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Unpublished Paper
ExpressO (2013)
  • Dayna B Matthew
HEALTH CARE, TITLE VI, AND RACISM’S NEW NORMAL Dayna Bowen Matthew ABSTRACT An estimated 84,570 minority patients die annually due to health care disparities that result from the unconscious racism that pervades American health care. Over a decade ago, the Institute of Medicine (IOM) reviewed the egregious inequalities that black and brown patients suffer when they seek medical care for heart disease, diabetes, cancer, asthma, pain, strokes and virtually every disease, illness or malady. The IOM report identified physician stereotypes, bias, and prejudice as a possible reason for these disparities, but could not explain exactly why biases caused minority patients to generally live sicker and die quicker than whites in this country. This article argues that social science advances made since the IOM Report, now clarify the connection between physician implicit bias and health disparities to explain this major contributor to health disparities, and inform what must be done to prevent them. While numerous authors have argued that unconscious racism in employment, law enforcement, civil adjudication, and voting must be regulated under anti-discrimination law, this article is the first to confront physician bias in health care, the first to comprehensively set forth the evidence that implicit biases can be intentionally controlled, and the first to apply the science of implicit bias to advocate reform of Title VI. Until now, courts and legislators have been unwilling to ascribe legal liability to unconscious discrimination. I argue here that the new social science I provide in this article is the leverage they have been missing. This article introduces empirical evidence that implicit biases are malleable and can be intentionally controlled to reduce the effect of stereotypes and prejudice. I assert that this evidence of malleability is a legal “game-changer” because it offers the legal and moral basis to hold unintentional discriminators accountable for intentionally failing to address their prejudices and the deadly harms they cause. The undisciplined system of subjective medical decision-making is as harmful as intentional discrimination; evidence that these harms can be mitigated will advance the behavioral realism discourse significantly. This article further provides empirical evidence that physician implicit bias is associated with biased clinical decision-making, treatment and diagnostic decisions, patient communication, and distorted statistical interpretation. While acknowledging that doctors are neither racist nor malicious, this article uses social science evidence to propose reforms to Title VI that will change the social norm that currently tolerates unconscious racial harms. Based on the scientific evidence, I propose a negligence standard and restoration of private enforcement under Title VI. These reforms can help to establish a new standard of care in medicine and beyond. In short, this article explains how we can achieve a paradigm shift in medicine, so that just, equal health care becomes the new, new normal.
  • health,
  • healthcare disparities,
  • civil rights,
  • discrimination,
  • inequality,
  • implicit bias
Publication Date
August 5, 2013
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