The coronavirus pandemic and worldwide protests for racial justice have highlighted the prevalence of racial discrimination and the often-tragic consequences of systemic inequality. Clearly, racism is a pressing public health issue. Public health and health policy experts agree it is imperative to identify and address health disparities and health care inequities that historically disadvantaged groups have experienced. However, these efforts often fail to reach and engage marginalized groups and sub-populations with disabilities. Intersectionality offers a framework for considering peoples’ overlapping identities and experiences in order to understand the complexity of prejudices that they face.
In America, one in four individuals are people who live with some type of disability, and they constitute the largest, most diverse, underserved group in the country. Disability also intersects with all historically-disadvantaged and under-represented racial and ethnic groups. The Centers for Disease Control and Prevention even reports that some racial and ethnic minority groups also have higher prevalence of disability.
However, the numbers alone fail to convey the extreme health disparity that individuals with disabilities and intersecting minority identities confront. In fact, the HHS Advisory Committee on Minority Health
described that being a member of a racial or ethnic minority group with a disability meant living with a “double burden” due to layers of sociopolitical disparities. Race and disability are overlapping identities that are subjected to systemic inequality and negative stereotyping. Individuals at this intersection may feel isolated from racial/ethnic groups because of their disability, and excluded from the disability community because of their race. In another example of exclusion, diversity initiatives often overlook disability, as demonstrated by the #Diversish
campaign, which highlights that most diversity, equity, and inclusion programs gloss over disability in hiring practices. It is important to think about why this is the case, and ways we can do better, starting in our local health departments.
Every day, we make split second judgments, about language, behavior, and our perception of others. The human brain processes massive amounts of detail by creating shortcuts and instantaneously categorizing new information based on previous experience, social conditioning, and stereotypes. In this process, known as unconscious or implicit bias, our brain sorts people into social groups and assigns an identity based on characteristics such as age, gender, race, ethnicity, sexual orientation, disability, and religion. We pay attention to facts that support our associations and filter out facts that oppose them. We tend to associate positive qualities with, and favor, people who are like us (in-group bias). These automatic thoughts and feelings are hard to control or stifle. Conversely, explicit attitudes are beliefs people consciously agree with and choose to express publicly.
The problem is that unconscious biases are often different, or even contradictory to, what we intentionally do and say publicly. They contribute to how we inadvertently support flawed cultural narratives and oppressive systems.
Research consistently shows that unconscious biases also result in negative outcomes in hiring, education, or medical treatment. Some evidence suggests unconscious bias can gradually shift over time to be more accepting towards social groups; however, it is hard to measure if shifts are translating in a meaningful way to promote equality. Research shows that implicit biases towards people with disabilities are actually worsening over time, regardless of how people outwardly declare to think and feel about people in the disability community. People with disabilities experience some of the most severe inequities in employment, educational opportunity, violence, and health outcomes. Therefore, if your health department equity and implicit bias training does not include questions or exercises centered on bias towards disability, you are contributing to the marginalization of this underserved population, and the intersectionality of disadvantaged minority groups who also have disabilities. Though all of us have implicit biases, we can take steps to manage and minimize them, build new mental linkages, and push for broader dismantling of structural policies and practices.
The first step is to acknowledge that we all have implicit biases, and that we can all change. To identify and examine these more closely, take the Implicit Association Test or other tests that measure implicit responses.
Strategies to Address Unconscious Biases
Explorations of implicit bias are not sufficient as a stand-alone exercise; they should be one element of a larger conversation about what contributes to structural inequities, and how our individual and organizational roles perpetuate these disparities despite our good intentions.
-Unpack Your Biases and Underlying Assumptions: It is uncomfortable but necessary to think through the perceptions, feelings, and stereotypes that may contribute to unconscious bias. This toolkit offers some prompts for exploring default assumptions about people with disabilities.
-Cultivate Intergroup Contacts: Meet and have a dialogue with individual members of diverse groups. Building one-on-one authentic relationships helps cultivate new positive associations and empathy. Appreciating individual qualities apart from one-dimensional stereotypes about a group also facilitates the breaking of misconceptions. For example, if you become aware that you assume people with disabilities are innately dependent, it may be transformative to meet a parent with a disability, who is also embodying the role of a capable caregiver.
-Find Common Ground: Focus on what you have in common with the individual members of the groups that you tend to stereotype.
“We are more alike, my friends, than we are unalike.”– Maya Angelou
-Educate Yourself and Others: Promote and participate in trainings and educational programs within your organization and community to increase awareness about unconscious biases and their impact. Try to secure or create trainings that use intersectional frameworks, and exercises informed by individuals with lived experiences.
- This online training explores unconscious bias in public health practice and includes ‘bias-busting’ strategies.
- This resource offers 50 ways to combat gender bias in the workplace, including exercises with realistic examples and targeted solutions.
- This free mini course addresses how to combat implicit bias in employment. Use this discussion as a launching pad for critically examining programs and policies to identify barriers and systems which create unequal opportunities.
-Build Partnerships: Consider individuals from diverse groups as equal collaborators, rather than clients who benefit from your work. Build on these partnerships to create social change. Address long-standing structural inequities with collective and inclusive action.
-Elevate Voices: Prioritize and amplify the perspectives of people living at the intersection of multiple types of marginalization. Look to collaborations who are leading the way in this work, such as the National Black Disability Coalition and the National Coalition for Latinxs with Disabilities.
-Stay Accountable: Keep reading, learning, changing, and working to promote true equality for all.