Health Equity (And All Equities) Won’t Get Better On Their Own

Posted on by gracesmuggler
 Figure 3 from The Misperception of Racial Economic Inequality by Michael Kraus et. al. Underestimates of the Black–White wealth gap from 1963 to 2016. Each of the small colored dots represents one respondent’s estimate. The large black dots represent mean respondent estimates of Black wealth when White wealth is set to $100. The diamonds represent the actual median Black wealth when White wealth is set to $100, calculated using federal data from the Survey of Consumer Finances (Bricker et al., 2017). Error bars indicate 95% confidence intervals around the mean estimates.

I recently attended a lecture at the University of Michigan by Dr. Michael Kraus, a Professor at Northwestern University, titled The Narrative of Racial Progress. His research challenges how we understand progress, and how our assumptions about progress can work against actual change.

One powerful part of the lecture involved a question Dr. Kraus asks his research subjects: “In the United States, if an average white family has $100 in wealth, how much does the average Black family have?” He asks participants to estimate this answer across various years in our history and to project it into the future. The answers are revealing.

As Dr. Kraus shared, every U.S. racial and ethnic group overestimates the level of racial wealth equality in our country, but white Americans overestimate it the most. The truth is stark: from 1963 to the present day, the average wealth of Black families has hovered around $8 for every $100 held by white families. The number has moved slightly up or down, but it has never moved steadily upward as we might hope.

This gap between perception and reality speaks volumes. Many of us have internalized the belief that racial progress is natural—that it simply happens as time goes on. But Dr. Kraus challenged this narrative directly. He asked, “If you expect that progress happens naturally, why would you think policies are needed to increase equity?”

It’s a sobering reminder that the story we tell ourselves about progress is often a comforting one, but it isn’t necessarily true. Progress doesn’t happen without effort, and without policies and community-driven action, inequities persist or even worsen.

This connects directly to the work we do at the Epilepsy Foundation of Michigan and within our national Epilepsy Foundation network. We are continually seeking to understand the data and personal experiences around health inequities, so we can close these gaps and build health equity. If the average Black household holds only 8-10% of the wealth of the average white household, is it any wonder that these inequities echo across our health systems, education systems, and social services? Wealth shapes access to care, stability, and opportunities, and disparities in wealth contribute to disparities in health outcomes.

Dr. Kraus’s lecture was a crucial reminder: Equity, whether in health or economics, will not improve on its own. It requires foresight, intention, research, and tangible action. We can’t afford to be passive; progress demands our active participation.

The disparities we face today weren’t created by chance, and they won’t be dismantled by chance either. It will take all of us, committed to recognizing inequities, understanding their roots, and working intentionally to create a fairer future.

Reference: The Misperception of Racial Economic Inequality by Michael W. Kraus, Ivuoma N. Onyeador, Natalie M. Daumeyer, Julian M. Rucker, Jennifer A. Richeson.

— Renee Roederer

Change the Context, Change the Bias

Posted on by gracesmuggler
A fork in the road in the forest. Public domain.


I recently attended a lecture by Dr. Keith Payne, a Professor of Psychology and Neuroscience at the University of North Carolina, who is changing the way we understand implicit bias — how it forms, how it operates, and how it functions within particular contexts.

We often think implicit bias works like this: When we are young, we absorb stereotypes and beliefs about race and ethnicity that begin to operate at a subconscious level. Unless we bring them to consciousness and challenge them, we assume they’ll stay fixed, deeply embedded in us.

But Dr. Payne’s research reveals something unique. It turns out that the context, the place, and the setting we’re in have a much bigger impact on the development and expression of implicit bias than we realize. For example, if someone takes an implicit bias test twice in the span of a couple of weeks, we might expect their results to stay roughly the same, right? Surprisingly, they don’t. The results can vary, sometimes quite widely.

However, while individual scores fluctuate, the collective score of a given place —say, a county— tends to stay remarkably constant. What’s even more telling is that the average implicit bias score of a county is highly correlated with levels of socioeconomic inequality, stratification, and segregation between racial and ethnic groups within that place. The context, the structures, and the markers of socioeconomic status and race shape implicit bias collectively.

This research offers a powerful insight: Implicit bias isn’t just an individual phenomenon. It’s a collective one, influenced deeply by our environment. And this brings us to an important takeaway. Implicit bias is not fixed, nor is it solely an individual problem. It’s shaped by systems, histories, and the settings we occupy.

This means that the work of changing implicit bias involves tackling systemic barriers and inequalities, but it also offers a profound opportunity. By making intentional changes in our contexts, we can reduce implicit bias.

When we change the context — by increasing diverse representation in leadership roles, creating more opportunities for voices from underrepresented groups to be heard, and actively working toward equity in our spaces — we’re not only working toward righting past wrongs. We’re actively reshaping the context that influences how implicit bias forms and expresses itself.

Increasing diverse representation is a matter of justice. And this fundamentally changes contexts. When people of different racial and ethnic backgrounds are visible in leadership, in decision-making, and in day-to-day interactions, it transforms the environment. And when the environment is changed, we reduce implicit bias, not just at an individual level, but collectively.

Change the context, change the bias.

— Renee Roederer