Implicit bias, lack of cultural competency, structural racism, and intentional historical discriminatory policies have affected equal access to healthcare for many groups of people in the United States. Until recently, many of us have been unaware of the attitudes and prejudices that have created these barriers and disparities.

The COVID pandemic brought healthcare inequities into sharp focus as illness and deaths rapidly mounted in minority communities, nursing homes, rural communities, Indigenous communities, and among frontline workers, disproportionately represented by women, minorities, and people of color.

As the population of the United States becomes more and more diverse, the need for culturally competent training has increased. The importance of workforce diversity within the healthcare system has become an imperative.

From a practical standpoint, implicit bias and lack of cultural competence affect outcomes and cost money. Eliminating health disparities will save billions of dollars by reducing healthcare costs, improving productivity, and saving lives.

Research has shown that addressing implicit bias and improving cultural competency is possible. Understanding the effects of colonial medicine, slavery, and Jim Crow provides a basis for examining structural issues that have been slow to change. Using a multipronged approach that targets individuals and institutions can improve attitudes and reduce disparities in the delivery of services.

In Michigan, several counties have implemented programs that connect people from historically disadvantaged populations to needed social services. The MSHIELD program seeks to eliminate healthcare disparities by working with existing community programs in four Michigan geographic regions to address the needs of high-risk medical and surgical patients. The program employs community health workers and care managers to help patients navigate complex healthcare and social services systems.

Through individual training and institutional change, Michigan is moving forward in its effort to address implicit bias in healthcare and improve access and outcomes for historically disadvantaged groups within the state.