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August 28, 2013

Unconscious Bias and Your Health

 Almost one year ago, I presented to a group of black female college students on the topic, “You Ain’t Crazy: It’s Your Mental Health”.  The sisters wanted to have a frank discussion around dealing with the stress associated with day-to-day issues, such as matriculation at a predominately white institute, culture, family, sexism, racism and how life plays out.  Responding to the pressures of it all, one student was asked why did she seek help with her issues, and her response was simple: “to make sure that I don’t go crazy”.   One point of frustration highlighted by these students was the interplay between perception and reality. There was the constant practice of second guessing their decisions, particularly scenarios dealing with race and culture.  After all, who wants to read more into a situation than is there? You know the questions: “Did he mean to say that? What does he mean? How should I take what was said?  How would you perceive that?”

Reading the situation is a complicated topic, or is it?  Dr. David R. Williams, professor of sociology and public health, discusses the topic of unconscious bias in the lives of Black Americans in the September 2013 issue of @essencemag. The two-face depiction captures the article’s title, “No, You’re Not Imagining It”. Williams offers a myriad of scenarios that often causes pause.  That is, as a Black person, “Is this really happening to me?”.  The element of surprise can grip Black folks though the bias imparted by whites can be unintentional.  Yet, the outcome or reality of the scenario can have a profound effect on the recipient.  Scholars define unconscious bias as the understanding that people can consciously believe in equality while simultaneously acting on subconscious prejudices they are not aware of.

Williams and other public health scholars have determined that the outcome is not a mere sense of challenge of the parts of Black people.  As noted in the Essence piece, someone who fosters and imparts racial prejudices can do so implicitly; though often automatic, the unconscious bias behavior leads to differential treatment – without effort.  Unconscious bias influences the lives of Black people in the form of employment (hence, economic),  educational and yes, health and health disparities – albeit heart disease, hypertension, diabetes, obesity, engagement in sexual risk behaviors and depression. While the scenarios offered by Dr. David R. Williams represent every day life as we move about,  the resulting questions are commonplace but thought-provoking: “Do you see me? “, and if you do, “how do your see me?  In health care, public health scholars ponder the same questions.  The relevance here is how you see me starts the dialogue of how your treat me as a person and as a patient.

As I reflect on recent life circumstances, I ponder my own moments of unconscious bias experiences. There I am in the supermarket as I shop for the next family dinner.  The checkout clerk pauses, looks and proceeds to ask me: “Why is your hair so short?  Are you a cancer patient, or are you making a statement?” Now, the picture shown here is not I, but the style is one that I own.  I am not making a statement nor am I a cancer patient.  The politics, bias and perceptions of Black hair, particularly for Black women, is a subject reserved for a read of Dr. Lynette Kvasny’s blog, Black Women’s Love Affair with Hair”. Yet, the very question and judgment (“or making a statement, cancer patient) speaks volumes.   My response to the clerk was “what if I am a cancer patient?”  His apologetic comments followed as I completed my transaction.

Case 2: I had a medical procedure done which was a high stress experience .  The waiting for the test results was heave, scary and a prayerful time.  During the film read with a physician, I stated aloud” “the mass has a meniscus”.  To which the physician replied, “how do you know that? How do you know meniscus?  How do you know this?  This surprises me”.  His surprise momentarily precluded the focus on my medical care.  My simple reply to his disbelief was “Chemistry 101 Lab and can we focus on my health”.

Then, there is the unconscious bias imparted in the workplace, the unconscious organizational impact.  This level of bias creates an organizational culture that permeates bias rather intentional or unintentional. This mini-me culture can reinforce bias.  This can create personal stress particular in hostile workplace environments.  The “I understand; I am sorry”, conjectures do little to offer individual support or reduce health stressors.   As one sister indicated in that August 2013 session, “Don’t let them steal your joy”.

As Dr. David Williams offers in the @essencemag article, there are others ways to confront these scenarios.  Taking care of your health tops his recommendations. Be resilient, and visualize positive outcomes.  Breathe. Pause.  For as much I share this advice, am I talking to myself? Yes, constantly.  After all, it is my (@myhealthimpact) physical and mental health to protect.



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In Partnership with: Poole College of Management, College of Humanities and Social Sciences, National Science Foundation, Penn State

Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation.
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