Passage 6
With an increasing array of innovations and research emerging from low-income
countries there is a growing recognition that even high-income countries could
learn from these contexts. It is well known that the source of a product influences
perception of that product, but little research has examined whether this applies
also in evidence-based medicine and decision-making. In order to examine
likely barriers to learning from low-income countries, this study uses established
methods in cognitive psychology to explore whether healthcare professionals and
researchers implicitly associate good research with rich countries more so than
with poor countries.
[A] Computer-based Implicit Association Test (IAT) [was] distributed to healthcare
professionals and researchers. Stimuli representing Rich Countries were chosen
from OECD members in the top ten (>$36,000 per capita) World Bank rankings and
Poor Countries were chosen from the bottom thirty (<$1000 per capita) countries
by GDP per capita, in both cases giving attention to regional representation. Stimuli
representing Research were descriptors of the motivation (objective/biased), value
(useful/worthless), clarity (precise/vague), process (transparent/dishonest), and
trustworthiness (credible/unreliable) of research.
Three hundred twenty one tests were completed in a four-week period between
March and April 2015. The mean Implicit Association Test result…for the sample
was 0.57 (95% CI 0.52 to 0.61) indicating that on average our sample exhibited
moderately strong implicit associations between Rich Countries and Good
Research. People over 40 years of age were less likely to exhibit pro-poor implicit
associations, and being a peer reviewer contributes to a more pro-poor association.
The majority of our participants associate Good Research with Rich Countries,
compared to Poor Countries. Implicit associations such as these might disfavor
research from poor countries in research evaluation, evidence-based medicine and
diffusion of innovations.
Measuring the bias against low-income country research: an Implicit Association
Test. Adapted from Harris et al. (2017).
Which of the following are incorrectly paired with their definitions?
A) Socioeconomic gradient in health - the discrete levels of health one attains
solely due to one’s social and economic means
B) Power - the capacity to accomplish one’s own aims and desires in social,
cultural, economic, or business matters
C) Prestige - the reputation of one’s social standing in the dominant society or
culture
D) Social stratification - the splitting of society’s members into levels or
gradients by overall wealth, power, or prestige
Correct answer is A
Of the options presented, the only concept that is incorrectly paired with its
definition is the socioeconomic gradient in health. The socioeconomic gradient
in health does not refer to the discrete levels of health that one attains solely
due to one’s social or economic means for multiple reasons. First, health is multifaceted and exists more on a gradient than it does on discrete levels. Second,
the level of health someone attains is not solely due to one’s social or economic
means, as it also depends on biological and genetic factors, for example. However,
there is a strong influence of social and economic factors on health, and thus the
socioeconomic gradient of health refers to the fact that, in general, many with
greater socioeconomic resources have better health outcomes and many with
lower socioeconomic resources have worse health outcomes. For this reason,
Answer A is the correct choice.
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