Where Implicit Bias Fails

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The implicit bias frame does not offer equity. It offers absolution from complicity in systems that harm people. And yet, individuals, organizations, and institutions continue to use the implicit bias frame to make sense of inequity and to address it.

Take police violence, for example. In the face of the devastating and disproportionate toll police violence takes on Black and Brown people in America, policymakers have responded by offering local law enforcement implicit bias training. The underlying assumption is, police violence is an interpersonal problem that takes place between an individual “bad” officer with bias and the civilian on whom their bias is projected. In this framing, the solution then requires an interpersonal remedy to address unconscious racial stereotypes that must drive racial inequity in police violence.

But this limited reading of the problem and solution, rooted in individualized and unconscious judgement, ignores the collective impact of police violence and the explicit choices that structure, authorize and weaponize police-community relations.

Police violence is also, and I would argue, largely, a structural problem, whose effects extend beyond individual civilians to the communities and populations who directly and indirectly suffer the burden of the disproportionate risk of this form of violence. This community and population-level impact is driven by intentional human design.

Police violence must be understood as the predictable by-product of policies that introduce militarized weapons into local precincts and permit use of force in the absence of a lethal threat. Racial inequity in police violence is then incentivized by “tough on crime” and “zero tolerance” politics that penalize poverty and Blackness. This inequity is exacerbated by municipal procedure to use petty offenses to generate city revenue. And it is perpetuated by law enforcement culture that fails to demand officer accountability.

Each of the preceding system-level factors are determined by explicit human choices, not implicit beliefs. Therefore, attending a training on implicit bias or simply substituting a Black or Brown officer for a white one, because they presumably harbor less anti-Black bias, does not address the systems-level choices at the core of police violence or the racial inequities those choices create.

Similarly in medicine, implicit bias training will not help institutions unpack their problematic relationship to entrenched local poverty and racial inequity – both drivers of racial health disparities. Those relationships, between hospitals, poverty and racial inequity, are structured by intentional business models and tax designations, not unconscious preferences or prejudices. And diversifying the physician workforce without disrupting the various manifestations of white hegemony that currently set clinical priorities, research agendas, and promotional criteria, will not magically narrow racial disparities in health outcomes.

One cannot simply change a cog in an assembly line and expect the line to produce a new product. Systems function as they are designed to. To get a new outcome, it requires building a new system or transforming the existing one – each of which relies on humans making different explicit choices, regardless of their implicit leanings.

Advocates, we can no longer afford to use an individual or interpersonal analysis of harm, like that offered by the implicit bias frame, to understand and confront inequity. It fails to capture the collective experience of harm and works to conceal the ways explicit choices encoded in process, reproduce harm, across systems and populations.

While the implicit bias frame may have gained traction because the solutions it offers are relatively simple, like admitting unknowing harm in one on one interactions. The frame ultimately fails where it absolves us from confronting our knowing role in maintaining systems that inequitably distribute harm among populations. That task is more complex and requires us to challenge our individual, organizational, and institutional choices to create and uphold legacies of oppression and privilege. We all must be accountable – to each other and to ourselves, for the systems we create, the systems we protect, and the systems we participate in that harm others. Because ultimately, the goal is not to simply adjust the ratio of good to bad apples, but to change the kinds of trees we are planting.

 

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The Most Important Questions We Won’t Answer For You

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My fellow pediatrician and friend Nia Heard-Garris and I wrote a piece on medium about how White Supremacy and anti-Blackness show up in medicine and how to start the conversation.

Check it out here and let me know what you think!

Charlottesville

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The torch-bearing, violence-streaked march of white nationalists through Charlottesville, Virginia yesterday, is terrifying. Present tense. Thanks HBO, but turns out we don’t need a fictionalized, revisionist look at the confederacy to imagine an America where Robert E. Lee is a hero, worthy of defense by militias and crowds shouting “blood and soil.” We get it already. It is the America we live in.

But in the wake of yet another iteration of emboldened racism, given platform and legitimacy by the president and his administration, it is important to be clear about the terms and legacy of this public debate.

White supremacy in America isn’t simply a set of informal ideas rooted in the racial superiority of people who call themselves white.

White supremacy is an institutionalized set of ideas founded on the racial superiority of people who call themselves white.

It’s not dangerous because some white people think they are better.

It is dangerous because it re-constitutes and maintains a tangible racial order where white people can become passive beneficiaries of public systems, public goods, public sympathy, and public protection, in ways black and brown people cannot. It is dangerous because this extreme perversion of “the public” excludes black and brown people. And the consequence is deadly.

So while yesterday’s staunch defense of the confederate flag and nostalgia for slavery may appear dated and unfamiliar, the political agenda underlying the protest is not.

In the last month, the Department of Justice, under the leadership of longtime civil rights opponent Jeff Sessions, resurrected white affirmative action to counter “race-based discrimination” in higher education that is costing supposedly deserving white students their so-called rightful place in our nation’s colleges and universities. The Republican-led House and then Senate each questioned and attempted to dismantle the merits of the Affordable Care Act, the only comprehensive national healthcare legislation to narrow deadly insurance and care gaps for black and Latinx patients. And just this past June, the president and Justice Department worked in tandem to request and secure voter data from states, an unprecedented move that has met bipartisan condemnation, and as the former head of the Civil Rights Division noted, is a prelude to voter purges that will disproportionately suppress voters of color.

So while a frequent response to yesterday, and the larger, more violent rally that took place today, is to support local organizations who condemn bigotry and hatred, such charity alone ignores the larger political agenda at stake. What is happening in Charlottesville is emblematic of what is happening to our democracy at large.

This fight is about who deserves the benefits of a shared America.

The answer to that question does not lie in outraged tweets. It lies in organized and sustained resistance to the resurgence of white supremacy that continues to threaten the lives, livelihoods, education, electoral participation, health and survival of people of color. There are only two sides of this and one is wrong.