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Survey finds nearly half of health care workers see widespread racial, ethnic discrimination towards patients
February 29, 2024
Structural racism is at the heart of many of the nation’s deepest health disparities. The COVID-19 pandemic resulted in more attention being paid to not just systemic inequities, but also the negative impact of interpersonal racism, discrimination, and implicit bias within health care settings. Research based on that time has demonstrated an association between discrimination against patients and negative mental health outcomes in health care workers (HCWs) who witness discrimination. (Hamed, 2022)
According to a recent survey from the Commonwealth Fund in partnership with the African American Research Collaborative (AARC), the situation has not improved. The poll of 3,000 HCWs, which oversampled less-represented worker races/ethnicities, suggests that many respondents believe patients can receive disparate care based on their demographics. It also found that dealing with discrimination is a substantial source of stress for many healthcare workers.
What the research shows
AARC held six focus groups with a variety of HCWs, including employees in community health clinics and hospitals and Black, Latino, White, Asian American/Pacific Islander (AAPI), and immigrant HCWs. Researchers then surveyed another 3,000 HCWs employed in various capacities in every region of the United States. The survey oversampled Black, Latino, and AAPI employees.
According to the findings, 47% of HCWs personally witnessed discrimination against patients within their facilities, with almost 75% reporting witnessing it within the past three years. Another 52% said health care discrimination and racism against patients is a serious problem for the industry. Younger (aged 18-39 years), Black, or Latino respondents were more likely than those age 60 years and older to consider racism against patients to be a major problem or crisis. Just under half of all HCWs indicated the discrimination causes them some (31%) or a great deal (16%) of stress and negatively impacts morale. Higher stress levels were more common among Latino, Black, and AAPI HCWs.
HCWs’ perception of how big a problem racial and ethnic discrimination is varies by the patients they interact with and where they work. Mental HCWs were more likely to say racism is a major problem or crisis compared to the overall health care workforce (68% vs. 52%). In community-based health care facilities such as health centers or school clinics, 63% of HCWs said racism against patients is a crisis or major problem as compared to long-term care facilities, outpatient facilities, and hospitals (51%, 47%, and 55%, respectively). (Commonwealth Fund, 2024)
Strategies to reduce discrimination based on ethnicity or race
Researchers asked HCWs their thoughts about effective strategies aimed at decreasing discrimination based on race or ethnicity in health care. The following solutions are examples of those deemed very or somewhat effective by two-thirds or more of the workers surveyed (Commonwealth Fund, 2024):
- Provide an easy way for patients and staff to anonymously report situations involving racism or discrimination. Consider both anonymous and confidential reporting and follow-up systems and enhance patient awareness of the availability of those options.
- Train staff to spot discrimination. Ensure that HCWs can not only recognize instances of discrimination and bias, but also that they are aware of how discrimination can lead to poor health outcomes.
- Examine policies to ensure they result in equitable outcomes. Several health systems have implemented racial equity progress reports and regularly conduct reviews of their policies and procedures to ensure equitable health care outcomes for patients, regardless of race or ethnicity.
- Require mandatory classes on discrimination at professional schools. Medical, nursing, and other professional schools should integrate courses on discrimination into their curriculum and ensure existing courses do not include inappropriate references to race or ethnicity.
Sources:
(2024, February 15). The Commonwealth Fund. Revealing disparities: health care workers’ observations of discrimination against patients. https://www.commonwealthfund.org/publications/issue-briefs/2024/feb/revealing-disparities-health-care-workers-observations
Hamed S, et al. (2022, May 16). BMC Public Health. Racism in healthcare: a scoping review. https://pubmed.ncbi.nlm.nih.gov/35578322/
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