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. But not everyone is equally protected. People of color, older adults, non-English speakers, and those with low income are far more likely to experience medication errors - and far less likely to have those errors reported, studied, or fixed. This isn’t just bad luck. It’s a system failure.

Medication Errors Don’t Happen Equally

A 2025 study across five NHS hospitals found that patients from certain racial and ethnic groups had significantly fewer medication incidents reported - not because they made fewer mistakes, but because their concerns were overlooked. Black, Asian, and Hispanic patients were less likely to have their complaints about wrong doses, missed medications, or confusing instructions taken seriously. The same study showed that male patients and those identifying as white were more likely to have their reports logged. That’s not a reflection of behavior. It’s a reflection of bias.

Why does this happen? Language barriers play a big part. A patient who doesn’t speak English fluently may not know how to ask for help. Or they may have been told before that their concerns won’t be heard, so they stay quiet. Cultural norms can also silence people. In some communities, questioning a doctor is seen as disrespectful. And when patients don’t speak up, errors go unreported - and uncorrected.

Clinical Trials Are Missing Key Populations

If a drug hasn’t been tested on you, how can you know it’s safe for your body? From 2014 to 2021, Black Americans made up only one-third of the participants in clinical trials for diseases they were most affected by. That gap hasn’t improved. Even during the COVID-19 vaccine trials - where diversity was a major focus - Black and Hispanic people were still underrepresented compared to their share of the population.

This isn’t just about fairness. It’s about safety. Medications affect people differently based on genetics, metabolism, and other factors tied to race and ethnicity. When trials lack diversity, we miss critical safety signals. In 2021, the U.S. Preventive Services Task Force couldn’t issue specific colorectal cancer screening guidelines for Black patients - not because the risk isn’t higher, but because there wasn’t enough data from Black participants in the studies.

And when new drugs finally come to market, the cost is often out of reach. In 2022, nearly 19% of Hispanic Americans and 11.5% of Black Americans were uninsured. For White Americans, that number was just 7.4%. If you can’t afford the medication, even a perfectly safe one doesn’t help you.

Doctors’ Biases Are Still Shaping Prescriptions

Implicit bias doesn’t always look like racism. Sometimes, it’s a doctor assuming a patient won’t follow instructions, so they prescribe a simpler - but less effective - drug. Or they underestimate a patient’s pain because of false beliefs about pain tolerance in Black patients. A 2024 study in JAMA Network Open found that these unconscious assumptions lead to higher use of dangerous over-the-counter painkillers among underserved groups - not because patients chose them, but because clinicians didn’t offer better options.

These biases aren’t just personal. They’re built into systems. Electronic health records often use algorithms that recommend treatments based on past data - data that reflects historical inequities. If Black patients were historically underprescribed opioids for pain, the algorithm learns to do the same - even if the patient’s condition has changed.

The World Health Organization’s Plan - And Why It’s Falling Short

In 2017, the World Health Organization launched its Medication Without Harm initiative, aiming to cut severe medication-related harm by 50% in five years. The plan had the right structure: focus on patients, professionals, medicines, and systems. It even included equity as a core goal.

But here’s the problem: 86 countries signed on. Only a handful actually changed their systems to track disparities. High-income nations like Australia and the UK have made progress in collecting demographic data on medication errors. But in low- and middle-income countries - where access to basic medicines is already limited - there’s little to no data collection at all. Without knowing who’s being harmed, you can’t fix it.

What’s Actually Working?

Some hospitals are starting to do things differently. One hospital in Chicago started training pharmacists to ask patients: “Do you ever feel confused about your medicines?” - not just “Do you take your pills?” That simple shift led to a 40% increase in error reporting among non-English-speaking patients.

Another initiative in California paired community health workers with patients who had complex medication regimens. These workers spoke the same languages, understood the cultural context, and helped patients navigate confusing pill schedules. Within a year, hospital readmissions due to medication errors dropped by 32% in those communities.

The Joint Commission, which accredits U.S. hospitals, now lists equity as a patient safety priority. But only 32% of hospitals have formal programs to address medication safety disparities. The rest say they care - but don’t act.

What Needs to Change

There are five clear steps that can make a real difference:

1. Collect demographic data on all medication errors. You can’t fix what you don’t measure. Hospitals need to track errors by race, language, age, and income - not just by type of mistake.
2. Require diverse clinical trials. Regulators like the FDA should require that new drug trials include patient populations that reflect the disease’s real-world impact.
3. Train staff in cultural humility. It’s not enough to offer translation services. Staff need to understand how cultural beliefs shape how patients see medicine, illness, and authority.
4. Invest in community-led safety programs. Patients know their own risks. Let them help design solutions. Community health workers, faith leaders, and local advocates are often the most trusted voices.
5. Use technology wisely. AI can help spot patterns - but only if it’s trained on fair data. Algorithms that ignore race and income might seem neutral, but they’re blind to the real disparities.

The Bottom Line

Medication safety isn’t just about pills and prescriptions. It’s about power, trust, and who gets heard. Right now, the system is designed for the majority - and everyone else pays the price in preventable harm. Fixing this won’t happen with a single policy or a new app. It needs ongoing work: better data, better training, better listening.

The goal isn’t to make safety equal for everyone. It’s to make sure no one is left behind because of the color of their skin, the language they speak, or how much money they have. That’s not just ethical. It’s the only way to make real progress on a problem that affects us all.