Chapter 8 of Just Medicine emphasizes that confronting unconscious racism in healthcare requires a radical paradigm shift. While implicit biases stem from engrained social and racial divisions, Matthew argues that change is possible through courage and collective effort. Using Thomas Frieden’s Health Impact Pyramid published in 2010, Matthew argues that addressing socioeconomic factors like housing, education, and employment will have the greatest impact on reducing health disparities, while individualized interventions will have limited, temporary effects.

In the first section, titled “Counseling and Education Interventions,” Matthew critiques current interventions that attempt to address implicit bias in healthcare, which tend to focus on individual education and awareness like adding implicit bias questions to the Medical College Admission Test (MCAT). While these efforts increase awareness, they do not address the deeper structural issues driving disparities. Social scientists’ recommendations often fall short because they focus on individual-level solutions, like education or counseling, without addressing systemic racial and economic inequalities. Matthew argues for macro-level interventions that tackle the structural roots of unconscious bias.

In the section titled “Clinical Interventions: CLAS and Professional Ethics Standards,” Matthew discusses the ineffectiveness of the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in addressing implicit biases and health disparities. Matthew reflects on her discussions with physicians who believe that additional legal oversight is unnecessary, and that healthcare should self-regulate.