Healthcare inequities in the United States based on race, ethnicity and many other factors are making minorities more prone to not only receive inadequate care, but ultimately it could lead to death. Maria Hernandez, President and COO of Impact4Health, explains how inadequate training and poor engagement with Black and Brown communities  can prove fatal for hospitals—and how this trend could be reversed. 


(Oakland, CAJanuary 11, 2021This pandemic has been disastrous for healthcareHowever, it has presented an opportunity to drastically improve the healthcare industry. The societal challenges caused by COVID-19 and increased friction among communities of color presents aopportunity to drastically improve healthcare by addressing unconscious bias. The concept of unconscious bias—inherent social stereotypes about other people often based on race, ethnicity, gender, and economic status, among other factors—makes some defensive. However, Dr. Maria Hernandez, President and COO of Impact4Health, a California-based consulting and education firm, says addressing unconscious bias in healthcare delivery can lead to much needed cultural shifts in medicine.  


Given time and guidance, hospitals, physicians’ offices and public health organizations can engage diverse patients more insightfully by acknowledging the discord and distrust that bias provokes and recognize the link to health outcome inequities and poor patient outcomes. This opportunity for greater empathy and cultural awareness  can foster much needed changes in patient encounters that link to better outcomes. 


Everyone has unconscious bias. Some medical schools are beginning to touch upon this during training but that’s rare. The need for this training is now being designed by health systems across the nation and it’s about time,” explains Hernandez. 


Physicians rationally feel they treat everybody the same and that this is basic to quality of careUnfortunately treating everyone the same in healthcare can be deadly. That approach only works if every patient has the same background, resources and access to medical care. To realize health equity—achieving equal health outcomes for each patient—requires healthcare professionals to consider broader set of factorsculture, socioeconomic, and a patient’s level of social support to offer the right treatment.  


Cultural misconceptions are pervasive in healthcareOne baseless belief contends people of color have a higher pain threshold, which often limits the frequency or dosage they receive for pain medication compared to whitesWomen with heart disease are underdiagnosedin part because of beliefs about how they respond to stress versus men.  


Unconscious bias is at the core of institutionalized racism, intergenerational poverty, and geographic segregation. The effects are chilling. Emergency rooms turn away minorities more often than whites.(1) Black and brown women who go to a hospital to deliver have a higher mortality rate than white women(2) while black infants face twice the mortality rate of white infants.(3) Healthcare systems serving indigenous peoples are under-resourced, understaffed, and overburdened.(4) 


What Can Be Done About It? 


To help diminish unconscious bias, Impact4Health creates tools and trainings to help. This approach has been demonstrated in a variety of healthcare settings and can be implemented in stages.  


The first step is identifying where problems exist in healthcare system. The best way to identify “pain points” is to collect and analyze data. Data reveals disparity. Tracking healthcare metrics in the context of race, ethnicity, languages and other factors produces actionable intelligence to improve outcomes. That’s why Impact4Health developed the Inclusion Scorecard for Population Healthfree, customizable assessment that helps break the cycle of unconscious bias while meeting the goals of healthcare providers. 


Next comes changing perspectives. Most effectively, cultural education can teach C-suite administrators the direct link between inclusion and better outcomes. In California, new legislation will require that doctors be trained on unconscious bias, a powerful initiative that could help improve health outcomes and patient engagement that improve outcomes and lower the cost of care . In short, a culture of inclusion in healthcare is a critical first step towards health equity. 


Healthcare organizations can maintain their momentum in terms of diversity, health equity, health equality and inclusion by engaging its communityThese efforts lead to an ongoing relationship that also helps provide health education that focuses on prevention of health problems. 


Achieving health equity is tremendously hard work, but it can be done” says Hernandez. “It needs to be a priority on the frontlines, at the doctor’s office and in the board room. Those leaders who want to improve healthcare outcomes, augment their staff, and improve productivity by embracing inclusion and health equity have to be committed to the work, and it requires a sea change in our healthcare culture to get there.” 


Impact4Health is a multidisciplinary team of community psychologists, public health researchers, physicians and health educators who promote health equity, working in partnership with hospitals, public health departments, and healthcare insurance providers. Strategies employed include training in cross-cultural health, inclusive leadership, and implementing the Inclusion Scorecard for Population Health. Impact4Health is also a leader in the development of health-related Pay For Success initiatives to address asthma-related emergencies for children living in vulnerable communities. For more information, please visit us as

  1. Harvard University; “Racism and discrimination in health care: Providers and patients”; | Accessed 31 DEC 2020 
  1. Centers for Disease Control and Prevention; “Breast Cancer Rates Among Black Women and White Women”; | Accessed 24 DEC 2020 
  1. U.S. Department of Health and Human Services, Office of Minority Health; “Infant Mortality and African Americans; | Accessed 24 DEC 2020 
  1. Chino, Michelle et al. ‘Improving Health Data for Indigenous Populations: The International Group for Indigenous Health Measurement’. 1 Jan. 2019 : 15 – 21. 



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