Offers an innovative plan to eliminate inequalities in American health care and save the lives they endanger
Over 84,000 black and brown lives are needlessly lost each year due to health disparities: the unfair, unjust, and avoidable differences between the quality and quantity of health care provided to Americans who are members of racial and ethnic minorities and care provided to whites. Health disparities have remained stubbornly entrenched in the American health care system—and in Just Medicine Dayna Bowen Matthew finds that they principally arise from unconscious racial and ethnic biases held by physicians, institutional providers, and their patients.
Implicit bias is the single most important determinant of health and health care disparities. Because we have missed this fact, the money we spend on training providers to become culturally competent, expanding wellness education programs and community health centers, and even expanding access to health insurance will have only a modest effect on reducing health disparities. We will continue to utterly fail in the effort to eradicate health disparities unless we enact strong, evidence-based legal remedies that accurately address implicit and unintentional forms of discrimination, to replace the weak, tepid, and largely irrelevant legal remedies currently available.
Our continued failure to fashion an effective response that purges the effects of implicit bias from American health care, Matthew argues, is unjust and morally untenable. In this book, she unites medical, neuroscience, psychology, and sociology research on implicit bias and health disparities with her own expertise in civil rights and constitutional law. In a time when the health of the entire nation is at risk, it is essential to confront the issues keeping the health care system from providing equal treatment to all.
Dayna Bowen Matthew, JD, PhD is the Dean and Harold H. Greene Professor of Law at the George Washington UniversityLaw School. Dr. Matthew is a leader in public health and civil rights law who has also held many public policy roles. These include serving as senior adviser to the Office of Civil Rights for the U.S. Environmental Protection Agency, and as a member of the health policy team for U.S. Sen. Debbie Stabenow of Michigan.
Table of Contents
Acknowledgments xi Introduction: The New Normal 1 1. Bad Law Makes Bad Health 9 2. Implicit Bias and Health Disparities 33 3. Physicians’ Unconscious Racism 55 4. From Impressions to Inequity: Connecting the Empirical Dots 75 5. Implicit Bias during the Clinical Encounter 106 6. Implicit Bias beyond the Clinical Encounter 128 7. From Inequity to Intervention: What Can Be Done about Implicit Bias 154 8. A Structural Solution 173 9. A New Normal: The Restoration of Title VI 195 Conclusion: Beyond Title VI 225 Notes 233 Index 265 About the Author 271
