Understanding racism and discrimination in healthcare

Why do people behave the way they do?

That question has fascinated scientists for decades, from biologists to sociologists. They are not on opposite sides of an argument. They simply study behaviour from different perspectives. Biologists focus on genes, the brain, and evolution, while sociologists look at the impact of culture and our surroundings. Their findings fit together like puzzle pieces, revealing that human behaviour never has just one cause. It emerges from an ongoing interaction between biological and social forces. That interaction helps explain why people sometimes, whether they mean to or not, sort the world into “us” and “them.” That is where the roots of discrimination and racism take hold.

Our blueprint and biological diversity

Everything begins with DNA, the blueprint of the human body. Genetically, people across the world share more than 99.9 percent of their DNA. The remaining 0.1 percent accounts for our individual traits, like eye colour, hair texture, and vulnerability to certain diseases. These variations arose through evolution and adaptation to different environments: darker skin provides protection in regions with intense sunlight, while lighter skin in northern areas helps the body produce vitamin D.

Those genetic variations do not line up with what we call “race.” In fact, the genetic differences within so-called racial groups are often greater than the differences between them. Modern genetics makes it clear that race has very little biological meaning. It is mostly a social and historical construct.

Culture, ethnicity, and social meaning

Many differences in human behaviour take shape within social contexts. Climate and living conditions also influence culture. Consider how people in Southern Europe often take a midday siesta because of the heat, and tend to eat and go to bed later than those in the North. Over time, adaptations to the environment grow into traditions, passed from generation to generation, becoming an essential part of a community’s cultural identity.

In everyday conversation, concepts such as race, ethnicity, culture, and migration background are often blended together. Yet they refer to different things. Culture describes shared traditions, habits, and values. Ethnicity points to shared ancestry or a sense of belonging to a particular group. A migration background simply means that a person, or their parents, moved from one region, country or continent to another.

How our brain works

Back to biology: To navigate the complexity of daily life, our brain sorts information into categories. It recognises patterns and puts people into mental “boxes.” This happens fast and automatically, shaped by what we already know. When we have little direct experience with a person or group, our minds fill the gaps with assumptions learned from our surroundings or the media. That is how stereotypes take hold: simplified images of others that may be inaccurate, yet still shape our thoughts and behaviour.

Stereotypes, prejudice, and discrimination form a psychological chain. It begins with our thinking. A stereotype is a generalisation about a group, such as the idea that young men are always loud. That thought can lead to a feeling, positive or negative, like irritation or distrust. That feeling is a prejudice. When those feelings influence what we do, discrimination occurs. For instance, denying a capable young man a job interview because of discomfort with his age group.

Racism is a particular form of discrimination based on the belief that some groups are superior to others because of skin colour or other physical traits labelled as “racial.” Discrimination more broadly refers to treating people unfairly because of characteristics that should not determine their opportunities, such as age, gender, religion, disability, sexual orientation, or migration background. Discrimination can be deliberate, but it can also happen unconsciously.

How does it show up in healthcare?

Racism and discrimination can surface in healthcare in many different ways, ranging from subtle personal interactions to systemic issues. They may occur between patients, clients, or students themselves, or from patients toward healthcare workers. They can also appear in the behaviour of professionals toward the people they care for, or between colleagues on the work floor. On a broader scale, discriminatory patterns may be built into institutional practices, such as hiring processes, protocols, or evaluation tools.

The consequences

The impact of discrimination reaches far beyond the moment it occurs. People who experience it often feel excluded, anxious, or powerless. When exposure continues over time, it can lead to stress, sleep problems, and lowered self-confidence. In healthcare, this may cause patients to hesitate when seeking help or to lose trust in the professionals caring for them.

Healthcare workers who encounter discrimination may face emotional exhaustion, reduced motivation, and a sense of insecurity at work. These effects can gradually undermine the quality of care they are able to provide.

Discrimination also affects entire teams and organisations. It disrupts communication, weakens collaboration, and allows unconscious biases to shape decisions about hiring, promotion, and who gets heard. Diversity on the work floor can suffer as a result. Ultimately, racism and discrimination harm not only individuals but also the fairness, safety, and overall quality of care within the healthcare system.

Staying connected

Tackling racism and discrimination is complex, yet the first step is awareness. Human behaviour always unfolds in relation to others. It takes two to tango. Progress depends not only on recognising how others behave, but also on examining our own assumptions and reactions. Reflecting on what shapes our thinking allows us to identify and interrupt unhelpful patterns. When we remain curious about ourselves and open to learning, we contribute to care that is genuinely fair, respectful, and inclusive for everyone.

Curious about yourself?

Try these tests for implicit bias:

1. Computer version in English (Implicit Project: https://www.projectimplicit.net/)
2. Mobile and computer versions in Dutch (Onderhuids Project: https://onderhuids.nl/test-jezelf/)

 

These columns by Nina Conkova are shared with permission from NieuwWij.nl. As an ENIEC member, Nina also publishes her work in our newsletter.