What 'truth' is the EDUCATE Act advancing?

How this bill illustrates the unctruth about implicit bias in healthcare.

I would be lying if I did not admit that it has become complicated over the years to maintain hope that leaders in the U.S. government truly care about the citizens' best interests, especially regarding healthcare. A government that genuinely cares about the health of all its citizens would fight to ensure equity and inclusivity in medical education and practice. However, the recent introduction of the Embracing Anti-Discrimination, Unbiased Curricula, and Advancing Truth in Education (EDUCATE) Act has led me to question strongly if that is, in fact, the case. 

While the act claims to regulate diversity, equity, and inclusion (DEI) policies in graduate medical schools, I am concerned about its potential impact, particularly on the health of BIPOC (Black, Indigenous, and People of Color) populations, including Black women.

I am greatly concerned that this bill is discriminatory, biased, and impedes truth, the complete opposite of what it claims to do.

These concerns are deeply rooted in the research I am currently conducting on implicit bias amongst healthcare providers and the impact that it has on the health outcomes of BIPOC populations.  

The members of Congress proposing this are an M.D. and DPM, which exemplify why healthcare providers must understand implicit bias and its implications for patient care. Implicit bias in healthcare refers to unconscious associations that can influence judgments, resulting in biases that may affect the standard of care provided to patients (FitzGerald & Hurst, 2017). Research based on results from the implicit bias test has shed light on these biases' influence on medical interactions, diagnosis, and treatment decisions.

The Implicit Association Test (IAT) has been utilized in research studies to measure healthcare providers' racial or ethnic bias (Maina et al., 2018). Studies have consistently shown that healthcare providers, like the general population, harbor implicit biases that can manifest within clinical settings. For example, a study published in the American Journal of Public Health found that healthcare professionals were more likely to perceive Black Americans as less cooperative and responsible than their counterparts (Hall et al.,2015). Negative perceptions of BIPOC populations are significant as they can lead to treatment decisions that adversely impact health outcomes. 

As a Black American, I cannot help but understand the implications of implicit bias in healthcare, especially when considering policies like the EDUCATE Act. While the act claims to promote fairness and prevent discrimination, it is clear to me that its provisions will exacerbate disparities in care for BIPOC populations. 

A key provision in the act prohibits medical schools from adopting beliefs about what it considers "oppressed or oppressor categories," which it defines as related to an individual's race, sex, or ethnicity. I am highly concerned by this language, given that implicit biases can operate unconsciously, influencing the behaviors and decisions of healthcare providers without their conscious awareness. Even though they might not intend to oppress a person based on characteristics, such as their race, sex, or ethnicity, they might very well engage in behaviors that do precisely that. Preventing medical schools from adopting beliefs that would help providers bring awareness to their implicit bias is dangerous and, in my opinion, bad medicine.

Moreover, the act's prohibition on recognizing a student's race or ethnicity and establishing DEI offices will hinder efforts to address systemic disparities in healthcare. Studies have shown that Black healthcare providers are less likely to demonstrate implicit bias than their counterparts (Maina et al., 2018). Therefore, DEI better equips healthcare teams with the tools to address the unique needs of diverse patient populations. DEI offices are one way to enable diverse speakers to present on topics related to implicit bias and cultural competency, which are not currently part of many medical school curriculums. Thus, prohibiting a student's race or ethnicity from being an area of consideration and prohibiting DEI offices from existing will ultimately impact the health outcomes of BIPOC populations.

I would be remiss if I did not acknowledge the impact the EDUCATE Act would have on BIPOC individuals, particularly Black women who face intersecting forms of discrimination and marginalization within healthcare systems. Kimberlé Crenshaw's work on intersectionality illustrates that we must be mindful of an individual's multiple marginalized identities related to race, class, and gender (Ray, 2023). Intersectionality makes the implications of the EDUCATE Act more concerning, given the existing disparities related to maternal mortality rates, access to reproductive healthcare, and treatment outcomes for Black women compared to their white counterparts. Hence, the EDUCATE Act will only perpetuate an inequitable care cycle as implicit biases among healthcare providers contribute to these disparities.

As we navigate policy changes like the EDUCATE Act, it is imperative to consider the potential implications for BIPOC health equity. As advocates for health equity, we must keep ourselves informed regarding the ongoing discussions surrounding policies like the EDUCATE Act. We must subscribe to reputable sources of information on health equity (like this Substack) and contact congressional leaders to voice concerns about the bill's potential adverse impacts. By doing so, we can strive toward a more equitable future for all.

References 

FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: A systematic review. BMC Medical Ethics, 18(1), 19. https://doi.org/10.1186/s12910-017-0179-8 

Hall, W. J., Chapman, M. V., Lee, K. M., Merino, Y. M., Thomas, T. W., Payne, B. K., Eng, E., Day, S. H., & Coyne-Beasley, T. (2015). Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. American Journal of Public Health, 105(12), e60–e76. https://doi.org/10.2105/AJPH.2015.302903

Maina, I. W., Belton, T. D., Ginzberg, S., Singh, A., & Johnson, T. J. (2018). A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test. Social Science & Medicine, (1982), 199, 219-229. https://doi.org/10.1016/j.socscimed.2017.05.009 

Ray, K. (2023). When Black Health, Intersectionality, and Health Equity Meet a Pandemic. Journal of Bioethical Inquiry, 20(4), 585–590. https://doi.org/10.1007/s11673-023-10299-8