Report on Perceived Healthcare Discrimination and its Implications for Sustainable Development Goals

Executive Summary

This report analyzes the findings of research conducted by Green, Farmer, Xu, and colleagues on perceived discrimination in healthcare among middle-aged and older adults in the United States. The analysis frames the issue within the context of the United Nations Sustainable Development Goals (SDGs), highlighting how systemic discrimination in healthcare presents a significant barrier to achieving key global targets, particularly SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), SDG 10 (Reduced Inequalities), and SDG 16 (Peace, Justice, and Strong Institutions).

Analysis of Findings in Relation to Sustainable Development Goals

SDG 3: Good Health and Well-being

The research underscores a direct conflict between perceived healthcare discrimination and the core mission of SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages. Systemic bias undermines progress towards universal health coverage by creating barriers to quality care.

• Erosion of Trust: Perceived discrimination leads to a breakdown of trust between patients and providers, discouraging individuals from seeking necessary medical care and adhering to treatment plans.
• Adverse Health Outcomes: The study links experiences of discrimination to negative health outcomes, including increased rates of chronic illness and lower overall health satisfaction, directly impeding the goal of improving health for all.
• Mental Health Impacts: Experiences of bias contribute to increased stress and decreased mental well-being, challenging the SDG 3 target of promoting mental health.

SDG 10: Reduced Inequalities

The findings provide clear evidence of inequalities within the U.S. healthcare system, directly challenging the objectives of SDG 10, which calls for reducing inequality within and among countries. The research identifies several dimensions of inequality:

1. Racial and Ethnic Disparities: Individuals from minority backgrounds report significantly higher levels of discrimination, highlighting persistent racial inequality in access to and quality of healthcare.
2. Socioeconomic Disparities: Lower-income individuals report more frequent discrimination, creating a cycle where economic disadvantage is compounded by biased treatment, further marginalizing vulnerable populations.
3. Age-Based Discrimination: Older adults face unique challenges related to ageism and stereotyping, which can lead to their health concerns being dismissed and is a form of inequality that SDG 10 seeks to eliminate.

SDG 5: Gender Equality and SDG 16: Peace, Justice, and Strong Institutions

The report also highlights the intersectional nature of discrimination, which is central to both SDG 5 and the development of inclusive institutions as outlined in SDG 16.

• Gender and Intersectionality (SDG 5): The research indicates that women, particularly those from minority backgrounds, face compounded biases. This intersection of gender and race creates a heightened sense of discrimination, undermining efforts to achieve gender equality and empower all women.
• Institutional Failures (SDG 16): The study points to institutional factors, including policies, practices, and inadequate training, as key drivers of discrimination. Addressing these structural barriers is essential for building the effective, accountable, and inclusive institutions required by SDG 16 to ensure equal access to justice and services for all.

Key Factors and Systemic Issues Identified

Drivers of Perceived Discrimination

The research identifies multifaceted and deeply embedded factors contributing to patients’ experiences of discrimination.

• Systemic Bias: Discrimination is presented not as isolated incidents but as a systemic issue rooted in the healthcare landscape.
• Demographic Factors: Race, ethnicity, socioeconomic status, age, and gender are all significant predictors of perceived discrimination.
• Institutional Culture: Healthcare policies and a lack of provider training on cultural competence and implicit bias perpetuate discriminatory practices.

Recommendations for Policy and Practice Aligned with SDGs

A Pathway to Health Equity

To address the challenges identified and advance the SDGs, a multi-stakeholder approach is required to reform healthcare delivery and eliminate discrimination.

1. Enhance Provider Training: Implement mandatory, ongoing training for healthcare professionals on cultural humility, implicit bias, and health equity to foster a more respectful and inclusive environment (Supports SDG 10 & 16).
2. Strengthen Institutional Policies: Develop and enforce clear anti-discrimination policies within healthcare institutions. Promote diversity and representation among healthcare professionals to better serve diverse populations (Supports SDG 16).
3. Empower Patients and Improve Advocacy: Increase access to patient advocacy resources and establish transparent, safe mechanisms for reporting discrimination without fear of retaliation (Supports SDG 10).
4. Promote Collaborative Action: Foster collaboration between policymakers, healthcare providers, and community organizations to design and implement interventions that address the root causes of health disparities (Supports SDG 3 & 10).

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  This goal is central to the article, which focuses on how discrimination in healthcare settings negatively impacts the health outcomes and well-being of middle-aged and older adults. The text explicitly states that perceived bias can lead to “adverse health outcomes,” “increased rates of chronic illness,” “lower overall health satisfaction,” and “decreased mental health.”

• SDG 10: Reduced Inequalities

  The article’s core theme is inequality within the U.S. healthcare system. It details how discrimination based on “race, ethnicity, gender, or socioeconomic status” creates significant disparities. The research highlights that “individuals from minority backgrounds often experience higher levels of discrimination” and “lower-income individuals reported feeling discriminated against more frequently,” directly addressing the goal of reducing inequalities.

• SDG 5: Gender Equality

  The article specifically identifies gender as a significant factor in perceived healthcare discrimination. It notes that “Women, particularly those from minority backgrounds, reported a heightened sense of discrimination,” and that the “intersection of gender and race means that women often face compounded biases.” This directly connects to the goal of ending discrimination against women.

• SDG 16: Peace, Justice and Strong Institutions

  This goal is relevant because the article points to systemic and institutional failures as root causes of discrimination. It mentions that “a systemic issue deeply embedded in the healthcare landscape” and that “healthcare policies, practices, and institutional cultures can influence patient experiences.” The call for policy reform and addressing “institutional barriers” to create a more equitable and inclusive healthcare system aligns with building effective and accountable institutions.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Under SDG 3: Good Health and Well-being

   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services… for all. The article connects to this target by highlighting how “socioeconomic disparities” and “inadequate access to medical services” prevent certain groups, particularly lower-income individuals, from receiving quality healthcare.
   • Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. The article relates to this by stating that perceived discrimination can lead to “increased rates of chronic illness” (non-communicable diseases) and “increased stress levels… and overall decreased mental health.”

2. Under SDG 10: Reduced Inequalities

   • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, colour, ethnicity, origin, religion or economic or other status. The entire article is an analysis of the lack of inclusion in healthcare for individuals based on their age, race, gender, and socioeconomic status, making this target directly relevant.
   • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory… policies and practices. The article explicitly calls for addressing “institutional factors” and “structural obstacles” and investing in “policy reform” to eliminate discriminatory practices that lead to unequal health outcomes.

3. Under SDG 5: Gender Equality

   • Target 5.1: End all forms of discrimination against all women and girls everywhere. The research finding that “Women, particularly those from minority backgrounds, reported a heightened sense of discrimination in healthcare settings” directly addresses the issue of discrimination that this target aims to eliminate.

4. Under SDG 16: Peace, Justice and Strong Institutions

   • Target 16.b: Promote and enforce non-discriminatory laws and policies for sustainable development. The article’s conclusion, which calls for “policy reform” and a “collective societal response to reshape healthcare delivery models and eliminate discrimination,” aligns with the promotion and enforcement of non-discriminatory policies within the healthcare institution.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions and implies several indicators that can be used to measure progress:

• Prevalence of perceived discrimination: The central subject of the research is “perceived discrimination in healthcare.” Data collected through surveys and interviews, as used in the study, can serve as a direct indicator. Progress would be measured by a reduction in the percentage of people reporting discrimination, disaggregated by race, gender, age, and socioeconomic status.
• Health outcomes for marginalized groups: The article links discrimination to “adverse health outcomes,” “increased rates of chronic illness,” and “lower overall health satisfaction.” Therefore, tracking and comparing these health statistics across different demographic groups can serve as an indicator of whether health equity is improving.
• Patient trust in healthcare providers: The article notes that perceived bias leads to a “lack of trust between patients and healthcare professionals.” Measuring levels of patient trust, particularly among vulnerable populations, can be an indicator of a more inclusive healthcare environment.
• Implementation of training programs: The article suggests “enhanced training programs for healthcare providers focused on cultural humility” as a solution. An indicator of progress would be the number of healthcare institutions that have implemented such training and the number of providers who have completed it.
• Availability of patient advocacy resources: The call for “improved patient advocacy resources” implies that tracking the availability and accessibility of these resources for marginalized communities can be a measurable indicator of institutional commitment to reducing discrimination.

4. Table of SDGs, Targets, and Indicators

Source: bioengineer.org