Anti-black Attitudes Are a Threat to Health Equity in the United States
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To assess the extent to which persistent racism shapes perspectives on public health policies aimed at improving health equity in the United States. Specifically we evaluate the relationship between implicit and explicit anti-black attitudes and support for the ACA at the beginning of the Trump administration.
We use bivariate statistics to examine views toward the ACA, anti-black attitudes, and demographic variables. Using logistic regression, we examine how anti-black attitudes and demographic variables relate to participants stating that the ACA has worsened the quality of health care services in the United States.
Data for this study come from the American National Election Studies 2016 Time Series Study, which targets US citizens age 18 and older currently living in the United States (N = 3245).
Implicit anti-black attitudes, particularly among whites, are strongly associated with negative feelings toward the ACA. A measure of explicit racial prejudice has the opposite relationship among whites. These results suggest that whites are most critical of the ACA when they hold positive attitudes toward blacks but hold negative stereotypes about blacks’ work ethic and reject policies to eliminate racial inequalities.
Anti-black racial attitudes are a critical barrier to enacting health policies that stand to improve health equity in the United States. Public health practitioners and policymakers should consider racism as an essential barrier to overcome in the push for greater health equity in the United States.
KeywordsRacism Implicit bias Affordable Care Act Health equity Policy
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors. The study utilizes data from the American National Election Studies (ANES) 2016 Time Series Study, a publically available dataset with identifying information removed to protect respondent confidentiality. Participation in the ANES is voluntary, and the procedures for the ANES are overseen by the ANES advisory board, University of Michigan, and Stanford University.
- 3.Paradies Y, Ben J, Denson N, Elias A, Priest N, Pieterse A, et al. Racism as a determinant of health: a systematic review and meta-analysis. Hills RK, editor. PLoS One. 2015 [cited 2019 May 13];10(9):e0138511. Available from: https://dx.plos.org/10.1371/journal.pone.0138511.
- 4.McMorrow S, Long SK, Kenney GM, Anderson N. Uninsurance disparities have narrowed for black and hispanic adults under the Affordable Care Act. Health Aff. 2015;34(10):1774–8 [cited 2019 May 13]. Available from: http://www.healthaffairs.org/doi/10.1377/hlthaff.2015.0757.CrossRefGoogle Scholar
- 5.Kino S, Kawachi I. The impact of ACA Medicaid expansion on socioeconomic inequality in health care services utilization. Urbanos Garrido RM, editor. PLoS One. 2018 [cited 2019 May 13];13(12):e0209935. Available from: http://dx.plos.org/10.1371/journal.pone.0209935
- 8.Prevention and public health fund [Internet]. [cited 2019 Mar 19]. Available from: https://www.apha.org/~/media/files/pdf/factsheets/160127_pphf.ashx
- 12.Chae DH, Lincoln KD, Adler NE, Syme SL. Do experiences of racial discrimination predict cardiovascular disease among African American Men? The moderating role of internalized negative racial group attitudes. Soc Sci Med. 2010;71(6):1182 [cited 2019 May 13]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922401/.CrossRefGoogle Scholar
- 13.Geronimus AT, Hicken MT, Pearson JA, Seashols SJ, Brown KL, Cruz TD. Do US black women experience stress-related accelerated biological aging?: a novel theory and first population-based test of black-white differences in telomere length. Hum Nat. 2010;21(1):19–38 [cited 2019 May 13]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20436780.CrossRefGoogle Scholar
- 14.Chae DH, Nuru-Jeter AM, Adler NE, Brody GH, Lin J, Blackburn EH, et al. Discrimination, racial bias, and telomere length in African-American men. Am J Prev Med. 2014;46(2):103–11 [cited 2019 May 13]. Available from: https://linkinghub.elsevier.com/retrieve/pii/S074937971300593X.CrossRefGoogle Scholar
- 15.Alang S, McAlpine D, McCreedy E, Hardeman R. Police brutality and black health: setting the agenda for public health scholars. Am J Public Health. 2017;107(5):662–5 [cited 2019 May 13]. Available from: http://ajph.aphapublications.org/doi/10.2105/AJPH.2017.303691.CrossRefGoogle Scholar
- 16.Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389(10077):1453–63 [cited 2019 May 13]. Available from: https://www.sciencedirect.com/science/article/pii/S014067361730569X.CrossRefGoogle Scholar
- 17.Gee GC, Hing A, Mohammed S, Tabor DC, Williams DR. Racism and the life course: taking time seriously. Am J Public Health. 2019;109(S1):S43–7 [cited 2019 May 13]. Available from: https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.304766.CrossRefGoogle Scholar
- 18.Stepanikova I. Racial-ethnic biases, time pressure, and medical decisions. J Health Soc Behav. 2012;53(3):329–43 [cited 2019 May 13]. Available from: http://journals.sagepub.com/doi/10.1177/0022146512445807.CrossRefGoogle Scholar
- 19.Feagin J, Bennefield Z. Systemic racism and U.S. health care. Soc Sci Med. 2014;103:7–14 [cited 2019 May 13]. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0277953613005121.CrossRefGoogle Scholar
- 21.Bonilla-Silva E. Racism without racists : color-blind racism and the persistence of racial inequality in America. 359 p.Google Scholar
- 23.Sabin JA, Rivara FP, Greenwald AG. Physician implicit attitudes and stereotypes about race and quality of medical care. Med Care. 2008;46(7):678–85 [cited 2019 May 13]. Available from: https://insights.ovid.com/crossref?an=00005650-200807000-00006.CrossRefGoogle Scholar
- 24.Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. 2013;28(11):1504–10 [cited 2019 May 13]. Available from: http://link.springer.com/10.1007/s11606-013-2441-1.CrossRefGoogle Scholar
- 25.Bonilla-Silva E. Feeling race: theorizing the racial economy of emotions. Am Sociol Rev. 2019;84(1):1–25 [cited 2019 Aug 18]. Available from: http://journals.sagepub.com/doi/10.1177/0003122418816958.CrossRefGoogle Scholar
- 26.State of the science: implicit bias review 2015. [cited 2019 May 13]. Available from: http://kirwaninstitute.osu.edu/wp-content/uploads/2015/05/2015-kirwan-implicit-bias.pdf.
- 27.Burke MA. Colorblind racism. [cited 2019 Aug 18]. 156 p. Available from: https://www.wiley.com/en-us/Colorblind+Racism-p-9781509524457.
- 29.Haney-López I. Dog whistle politics : how coded racial appeals have reinvented racism and wrecked the middle class. 277 p.Google Scholar
- 32.Tesler M. The spillover of racialization into health care: how President Obama polarized public opinion by racial attitudes and race. Am J Pol Sci. 2012;56(3):690–704 [cited 2019 May 13]. Available from: http://doi.wiley.com/10.1111/j.1540-5907.2011.00577.x.CrossRefGoogle Scholar
- 34.Lanford D, Quadagno J. Implementing ObamaCare. Sociol Perspect. 2016;59(3):619–39 [cited 2019 May 14]. Available from: http://journals.sagepub.com/doi/10.1177/0731121415587605.CrossRefGoogle Scholar
- 36.Knowles ED, Lowery BS, Schaumberg RL. Racial prejudice predicts opposition to Obama and his health care reform plan. J Exp Soc Psychol. 2010;46(2):420–3 [cited 2019 May 13]. Available from: https://www.sciencedirect.com/science/article/pii/S0022103109002649.CrossRefGoogle Scholar
- 37.6 Charts About Public Opinion On The Affordable Care Act | The Henry J. Kaiser Family Foundation. [cited 2019 May 13]. Available from: https://www.kff.org/health-reform/poll-finding/6-charts-about-public-opinion-on-the-affordable-care-act/
- 38.2016 Time Series Study - ANES | American National Election Studies [Internet]. [cited 2019 May 13]. Available from: https://electionstudies.org/project/2016-time-series-study/
- 39.Artiga S, Orgera K, Damico A. Changes in health coverage by race and ethnicity since implementation of the ACA, 2013-2017. Issue Br. 2019;(February):2013–7. Available from: http://files.kff.org/attachment/Issue-Brief-Changes-in-Health-Coverage-by-Race-and-Ethnicity-since-Implementation-of-the-ACA-2013-2017.
- 40.Haney Lopez I. Today’s dominant racial dog whistle? Obamacare | HuffPost. Huffington Post. 2014 [cited 2019 Aug 18]. Available from: https://www.huffpost.com/entry/obamacare-dog-whistle-politics_b_4759499.
- 41.Green AR, Carney DR, Pallin DJ, Ngo LH, Raymond KL, Iezzoni LI, et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Gen Intern Med. 2007;22(9):1231–8 [cited 2019 Aug 18]. Available from: http://link.springer.com/10.1007/s11606-007-0258-5.CrossRefGoogle Scholar
- 42.U.S. Census Bureau QuickFacts: UNITED STATES [Internet]. [cited 2019 May 13]. Available from: https://www.census.gov/quickfacts/fact/table/US/PST045218.
- 43.Henry PJ, Sears DO. The Symbolic Racism 2000 Scale. Polit Psychol. 2002;23(2):253–83 [cited 2019 May 14]. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/0162-895X.00281.CrossRefGoogle Scholar