The perpetual cycle of racial bias in healthcare and healthcare education: a systematic review

Objectives: This systematic review aimed to identify and categorise racial bias in healthcare and education, evaluate their impact on healthcare practitioners, students, and patients, and explore strategies to reduce these biases and improve health equity.
Method: A systematic review was conducted following PRISMA guidelines to investigate racial bias in healthcare and healthcare education. Databases searched included PubMed, Cochrane, EMBASE, CINAHL. Identification of additional papers was completed by employing backward and forward snowballing techniques. Rigorous interprofessional multi-reviewer screening and data extraction processes were performed. Thematic analysis was conducted inductively and collaboratively refined, with disagreements resolved through discussion and a third reviewer confirming resolutions as an additional quality assurance measure.
Results: From an initial pool of 1,634 records, 45 studies were included in the final review. The studies employed various designs, primarily cross-sectional, with most conducted in the United States of America. Five themes emerged: disparities in healthcare access and/or provision, perceived discrimination and/or medical mistrust, provider bias and/or stereotyping, disparities in education and training, and healthcare literature disparities.
Conclusions: The findings suggest significant racial disparities across multiple medical specialties, including maternal and infant healthcare, chronic disease management, and emergency care. The review also highlights the underrepresentation of racial minorities in medical imagery and educational materials, contributing to implicit bias and inadequate training for healthcare providers. Overall, the five identified themes appear interconnected, forming a self-reinforcing cycle of racial bias in healthcare and education.
PROSPERO Registration number: CRD42024518475.