethnic groups. Additionally, employers may despise healthcare givers from certain groups and offer them lower wages for similar care services (Bertrand & Duflo, 2017).
Health systems have recently raised their concern about analyzing and solving the social factors that affect individual health and the population’s gaps in health and health results (CDC). Research has identified various factors and theories related to inequalities in treatment outcomes and death across race, sex, ethnicity, and other social-economic attributes (Petersen et al., 2019). Major B et al. (2018) outlined these factors as patient-clinician discordance, physician prejudice, and daily experiences of discrimination. Rivenbark & Ichou (2020) looked at evidence correspondent with statistical discrimination for hypertension, diabetes, and depression diagnoses and found that some caregivers act to know more. These possible beliefs held by the caregiver about the occurrence of the illness across racial groups could be held responsible for racial differences in diagnosing these illnesses. In addition, the researchers discovered that race and ethnicity impact decisions through differences in communication patterns between white doctors and minority patients (Rivenbark & Ichou, 2020).
Increasing diversity in the healthcare workforce is believed to improve the quality of care delivered, especially to minority populations (American College of Physicians, 2019). The Association of American Medical Colleges came up with the term Underrepresented in medicine to accommodate racial and ethnic populations that are not well represented in the medical profession concerning the overall population (American College of Physicians, 2019). According to United States census estimates, the frequency of African American and Hispanic persons in the continent’s population is 13% and 18%, respectively (U.S. Census Bureau, 2019). However, the percentage of physicians taking full-time medical school courses from these minority groups is approximately 6% and 5%, respectively (Facts, A. A. M. C, 2019).
Statistical discrimination analyzes relations and attitudes that unconsciously affect people’s perceptions, thus impacting their behavior, communications, and decision-making (FitzGerald & Hurst, 2017). According to Marcelin et al. (2019), the issue of prejudice, stereotyping and racial profiling continue to aggravate healthcare disparities. They suggested recruiting more medical professionals from underrepresented groups would help mitigate this issue. Marcelin et al. (2019) noted that racial profiling might affect the processing of a person’s information resulting in unexpected inequalities that have consequences in medical schools, faculty hiring, promotion, growth opportunities, and patient care. Even though healthcare is available in the U.S. for every person, the fear and doubt of healthcare facilities may negatively impact racial groups’ experience (Petersen et al., 2019). Statistical discrimination, language barriers, caregivers’ bias, and the perception of the existence of these obstacles discourage these people from seeking care (Rivenbark & Ichou, 2020). For instance, CDC depicted that barriers may bring disparities in STI healthcare to diagnoses, treatment, and prevention services (CDC). Everyone should have a chance to healthy living, but discrimination has been a significant barrier to health equity.
Strategies for addressing statistical discrimination
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At an Organizational Level
To effectively eliminate racial profiling and other types of discrimination in the healthcare systems, parties involved must show commitment at organizational and individual levels. At the organizational level, various measures can be implemented to ensure healthcare diversity, equity, and inclusion. First, healthcare systems could frequently provide diversity training to the workers and use Implicit Association Test (IAT) tool to predict discriminatory behaviors. Capers et al., 2019 found that two-thirds of the admissions committee members in the study recognized IAT as a way to reduce biases, while 21% admitted that this discrimination influences their decisions in the subsequent admission cycle. As Marcelin et al. (2019) suggest, the Infectious Diseases Society of America (IDSA) should reflect on ways to integrate diversity and IAT in their training for leaders.
Additionally, healthcare organizations must be willing to adopt a culture of inclusion. Marcelin et al. (2019) depicted that culture inclusion requires not just beyond diversity training and cultural competence but also an established capacity to change. Healthcare facilities should not only employ clinicians from minority groups but also recruit leaders from these groups to take the responsibilities of change agents and have the mandate to establish equitable environments. In addition, academic medical institutions should not be left out, for they should establish considerable strategies for the admission of medical trainees and evaluate faculty hiring, promotion, and work retention (Marcelin et al., 2019).
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At a Personal Level
At a personal level, healthcare professionals and employers should deliberately reflect to help discovers their probable discriminations and rectify them. Also, it allows them to put themselves in a discriminatory situation and understand the possible impact of their discrimination on the person whom they would interact with. In addition, records on lapses in care due to caregivers’ discrimination should be included to help give providers real-life illustrations of the consequences of being ignorant of those discriminations (Tenney, 2017). Deliberate reflections cultivate self-moderation and consciousness on the issue of statistical discrimination and can help reduce stereotyping and biases (Burns et al., 2017). Moreover, providers can engage in open discussion when unintentional discrimination cases occur to help them rectify the behavior. Furthermore, individuals should ask questions about how keenly they respond to stereotyping and discrimination in witnessed interactions.
Impacts of Statistical Discrimination on Healthcare
When clinicians fail to recognize individual patients more than they perceive demographic features, it may lead to premature closure and missed diagnoses. During the onset of the human immunodeficiency virus (HIV) pandemic, the occurrence of the disease among gay men resulted in a primary belief that it was for gay men, thus hindering the discovery of the disease in the other population (Marcelin et al., 2019). Moreover, the fact that it occurred highly in white gay men is a possibility that this led to missed recognition of HIV in people of color.
People from minority racial and ethnic groups who have experienced discrimination in the past may lack the ability to seek medical care due to fear of being discriminated against again. Research has shown that discrimination experiences within the healthcare sector may negatively influence an individual’s trust and may negatively affect individuals’ trust in and approval of the healthcare system, thus resulting in delaying or foregoing seeking care (Rivenbark & Ichou, 2020). In addition, Togioka et al. (2022) noted that continued exposure to statistical discrimination could damage the affected individual’s mental well-being, low self-esteem, poor self-care, and increasing susceptibility to substance abuse, depression, suicidal ideation, and anxiety.
Diversity and Inclusion in Healthcare
Research has shown that team diversity is relational to high productivity, yet an organization can be diverse but not inclusive (Lee et al., 2021). It means that leaders from minority clusters may be kept in place but do not actively contribute to ensuring the underrepresented minority are included. Studies have shown that healthcare in the United States is a long way from being equitable for patients or health workers, and organizational cultures are a long way from being inclusive (Lee et al., 2021). As Lee et al., 2021 depicted, inclusion in healthcare organizations goes beyond race and ethnicity; it should be shared among other groups that believe and feel they are not reliably treated with respect and fairness, including women and people living with disabilities. The issue of inclusivity can be addressed in various ways;
First, leaders should identify that diversity is necessary and essential but not sufficient to establish a just and inclusive culture (Lee et al., 2021). Leadership and management’s perceptions of the diversity and inclusiveness of organizational culture are more favorable than those of the rest of the workforce. Additionally, leaders should know that every leader is at risk for blind spots and appreciate leadership concepts (Rivenbark & Ichou, 2020).
Moreover, healthcare facilities should evaluate stereotypical traits of leaders among existing leaders that may limit efforts for cultural inclusiveness and operational success (Lee et al., 2021). Evaluating whether there are stereotypical behaviors against minorities can help combat statistical discrimination. Helping minorities through the use of 360-degree evaluations to advise them to change their behaviors in ways that adapt to these dominant cultures for leadership in U.S. organizations to exploit their opportunities for success within their organization (Lee et al., 2021). However, leaders in healthcare organizations must know those good intentions are not enough; they should do much more than assess and improve care equity.
Barriers and Facilitators
Integration of diversity, equity, and inclusion in healthcare may not happen overnight and possibly may never happen due to various hindrances. Ignorance and slowed responses against cases of statistical discrimination among healthcare professionals may hinder the mitigation process of these discriminatory behaviors. For instance, when a review of the American medical system was done, the conclusive report hindered the inclusion of African American physicians, for it concluded that the medical education in African American institutions was deficient (Lee et al., 2021). By recommending limited chances for African American physicians, the report closed five of seven medical institutions for African-Americans.
Professionals in the healthcare field may suffer from stereotype threat. Stereotype threat can be described as a psychological situation where an individual underperforms in their work because of fear of achieving negative stereotypes (Lee et al., 2021). These fears among healthcare providers can act as barriers to eliminating statistical discrimination among workers. Nevertheless, if the working environment is not favorable based on diversity, equity, and inclusion, healthcare workers from minority ethnic groups may find it challenging to deliver. Research has shown that stereotype threat affects minority performance on the Medical College Admission Test and the United States Medical Licensing Examination (Bullock et al., 2020). Also, bullock et al. (2020) noted that this threat results in mental health damage to African American students and trainees in medical fields.
Person beliefs among care providers and other healthcare stakeholders may hinder the effective address of statistical discrimination. The individual from the majority community may carry with them historical beliefs regarding African American biological differences and may use them to justify pain and medical tolerance of African American individuals (Lee et al., 2021). According to Lee et al. (2021), these false beliefs still exist in society and medical practices, thus health disparities such as the undertreatment of pain in African American patients. Unfortunately, changing these persons’ beliefs can be the most challenging venture in trying to achieve a discriminatory-free environment in healthcare. These beliefs have presented a considerable barrier to healthcare equity.
Facilitators
Some of the facilitators to the elimination of statistical discrimination in healthcare facilities may include;
- Multi-sectoral measures from legal authorities address any intersecting forms of discrimination and ensure that equal quality of care is given to everyone, considering the precise needs of each individual (UNAIDS, 2017). Also, organization review and reform laws that reinforce stigma and discrimination.
- Merging and disseminating prevailing evidence on effective programmatic and policy reactions to mitigate discrimination in healthcare sectors, thus ensuring that national Ministries of Health, in association with other sectors, can establish and expand evidence-based programs to decrease racial discrimination in healthcare.
- Establishment of Fast-Track zero discrimination targets by the United States. The states should measure statistical discrimination in the health sector and set time-bound targets to mitigate it. According to a report by UNAIDS (2017), levels of such discrimination should be determined from the perspective of both service users and service providers in association with civil society and other stakeholders.
- Incorporating confidentiality and privacy into pre-and in-service training programs for health providers (Togioka et al., 2022). This ensures that health workers have the capacity needed to provide discrimination-free healthcare, issues related to human rights, and free and informed consent. In addition, police and law enforcement officers should be equipped with knowledge of the right to non-discrimination to reinforce these laws effectively.
- Creation of a supportive working environment for health workers and to reduce discrimination towards healthcare workers on racial bases.
Building of Open and Supportive Environments
An open and supportive environment can be created by strictly implementing policies on bullying, harassment, and discrimination in most organizations. Studies have discovered that medical students rarely report cases of bullying and discrimination than nursing students for fear of the consequences they may encounter (AoMRC, 2016). Some of these policies are kept inactive with the organization’s culture, but if well implemented, they can help establish a supportive environment. It should come as a wake-up call to the healthcare sector for the need to change the culture around bullying and discrimination. Inter-professional working in the welfare of patient safety. Healthcare organizations should also develop novel initiatives to create supportive environments and inspire persons experiencing bullying and discrimination or those witnessing these issues to speak up (AoMRC, 2016).
The stakeholders, i.e., medical institutions, healthcare organizations, and healthcare facilities, should join hands to motivate good practice across clinical spheres (Bullock et al., 2020). They should educate health practitioners and trainers to spread awareness of prohibited behaviors in medical fields and also facilitate groups to heighten the training environment (AoMRC, 2016). Building effective clinical teams-Creation of an open and supportive environment should be the responsibility of every worker. Organizations should aim to modify activities that cultivate positive attempts to establish good workplace behavior (AoMRC, 2016). Working in teams encourages oneness and positive energies towards a common goal.
In conclusion, statistical discrimination theory has existed in the healthcare sector for a long time. It contributes to the aggravation of health inequalities resulting in gaps in dominance and severity of illness across racial groups. This has been a barrier to quality healthcare and access to care for minority groups due to a lack of healthcare diversity and inclusion. Statistical discrimination can be addressed at an organizational and personal level. Some of the strategies that can be used include; the provision of diversity training to the workers and the use Implicit Association Test (IAT), the adoption of a culture of inclusion, deliberate reflection, and questioning oneself on how keenly they respond to stereotyping and discrimination in witnessed interactions. Finally, suppose these issues fail to be addressed. In that case, they may cause implications such as premature closure and missed diagnoses, lack to seek for medical care for minority persons, damage to the affected individual’s mental well-being, low self-esteem, poor self-care, and increasing susceptibility to substance abuse, depression, suicidal ideation, and anxiety.
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