Discrimination in Pediatrics Raises Questions About Weathering

Reports of racism and healthcare discrimination in pediatric clinics are setting off alarm bells for Urban Institute researchers who are concerned about the impacts on care access, long-term clinical outcomes, and weathering.

In a new report, the team revealed that one in eight parents reported some kind of discrimination against them in the pediatric setting; another 3 percent said their child was the target of racism or discrimination.

These incidents can have long-term consequences as industry experts take a closer look at how adverse experiences can influence clinical outcomes in the future, a concept known as weathering. In the short term, experiences of discrimination could discourage care access, the researchers added.

Incidences of racism or discrimination are more common than perhaps most would like to admit, the survey of nearly 10,000 parents with kids under age 19 showed. One in eight parents reported some type of unfair treatment on the basis of race or ethnicity, language, health insurance type, weight, income, disability, or other characteristics.

Looking at Black people alone, experiences of discrimination happened for 22 percent of parents. This is 10 percentage points higher than the rate of discrimination among White and Hispanic parents.

Discrimination against kids themselves was less common, although still marked, with 3 percent of all parents saying their child faced some type of discrimination based on race, ethnicity, country of origin, or preferred language. For Black kids, that figure was 9 percent.

Notably, trends of discrimination in the pediatric setting didn’t change with the age of the child. Parents of kids under age three were just as likely as parents of older children to face discrimination in the healthcare setting. Similar findings emerged for kids experiencing discrimination.

This calls into question the issue of weathering in healthcare. Kids who experience or witness discrimination from a young age may see adverse impacts as they get older.

“Even if children under age 3 were not the direct target of unfair treatment, very young children could experience adverse fallout if parents’ health is negatively affected following these experiences, given the close linkage between parental and child health,” the researchers said.

Children have a very deep understanding of fairness even at a young age, the researchers added, which can ultimately “undermine health, wellbeing, health care access, and trust in the health care system among children and their families,” the team said.

That lack of trust and care access is already playing out among adult survey respondents. Seven in 10 parents who experienced unfair treatment said the experience ultimately disrupted their healthcare. For around half of parents (48 percent), that meant looking for a new healthcare provider, while 46 and 41 percent delayed or went without healthcare, respectively. Around a quarter of parents said they did not heed provider recommendations.

A third of parents took action to report racism and discrimination.

Around one in five (22 percent) said they addressed the situation directly with the provider, while 15 percent filed a complaint, and 14 percent wrote an online provider review or shared the experience on social media.

But still, parents are left worried about healthcare access in the future. Four in 10 Black parents and three in 10 Hispanic parents said they are worried that they or a family member will be treated unfairly again in the future.

Tamping down on racism and discrimination in healthcare settings should begin with understanding why these issues happen, something the researchers said is complex. Some providers harbor racist beliefs, and everyone has implicit biases. This can lead to overt and covert discrimination, the team said.

Explicit and implicit biases are compounded by structural racism and social determinants of health.

The healthcare industry alone cannot reverse systemic racism in the US, but it can set up guardrails to prevent implicit bias and overt racism in its own settings. Thoughtful implicit bias training is one key step in the right direction, the researchers recommended, as is cultivating better workforce diversity. Workforce diversity can be achieved through tailored hiring practices, but also hinges on more diverse medical school recruitment.

And when discrimination does happen, healthcare organizations need an accountability structure.

“Mechanisms for accountability to prevent or address unfair treatment in health care could include creating feedback loops for health insurance plans to document instances of unfair treatment by providers through patient satisfaction surveys and related data collection efforts,” the researchers suggested.

Patient experience surveys should be stratified by race and ethnicity, the team added. This will allow organizations to determine how a clinician or office staff member treats all patients and determine whether they are truly qualified to “provide culturally competent and effective evidence-based care as part of performance evaluations,” the researchers concluded.