Advancing Health Equity

Structural bias and racism—both within health care and the larger community—are unacceptable and serious threats to Pennsylvanians’ health our nation’s wellbeing. HAP is committed to leading efforts to eliminate health inequities caused by structural bias and racism.

Understanding Health Disparities

Health disparities graphic Evidence overwhelmingly points to bias and racism as the root cause of health inequity in the U.S. Across many measures, health outcomes are often worse for communities that have been marginalized and discriminated against on the basis of race, ethnicity, sex, nationality, language, sexual orientation, gender identity, disability, and other factors.

For example:

The CDC notes that racial and ethnic minority populations, compared with white populations, experience higher rates of diabetes, hypertension, obesity, asthma, and heart disease and that the life expectancy for Black Americans is four years lowers than that of white Americans.
A 2021 study of 30 U.S. cities from 2016–2018 estimated that health inequities contribute to 74,402 more deaths annually among Black people than white people.
Pennsylvania’s 2022 state health assessment found that the maternal mortality rate in the commonwealth from 2015–2019 was more than twice as high for Black people as it was for white people.
In a 2021 survey of LGBTQ youth, 42 percent reported seriously considered attempting suicide and 48 percent reported that they wanted counseling from a mental health professional but were unable to obtain it.

Eliminating these inequities—and the racism and biases that cause them—is central to promoting health equity.

How Bias and Racism Affect Health

Racism and bias influence health outcomes in a variety of ways.

Provider bias occurs during clinical interactions when the quality of health care is directly affected by the provider’s own, internal bias. Often, this happens unintentionally and without the provider’s knowledge.

Health care providers and their organizations are influenced by the same biases that exist within the larger community. Harm can happen when a provider consciously or subconsciously makes assumptions about a patient based on their stored knowledge associated with a characteristic of that patient.

For example, a provider might draw unfounded conclusions about a patient’s ability to pay or likelihood to comply with follow-up instructions because of the patient’s race and alter their recommended treatment as a result. Or, a provider may miss a critical diagnosis by substituting their knowledge associated with a patient’s ethnicity over careful evaluation of the patient as an individual. When provider bias occurs, it erodes the trust between the patient and provider, further affecting quality of care.

Health care providers and organizations can address provider bias by intentionally changing their own actions, and institutional processes and culture.

Exposure to discrimination also affects patient’s health outcomes and contributes to health inequity. Structural racism and bias can negatively affect a person’s access to health care, as well as many circumstances that contribute to their wellbeing, often referred to as social determinants of health.

For example, discriminatory housing practices and public policies have resulted in communities of color being disproportionately affected by factors such as unhealthy air or limited access to healthy food. Discrimination against LGBTQ communities has resulted in higher rates of homelessness. All these factors affect a person’s health.

Health care providers and organizations can address patients’ exposure to discrimination by understanding the health effects of discrimination and working to counter them through the care they provide and community advocacy.

Achieving health equity requires addressing BOTH provider bias and patients’ exposure to discrimination.

HAP’s Commitment to Health Equity

Structural racism and bias in health care are unacceptable. HAP is committed to working with Pennsylvania’s hospital community to advance health equity.

HAP’s Racial Health Equity Learning Action Network (RHELAN) will help hospitals and health systems identify and confront systemic inequality and structural racism in health care while addressing racial, cultural, and ethnic health disparities in our communities. Learn more on HAP’s RHELAN web page.