Disability bias remains strong, Harvard scientist says
By Louise Kinross
Implicit bias based on a person's sexual orientation or race is dissolving rapidly in the United States, research at Harvard University finds. But the same data identifies a disturbing persistence in hidden bias towards disabled people. Tessa Charlesworth, a post-doctoral Harvard psychology student, studied changes in attitudes toward six social groups over 10 years using 4.4 million implicit and explicit online tests in this 2019 Psychological Science study. Her research provides useful context for two recent American studies we reported on* that showed bias against disabled people is prevalent among health workers. We spoke about a new study Tessa has in review that looked at American data on social prejudices from 2007 to 2020.
BLOOM: What is a simple way to understand implicit and explicit bias?
Tessa Charlesworth: As you can image, they are very complex phenomena that psychologists like to spend a lot of time thinking about. Let’s start with explicit. For decades, every social survey you can think of has measured explicit attitudes. So when we ask you ‘How much do you like Black Americans, or people with disabilities, or women in science, those are explicit attitudes we’re aware of and willing to consciously report.
Of course that doesn’t tell the whole story, because we may be unaware of beliefs we hold or unwilling to express them. For example, we might think we hold equitable attitudes around gay marriage, but inside our minds our beliefs may be more negative. Or sometimes we know that we hold more negative beliefs, but we're unwilling to report them because of social sanctions.
So we need to find a way to measure automatic associations that come to mind, rather than just asking people. This is where the method of using reaction time or speed and how quickly you associate pairs of concepts in your mind can uncover what is hidden.
BLOOM: How does the Project Implicit website, which you used, measure a person's bias?
Tessa Charlesworth: For the disability task, people would be associating good words like pleasant, glorious, wonderful and good and bad words like horrible, nasty, ugly and bad with two images such as bathroom signs for people with and without disabilities.
BLOOM: So you use symbols, not real-life images of people.
Tessa Charlesworth: Yes, researchers have toyed with using real people, but because of how intersectional social biases are, it would be unclear if you had a picture of a black woman in a wheelchair whether you're measuring attitudes to disability or gender or race. We're trying to get at a more abstract or high level concept of disability. Some of the pictures for disability are a wheelchair parking symbol, an image of someone with a cane and an image of a person with a seeing-eye dog. They focus on physical disability.
BLOOM: Why did your study compare implicit bias towards a number of marginalized groups?
Tessa Charlesworth: So far most research from the U.S. perspective has been on Black Americans and understanding the causes and consequences of those biases. That's captured the public attention, for many good reasons. But we wanted to see if there was something unique about what we were finding about racial bias, or whether we would see something similar in all social biases.
What we found was a cultural transformation in implicit race and sexuality bias. Racial bias dropped 26 per cent over 14 years and sexuality bias dropped 65 per cent. But we got absolutely no change in disability bias. Implicit disability bias dropped only 2 per cent.
BLOOM: How does the persistence in hidden disability discrimination compare to spoken attitudes about disabled people?
Tessa Charlesworth: Explicit bias declined in every single social group we looked at, but it decreased the slowest in disability and age bias. Explicit disability bias dropped 37 per cent. Regardless of the social bias we're talking about, we're less willing to say 'I don't like x group' than we were even just 10 years ago.
We also used time series models, which are used to forecast the weather or stock market, to predict how the trends from the past may continue in the future. We wanted to know how long it would take for implicit biases to reach zero, or no bias, at the population level. For sexuality, which has decreased really fast, that's as early as in mid 2022. But for disability bias, which has been the most stable and flat in the past, we found it would take more than 200 years.
BLOOM: So you're saying that something cataclysmic would have to happen for us to make a comparable dent in negative attitudes about disability?
Tessa Charlesworth: Yes. We've seen that we can change the dial on implicit disability bias, but so far we've only seen it go in a negative direction. We saw a very rapid increase of about 10 per cent in 2016 to 2017, which almost perfectly coincided with President Trump's mocking of the New York Times reporter with a disability.
BLOOM: Why is implicit disability prejudice so stubborn?
Tessa Charlesworth: There are a couple of reasons. Disability bias at baseline is one of the strongest in society, so psychologically that contributes to it being stable. It's widespread and held by most people. To give you an example, when we looked at where biases were starting in 2017, race bias was already half the strength of disability bias.
The other issue is that disability bias is not nearly as talked about as race or sexuality, which are the implicit attitudes that are changing the fastest. Our attention, in terms of social change, is paid to race and sexuality. We haven't had the same kinds of overwhelming moments for disability like the gay marriage movement or Black Lives Matter.
BLOOM: Do you make any recommendations on how we could achieve that?
Tessa Charlesworth: As psychologists focused on studying the mind, attitudes and society, it's not exactly our area of expertise to tell people what to do. But we're very excited about potential policy-makers, advocates and people with lived experience helping us understand and test interventions. From my data I would feel comfortable saying that that we need to get the conversations around disability and disability rights to the level of current conversations we have around race and sexuality. That includes greater representation in the media and in popular culture, and not just ads that we sometimes see with a token person in a wheelchair. We need things on Netflix about all sorts of disabilities that really bring it into dinner table conversation.
BLOOM: Seeing how pervasive disability bias is, wouldn't it make sense for medical schools to look specifically at ways to counter it in their curriculum and materials? I know there's been a movement to include racialized images in medical textbooks.
Tessa Charlesworth: Absolutely there's a huge role for medical schools. The same kind of poor treatment of disabled people happens for people who are in larger bodies. We know that the standard health education in medical school stigmatizes people in larger bodies and that medical students who may have come in with relatively neutral biases become more biased as a result of that training. They've tried to address that with the Health at Every Size approach that shows that health can look different in many different bodies and isn't just about thin, able-bodied white men. It would be useful to have something similar for disability.
BLOOM: Have you found places in the world where implicit bias toward disability is weaker?
Tessa Charlesworth: That's a great question. We're going to start looking at that. But we have found that age bias is present in 34 different countries we've looked at, so if that's any indication, we can assume it's everywhere.
*Clinicians who report low disability bias score high for ableism at an unconscious level
*Most doctors hold distorted view of disabled life, American study finds
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