Anti-black Attitudes Are a Threat to Health Equity in the United States

  • Adrienne MilnerEmail author
  • Berkeley Franz



To assess the extent to which persistent racism shapes perspectives on public health policies aimed at improving health equity in the United States. Specifically we evaluate the relationship between implicit and explicit anti-black attitudes and support for the ACA at the beginning of the Trump administration.


We use bivariate statistics to examine views toward the ACA, anti-black attitudes, and demographic variables. Using logistic regression, we examine how anti-black attitudes and demographic variables relate to participants stating that the ACA has worsened the quality of health care services in the United States.

Survey Population

Data for this study come from the American National Election Studies 2016 Time Series Study, which targets US citizens age 18 and older currently living in the United States (N = 3245).


Implicit anti-black attitudes, particularly among whites, are strongly associated with negative feelings toward the ACA. A measure of explicit racial prejudice has the opposite relationship among whites. These results suggest that whites are most critical of the ACA when they hold positive attitudes toward blacks but hold negative stereotypes about blacks’ work ethic and reject policies to eliminate racial inequalities.


Anti-black racial attitudes are a critical barrier to enacting health policies that stand to improve health equity in the United States. Public health practitioners and policymakers should consider racism as an essential barrier to overcome in the push for greater health equity in the United States.


Racism Implicit bias Affordable Care Act Health equity Policy 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors. The study utilizes data from the American National Election Studies (ANES) 2016 Time Series Study, a publically available dataset with identifying information removed to protect respondent confidentiality. Participation in the ANES is voluntary, and the procedures for the ANES are overseen by the ANES advisory board, University of Michigan, and Stanford University.

Supplementary material

40615_2019_646_MOESM1_ESM.docx (21 kb)
ESM 1 (DOCX 16 kb)


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Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.College of Health and Life SciencesBrunel University LondonUxbridgeUK
  2. 2.Department of Social Medicine, Heritage College of Osteopathic MedicineOhio UniversityAthensUSA

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