OPPRESSION, DISCRIMINATION, AND CULTURAL BIAS IN HEALTHCARE

A person’s experience is influenced by the intersection of their sex, gender identity, race, ethnicity, sexual orientation, socioeconomic status, ability, and other social determinants. All these factors have an impact on a patient’s access to healthcare, health risks, and health outcomes. Any past and present discrimination, oppression, or fear related to these factors can greatly influence an individual’s actions to actively seek care when needed or, conversely, to defer their healthcare needs until a crisis occurs.

Providing whole-person, patient-centered care requires a healthcare professional to proactively consider the intersection between each person’s diverse identities and broader cultural factors. Such an “intersectionality” perspective should not lead to assumptions about an individual based on the minority groups with which they identify but should inform the clinical experience in a positive manner in order to respect and address each person’s unique needs (Medina-Martinez et al., 2021).

Cultural Bias and the Provision of Care

When working with patients, it is especially important for clinicians to build a positive rapport as a way to counteract the exclusion, discrimination, and stigma their patients may have experienced previously in the healthcare environment. However, despite their best intentions, healthcare professionals may hold internalized cultural biases that affect their interaction with patients. For example, a clinician, case manager, or other staff member may say something or use body language that communicates a stereotype or negative message about a patient.

These biases can lead to unequal care and affect a patient’s decision to follow medical advice or return for follow-up care. Negative messages can also become internalized in the patient, adding to a person’s stress and contributing to negative mental and physical health outcomes (Medina-Martinez et al., 2021).

A review of a number of research studies shows that bias in the healthcare community has far-reaching consequences for healthcare recipients.

• A literature review from 2018 showed that some medical professionals were more likely to view women experiencing chronic pain as emotional, hysterical, or sensitive.
• Results from a 2019 study showed that more than 80% of medical students had an implicit bias against lesbian and gay people.
• A 2017 study found that healthcare professionals were more likely to assume that older adult patients are offensive, helpless, demanding, and unwilling to receive treatment.
• A 2020 study showed that 83.6% of respondents implicitly preferred people without disabilities and viewed people with disabilities as having a lower quality of life due to their disabilities.
• Results from a 2015 study indicated that healthcare professionals can view people with obesity as lazy, weak-willed, lacking self-control, and unlikely to adhere to treatment regimens.
• Research from 2017 indicated that some physicians may be more likely to think that people from low socioeconomic backgrounds are less intelligent, independent, responsible, and rational than people from higher socioeconomic backgrounds.
  (Smith Haghighi, 2023)

Studies have shown that no matter how individuals may feel about prejudiced behavior, everyone is susceptible to biases based on cultural values and stereotypes that were embedded in their belief systems from a young age. To increase one’s own awareness of internal bias, it is helpful to notice times when biased attitudes and beliefs may arise. Such internal awareness is the first step in making changes. Internal questions to ask may include:

• How do my current beliefs help me?
• What might I lose if I change my beliefs?
• How might my current beliefs harm others?
• How might it benefit me and others to change my beliefs?
  (NCCC, n.d.)

It is important for clinicians and case managers to focus on remaining open and compassionate by consciously intending to set aside assumptions and get to know a patient as an individual. For example, when first meeting a new patient who is a transgender man, the clinician can imagine what it might be like for this person to see a new provider for the first time. Instead of focusing on the patient’s gender identity and when or if he has transitioned, the clinician or case manager can focus on getting to know him as a person, such as understanding where he lives and works and more about his family support.

Institutional Nondiscrimination Statements

AMERICAN NURSES ASSOCIATION (ANA)

The ANA (2018) advocates for continued efforts to eliminate discrimination in healthcare, as described in the following statement:

The American Nurses Association (ANA) recognizes progress in most national efforts to eliminate discrimination associated with race, gender, and socioeconomic status through improving access to and attainment of health care, and quality of health care. However, concerted efforts must continue for discrimination to be eliminated in all of its forms. ANA recognizes impartiality begins at the level of the individual nurse and should occur within every health care organization. All nurses must recognize the potential impact of unconscious bias and practices contributing to discrimination, and actively seek opportunities to promote inclusion of all people in the provision of quality health care while eradicating disparities. ANA supports policy initiatives directed toward abolishing all forms of discrimination.

AMERICAN PHYSICAL THERAPY ASSOCIATION (APTA)

The APTA (2019) published the following nondiscrimination statement:

The American Physical Therapy Association opposes discrimination on the basis of race, creed, color, sex, gender, gender identity, gender expression, age, national or ethnic origin, sexual orientation, disability, or health status.

AMERICAN OCCUPATIONAL THERAPY ASSOCIATION (AOTA)

The AOTA’s vision statement (2021) affirms its commitment to diversity, equity, and inclusion, as follows:

AOTA is committed to creating an environment where all people within our professional community are valued and able to give their best in the communities where they live and work. AOTA strives to recognize and uplift the diversity of our profession and is committed to creating opportunities to foster inclusivity, participation, and representation. We will act with intention and live our values to be inclusive, equitable, just, and accountable in this work.

THE JOINT COMMISSION (TJC)

Joint Commission ambulatory care standards address discrimination and a patient’s right to have an advocate: “As a patient, you have the right to be informed about and make decisions regarding your care. You also have the right to care that is free from discrimination as well as the right to have a patient advocate” (TJC, 2019).