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Eliminating Explicit and Implicit Biases in Health Care: Evidence and Research Needs
Open accessAbstract
Health care providers hold negative explicit and implicit biases against marginalized groups of people such as racial and ethnic minoritized populations. These biases permeate the health care system and affect patients via patient–clinician communication, clinical decision making, and institutionalized practices. Addressing bias remains a fundamental professional responsibility of those accountable for the health and wellness of our populations. Current interventions include instruction on the existence and harmful role of bias in perpetuating health disparities, as well as skills training for the management of bias. These interventions can raise awareness of provider bias and engage health care providers in establishing egalitarian goals for care delivery, but these changes are not sustained, and the interventions have not demonstrated change in behavior in the clinical or learning environment. Unfortunately, the efficacy of these interventions may be hampered by health care providers’ work and learning environments, which are rife with discriminatory practices that sustain the very biases US health care professions are seeking to diminish. We offer a conceptual model demonstrating that provider-level implicit bias interventions should be accompanied by interventions that systemically change structures inside and outside the health care system if the country is to succeed in influencing biases and reducing health inequities.
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“By simulating scenarios that mirror real-life clinical decision-making processes, and through reading the multi-agent conversations, clinicians can be made aware of potential cognitive biases and how to correct them. This facilitates learning in a controlled, educational environment [25,26].”
From Mitigating cognitive biases in clinical decision-making through multi-agent conversations using large language models: simulation study (2024) · cites this paper as [26]
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Guliyeva, A. S. K., Nikitina, N. I., Gardanova, Z. R., & Ilgov, V. I. (2023) · Springer proceedings in business and economics · doi:10.1007/978-3-031-27785-6_18
Wagner, Z., Moucheraud, C., Shah, M., Wollum, A., Friedman, W., & Dow, W. H. (2023) · SSRN Electronic Journal · doi:10.2139/ssrn.4454889
“As such, reducing provider bias is complicated, and interventions that attempt to do so are nascent and show mixed results (Vela et al. , 2022 ).”
InfluentialOphthalmia Neonatorum, Helen Keller, and the Social Dimensions of Eye Disease
Harman, L. E., & Margo, C. E. (2023) · Cornea · doi:10.1097/ico.0000000000003332
“27,28 35 However, what is so remarkable about Keller ’ s 1909 essay is that a young, blind-deaf woman and an outsider to medicine was able to sense an unacceptable inconsistency in the delivery of basic health care.”
BackgroundNafiu, O. O. (2023) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000006489
Bhattacharya, A., Camacho, D., Larson, J., & Chakraborty, P. (2023) · Social Work · doi:10.1007/978-3-031-42602-5_11-1
Health literacy strategies: a Caribbean approach
Herry, A. (2023) · International Journal of Family & Community Medicine · doi:10.15406/ijfcm.2023.07.00233
Alexander-Laine, A. (2024) · International Journal of Management and Humanities · doi:10.35940/ijmh.g1692.10070324
“Additionally, African American women are nearly 50% more likely to have high blood pressure than non-Hispanic white women [41].”
BackgroundDiversity, Equity, Inclusion, and Access: A Road Map for Athletic Trainers
Bates, T., & Lopez, R. M. (2024) · Journal of Athletic Training · doi:10.4085/1062-6050-0331.23
Blind spots in medical education – International perspectives
Tackett, S. A., Steinert, Y., Mirabal, S., Reed, D. A., Whitehead, C. R., & Wright, S. M. (2024) · Medical Teacher · doi:10.1080/0142159x.2024.2345271
“These may be impossible for any individual to fully overcome (Vela et al. 2022).”
Hatch, A., Shungu, N. P., Ford, M. E., & Toll, B. A. (2024) · Journal of the National Medical Association · doi:10.1016/j.jnma.2024.05.001
Diversity, Equity, and Inclusion
DeMartino, J., Katsuki, M. Y., & Ansbro, M. R. (2024) · Obstetrics and Gynecology Clinics of North America · doi:10.1016/j.ogc.2024.05.007
Casanova-Pérez, R., Bascom, E., Mohanraj, D., Apodaca, C., Lane, C., Vidyarthi, D., Yang, C. L., Pratt, W., Sabin, J., Weibel, N., et al. (2024) · doi:10.2196/preprints.64924
Perspectivas culturales relacionadas con la autogestión en personas con enfermedad crónica.
Sánchez, J. W. M., Valtier, M. C. G., Gutiérrez-Valverde, J. M., Rivera, S. G. S., Martínez, N. H., & Fonseca, M. P. (2024) · Dilemas contemporáneos Educación Política y Valores · doi:10.46377/dilemas.v12i1.4307
Addressing Bias in the Occupational Therapy Admissions Process
Lancaster, S., Woods, L., & Zachry, A. H. (2024) · Occupational Therapy In Health Care · doi:10.1080/07380577.2024.2397667
“In addition to the use of holistic admissions, there is a need to mitigate bias and stereotype threats to minimize their influence on the admissions process (Spencer et al., 2016; Vela et al., 2022).”
Mizel, M., Haas, A., Adams, J., Martino, S. C., Haviland, A. M., Ghosh-Dastidar, B., Dembosky, J. W., Williams, M., Abel, G. A., Maksut, J., et al. (2024) · BMJ Quality & Safety · doi:10.1136/bmjqs-2024-017430
“40 69 Having clear decision processes and requiring rationales for decisions reduces the influence of implicit bias by promoting evidence-based protocols and increasing organisational accountability.”
Goffigan‐Holmes, J., Allison, D. I., Warren, K., Nwagwu, C. D., & Nduom, E. K.-E. (2024) · Springer eBooks · doi:10.1007/978-3-031-63050-7_14
Assessing Facility Readiness to Provide Equitable Birthing Care in New York State: A Baseline Survey
Gowani, S., Kellachan, J., Enwere, C., & Kacica, M. A. (2024) · Journal of Public Health Management and Practice · doi:10.1097/phh.0000000000001997
“28 Because most NYS facilities have implicit bias, racial equity, or cultural competence training in place, the next step is for facilities to consider structural inequities within their system that contribute to bias.”
Responsibilities of Medical Professionals Amidst Geopolitical Conflict
Feldman, C. L., & Spence, N. Z. (2024) · Journal of General Internal Medicine · doi:10.1007/s11606-024-09189-5 · Cited by 1
Bhattacharya, A., Camacho, D., Larson, J., & Chakraborty, P. (2024) · Social Work · doi:10.1007/978-3-031-60383-9_11
Jaramillo, J. P., Hough, S., Walker, J., Hicks, T., Thomas, F. P., Ciammaichella, E., Harfenist, S., Tam, K., & Whitchurch, J. (2024) · Journal of Spinal Cord Medicine · doi:10.1080/10790268.2024.2426312
“…opportunities for improvement, including: increasing diversity of staff to reflect diverse patient populations served, ongoing efforts to reduce and eliminate biases, inclusion of health equity goals in healthcare programming, and delivering services in diverse, politically sensitive areas (6–9).”
Analyzing Patterns in Anesthesiology Residents' Exam Performance Using Data Mining Techniques
DACCPM, Karimian, M., Rahmatizadeh, S., Kohzadi, Z., Kohzadi, Z., Madadi, F., & Dabbagh, A. (2024) · Anesthesiology and Pain Medicine · doi:10.5812/aapm-151686
“There are three potential sources of bias in the study, which we describe briefly below (21, 22): - Content relevance: To address bias effectively, we meticulously ensured that our test content covered a range of topics, closely adhering to the national board's comprehensive blueprint.”
Cunningham, J. D. (2024) · Springer eBooks · doi:10.1007/978-3-031-76204-8_3
Racial equity in and through medical interaction scholarship: A scoping review
Venetis, M. K., Hull, S. J., Nolan-Cody, H., Austin, J. T., Salas, M. J., Mai, S., Shields, L., & Alvarez, C. F. (2025) · Patient Education and Counseling · doi:10.1016/j.pec.2025.108648
McLean, J., Chambers, P., Steventon, L., Cruickshank, S., & Nabhani‐Gebara, S. (2025) · BMJ Quality & Safety · doi:10.1136/bmjqs-2024-017560
“16 While there are increasing efforts to explore how treatments can be improved for people from MEG in Western societies, a holistic global review of this pressing matter does not yet exist.”
Tait, R. C. (2025) · Pain Medicine · doi:10.1093/pm/pnaf028
Salmond, S. W., Aktan, N. M., Pitts, S., Repsha, C. L., Manchester, J., Schill, K. O. A. C., & Allread, V. (2025) · Orthopaedic Nursing · doi:10.1097/nor.0000000000001107
“(Vela et al., 2022, p. 479) ● Assuming an 80-year-old patient cannot email, text, or research self-care using the internet.”
InfluentialÁlvarez‐Aguado, I., Córdova, V. V., Roselló‐Peñaloza, M., Farhang, M., Rivera, F. M.-L., Carrasco, F. G., & González, H. S. (2025) · British Journal of Learning Disabilities · doi:10.1111/bld.12653
Biais implicites, stéréotypes et disparité de prise en charge en pédiatrie
Guedj, R. (2025) · Perfectionnement en Pédiatrie · doi:10.1016/j.perped.2025.04.011
Metadata
- Authors
- Vela, M. B., Erondu, A. I., Smith, N. A., Peek, M. E., Woodruff, J. N., & Chin, M. H.
- Affiliations
- University of Illinois Chicago (US)
- University of California, Los Angeles (US)
- Hospital of the University of Pennsylvania (US)
- University of Chicago (US)
- ORCID
- Woodruff, James N.
- Venue
- Annual Review of Public Health
- Publisher
- Annual Reviews
- Published
- 2022-04-05
- Volume
- 43
- Issue
- 1
- Pages
- 477-501
- ISSN
- 0163-7525 (ISSN-L)
- 1545-2093
- PMC
- PMC9172268
- OpenAlex
- W4206528627
- Cited by
- 426
- References
- 102
- Citations by year
- 2026: 89 · 2025: 176 · 2024: 97 · 2023: 55 · 2022: 9
- FWCI
- 14.19
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Annual Review of Public Health (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion, cc-by)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092949)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Cultural Competency in Health Care
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Social Sciences › Sociology and Political Science › Social and Intergroup Psychology
- Keywords
- implicit bias, explicit bias, healthcare workers, racial and ethnic minorities, health disparities, bias interventions, patient-clinician communication, clinical decision-making, organizational discrimination, structural change, conceptual model
- MeSH terms
- Attitude of Health Personnel, Communication, Health Personnel, Humans, Bias, Healthcare Disparities
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