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Racial Dynamics in Education and Health Care

How teachers and doctors inadvertently contribute to racial inequality

By Rachel D. Godsil and Linda R. Tropp

This is the third of a four-part series exploring how racial bias and prejudice continue to have a negative impact in America, despite Americans' widespread rejection of racist ideologies. It draws extensively from our volume, The Science of Equality: Addressing Implicit Bias, Racial Anxiety, and Stereotype Threat in Education and Healthcare. This part explores how racial dynamics can diminish educational and health care outcomes.

White teachers would reasonably be outraged if anyone suggested that they entered their profession with the goal of harming students of color. But research shows that even the most well-meaning and egalitarian teachers may hold implicit biases or experience racial anxiety and stereotype threat—inadvertently contributing to unequal educational outcomes for students from different racial groups.

Disproportionate suspension and expulsion rates are a particularly vivid example of the problem. Black high school students are nearly three times as likely as whites to be suspended than placed in after-school detention, and they are disproportionately more likely to be disciplined for such subjective reasons as “disrespect” or “loitering” than for “objective” reasons like getting into a fight. It’s possible, of course, that African American kids are proportionately more likely than whites to loiter than get in fights. But it's more likely that teachers and administrators punish black students more harshly than whites when the criteria for determining whether to punish are subjective. Close ethnographic studies of student-teacher interactions suggest that interactions between white authority figures and black students are frequently marred by implicit racial bias.

Race can also play a role in evaluations of performance and achievement. In one experiment, law firm partners were asked to evaluate a memorandum supposedly written by a third-year associate named Tom Meyer. Half of the partners were led to believe the Meyer was black and the other half that he was white. The partners found twice as many spelling and grammatical errors in the memorandum they thought was written by "black" Tom Meyer than "white" Tom Meyer. And their comments suggested very different assessments of the associate's capacity: White Tom Meyer was described as having “potential” and “good analytical skills"; black Tom Meyer by contrast, “needs lots of work” and is “average at best.” One partner stated he “couldn’t believe [the associate] went to NYU.” It is doubtful the partners who read and commented on the memorandum saw themselves as racist, but subconscious ideas about academic ability clearly guided their appraisals.

Sometimes, however, teachers can go too far the other way, giving overly positive praise to African American students in ways that undermine rather than bolster their confidence. In a study of teacher reactions to a poorly written essay, researchers found that the (white) teachers gave less criticism and more praise to essays supposedly written by black and Latino students. Yet students need critical feedback and honest evaluations if they are to succeed—and that’s precisely what minority students weren’t receiving from their well-intentioned teachers.

(In an interesting wrinkle, teachers who felt strongly supported by their schools gave equal feedback to black but not Latino students. These teachers apparently felt free to criticize black students without fear of being seen as racist, but retained some implicit bias about the potential writing capacities of the Latino students.)

In healthcare, as in education, disparities arise in part because of implicit bias and interpersonal racial dynamics. People of color on average have elevated blood pressure and higher rates of obesity and smoking. They are also less likely to be screened for certain types of cancer and suffer from overall higher mortality than whites. Many health care decisions have interpersonal and subjective components that may impede provider-patient communication. One early study used videos of actors trained to use identical language and gestures to describe symptoms of cardiac disease. Physicians were less likely to refer African Americans for cardiac catheterization than whites, and were least likely to refer black women. A more recent study showed that physicians had more negative implicit attitudes toward blacks and held stereotypes of blacks as uncooperative patients. This again has serious real-world impacts: The more negative the doctors’ implicit attitudes, the less likely they were to recommend thrombolytic drugs for black patients.

Racial anxiety in part explains why physicians working with patients of color may be less likely to be empathic, to elicit sufficient information, or to encourage patients to participate in medical decision-making. Studies using recordings of patients of color interacting with doctors of other races have shown that they tend to have shorter visits with white doctors and to engage in less positive patient-doctor interactions. In a study of breast cancer patients—a context in which black women have historically experienced significantly worse outcomes than white women, even when income and insurance availability are held constant—white doctors spent significantly less time engaging in relationship-building activities with patients of color than with whites. Ultimately, these racial dynamics affect not just the quantity but the quality of health services that African Americans receive.

Rachel D. Godsil is Director of Research at the Perception Institute and Eleanor Bontecou Professor of Law at Seton Hall University School of Law.
Linda R. Tropp is Professor in the Department of Psychological and Brain Sciences and Director of the Psychology of Peace and Violence Program at the University of Massachusetts, Amherst.

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