Addressing Health Disparities in Medication Safety Research

Every year, millions of people around the world suffer harm from medications that should have kept them safe. For some, it’s a simple mistake-a wrong dose, a missed warning. For others, it’s a system failure. And the worst part? These failures don’t hit everyone equally. People of color, older adults, non-English speakers, and low-income communities are far more likely to experience dangerous medication errors-and far less likely to have their concerns heard or documented. This isn’t bad luck. It’s systemic.

Medication Errors Don’t Happen in a Vacuum

The World Health Organization calls medication harm one of the top global patient safety issues. Their Medication Without Harm campaign, launched in 2017, aims to cut severe, avoidable medication-related harm by 50% within five years. The cost of these errors? Over $42 billion annually. But behind that number are real people-people who can’t afford their prescriptions, who don’t trust their doctors, or who don’t speak the language used in hospitals.

A 2025 study across five NHS hospitals found that patients from white or Black ethnic backgrounds were more likely to have medication incidents reported than those from other minority groups. That doesn’t mean those groups have fewer errors. It means their errors go unnoticed. Why? Language barriers. Cultural mistrust. Clinicians assuming a patient doesn’t understand their own symptoms. A Black patient in Georgia told researchers that doctors often dismissed their pain as “emotional,” not physical. That’s not an isolated case. It’s a pattern.

Who Gets Left Out of Clinical Trials?

New drugs are tested in clinical trials. But those trials rarely reflect the real world. From 2014 to 2021, Black Americans made up only about one-third of participants in trials for conditions they were most affected by. The same gap existed for Hispanic and Indigenous populations. Even during the COVID-19 vaccine trials-where diversity was a major talking point-Black people were still underrepresented compared to their share of the population.

This isn’t just about fairness. It’s about safety. If a drug hasn’t been tested on your body type, your metabolism, or your genetic background, how do we know it won’t hurt you? In 2021, the U.S. Preventive Services Task Force couldn’t issue specific colorectal cancer screening guidelines for Black patients because there simply weren’t enough studies that included them. That’s not science. That’s neglect.

Cost Blocks Access-And Safety

Even when a medication is proven safe and effective, many people can’t get it. In 2022, nearly 19% of Hispanic Americans and 11.5% of Black Americans were uninsured. That’s compared to 7.4% of White Americans. When you can’t afford your blood pressure pill, you skip doses. When you can’t pay for a new anticoagulant, you stick with an older, riskier one. That’s not choice. That’s survival.

And when you can’t afford your meds, you turn to over-the-counter alternatives. A 2024 JAMA Network Open study found that people in underserved communities often rely on herbal supplements, expired prescriptions, or shared medications because they have no other option. These aren’t informed decisions-they’re desperate ones. And they lead to dangerous interactions, overdoses, and avoidable hospitalizations.

Biases in the Clinic Are Deadly

Implicit bias isn’t just a buzzword. It changes prescriptions. It changes dosages. It changes whether a patient’s complaint is taken seriously.

A well-documented example: Black patients are consistently undertreated for pain. Studies show doctors are less likely to believe Black patients are in real pain, even when their symptoms match those of White patients. That leads to underprescribing of opioids, but also to underprescribing of safer alternatives because the pain isn’t seen as legitimate.

The Agency for Healthcare Research and Quality (AHRQ) calls this a patient safety crisis-not a social one. Why? Because these disparities aren’t accidental. They’re built into how care is delivered. A doctor assumes a patient won’t understand complex instructions. A pharmacist skips explaining side effects because they think the patient won’t follow them. A nurse doesn’t double-check a dosage because they assume the family won’t notice.

These aren’t malicious acts. They’re unconscious habits. And they’re deadly.

Technology Can Help-Or Hurt

Electronic health records were supposed to fix this. But they often make disparities worse. Algorithms used to flag high-risk patients sometimes rely on historical data that includes biased practices. If Black patients were historically underprescribed certain drugs because of bias, the algorithm might assume they’re “low risk” now-even if their condition is worsening.

That’s why the U.S. Office of the National Coordinator for Health Information Technology launched a $15 million initiative in 2024 to build AI tools that detect medication safety disparities in real time. These tools don’t just look at diagnoses. They look at race, income, language, insurance status, and prescription refill patterns. They ask: Is this patient getting the same level of safety checks as others?

But tech alone won’t fix this. If we don’t fix the human side-the assumptions, the silence, the lack of cultural training-then we’re just automating bias.

What’s Being Done? And What’s Missing?

The Joint Commission now lists equity as a formal patient safety goal. That’s progress. The WHO includes equity as one of its four core domains in the Medication Without Harm framework. Good. But action is lagging.

A 2024 survey by the American Hospital Association found that only 32% of U.S. hospitals have formal programs to address medication safety disparities-even though 78% say it’s a priority. That gap between recognition and action is huge.

Some hospitals are trying. One in Chicago now hires bilingual medication safety advocates who walk patients through their prescriptions in their native language. Another in Texas uses community health workers to follow up with patients after discharge, checking if they understand their meds and can afford them. These aren’t fancy tech solutions. They’re human ones.

But they’re rare. And they’re underfunded.

How to Fix This-For Real

There’s no single fix. But there are clear steps that work:

• Train clinicians in cultural humility, not just cultural competence. It’s not about memorizing traditions-it’s about listening without judgment.
• Expand professional interpretation services in every clinic and hospital. Not just phone interpreters-on-site, trained medical interpreters who know drug names and side effects.
• Collect and report demographic data with every medication error. If you don’t track who’s being harmed, you can’t fix it.
• Include diverse populations in clinical trials from day one-not as an afterthought, but as a requirement for approval.
• Reduce out-of-pocket costs for high-risk medications. No one should choose between food and their heart medication.
• Partner with community organizations. People trust their churches, their barbershops, their local nonprofits. Let them help design safety messages.

It’s Not Just a Health Issue. It’s a Justice Issue.

Medication safety isn’t just about pills and prescriptions. It’s about who gets to live safely. Who gets to be heard. Who gets to trust the system.

When a Latina woman in Arizona can’t get her insulin because the pharmacy won’t accept her Medicaid card, that’s a medication safety failure. When an elderly Asian man in California doesn’t report his dizziness because he’s afraid of being called “confused,” that’s a medication safety failure. When a Black teenager in Detroit skips his asthma inhaler because he doesn’t want to be labeled “noncompliant,” that’s a medication safety failure.

These aren’t edge cases. They’re the norm. And they’re preventable.

The data is clear. The solutions exist. What’s missing is the will to change.