FIGURE 3 - uploaded by Marsha Lillie-Blanton
Content may be subject to copyright.
"How Big a Problem is Racism in Different Areas?" Source: Kaiser Family Foundation Survey of Race, Ethnicity and Medical Care: Public Perceptions and Experiences, October 1999 (conducted July-September, 1999). Note: Responses of "do not know" not shown.
Source publication
To assess the public's perceptions and attitudes about racial and ethnic differences in health care, the Kaiser Family Foundation surveyed a nationally representative sample of 3,884 whites, African Americans, and Latinos in 1999. The survey found that the majority of Americans are uninformed about health care disparities--many were unaware that bl...
Context in source publication
Context 1
... the public views racism as less of a major problem in health care than in other sectors of society, which is a perception that may or may not reflect the reality of the health care system. On average, 19 percent of the public (16 percent of whites, 35 percent of African Americans, and 30 per- cent of Latinos) say racism is a major problem in health care compared to an average of 31 to 35 percent that say racism is a major problem in other sectors of society (see Figure 3). ...
Similar publications
It is often alleged that Canada's publicly-funded, single payer health care system, delivers better health outcomes, and distributes health resources more fairly than the mainly private U.S. multi-payer system. Our findings contradict these allegations. Differences between the U.S. and Canada in infant mortality and life expectancy --the two indica...
Introduction:
The Bogotá-Region is an area where demographic trends and epidemiological profiles change constantly; these specific conditions determine health needs.
Objective:
To establish the demographic and epidemiological profile of the Bogotá-Region, its relationship with institutional response and opportunities for the development of a unive...
The objectives of this study were to classify different methodological approaches to measuring inequity in health care, identify the strengths and weaknesses of each approach, and suggest directions for future improvement of each approach. The authors classified three approaches to measuring inequity in health care according to: (1) collective expe...
Using a retrospective cohort study design, we report empirical evidence on the effect of parental socioeconomic status, primary care, and health care expenditure associated with preterm or low-birth-weight (PLBW) babies on their mortality (neonatal, postneonatal, and under-5 mortality) under a universal health care system. A total of 4668 singleton...
Citations
... To improve this equity in healthcare, research already focuses on investigating intercultural attitudes of healthcare practitioners towards ethnic minority patients. For instance, the study of such attitudes can aid in understanding equity related problems ranging from general social and ethnic differences in healthcare systems [6] to more specific problems like racism in healthcare [7]. ...
... As intercultural attitudes are at a central position of intercultural competence, measuring the attitudes of graduate healthcare practitioners can give an indication to which extent the potential to learn new intercultural capabilities is facilitated (i.e., in case of a more ethnorelative disposition) or hampered (i.e., in case of a more ethnocentric disposition) by the practitioner's attitudes [31]. Awareness and change of intercultural attitudes can thus prove to be key in order to understand and address issues like ethnic differences and racism in healthcare systems through learning processes [6,7]. ...
Objective
Measuring intercultural attitudes can aid in understanding and addressing persistent inequities in healthcare. Instead of creating new instruments, several sources call for a more rigorous revalidation of existing instruments towards a more broad population. As an example of such an existing instrument, the EMP-3 (Ethnic Minority Patients) focuses on the attitudes of physicians towards ethnic minority patients. Starting from a robust theoretical underpinning and a rigorous methodological setup, the present study revalidates the EMP-3 instrument for physicians towards the REMP-3 instrument for graduate healthcare practitioners.
Methods
We assessed the reliability and validity of the old EMP-3, which we then updated to a new REMP-3 instrument. We used structural equation modeling to model the framework of intercultural effectiveness on two waves of independent data, N2021 = 368 and N2022 = 390. Within this framework, we tested the new REMP-3 instrument as an operationalization of intercultural attitudes. We conducted a confirmatory factor analysis on the first wave, after which we made adaptations to the original EMP-3 instrument to obtain a new REMP-3 instrument. The new REMP-3 instrument was then cross-validated using the data of the second wave.
Results
The new REMP-3 instrument is a psychometric upgrade compared to the EMP-3. The REMP-3 now has a cross-validated structure, with three subscale dimensions (i.e., task perception, background perception and the perceived need to communicate) and an overarching higher-order, full-scale dimension. Both the subscales as well as the full instrument show acceptable to good internal consistency reliability, with a reduced number of items from eighteen to ten. As theoretically predicted, the REMP-3 also functions as a measure of intercultural attitudes in an intercultural competence framework.
Conclusion
Ultimately, the REMP-3 instrument can contribute to more equity in healthcare by concisely and reliably assessing and monitoring attitudes in healthcare practitioners. This attitude assessment represents the potential of learning new skills and knowledge to address interactions with ethnic minority patients, which is especially useful during training situations like an internship.
... For example, lower (vs. higher) class individuals are more likely to underestimate class-based health disparities (Lillie-Blanton et al., 2000;Shankardass et al., 2012) and show less criticism of the rich-poor gap (Martin, 2009; see also Cheung, 2016). They also tend to be relatively less favourable toward changing the unequal status-quo (Yogeeswaran et al., 2018). ...
Does COVID‐19 affect people of all classes equally? In the current research, we focus on the social issue of risk inequality during the early stages of the COVID‐19 pandemic. Using a nationwide survey conducted in China (N = 1,137), we predicted and found that compared to higher‐class individuals, lower‐class participants reported a stronger decline in self‐rated health as well as economic well‐being due to the COVID‐19 outbreak. At the same time, we examined participants' beliefs regarding the distribution of risks. The results demonstrated that although lower‐class individuals were facing higher risks, they expressed lesser belief in such a risk inequality than their higher‐class counterparts. This tendency was partly mediated by their stronger endorsement of system‐justifying beliefs. The findings provide novel evidence of the misperception of risk inequality among the disadvantaged in the context of COVID‐19. Implications for science and policy are discussed.
... A wide gap exists between White and non-White populations in terms of both healthcare utilization and health outcomes (Mead et al., 2008). The disproportionate health burdens experienced by racial/ethnic minority groups are due to many factors, including discrimination, language barriers, low socioeconomic status (Crimmins et al., 2004), inadequate access to healthcare (Wang and Luo, 2005;Weinick et al., 2000), and inferior quality of healthcare received (Lillie-Blanton et al., 2000). Distrust of health providers may exacerbate health disparities due to reduced utilization of preventive services (Musa et al., 2009). ...
Many Chinese Americans experience certain barriers (e.g., low income, English as a second language, lack of insurance, cultural differences, discrimination) when they seek oral healthcare services. These barriers may contribute to health disparities by discouraging use (leading to reduced utilization) of preventive and treatment services. This research adopts a modeling approach to develop theory that accounts for dynamic relationships operating at multiple levels, from individuals to families to communities. A multi-method and multi-level modeling approach allows for the interaction of factors at different levels of aggregation. This research applies spatially explicit agent-based modeling to examine how demographic, socioeconomic, and geographic factors shape access to oral healthcare for low-income Chinese Americans in New York City. The simulation model developed in this research was used to test different intervention scenarios involving community health workers who facilitate care coordination and other health promotion activities. In addition to demographic characteristics and socioeconomic factors, this study also considers geographic factors and spatial behavior, such as distance and activity space. The overarching contribution of this study is to provide a complex systems science framework to better understand access to oral healthcare for urban Chinese Americans, toward adapting it for other racial/ethnic minority groups, by integrating health-seeking behaviors at the individual level, barriers to care at multiple levels, and opportunities for health promotion at the community level.
... Yet, research on discrimination in health care is still relatively limited. In the early 2000s, few published studies had as their primary purpose improving understanding of discrimination in health care or the association of such experiences with health behaviors, health care utilization, or health outcomes (LaVeist et al., 2000;Lillie-Blanton et al., 2000). Furthermore, measures of personal discrimination in health care frequently consisted of single items and assessed discrimination in medical settings or by providers in general (Lillie-Blanton et al., 2000). ...
... In the early 2000s, few published studies had as their primary purpose improving understanding of discrimination in health care or the association of such experiences with health behaviors, health care utilization, or health outcomes (LaVeist et al., 2000;Lillie-Blanton et al., 2000). Furthermore, measures of personal discrimination in health care frequently consisted of single items and assessed discrimination in medical settings or by providers in general (Lillie-Blanton et al., 2000). Items about health care discrimination were sometimes included in measures that examined discrimination occurring in multiple contexts (Klonoff & Landrine, 1999;Krieger & Sidney, 1996;Ren et al., 1999). ...
Background
Discrimination occurs in health care settings contributing to health inequities. Yet guidance on how best to measure discrimination in health care is still limited.
Objectives
We sought to (1) identify and describe the characteristics of published studies that used the Discrimination in Health Care Measure, a scale first published in 2001; (2) review how the measure has been used or adapted and summarize the measure’s published psychometric properties and its variations; and (3) summarize associations between the measure and health-related variables.
Methods
We performed a systematic search and review of the measure by searching PsychINFO, PubMed, Sociological Abstracts, and Web of Science from January 1, 2001 through January 31, 2017. We screened 260 unique articles, identified 22 eligible articles, and completed a narrative synthesis.
Results
Most studies measured race or ethnicity-based discrimination. All studies made minor revisions to the measure, and most reported high reliabilities. Discrimination in health care, using this measure, was associated with adverse health outcomes.
Discussion and Practice Implications
Study results indicate that the measure is easy to use and adapt. Researchers should consider using the Discrimination in Health Care Measure when designing studies that will examine individuals’ discriminatory experiences when receiving health care.
... Delivery of resource information by a physician was important especially to African American caregivers in this study given the perception of the physician's authority. Although corroborated by Peterson et al. (2016), this finding may contradict evidence of higher levels of distrust of physicians among African American people compared to other groups (Lillie-Blanton et al., 2000). Perhaps because they were caregivers -functioning as an extension of the care recipient's medical team -African American caregivers in this study held physicians in higher regard or had developed more trusting relationships than has been seen in studies of more general populations. ...
Community resource referral systems have been implemented into care settings that serve persons with dementia but with little input from caregivers. Focus groups were conducted with African American, Hispanic, and Asian caregivers to describe their preferences for community resource referral information. Caregivers discussed the significance of a community resource list for dementia caregiving and self-care and articulated strategies for effective information delivery during a medical visit. Most caregivers acknowledged that resource needs change with progression of dementia, but no patterns emerged with regard to preference for information delivered incrementally based on disease stage or all at once. Hispanic and Asian caregivers felt that resource information should specify service providers’ language and cultural capabilities. All caregivers agreed that delivery by a member of the care team with knowledge of dementia-specific resources would be most effective. Optimal delivery of community resource referrals is caregiver-centered and customizable to individual and subgroup preferences.
... Previous research has shown that non-Hispanic Blacks and Hispanics are more likely than whites to have negative perceptions about the health care system and believe that minorities receive lower quality care. 21 We did not evaluate the association between negative beliefs about genetically targeted care and acceptance of genetic testing or other types of genomic medicine; this is an important issue to evaluate as part of future studies. Despite this, our research provides novel insight on African Americans who are most likely to have negative beliefs about genetically targeted care. ...
We examined beliefs about genetically targeted care (GTC) among African American men and women in a hospital-based sample and identified sociodemographic, cultural, and clinical factors having significant independent associations with these beliefs. Specifically, beliefs about GTC were evaluated after respondents were randomly primed with a racial or non-racial cue about race and genetics. Despite priming with a racial or non-racial cue, many respondents had positive beliefs about GTC. But, 49% believed that GTC would limit access to medical treatment, 46% believed that people will not trust GTC, and 20% believed that people like them would not benefit from GTC. Racial and non-racial priming did not have significant associations with negative beliefs about GTC. However, cultural beliefs related to temporal orientation were associated significantly with believing that genetically targeted care will limit access to medical treatment. Greater levels of future temporal orientation were associated with a reduced likelihood of endorsing this belief (OR = 0.70, 95% CI = 0.49, 1.01, p = 0.05). Respondents who had a chronic medical condition had an almost three-fold greater likelihood of believing that they would not benefit from GTC (OR = 2.90, 95% CI = 1.00, 8.37, p = 0.05). Greater exposure to information about genetic testing for chronic conditions was also associated with a reduced likelihood of believing that they would not benefit from GTC (OR = 0.40, 95% CI = 0.64, 0.91, p = 0.02). African Americans have diverse beliefs about GTC that should be considered as genetic and genomic services are offered.
... Evaluations of African Americans were generally closer to the favorable end of the feeling thermometer scale than to the unfavorable end, but they were nonetheless less favorable than evaluations of Caucasians. Even for positive attitudes, favoring one group can be harmful, because it may lead to preferential provision of positive treatment (Greenwald and Pettigrew 2014) and undermine trust in medical care (Lillie-Blanton, Brodie, Rowland, Altman, and McIntosh 2000;Sewell and Ray 2015;Smedley et al. 2003). Several components of the medical school experience represent promising avenues for mitigating this bias. ...
... Such efforts are vital in light of the documented widespread harm of medical racism (Hoberman 2012). For example, there is evidence that (some subgroups of) Black Americans trust medical providers less than White Americans do because of firsthand and secondhand experiences of bias (Lillie-Blanton et al. 2000;Sewell and Ray 2015;Smedley et al. 2003). One recent study documented an alarmingly pervasive view among medical students that Black people have higher pain tolerance than White people, resulting in inadequate pain management recommendations for hypothetical Black patients (Hoffman, Trawalter, Axt, and Oliver 2016). ...
Despite the widespread inclusion of diversity-related curricula in U.S. medical training, racial disparities in the quality of care and physician bias in medical treatment persist. The present study examined the effects of both formal and informal experiences on non-African American medical students’ (N = 2,922) attitudes toward African Americans in a longitudinal study of 49 randomly selected U.S. medical schools. We assessed the effects of experiences related to medical training, accounting for prior experiences and attitudes. Contact with African Americans predicted positive attitudes toward African Americans relative to white people, even beyond the effects of prior attitudes. Furthermore, students who reported having witnessed instructors make negative racial comments or jokes were significantly more willing to express racial bias themselves, even after accounting for the effects of contact. Examining the effects of informal experiences on racial attitudes may help develop a more effective medical training environment and reduce racial disparities in healthcare.
... Although some of this inequality may be due to differences in poverty rates, it does not negate the fact that race plays an important role in determining the quality of and access to health care that individuals receive (Lillie-Blanton, Brodie, Rowland, Altman, & McIntosh, 2000). As such, universal health care policies may play an important role in reducing racial health disparities in the United States. ...
Political rhetoric surrounding Universal Health Care in the United States typically deals only with differences in political ideology. Research on symbolic racism, however, indicates that subtle racial prejudice may also predict attitudes toward policies like universal health care that are assumed to benefit racial minorities. This subtle racial prejudice hypothesis was supported across three studies conducted in the U.S. A measure of attitudes toward universal health care was found to be a reliable, single-dimension measure associated with political ideology (Pilot Study). Subtle racial prejudice (as measured by the Modern Racism Scale) predicted opposition to universal health care, even when statistically controlling for political ideology and attitudes toward the poor (Study 1). Moreover, reading about a Black individual (compared to a White individual) receiving universal health care benefits reduced support for universal health care, even when statistically controlling for political ideology and right-wing authoritarianism (Study 2). Being a person who takes advantage of the system (e.g., free rides) was a significant predictor of universal health care attitudes while race was not (Study 3). This work demonstrates that subtle racial prejudice plays a critical role in predicting universal health care attitudes among U.S. citizens, reflecting a long-standing history of associations between subtle racial prejudice and opposition to governmental assistance programs in the U.S.
... Others have echoed similar sentiments, particularly noting that health disparities and health inequities research is more likely to be undertaken by individuals from backgrounds underrepresented in the biomedical sciences, and thus there is a need to better prepare this cadre of investigators. [14][15][16] On the health disparities front, as recently as the turn of the century, the problem was considered by some to be nothing more than perceptual 17,18 and was not the focus of substantive research until the mid-to-late 80s and early 90s. 13 Again, the 1985 Surgeon General's report recognized that health disparities were prevalent and endemic in the United States, and specifically showed that, for many of the health indicators examined, significantly large disparities existed between certain minority populations (African Americans, Hispanics and Native Americans/Alaska Natives) and their White counterparts. ...
p>Aspiring junior investigators from groups underrepresented in the biomedical sciences face various challenges as they pursue research independence. However, the biomedical research enterprise needs their participation to effectively address critical research issues such as health disparities and health inequities. In this article, we share a research education and mentoring initiative that seeks to address this challenge: Programs to Increase Diversity among Individuals Engaged in Health Related Research (PRIDE), funded by the National Heart, Lung, and Blood Institute (NHLBI). This longitudinal research-education and mentoring program occurs through summer institute programs located at US-based academic institutions. Recruited participants are exposed to didactic and lab-based research-skill enhancement experiences, with year-round mentoring over the course of two years. Mentor-mentee matching is based on shared research interests to promote congruence and to enhance skill acquisition. Program descriptions and sample narratives of participants’ perceptions of PRIDE’s impact on their career progress are showcased. Additionally, we highlight the overall program design and structure of four of seven funded summer institutes that focus on cardiovascular disease, related conditions, and health disparities. Mentees’ testimonials about the value of the PRIDE mentoring approach in facilitating career development are also noted. Meeting the clinical and research needs of an increasingly diverse US population is an issue of national concern. The PRIDE initiative, which focuses on increasing research preparedness and professional development of groups underrepresented in the biomedical research workforce, with an emphasis on mentoring as the critical approach, provides a robust model that is impacting the careers of future investigators. Ethn Dis. 2016;26(3):379- 386; doi:10.18865/ed.26.3.379 </p
... 61 More than half of HAs surveyed agreed that the cost of medical care is a major problem facing the average HA. 86 Numerous pain investigations have found that, compared to NHWs, HAs are less likely to have consulted a physician for acute 43 or chronic pain. 30,64,87,101,109 One national survey found that Hispanic ethnicity and speaking Spanish as one's primary language were significant predictors of lower access to chronic pain treatment. ...
Unlabelled:
Although the Hispanic population is a burgeoning ethnic group in the United States, little is known about their pain-related experience. To address this gap, we critically reviewed the existing literature on pain experience and management among Hispanic Americans (HAs). We focused our review on the literature on nonmalignant pain, pain behaviors, and pain treatment seeking among HAs. Pain management experiences were examined from HA patients' and health care providers' perspectives. Our literature search included variations of the term "Hispanic" with "AND pain" in PubMed, Embase, Web of Science, ScienceDirect, and PsycINFO databases. A total of 117 studies met our inclusion criteria. We organized the results into a conceptual model with separate categories for biological and/or psychological and sociocultural and/or systems-level influences on HAs' pain experience, response to pain, and seeking and receiving pain care. We also included information on health care providers' experience of treating HA patients with pain. For each category, we identified future areas of research. We conclude with a discussion of limitations and clinical implications.
Perspective:
In this critical review of the literature we examined the pain and management experiences of the HA population. We propose a conceptual model, which highlights findings from the existing literature and future areas of research.
