Research Article: Racial Bias in Perceptions of Others’ Pain

Date Published: November 14, 2012

Publisher: Public Library of Science

Author(s): Sophie Trawalter, Kelly M. Hoffman, Adam Waytz, Richard Fielding.


The present work provides evidence that people assume a priori that Blacks feel less pain than do Whites. It also demonstrates that this bias is rooted in perceptions of status and the privilege (or hardship) status confers, not race per se. Archival data from the National Football League injury reports reveal that, relative to injured White players, injured Black players are deemed more likely to play in a subsequent game, possibly because people assume they feel less pain. Experiments 1–4 show that White and Black Americans–including registered nurses and nursing students–assume that Black people feel less pain than do White people. Finally, Experiments 5 and 6 provide evidence that this bias is rooted in perceptions of status, not race per se. Taken together, these data have important implications for understanding race-related biases and healthcare disparities.

Partial Text

Relative to White Americans, Black Americans experience higher rates of diseases, disability and premature death [1], [2]. Disparities in healthcare contribute to these health disparities. Black patients are more likely to receive lower-quality healthcare and are subject to less desirable procedures. For instance, Black patients are over three times more likely than White patients to have limbs amputated as a result of diabetes [3]. Moreover, Black patients are systematically undertreated for pain [4]–[6]. They are less likely than Whites to receive pain medication and, when they do, they receive less [7], [8]. Numerous explanations have been proposed, ranging from assumptions about Black patients’ inability to pay for healthcare to racial prejudice [6], [9]. These explanations generally imply that Black patients’ pain is recognized but not treated. Another explanation, however, is that Black patients pain is not recognized in the first place. The present work begins to examine this possibility; it provides evidence that people–including medical personnel–assume a priori that Black people feel less pain than do White people.

Although these NFL injury data are provocative, the effect of race was small and alternative explanations abound (e.g., players’ determination to play even while injured). We thus sought more direct and conclusive evidence for our hypothesis by conducting a set of experiments. In our first experiment, we tested whether Whites assume that Black people feel less pain than do White people.

The fact that racial bias in perception of others’ pain was not related to explicit or implicit race-related attitudes and/or concerns raises the possibility that this bias is not rooted in racial animus, at least not primarily or entirely. Thus, in Experiment 2, we replicated Experiment 1 with Black participants, reasoning that Black Americans might also show the bias.

In our introduction, we claim that this bias may shed light on racial disparities in healthcare and, specifically, pain treatment. To begin to investigate this claim, we replicated Experiments 1 and 2 with a sample of registered nurses and nursing students.

Experiments 1–3 provide some support for our thesis that people–including nurses and nursing students–assume a priori that Blacks feel less pain than do Whites. Recall, however, that independent coders rated the Black targets as significantly more threatening than the White targets (Experiment 1). It is thus possible that participants assumed that threatening individuals feel less pain than do non-threatening individuals; not that Blacks feel less pain than do Whites. This explanation of our data is not quite satisfactory, however. Extant research has demonstrated that individuals often over-perceive threat in Black targets [25], [26]. In this way, perceived threat is not a confound. Being perceived as a threat is part of what it means to be Black in America [27]. Indeed, we suspect that perceived threat might be part of our effect. Nonetheless, we wanted to rule out the possibility that perceived threat was a confound in our stimuli. To do this, we created Black-White morphed faces, which we labeled as either being Black or White. We predicted that, even when looking at the same target person, participants would assume that the target would feel less pain when the target was labeled “Black” vs. “White.”

In Experiment 5, we began to explore what psychological processes underlie this bias. Because this bias does not appear to be the direct result of racial prejudice (Experiment 1) or intergroup dynamics (Experiment 2), we looked to a social dimension beyond race; namely, status. We reasoned that the pain of lower-status individuals might be systematically underestimated because people assume that individuals who have had a life full of adversity are tough by necessity, whereas those who have had a life of privilege are frail by virtue of being sheltered and coddled. Because Blacks have relatively low status in U.S. society, people may assume that Black people have less privileged lives–lives with more hardships–and infer that they must be tougher. We tested this idea in Experiment 5 using a mediation approach.

In Experiment 6, we examined the effect of perceived privilege on perceptions of pain using a moderation approach and using a different operationalization of privilege. In particular, we tested whether giving participants information about the status of the target person might undo the racial bias. Specifically, we wanted to test whether participants would perceive a lower-status person as feeling significantly less pain than a higher-status person. If the bias we have documented is really about status and the privilege or hardship that status confers, as Experiment 5 suggests, then experimentally manipulating the target person’s status should moderate the racial bias.

The present work demonstrates that people assume a priori that Blacks feel less pain than do Whites. This finding has important implications for understanding and reducing racial bias. It sheds new light on well-documented racial biases. Consider, for instance, the finding that White Americans condone police brutality against Black men relative to White men [15]. Although it may be that some Whites (and non-Whites) condone police brutality against Black men because they condone harm against Black men, it may also be the case that at least some people condone police brutality against Black men because they assume that Black men feel less pain. They may perceive the same violent act as less injurious in the case of Black victims. As another example, consider the finding that Whites are not distressed at seeing harm inflicted upon Black (vs. White) people [18]. While it may be that some Whites do not care about Black people and their pain, it may also be the case that at least some Whites fail to realize that Black people feel as much pain as White people. Although still alarming, this explanation is decidedly different from the claim that White people simply do not care about Black people.