Written by Maryam Ishfaq

In New York State, one of the leading causes of death is cardiovascular disease, with 27% of affected individuals dying from poor lifestyle choices, lack of health interventions, and inequitable cardiovascular healthcare. New York City, with its large and diverse population, accounts for more than half of cardiovascular-related deaths in the state. This disparity in healthcare outcomes is associated with the enduring healthcare inequities that disproportionately affect communities of color and low socioeconomic populations that face barriers to accessing quality care. Implicit bias plays a critical role in these disparities, as healthcare providers within the city may unconsciously provide different levels of care based on a patient’s race, background, or socioeconomic status, thus leading to more cases of patients experiencing delayed diagnoses, delayed treatment plans, and worse health outcomes. Addressing these issues requires systemic healthcare reform and a commitment to managing implicit bias in healthcare-providing facilities. 

Implicit bias refers to the unconscious stereotypes that people have towards certain groups that influence their actions and their decisions. In healthcare, implicit bias can manifest and create major issues when clinicians unconsciously associate specific demographic characteristics such as race, gender, and socioeconomic status with particular healthcare outcomes. For example, a healthcare provider may unknowingly assume that a Black patient is less likely to adhere to medical advice, resulting in less comprehensive medical treatment recommendations. Prior research has indicated that healthcare professionals are just as likely to hold implicit biases as the general population, regardless of their educational background. A systematic review revealed that these biases can affect patient and provider interactions and patient treatment decisions and contribute to health disparities.

In neighborhoods in New York City, such as Jamaica and Queens Village, socioeconomic factors intensify these disparities. High poverty rates alongside unemployment rates and rent burdens leave many with limited access to healthy lifestyle options. Approximately 20% of residents in Jamaica live in poverty, with unemployment rates exceeding the citywide average. In addition, 56% of households in these areas face rent burdens that make it increasingly difficult to afford nutritious food, medicine, necessities, and healthcare services. These economic issues, combined with the implicit biases in healthcare in these communities, result in many patients having delayed diagnoses and poor treatment for cardiovascular-related issues, namely heart disease, contributing to higher rates of cardiovascular morbidity and mortality. 

Socioeconomic factors are one of the key determinants of healthcare access in New York City, as low-income and high-minority populated areas face significant barriers. In Jamaica and Queens Village, a high proportion of residents are Black and/or Hispanic and have limited access to high-quality healthcare facilities. Many residents in these communities find that their healthcare issues are improperly addressed, or they endure their problems for longer than they should. Many of them also lack health insurance and rely on Medicaid, which can limit their access to certain specialized cardiovascular care and other services. Moreover, hospitals and clinics within these areas tend to be underfunded by the city and overburdened by the influx of patients, leading to longer wait times for service and reduced quality of care. The correlation between poor healthcare access and low socioeconomic status often results in many individuals with preventable conditions, such as hypertension and diabetes, remaining untreated, increasing their risk of experiencing severe health complications. 

These disparities are fueled by social determinants such as housing, transportation costs, and food insecurity, which prevent many residents from seeking urgent medical attention. Addressing these systemic issues requires enhanced focus on policy changes that increase healthcare funding, especially in minority-populated areas. A few strategies to achieve this include implementing bias training for medical professions in New York City and expanding community-led initiatives to bridge these gaps in healthcare. 

Currently, New York City has several city-based initiatives aimed at reducing implicit bias, which include bias training programs for healthcare providers and community health workshops. For example, the New York State Uniform Assessment Tool Evaluation has been implemented and it requires hospitals to adopt standardized patient assessment protocols to minimize the frequency of subjective judgments for patients. In addition, city-funded health initiatives are focused on increasing awareness and education for cardiovascular health among high-risk populations and those of a lower socioeconomic status. However, the effectiveness of these programs is mixed, as many healthcare-providing facilities do not receive adequate follow-ups or are not widespread in the city. 

Potential policy recommendations to address these disparities include increasing healthcare funding for under-resourced communities and mandating a widespread comprehensive implicit bias training program for healthcare providers, while also supporting existing community health initiatives focused on education and preventative healthcare. Enhancing patient-provider interactions, funding equitable resource distribution, and improving access to quality services can significantly reduce current health disparities. There should also be greater emphasis on the local organizations in New York City that are dedicated to improving patients’ lives through immersive and equitable healthcare programs, as these organizations often are underfunded or lack proper resources to exceed their beneficial potential. Public policies should address social determinants such as affordability of housing, transportation access, and food security to foster a long-term sustainable and sufficient change in NYC. 

Addressing implicit bias and healthcare disparities in New York City requires a well-coordinated approach to involve the community, policymakers, and healthcare providers. Education for providers, systemic reforms, and active community engagement are all essential for reducing cardiovascular-related deaths and improving health equity for patients. By enhancing the current powerful and impactful community-led initiatives and introducing new policy measures, New York City can make significant progress toward eliminating implicit bias and improving health outcomes. A collaborative effort is crucial for creating a healthcare environment that is both equitable and inclusive. 

Edited by Aisha Hassan