Under the radar: how unexamined biases in decision-making processes in clinical interactions can contribute to health care disparities

Abstract

Several aspects of social psychological science shed light on how unexamined racial/ethnic biases contribute to health care disparities. Biases are complex but systematic, differing by racial/ethnic group and not limited to love-hate polarities. Group images on the universal social cognitive dimensions of competence and warmth determine the content of each group's overall stereotype, distinct emotional prejudices (pity, envy, disgust, pride), and discriminatory tendencies. These biases are often unconscious and occur despite the best intentions. Such ambivalent and automatic biases can influence medical decisions and interactions, systematically producing discrimination in health care and ultimately disparities in health. Understanding how these processes may contribute to bias in health care can help guide interventions to address racial and ethnic disparities in health.

FIGURE 1—

Stereotype Content Model links among key variables potentially giving rise to disparate treatment. Note. Arrows indicate primary causal direction shown among variables in each column. The competition, warmth, active discrimination row is mediated by high-warmth (pride, pity) vs low-warmth (disgust, envy) emotions. The status, competence, passive discrimination row is mediated by high-competence (pride, envy) vs low-competence (disgust, pity) emotions.