One of the key contributors to disparate outcomes between communities in diabetes management is implicit bias on the part of practitioners and the medical industry. Implicit bias, also known as implicit social cognition, refers to the unconscious, underlying ideas, expectations, assumptions and stereotypes a person has towards another individual or group. People of all professions, including diabetes care practitioners, demonstrate implicit bias in their work whether they realize it or not. This leads to worse outcomes for marginalized communities.
As minority populations boom over the coming decades, theses disparities will only become more pronounced. 12.7% of African Americans are diagnosed with diabetes, 12.1% of Hispanics and 8% in Asians compared with 7.4% of Whites. The greater prevalence in minority communities makes it all the more vital that health care professionals work to combat their own and industry bias. Implicit bias among health care providers is shown by positive attitudes towards white and negative attitudes to people of color according to studies.
The first step to addressing implicit bias is recognizing it. Practitioners need to discover where their implicit biases lie by understanding the different dimensions that exist. Care providers need to understand that they can have biases based on gender, race, ethnicity, age, economic status, and body size. Georgetown University’s National Center for Cultural Competence offers the following questions to begin to understand how implicit biases play out:
- Do my biases impact the amount of time I spend with patients?
- How do I communicate with patients and their families?
- How does this affect my ability to feel and express empathy towards my patients?
- And how does it affect the treatments I recommend for patients? Or diminish my ability to interact positively with patients and their families?
- Do I feel less comfortable with patients who are of a different race than I?
- Do colleagues and others with whom I work display attitudes or behaviors influenced by bias? Can I openly raise my concerns with them?
Health care providers aim to make impartial, objective decisions, which may make accepting biases difficult. However, practitioners who do not practice a healthy skepticism to their own perceived fairness may continue to make biased decisions without ever becoming aware, leading to decreased care for some patients.
In her recent guest commentary to Today’s Dietitian, Constance Brown-Riggs (MSEd, RD, CDE, CDN) recommends an hour of implicit bias training during each five-year cycle as part of the required continuing education related to the topic of ethics. She argues this will expedite the delivery of equitable care and shorten the cultural distance between the RD and his patients. This would play a crucial role in minimizing disparities between minority populations.