Racial disparities in pain care may stem, in part, from a perceptual source. While perceptual disruptions in recognizing painful expressions on Black faces have been demonstrated under tightly-controlled conditions (e.g., controlling for low-level stimulus differences in luminance and facial structure, using all male stimuli), these effects may be exacerbated by cues to racial prototypicality. Indeed, both bottom-up (e.g., skin tone, facial structure) and top-down (e.g., stereotype associations between race and gender) factors related to racial prototypicality moderate social perception, with some evidence pointing towards deleterious consequences in the domain of health. Here, we assessed whether these factors shape racial bias in pain perception: we examined the effect of racially prototypical features in Experiments 1 and 2 and target gender in a meta-analysis across five additional experiments. Overall, darker skin tones were associated with more stringent pain perception and more conservative treatment, while racially prototypic structural features exacerbated racial bias in pain outcomes. Moreover, target gender reliably moderated the effect of race on pain outcomes: racial biases in both pain perception and treatment were larger for male (versus female) targets. Taken together, these data demonstrate the overall robustness of racial bias in pain perception and its facilitation of gaps in treatment, but also the extent to which these biases are moderated by both bottom-up and top-down factors related to racial prototypicality.
Bottom‐up vs. top‐down effects on terrestrial insect herbivores: a meta‐analysis