Viewing racism as a biology problem totally ignores the real forces driving it

In recent years, implicit bias has emerged as something of a buzzword for talking about racial justice in America. Implicit bias is a very real phenomenon and certainly affects wide swaths of American life. Its role in health care has been evident at least since the publication of the Institute of Medicine’s influential book, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care” in 2002.  

Implicit bias is a problem of cognitive “mind bugs” and unconscious stereotypes. It can be manifest by a police officer who thinks a 12-year-old African American boy is really a 20-year-old “thug.” Or an ER doctor who thinks a young black woman presenting with symptoms of disorientation must be on welfare and using drugs.  

The problem with the embrace of implicit bias is not that it doesn’t exist; it is that it has been used to explain too much of our current problems of racial injustice. As a master narrative for talking about racial injustice, implicit bias tells us that overt racism is largely a thing of the past, at most a marginal holdover among a few extreme elements in society. It gives us too easy an out for feeling good about our stance on racism. Everybody has implicit biases, and since we can’t consciously control these biases it feels like they are not really our fault.

Health care can be deeply affected by implicit bias, as cultural stereotypes shape how doctors ask questions of patients and interpret the responses they get. Some of these issues are addressed through so-called “cultural competence” training. But like the focus on implicit bias, cultural competence often underplays or obscures deeper structural factors affecting the delivery of health care in a society suffused with racial injustice.

The confluence of cognitive psychology and neuroscience in studies of implicit bias adds a new wrinkle to this dynamic. The tendency now is to treat racism as a material “thing” that can be empirically observed as a biological or physiological phenomenon, and quantifiably measured by scientific methods. This tendency is reinforced when such tests of associations are paired with fMRI scans to produce glowing images of racism supposedly at work in the brain.

Unlike a common-sense understanding of explicit racism, implicit bias is a distinctively scientific concept. It is defined, identified, measured, and addressed by experts from the worlds of social psychology and cognitive neuroscience.

The remedies for implicit bias engage us as isolated individuals. Like the nostrums of self-help gurus, the programs to address implicit bias largely involve experts telling individuals how to work on themselves to be the best non-biased person they can be.  

How do we do this? Maybe the experts will tell us to download a screensaver that shows positive minority exemplars, like Martin Luther King, Jr. or Denzel Washington. Or perhaps it involves following a checklist to ensure one does not make hasty hiring decisions influenced by subtle unconscious biases. Most likely, it involves enrolling in some sort of diversity training class developed and perhaps implemented by the now multi-billion-dollar diversity management industry. Unfortunately, while these techniques might make us feel better about ourselves, they have not been shown to make much difference for the people actually subject to implicit bias.

At the more extreme end, when researchers view racism as a biological phenomenon, they introduce the possibility of treating it a medical problem. Enter a team of researchers at Oxford University who conducted several studies purporting to show how the beta-blocker propranolol reduces subjects’ implicit biases. Similar studies have explored the impact of the hormone Oxytocin and trans-cranial magnetic stimulation on reducing implicit bias.

When racism is treated as biology, it is also naturalized and taken out of history as some sort of timeless attribute of the human brain. But health care practitioners seeking to address issues of racial disparities should not be seduced by the appeal of an easy technical fix to racism. They need to develop not only cultural competence, but also “structural competence” — an awareness of the social and historical legacies that shape how the institutions in which they work are part of a broader system that perpetuates racial inequity.

In the end, if racism is reduced to a biological phenomenon susceptible to technological interventions, who needs a March on Washington to promote racial justice when you have the right pill for the job? Whether by pills, screen savers, or diversity training, it seems that the experts will bring about a millennium of racial understanding with little or no effort from the people. All we have to do is follow their directions and, perhaps, buy the products and services derived from their research.

In reality, addressing persistent racial disparities in health will require us to move beyond looking only at implicit bias to consider more broadly how larger structural and institutional forces shape inequality in our society. There may be a role for experts to play in helping us address implicit bias, but in the end, there is not technical “fix” for racial injustice. It requires sustained social and political action across a variety of fronts, with active and engaged citizens who make use of expert knowledge but do not subordinate themselves to it.   

[Photo by Pug50 via Flickr.]