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Racial Bias in Perceptions of Others’ Pain
Sophie Trawalter
1,2
*, Kelly M. Hoffman
2
, Adam Waytz
3
1Frank Batten School of Leadership and Public Policy, University of Virginia, Charlottesville, Virginia, United States of America, 2Department of Psychology, University of
Virginia, Charlottesville, Virginia, United States of America, 3Kellogg School of Management, Northwestern University, Evanston, Illinois, United States of America
Abstract
The present work provides evidence that people assume a priori that Blacks feel less pain than do Whites. It also
demonstrates that this bias is rooted in perceptions of status and the privilege (or hardship) status confers, not race per se.
Archival data from the National Football League injury reports reveal that, relative to injured White players, injured Black
players are deemed more likely to play in a subsequent game, possibly because people assume they feel less pain.
Experiments 1–4 show that White and Black Americans–including registered nurses and nursing students–assume that Black
people feel less pain than do White people. Finally, Experiments 5 and 6 provide evidence that this bias is rooted in
perceptions of status, not race per se. Taken together, these data have important implications for understanding race-
related biases and healthcare disparities.
Citation: Trawalter S, Hoffman KM, Waytz A (2012) Racial Bias in Perceptions of Others’ Pain. PLoS ONE 7(11): e48546. doi:10.1371/journal.pone.0048546
Editor: Richard Fielding, The University of Hong Kong, Hong Kong
Received July 18, 2012; Accepted September 26, 2012; Published November 14, 2012
Copyright: ß2012 Trawalter et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: These authors have no support or funding to report.
Competing Interests: The authors have declared that no competing interests exist.
* E-mail: strawalter@virginia.edu
Introduction
Relative to White Americans, Black Americans experience
higher rates of diseases, disability and premature death [1,2].
Disparities in healthcare contribute to these health disparities.
Black patients are more likely to receive lower-quality healthcare
and are subject to less desirable procedures. For instance, Black
patients are over three times more likely than White patients to
have limbs amputated as a result of diabetes [3]. Moreover, Black
patients are systematically undertreated for pain [4–6]. They are
less likely than Whites to receive pain medication and, when they
do, they receive less [7,8]. Numerous explanations have been
proposed, ranging from assumptions about Black patients’ inability
to pay for healthcare to racial prejudice [6,9]. These explanations
generally imply that Black patients’ pain is recognized but not
treated. Another explanation, however, is that Black patients pain
is not recognized in the first place. The present work begins to
examine this possibility; it provides evidence that people–including
medical personnel–assume a priori that Black people feel less pain
than do White people.
Consistent with this thesis, a study of physician-patient
interactions has shown that physicians underestimate Black
patients’ pain more than White patients’ pain [10]. Because this
study was not an experiment, however, it is not clear whether this
bias was the result of patient race, physician characteristics, and/
or characteristics of the patient-physician interaction. Social
psychological research provides relevant but inconclusive exper-
imental evidence for our thesis. Work on stereotyping and
prejudice has shown that Blacks, Black men in particular, are
stereotyped as being dangerous and physically tough–qualities that
might make them seem impervious to pain [11–14]. Work on
dehumanization has shown that Black men are infra-humanized
and that the infra-humanization of Black men is associated with
the condoning of police brutality against Black men [15]. These
findings suggest that people do not care about harm inflicted upon
a Black victim and/or that they do not recognize the extent to
which a Black victim might be injured by such harm. Finally, work
on the ‘‘intergroup empathy gap’’ has shown that Whites often fail
to ‘‘feel’’ the pain of outgroup members, including Black people
[16,17]. Studies using fMRI technology have shown that for White
participants, a network of neural regions involved in processing
one’s own pain (‘‘the pain matrix’’) responds similarly to viewing
harm inflicted on racial ingroup but not racial outgroup members
[18,19]. Again, these findings suggest that people do not care
about Blacks’ pain and/or do not recognize how much pain Blacks
might feel. In the present work, we tested the latter possibility. We
provide experimental evidence that people, including medical
personnel, assume a priori that Blacks feel less pain than do Whites.
We also provide archival evidence to illustrate the potential
breadth of this phenomenon.
Archival Study
We began testing our hypothesis using the National Football
League’s (NFL) 2010 and 2011 injury reports. Throughout the
football season, coaching staffs and team medical personnel must
evaluate injured players and rate their likelihood of being able to
play the following week. We reasoned that if Black players are
assumed to feel less pain, then they might be rated as more likely to
play when injured relative to White players.
Methods
Research assistants blind to study hypotheses transcribed the
NFL Injury Reports for the 2010 and 2011 seasons. Research
assistants recorded each injury for each season, the players’ race,
age, experience (years) in the NFL, position, and injury type, as
well as players’ next-game status. Next-game status ranged from
Out (definitely not playing) to Doubtful, Questionable, and
Probable. This ordinal classification system served as our
dependent measure.
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Results and Discussion
We constructed a multi-level model to examine the effect of
player race on next-game status. We did this for all injuries aside
from concussions and illnesses. See Table 1 for a list of injuries.
Control variables all affected next-game status; position: F(21,
5530) = 1.91, p= .008, injury: F(56, 5530) = 3.49, p,.0001, and
experience: F(1, 474) = 3.82, p= .05. As predicted, the analysis
revealed that relative to injured White players, injured Black
players were deemed more likely to play in the next game,
controlling for players’ experience in the NFL, position, and injury
type, F(1, 5530) = 6.39, p= .01, M
Black
= 1.97, SE
Black
= .11, and
M
White
= 1.84, SE
White
= .12. We also examined Huber-White
standard errors allowing for heteroscedasticity clustered at the
team, team-year, and player level. These standard errors are larger
than classical standard errors but similar to each other. Results
held when we used these conservatively large standard errors in
our inferences. Results also held when taking out data from Tom
Brady and/or the Patriots; Tom Brady of the Patriots was placed
on the injury list almost every week despite playing every (or nearly
every) game. Interestingly, players’ race had no effect on next-
game status in the case of concussions and/or unspecified illnesses,
F,1.
These findings are consistent with our claim that Black people–
in this case, Black players–are presumed to feel less pain than
White people. Indeed, it is telling that when mandated standard-
ized testing (rather than human judgment) was used to determine a
player’s next-game status, as is the case with concussions, the racial
bias disappeared. Although a racial difference emerged among
NFL players, these data are far from conclusive. Assuming that
Black players feel less pain is one of many reasons why injured
Black players might be more likely to play compared with injured
White players. For example, it is possible that Black players are
more likely to want to play when injured or that they have been
socialized to ignore and play through their pain [12].
Experiment 1
Although these NFL injury data are provocative, the effect of
race was small and alternative explanations abound (e.g., players’
determination to play even while injured). We thus sought more
direct and conclusive evidence for our hypothesis by conducting a
set of experiments. In our first experiment, we tested whether
Whites assume that Black people feel less pain than do White
people.
Methods
Ethics statement. All studies were approved by the Institu-
tional Review Board at the University of Virginia and conducted
in the U.S. All participants provided consent, either by signing a
written consent form or indicating their consent by clicking on a
button on an online (written) consent form.
Table 1. List of injuries for football seasons 2010 and 2011.
Injury Frequency Percent
Knee 1803 22.78
Ankle 1255 15.86
Hamstring 783 9.89
Shoulder 683 8.63
Foot 463 5.85
Groin 417 5.27
Back 339 4.28
Calf 228 2.88
Hip 185 2.34
Toe 179 2.26
Neck 167 2.11
Quadriceps 145 1.83
Thigh 133 1.68
Head 131 1.66
Ribs 116 1.47
Elbow 112 1.42
Hand 95 1.2
Thumb 90 1.14
Wrist 89 1.12
Chest 65 0.82
Finger 64 0.81
Shin 46 0.58
Forearm 45 0.57
Abdomen 38 0.48
Fibula 38 0.48
Rib 32 0.4
Achilles 29 0.37
Biceps 23 0.29
Triceps 23 0.29
Pectoral 13 0.16
Pelvis 12 0.15
Glutes 10 0.13
Heel 10 0.13
Eye 9 0.11
Oblique 6 0.08
Migraine 5 0.06
Arm 4 0.05
Lower Leg 4 0.05
Stinger 4 0.05
Arch 3 0.04
Jaw 2 0.03
Kidney 2 0.03
Leg 2 0.03
Back Spasm 1 0.01
Cheek 1 0.01
Collar bone 1 0.01
Dehydrated 1 0.01
Ear 1 0.01
Eye Lid 1 0.01
Hernia 1 0.01
Table 1. Cont.
Injury Frequency Percent
Infection 1 0.01
Lacerated Kidney 1 0.01
Nose 1 0.01
Tibia 1 0.01
Tooth 1 0.01
doi:10.1371/journal.pone.0048546.t001
Racial Bias in Perceptions of Others’ Pain
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Participants. We recruited 250 White participants from the
University of Virginia (UVA) Department of Psychology partic-
ipant pool (N= 102) and via Mechanical Turk (N= 148), an online
marketplace powered by Amazon.com. UVA participants received
course credit for their participation. Mechanical Turk participants
received $0.50 for their participation. We excluded 10 participants
from our analyses below for not being native English-speakers
and/or American. In all experiments, we excluded non-English-
speakers and non-Americans because we suspect this racial bias in
pain perception is a cultural phenomenon. Including these
participants in our analyses does not change the results of
Experiments 1, 2, 4, 5, and 6 but does change the results of
Experiment 3 (see below). The final sample of 240 varied in age
(M= 28.47, SD = 12.16) and gender (63% female).
Stimuli. We used standardized pictures from the Productive
Aging Lab Face Database [20]. Specifically, we used 9 pictures
each of Black and White men, and 6 pictures each of Black and
White women. Pilot testing revealed that Black and White, male
and female targets were rated as equally attractive, emotionally
expressive, and familiar, all Fs,1. However, the female targets
and White targets were rated as significantly less threatening than
the male targets and Black targets, respectively, F= 21.81,
p,.0001 and F= 5.11, p= .03. These differences were expected.
They reflect commonly held stereotypes about gender and race,
beliefs about what it means to be male or female, Black or White.
Indeed, we acknowledge the possibility that perceived threat is
part of this racial bias in pain perception and address this potential
‘‘threat’’ confound in Experiment 4.
Procedure. After signing (or clicking ‘‘continue’’ to indicate
agreement with) the consent form, participants were asked to rate
the amount of pain they would feel in 18 situations. Situations
ranged from getting a paper cut and getting shampoo in the eye, to
getting an injection in the arm, stubbing a toe on a chair, and
slamming a hand in a car door. Then, participants were randomly
assigned to rate the amount of pain a Black or White gender-
matched target person would feel in the same 18 situations. A
subset of female participants (N= 63) saw a male target; i.e., not a
gender-matched target. Excluding these participants does not
change the pattern of results. Participants made all of their ratings
on 4-point scales (1-not painful,2-slightly painful,3-moderately painful,
4-extremely painful). This pain measure for self and other was
internally reliable, a= .85. Next, participants completed measures
of race-related attitudes and/or concerns (i.e., the Motivation to
Respond without Prejudice Scale [21]; the White Guilt Scale [22]; the
Modern Racism Scale [23]; the Implicit Association Test [24]). Finally,
participants were asked a number of demographic questions
including age, gender, race/ethnicity, social economic status
(education/parental education, household income, and subjective
social class), nationality (country of birth), and number of years in
the U.S.
Results and Discussion
We constructed a general linear model (GLM) to examine the
effect of target race on perceptions of pain. We controlled for
participants’ age, gender, and self-ratings of pain. We controlled
for age because all targets were young adults, making them
more similar to younger participants. Indeed, across experi-
ments, age was often a significant predictor of participants’
ratings of the target’s pain. We controlled for gender given our
a priori assumption that women would report more pain, both
for themselves and for the target. Finally, we controlled for self-
ratings of pain because these self-ratings were so variable (with
some participants reporting relatively low levels of pain across
scenarios and others reporting relatively high levels of pain
across scenarios) and so highly predictive of participants’ ratings
of the target’s pain. Across experiments, the best predictor of
pain ratings was self-ratings of pain. See Table 2 for test
statistics for all covariates, for all experiments. More important-
ly, and consistent with predictions, participants’ pain ratings
were significantly lower for a Black vs. White target,
F(1,235) = 15.07, p= .0001, d= .51. See Figure 1. This result
held when not controlling for covariates. As a brief aside, the
effect of target race on pain ratings also held in Experiment 5
but not in Experiments 2, 3, 4, and 6–experiments in which cell
sizes are relatively smaller. Our sense is that self-ratings of pain
are too variable and too predictive to be ignored. The
interested reader can look at the Supporting Information for
tables of unadjusted means and standard deviations for self-
Figure 1. Pain ratings (estimated means and standard errors) for Experiments 1–5.
doi:10.1371/journal.pone.0048546.g001
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ratings of pain and ratings of the target’s pain, and correlations
between self-ratings of pain and ratings of others’ pain.
Explicit and/or implicit race-related attitudes and/or concerns
did not moderate this effect, suggesting that this bias in pain
perception is not the result of racial prejudice per se. In other
words, although we observed a difference in the way people
treated (perceived) a Black vs. a White target (i.e., a racial bias in
pain perception), this difference was not associated with negative
or otherwise demeaning thoughts, feelings, or action tendencies
toward Black people more generally (i.e., racial prejudice).
Experiment 2
The fact that racial bias in perception of others’ pain was not
related to explicit or implicit race-related attitudes and/or
concerns raises the possibility that this bias is not rooted in racial
animus, at least not primarily or entirely. Thus, in Experiment 2,
we replicated Experiment 1 with Black participants, reasoning that
Black Americans might also show the bias.
Methods
Participants. We recruited 42 Black participants from the
UVA Psychology participant pool (N= 17) and via Mechanical
Turk (N= 25). UVA participants received course credit for their
participation. Mechanical Turk participants received $0.50 for
their participation. We excluded 7 participants from the analyses
below for not being native English-speakers and/or American.
Including these participants in our analyses does not change the
pattern of results below. Our final sample of 35 varied in age
(M= 30.22, SD = 14.08) and gender (67% female).
Procedure. The procedure was identical to that of Experi-
ment 2 with the exception that participants did not complete any
of the race-related measures.
Results and Discussion
We constructed another GLM to examine the effect of target
race on pain ratings, again controlling for participants’ age,
gender, and self-ratings of pain. Analyses revealed a similar bias.
Participants’ ratings were significantly lower for a Black vs. White
target, F(1,30) = 5.27, p= .03, d= .84. See Figure 1. These findings
suggest that this bias is not rooted solely in racial prejudice or
intergroup dynamics.
Experiment 3
In our introduction, we claim that this bias may shed light on
racial disparities in healthcare and, specifically, pain treatment. To
begin to investigate this claim, we replicated Experiments 1 and 2
with a sample of registered nurses and nursing students.
Methods
Participants. We recruited 56 participants with the help of
faculty members and administrators at a school of nursing.
Participants were mailed a $10 gift certificate for their participa-
tion. Thirteen identified the main hypothesis, and thus their data
were removed. It is worth noting that most of these participants
completed the study toward the end of data collection, suggesting
that they had heard about the study from someone else. Including
these participants in our analyses did change the results–the
pattern did not change but the difference between target race
conditions was no longer statistically significant. The final sample
of 43 included 29 registered nurses and 14 nursing students. The
sample varied in age (M= 32.64, SD = 12.84) and ethnicity (88%
White, 7% Black, and 5% other). All participants except one were
women.
Procedure. The procedure was identical to that of Experi-
ment 2.
Results and Discussion
We constructed a GLM to examine the effect of target race
on ratings of pain, controlling for participants’ age and self-
ratings of pain. We did not control for gender as only one
participant was male. However, we controlled for participant
race given that we had participants from various ethnic/racial
groups. We reasoned, based on Experiments 1 and 2, that there
might be ethnic/racial group differences in pain ratings; namely,
that Black participants might systematically report greater pain
than White participants (see Supporting Information). As in the
first two experiments, participants’ pain ratings were significant-
ly lower for a Black vs. White target, F(1,38) = 4.90, p= .03,
d= .72. See Figure 1. In other words, nurses and nursing
students in this study also assumed that Blacks feel less pain
than do Whites.
Experiment 4
Experiments 1–3 provide some support for our thesis that
people–including nurses and nursing students–assume a priori that
Blacks feel less pain than do Whites. Recall, however, that
independent coders rated the Black targets as significantly more
threatening than the White targets (Experiment 1). It is thus
possible that participants assumed that threatening individuals feel
less pain than do non-threatening individuals; not that Blacks feel
less pain than do Whites. This explanation of our data is not quite
satisfactory, however. Extant research has demonstrated that
individuals often over-perceive threat in Black targets [25,26]. In
this way, perceived threat is not a confound. Being perceived as a
threat is part of what it means to be Black in America [27]. Indeed,
Table 2. Test statistics for covariates in experiments 1–5.
Experiment 1 Experiment 2 Experiment 3 Experiment 4 Experiment 5 Experiment 6
Self-ratings F= 123.74 F= 61.40 F=37.41 F=54.79 F=130.40 F= 366.53
p,.0001 p,.0001 p,.0001 p,.0001 p,.0001 p,.0001
Age F= 3.57 F= 7.78 F,1F= 5.24 F,1F= 2.99
p=.06 p= .01 p=.03 p=.08
Gender F,1F,1F= 1.40 F= 3.67 F,1
p=.24 p= .06
Race/ethnicity F,1F,1F,1F,1
doi:10.1371/journal.pone.0048546.t002
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we suspect that perceived threat might be part of our effect.
Nonetheless, we wanted to rule out the possibility that perceived
threat was a confound in our stimuli. To do this, we created Black-
White morphed faces, which we labeled as either being Black or
White. We predicted that, even when looking at the same target
person, participants would assume that the target would feel less
pain when the target was labeled ‘‘Black’’ vs. ‘‘White.’’
Methods
Participants. We recruited 99 participants via Mechanical
Turk. We excluded 39 participants: 13 for not being native
English-speakers and/or American and the rest for failing the
manipulation checks. Including these participants does not change
the results, however. The final sample of 60 varied in age
(M= 30.98, SD = 11.24), gender (63% female), and race/ethnicity
(73% White, 8% Black, 19% other).
Stimuli. We morphed a Black and a White male target face
and a Black and a White female target face from Experiment 1
using FantaMorph software. The resulting male and female faces
were racially ambiguous.
Procedure. The procedure was identical to that of Experi-
ment 2, with the exception that all male participants saw the same
(morphed) male target face and all female participants saw the
same (morphed) female target face. Participants in the ‘‘Black
target’’ condition were told that the racially-ambiguous target
person was Black. Participants in the ‘‘White target’’ condition
were told that the racially-ambiguous target person was White.
After completing the pain ratings, participants were asked two
questions about the target person: his/her name and his/her race/
ethnicity.
Results and Discussion
We constructed a GLM to examine the effect of target race on
pain ratings, again controlling for participants’ age, gender, and
self-ratings of pain. Analyses revealed a similar racial bias.
Participants’ ratings were significantly lower for a Black vs. White
target, F(1,53) = 5.97, p= .02, d= .67. See Figure 1. Because
participants in both the Black target and White target conditions
saw the same target faces, these differences cannot be attributed to
differences in the target faces; they can only be attributed to the
racial label ascribed to the target faces. In other words, the
documented bias seems to be a race-related bias. Given the
pervasiveness and potentially negative consequences of this bias, it
is imperative to understand what is driving this effect. Experiments
5 and 6 begin to uncover the underlying mechanism of this bias.
Experiment 5
In Experiment 5, we began to explore what psychological
processes underlie this bias. Because this bias does not appear to be
the direct result of racial prejudice (Experiment 1) or intergroup
dynamics (Experiment 2), we looked to a social dimension beyond
race; namely, status. We reasoned that the pain of lower-status
individuals might be systematically underestimated because people
assume that individuals who have had a life full of adversity are
tough by necessity, whereas those who have had a life of privilege
are frail by virtue of being sheltered and coddled. Because Blacks
have relatively low status in U.S. society, people may assume that
Black people have less privileged lives–lives with more hardships–
and infer that they must be tougher. We tested this idea in
Experiment 5 using a mediation approach.
Methods
Participants. We recruited 127 participants via Mechanical
Turk. Participants received $0.50 for their participation. We
excluded 23 participants for not being native English-speakers
and/or American. Including these participants in our analyses did
not change the results below. For the sake of consistency across
studies, however, we excluded these participants from the analyses.
The final sample of 104 varied in age (M= 27.06, SD = 11.32),
ethnicity (71% White, 9% Black, 20% other), and gender (51%
female).
Procedure. Experiment 5 was a direct replication of Exper-
iments 2 and 3 with one exception. At the end of the study,
participants rated their own privilege on 4 items (i.e., how
privileged do you think you are? How hard do you think your life
has been? How lucky do you think you have been? How much
adversity do you think you have overcome?) and the target
person’s privilege using the same 4 items with anchors at 1-Not at
all to 4-Extremely.
Results and Discussion
We constructed a GLM to examine the effect of target race on
perceptions of pain, controlling for age, gender, race, and self-
ratings of pain. In replication of Experiments 1–4, participants’
pain ratings were lower for a Black vs. White target, F(1,98) = 3.67,
p= .06, d= .39. See Figure 1.
We constructed a similar GLM to examine the effect of target
race on perceptions of privilege, controlling for age, gender, race,
and self-ratings of privilege. As expected, participants’ ratings of
the target person’s privilege were significantly lower for a Black vs.
White target, F(1,98) = 21.73, p,.0001, d= .94. In other words,
participants assumed that the Black target was less privileged and
faced more hardship than the White target.
Finally, to examine whether perceptions of privilege mediated
perceptions of pain, we regressed perceptions of pain onto
perceptions of privilege, again controlling for all covariates.
Consistent with predictions, participants’ ratings of the target’s
privilege predicted pain ratings, F(1,97) = 7.39, p= .008, d= .55.
The less privileged the target seemed, the less participants thought
s/he would experience pain. In other words, participants
associated hardship with physical toughness. Importantly, target
race (Black vs. White) was no longer predictive of pain ratings once
we controlled for participants’ perceptions of the target’s privilege,
F,1, while target’s privilege continued to predict pain ratings
F(1,96) = 3.98, p= .05, d= .41, Sobel test z=22.42, p= .02. See
Figure 2 for mediation model. These data suggest that perceptions
of social status–how much privilege/hardship a person has
experienced in life–mediate perceptions of pain. Perceived
privilege/hardship accounted for the racial bias in perceptions of
others’ pain.
Experiment 6
In Experiment 6, we examined the effect of perceived privilege
on perceptions of pain using a moderation approach and using a
different operationalization of privilege. In particular, we tested
whether giving participants information about the status of the
target person might undo the racial bias. Specifically, we wanted
to test whether participants would perceive a lower-status person
as feeling significantly less pain than a higher-status person. If the
bias we have documented is really about status and the privilege or
hardship that status confers, as Experiment 5 suggests, then
experimentally manipulating the target person’s status should
moderate the racial bias.
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Methods
Participants. We recruited 302 participants via Mechanical
Turk. Participants received $0.50 for their participation. We
excluded 23 participants for not being native English-speakers
and/or American and 34 for failing the manipulation checks (not
remembering the target’s status or race, or giving the same answer
for all questions in the study). Including these participants in our
analyses changed the results below slightly–the pattern did not
change but the difference between status conditions became
marginally significant. The final sample of 245 varied in age
(M= 31.73, SD = 11.71), ethnicity (84% White, 5% Black, 11%
other), and gender (61% female).
Procedure. We used eight pictures of middle-aged, Black and
White target persons in business attire. Participants were randomly
assigned to view a gender-matched target. They were told to
imagine that this person was of lower-, equal-, or higher-status, as
a manipulation of perceived privilege. Specifically, participants in
the lower-status condition were told, ‘‘Imagine that you and
Jordan both work at the same company. He is your subordinate.
You dictate and oversee his day-to-day tasks. He depends on your
recommendation for promotions and salary increases.’’ Partici-
pants in the equal-status condition were told, ‘‘Imagine that you
and Jordan are associates at the same company. You both have a
manager who dictates and oversees your day-to-day tasks. You
both depend on his recommendation for promotions and salary
increases.’’ Participants in the higher-status condition were told,
‘‘Imagine that you and Jordan both work at the same company.
He is your superior. He dictates and oversees your day-to-day
tasks. You depend on his recommendation for promotions and
salary increases.’’ We manipulated relative status rather than
absolute status because status is relative–what is high status for one
person may not be high status for another person. This
manipulation complements the operationalization of privilege in
Experiment 5, assessing perceived privilege through a closely
related construct, social status [28]. Next, participants were asked
to report how much pain they would feel if they accidentally
stapled their own hand with an industrial stapler and how much
pain this other person would feel if s/he accidentally stapled their
hand with an industrial stapler. Participants made these ratings on
6-point scales (1-not at all painful,6-extremely painful). Participants
then answered questions about their perceptions of the target;
namely, how similar they felt to the target person and how much
control the target person ostensibly had over their outcomes.
Again, they made these ratings on 6-point scales. Lastly,
participants answered demographic questions and manipulation
checks (e.g., questions about the status and race of the target).
Results and Discussion
We constructed a GLM to examine the effect of target race,
target status, and their interaction, controlling for age, gender,
race, and self-ratings of pain. Results revealed that target status
indeed affected participants’ ratings of the target’s pain,
F(2,230) = 3.78, p= .02, g
2
= .03. This effect was not moderated
by target race, F,1. See Figure 3. Our a priori (linear) contrast
comparing lower-, equal-, and higher-status targets (21 0 1) was
significant, F(1,230) = 5.91, p= .02, such that lower status resulted
in lower pain ratings. As can be seen in Figure 3, however, the
means of participants in the same-status condition are comparable
to the means of participants in the lower-status condition.
Although we predicted that the means of participants in the
same-status condition would fall in-between the means of
participants in the lower- and higher-status condition, we think
that our same-status prompt may have conveyed low-status; i.e.,
‘‘you both have a manager who dictates and oversees your day-to-
day tasks. You both depend on his recommendation for
promotions and salary increases’’ may have communicated to
participants that the target person (and they themselves) had low
status.
Secondary analyses. We also examined participants’ im-
pressions of the target person. Analyses revealed that participants’
ratings of how much control the target ostensibly had over their
outcomes predicted pain ratings, F(1,234) = 7.24, p= .007, con-
trolling for self-ratings of pain, gender, age, and race. Participants
attributed less pain to a target they perceived as having less status
and power. Participants’ ratings of how similar they felt to the
target did not predict pain ratings, F,1, suggesting that
perceptions of status and power, but not similarity, influenced
perceptions of the target’s pain. Taken together, data from
Experiments 5 and 6 suggest that people use information (or
assumptions) about status to estimate others’ pain. People seem to
have a more general stereotype about low-status people; namely,
that they are tough. What this means is that this bias may
generalize to other low-status groups and that, as long as Black
Figure 2. Mediation model for Experiment 5. All coefficients are standardized betas. Coefficients in parentheses are betas when controlling for
perceptions of hardship. {p= .06; *p,.05; **p,.01; ***p,.001.
doi:10.1371/journal.pone.0048546.g002
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Americans are perceived to be low-status in our society, their
capacity for pain is likely to be underestimated.
General Discussion
The present work demonstrates that people assume a priori that
Blacks feel less pain than do Whites. This finding has important
implications for understanding and reducing racial bias. It sheds
new light on well-documented racial biases. Consider, for instance,
the finding that White Americans condone police brutality against
Black men relative to White men [15]. Although it may be that
some Whites (and non-Whites) condone police brutality against
Black men because they condone harm against Black men, it may
also be the case that at least some people condone police brutality
against Black men because they assume that Black men feel less
pain. They may perceive the same violent act as less injurious in
the case of Black victims. As another example, consider the finding
that Whites are not distressed at seeing harm inflicted upon Black
(vs. White) people [18]. While it may be that some Whites do not
care about Black people and their pain, it may also be the case that
at least some Whites fail to realize that Black people feel as much
pain as White people. Although still alarming, this explanation is
decidedly different from the claim that White people simply do not
care about Black people.
In the context of healthcare, our findings imply that one reason
Black patients are undertreated for pain may be that medical
personnel assume that Black patients feel less pain than do White
patients. On the one hand, this is a more charitable attribution
than blatant racism and the notion that (at least some) medical
personnel withhold medication from Black patients. On the other
hand, this bias may pose a more pernicious problem. Interventions
aimed at reducing racial disparities in healthcare will need to
target not only treatment but diagnosis of pain and illness. To that
end, less subjective pain assessment methods need to be developed.
In addition, simple mental exercises, such as perspective-taking,
could be used. Research has shown that taking the perspective of
patients can effectively reduce racial bias in pain treatment and
improve Black patients’ satisfaction [5,29], although our data
suggest that such exercises will need to challenge assumptions
about patients’ status to be effective. The present work also implies
that current ‘‘paternalistic’’ models of doctor-patient relationships–
whereby patients depend on their doctors but not vice versa–may
unwittingly increase bias in perceptions of patients’ pain. In
contrast, collaborative models, whereby doctors and patients
depend on each other to reach mutually-satisfying outcomes, may
reduce this bias. Future work should examine this possibility.
In sum, the present work finds that people assume that, relative
to Whites, Blacks feel less pain because they have faced more
hardship. At first blush, this assumption seems innocuous, even
complimentary. It acknowledges the hardship Black people have
faced and glorifies their strength and resilience. Nonetheless, this
assumption leads to racial bias and potentially disastrous outcomes
(e.g., condoning policy brutality against Blacks, underestimating
and undertreating Black patients’ pain). Therein lies the problem.
Supporting Information
Table S1 Unadjusted means and standard deviations
for self-ratings and ratings of others’ pain.
(DOCX)
Table S2 Zero-order correlations between self-ratings
and ratings of others’ pain.
(DOCX)
Acknowledgments
We gratefully acknowledge Benjamin Converse, Adam Galinsky, Hal
Hershfield, Sarah E. Johnson, Jennifer Richeson, Barbara Spellman,
Timothy Wilson, members of the Working Group on Racial Inequality,
and members of the Social Cognition and Behavior Lab at the University
of Virginia for their feedback. We are also grateful to Thomas Dee for his
assistance with data analysis of the NFL injury reports data, and to Norm
Oliver and Linda Bullock for their help and support recruiting medical
personnel.
Figure 3. Pain ratings (estimated means and standard errors) for Experiment 6.
doi:10.1371/journal.pone.0048546.g003
Racial Bias in Perceptions of Others’ Pain
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Author Contributions
Conceived and designed the experiments: ST KH AW. Performed the
experiments: ST KH. Analyzed the data: ST KH. Contributed reagents/
materials/analysis tools: ST KH AW. Wrote the paper: ST KH AW.
References
1. US Department of Health and Human Services (2007) National healthcare
disparities report. Agency for Healthcare Re search and Quality website.
Available: http://archive.ahrq.gov/qual/nhdr07/nhdr07.pdf. Accessed 2012
July 18.
2. Smedley BD, Stith AY, Nelson AR (2003) Unequal treatment: Confronting
racial and ethnic disparities in health care. Washington, D.C.: The National
Academies Press. 764 p.
3. Agency for Healthcare Research and Quality (2009) Disparities in health care
quality among racial and ethnic minority groups: Findings from the national
healthcare quality and disparities reports, 2008. Agency for Healthcare Research
and Quality website. Available: http://www.ahrq.gov/qual/nhqrdr08/
nhqrdrminority08.pdf. Accessed 2012 July 18.
4. Bonham VL (2001) Race, ethnicity, and pain treatment: Striving to understand
the causes and solutions to the disparities in pain treatment. J Law Med Ethics
29: 52–68.
5. Drwecki BB, Moore CF, Ward SE, Prkachin KM (2011) Reducing racial
disparities in pain treatment: The role of empathy and perspective-taking. Pain
152: 1001–1006.
6. Green CR, Anderson KO, Baker TA, Campbell LC, Decker S, et al. (2003) The
unequal burden of pain: Confronting racial and ethnic disparities in pain. Pain
Med 4: 277–294.
7. Freeman HP, Payne R (2000) Racial injustice in health care. N Engl J Med 342:
1045–1047.
8. Todd KH, Deaton C, D’Adamo AP, Goe L (2000) Ethnicity and analgesic
practice. Ann Emerg Med 35: 11–16.
9. Shavers VL, Bakos A, Sheppard VB (2010) Race, ethnicity, and pain among the
U.S. adult population. J Health Care Poor Underserved 21: 177–220.
10. Staton LJ, Panda M, Chen I, Genao I, Kurz J, et al. (2007) When race matters:
Disagreement in pain perception between patients and their physicians in
primary care. J Natl Med Assoc 99: 532–538.
11. Cottrell CA, Neuberg SL (2005) Different emotional reactions to different
groups. J Pers Soc Psychol 88: 770–789.
12. hooks b (2004) We real cool: Black men and masculinity. New York: Routledge.
160 p.
13. Maner J K, Kenrick DT, Becker DV, Robertson TE, Hofer B, et al. (2005)
Functional projection: How fundamental social motives can bias interpersonal
perception. J Pers Soc Psychol 88: 63–78.
14. Payne BK (2001) Prejudice and perception: The role of automatic and
controlled processes in misperceiving a weapon. J Pers Soc Psychol 81: 181–192.
15. Goff PA, Eberhardt JL, Williams MJ, Jackson MC (2008) Not yet human:
Implicit knowledge, historical dehumanization, and contemporary consequenc-
es. J Pers Soc Psychol 94: 292–306.
16. Dovidio JF, Johnson JD, Gaertner SL, Pearson AR, Saguy T, et al. (2010)
Empathy and intergroup relations. In: Mikulincer M, Shaver PR, editors.
Prosocial motives, emotions, and behavior. Washington, DC: American
Psychological Association. 393–408.
17. Forgiarini M, Gallucci M, Maravita A (2011) Racism and empathy for pain on
our skin. Front Psychol 2: 1–7.
18. Avenanti A, Sirigu A, Aglioti SM (2010) Racial bias reduces empathic
sensorimotor resonance with other-race pain. Curr Biol 20: 1018–1022.
19. Xu X, Zuo X, Wang X, Han S (2009) Do you feel my pain? Racial group
membership modulates empathic neural responses. J Neurosci 29: 8525–8529.
20. Minear M, Park DC (2004) Lifespan database of adult facial stimuli. Behav Res
Methods Instrum Comput 36: 630–633.
21. Plant EA, Devine PG (1998) Internal and external motivation to respond
without prejudice. J Pers Soc Psychol 75: 811–832.
22. Swim JK, Miller DL (1999) White guilt: Its antecedents and consequences for
attitudes toward affirmative action. Pers Soc Psychol Bull 25: 500–514.
23. McConahay JB (1986) Modern racism, ambivalence, and the Modern Racism
Scale. In: Dovidio JF, Gaertner SL, editors. Prejudice, discrimination, and
racism. Orlando: Academic Press. 91–125.
24. Greenwald AG, McGhee DE, Schwartz JLK (1998) Measuring individual
differences in implicit cognition: The Implicit Association Test. J Pers Soc
Psychol 98: 111–120.
25. Hugenberg K, Bodenhausen GV (2003) Facing prejudice: Implicit prejudice and
the perception of facial threat. Psychol Sci 14: 640–643.
26. Shapiro JR, Ackerman JM, Neuberg SL, Maner JK, Becker DV, et al. (2009)
Following in the wake of anger: When not discriminating is discriminating. Pers
Soc Psychol Bull 35: 1356–1367.
27. Hugenberg K, Bodenhausen GV (2004) Ambiguity in social categorization: The
role of prejudice and facial affect in race categorization. Psychol Sci 15: 342–
345.
28. Fiske ST (2010) Interpersonal stratification: Status, power, and subordination.
In: Fiske ST, Lindzey G, Gilbert DT, editors. Handbook of social psychology
(5th ed.). Hoboken: Wiley. 941–982.
29. Blatt B, LeLacheur SF, Galinsky AD (2010) Does perspective-taking increase
patient satisfaction in medical encounters? Acad Med 85: 1445–1452.
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