There is increasing evidence that implicit bias – non-conscious attitudes toward specific groups – is a source of racial inequities in certain aspects of health care, and lawmakers are taking note.

Since the tragic murder of George Floyd in May 2020, wherein a Black man was killed by police, several U.S. federal and state legislators have introduced proposals declaring racism as a public health crisis. In March 2024, four U.S. senators led a resolution calling out the “implicit racial and ethnic biases within the health care system, which have an explicit impact on the quality of care experienced by members of racial and ethnic minority groups.”

Following this reasoning, states like California and Massachusetts have enacted legislation mandating implicit bias training for health care providers. Health institutions have also focused on addressing implicit bias among the next generation of providers. For example, the American Medical Association’s guidelines to address systemic racism in medicine includes requiring training that covers various forms of racial bias.

But is implicit bias training improving care quality for Black patients? We are a social and health psychologist and a health economist who are investigating the role that provider implicit bias plays in racial health care disparities. Our ongoing review of the existing evidence suggests the answer is: not yet.

The first thing to understand is that implicit bias isn’t just one thing. It involves multiple interconnected components that govern how someone interacts with specific groups or its members: affect, behavior and cognition.

Psychologists sometimes refer to those components as the ABCs.

The affective component of bias, also known as prejudice, is defined as having negative feelings towards a group or its members. The behavioral component of bias, or discrimination, involves negative or harmful actions towards a group or its members. Lastly, the cognitive component of bias, also known as stereotyping, refers to expectations and beliefs about a group.

One common misunderstanding is that implicit bias is inherently unconscious and people are unaware of their own negative feelings, beliefs and behaviors. In fact, research suggests that people are remarkably accurate in perceiving their own levels of implicit bias.

Each component of bias can operate at implicit and explicit levels. At the implicit level, the ABCs arise spontaneously and effortlessly, while ABCs operating at the explicit level are intentional and effortful. For example, the unease someone may feel when encountering a large Black man at night is an emotion triggered at the implicit level. Actively making an effort to replace those feelings of unease with neutral or positive feelings are emotions activated at the explicit level.

Black and white people experience stark differences in treatment during medical interactions. A December 2023 survey from the Kaiser Family Foundation found that nearly 1 in 5 Black people reported experiencing unfair or disrespectful treatment from their health care providers in the past three years because of their race. Only 3% of white respondents reported similar treatment. Researchers have seen similar health inequities across race and ethnicity.

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