Equity & Anti-Racism in Global Healthcare

Objective

Explore the impact of implicit bias on global healthcare

Goals

• Identify implicit bias
• Recognize the impact of implicit bias on patient outcomes
• Practice strategies to mitigate personal bias
• Navigate difficult but important conversations about bias

Weighing up the good with the bad

While global healthcare initiatives can have a positive impact, they can also have unintended consequences. 

Perpetuating colonial dynamics

Well-meaning heroism perpetuates notions that the ‘natural order’ of things is for ‘primitive people’ in resource-poor countries to rely on ‘superior’, resource-rich countries for aid. In reality, such reliance is brought about by global inequities, not lack of ability.

Subjugating local expertise

Global healthcare provision is often given on our own terms. The knowledge of local, often more experienced, doctors can be dismissed or overruled by visiting clinicians keen to share their knowledge and ‘more advanced’ ways - undermining their greater expertise on the local spectrum of diseases and effective treatments. 

The right care, the right way

To ensure that your visit has a positive impact, it’s important to exercise cultural humility to learn more about the countries we visit and provide the right care, in the right way. This involves looking at the bigger picture; considering both your own culture and the culture in the country you’re visiting, and where they fit into a world that’s full of inequalities. 

• Exhibiting bias about poverty
• Assuming patients have low intelligence
• Lack of cultural humility
• Speaking to the interpreter
• Speaking loudly to patients where there is a language barrier
• Disparaging local medical practices
• Assuming patients have limited capability
• Giving an inappropriate diagnosis based on bias

Strategies for identifying and challenging bias

• Step 1 - REFLECT - when have I acted with bias in a patient interview?
• Step 2 – STOP – was I thinking fast or slow?
• Step 3 – SWITCH – try to see it from the other person’s perspective
• Step 4 – CHALLENGE – attributes or situation
• Step 5 – COUNTER – say something that contradicts your bias

Implicit Association Test

The Implicit Association Test (IAT) was created by Project Implicit.

It measures attitudes and beliefs that people may be unwilling or unable to say out loud. The IAT may be especially interesting if it shows that you have an implicit attitude that you didn’t know about.

For example, you may believe that women and men should be equally associated with science, but your automatic associations could show that you (like many others) associate men with science more than you associate women with science.

Implicit Association Test

• Gain trust – speak their name, make gentle eye contact
• Withhold judgment – “I know you don’t mean to offend, but…”
• Mirror – “When you said…”
• Challenge – “Your meaning could be interpreted as…”
• Reposition – “How would you feel if someone suggested that…”