Latest Blog Post

18 JUNE 2020

“A young man goes to the doctor complaining of severe pain in his back. He expects and trusts that a medical expert, his physician, will assess his pain and prescribe the appropriate treatment to reduce his suffering. After all, a primary goal of health care is to reduce pain and suffering. Whether he receives the standard of care that he expects, however, is likely contingent on his race/ethnicity. But research suggests that if he is black, then his pain will likely be underestimated and undertreated compared with if he is white”.

This is an is an extract of a case study from research in the USA that examines racial bias in pain assessment and treatment recommendations.  The study highlights false beliefs about biological differences between blacks and whites including that half of white medical trainees in the US believe such myths as black people have thicker skin or less sensitive nerve endings than white people.

Issues of race and systemic biases play out across all areas of our communities, across the globe, across time. The current ‘black lives matter’ movement is a powerful example of a recurring theme.

Just last week data released from the Implicit Association Test (a joint initiative from Harvard, Yale and the University of Sydney) suggests that three in four Australians hold a negative or implicit bias against Indigenous Australians

For those of us working to improve our health systems, current events should prompt critical questions about our own practices and beliefs.  What role do our racial biases play in overall health outcomes for racial minorities across the healthcare system?  How do they relate to other biases; rich versus poor, male versus female, young versus old, employed versus unemployed, thin versus obese, etc.?

Research indicates that disparities in health care outcomes are, in part, driven by factors beyond health care professionals’ control. For example, pharmacies in racial minority communities are less likely to carry certain analgesics; racial minorities tend to live in lower socio-economic areas, are more likely to be unemployed, have less income to purchase health care services; and attitudes toward use of the health care system differ across racial and ethnic lines.

We also know that that many health care providers appear to have implicit bias in terms of positive attitudes toward whites and negative attitudes toward people of colour. New findings suggest intergroup anxiety and the resulting situational discomfort encroach on the clinical decision-making process by influencing white providers' decisions about which pain treatments to recommend to black patients.

Australians tend to overlook our own racial biases.  We know there is a strong link between chronic pain and lower socio-economic status.  We know Aboriginal and Torres Strait Islander communities are at higher risk of living with painful conditions. This may be related to difficulty accessing appropriate care for pain management, financial pressures, lack of education and low health literacy, or living in a rural or remote area.  It may also reflect lower expectations or other biases.

For many decades governments and health care providers have invested in policies to address inequalities like the Closing the Gap approach.   The poor outcomes of these efforts may be a result of seeking to address individual behaviours as though inequalities are a product of Indigenous lack, morally and intellectually, rather than socially determined.  We know disadvantage is a multifaceted issue that is usually more about opportunity than it is about the efforts of individuals.

Aboriginal and Torres Strait Islander communities report not feeling culturally safe in hospitals, especially when there was no Aboriginal healthcare worker to provide support and alleviate their concerns. Key themes for Aboriginal and Torres Strait Islanders include feelings of ‘shame’ in not understanding healthcare information or not feeling as though they can ask questions of doctors.  Distance and transport can be huge issues when having to travel far from home for health care, but on-line language intense consultations appear to be less effective with Indigenous Australians who have a clear preference for culturally sensitive in-person support and information to be provided through face-to-face discussions.

Given the prevalence and costs of pain, the level of trust that the public places in health professionals and the fact that they see thousands of patients throughout their careers, there is a public health need for interventions that reduce disparities and improve pain care.  

The National Strategic Action Plan for Pain Management  recommends the establishment of clinical pain liaison roles that utilise the skills of GPs, nurses or allied health practitioners to identify chronic pain early in primary care, support education of local practitioners and smooth transitions and communications across services especially in priority population groups. 

Inequality and discrimination should not be barriers to health care, but they are.  We can’t always see our biases, but they are there.  At Painaustralia, we are committed to ensuring people experiencing pain have access to the best possible treatment, regardless of their circumstances.  We still have a long way to go to realise this goal.

What are your views, and suggestions on this complex issue? Please do leave a comment or write to us, we are very interested in your input.

Carol Bennett,
Painaustralia CEO