Every year, millions of people around the world suffer harm because of medication errors-wrong doses, missed prescriptions, dangerous interactions. But not everyone is equally at risk. Medication safety isn’t the same for everyone. People of color, older adults, non-English speakers, and those with low incomes are far more likely to experience preventable harm from medications-and far less likely to have their concerns heard or documented. This isn’t random. It’s systemic.
Why Some Patients Are Left Behind
A study across five NHS hospitals in 2021 found that patients from certain ethnic groups filed far fewer medication error reports than others. Not because they had fewer mistakes happen to them. But because they didn’t feel safe speaking up. Language barriers, cultural distrust, and past experiences of being ignored made many patients stay silent. One Black patient in Georgia described how her doctor dismissed her concerns about a new medication, assuming she didn’t understand the instructions. She didn’t report it. She just stopped taking it. That’s not compliance-it’s survival. The problem goes deeper than communication. Research shows clinicians often make unconscious assumptions about patients based on race, age, or income. A 2024 study in JAMA Network Open found that doctors were more likely to prescribe cheaper, less effective drugs to Black and Hispanic patients, assuming they couldn’t afford or manage more complex regimens. That’s not care. That’s bias dressed as cost-saving. Even when new drugs are approved, they don’t reach everyone equally. Between 2014 and 2021, Black Americans made up just one-third of participants in clinical trials for drugs treating conditions they were most likely to die from. That means we don’t really know how those drugs affect them. The U.S. Preventive Services Task Force couldn’t even set specific colorectal cancer screening guidelines for Black patients in 2021-because the data just wasn’t there. How can you fix a problem you refuse to measure?The Hidden Cost of Inequality
The World Health Organization calls medication errors a global crisis. They cost $42 billion a year in avoidable harm. But behind that number are real people. A diabetic in Detroit skips insulin because the co-pay is too high. A Spanish-speaking elder in Chicago gets the wrong pill because no interpreter was available. An elderly woman in Birmingham takes two blood pressure pills at once because her doctor didn’t explain the difference. These aren’t rare cases. They’re the norm for marginalized communities. And the consequences are deadly. People of color are more likely to be uninsured. In 2022, nearly 19% of Hispanic Americans and 11.5% of Black Americans had no health coverage-compared to just 7.4% of white Americans. That means even when safer medications exist, they’re out of reach. New drugs often cost hundreds, even thousands, per month. For many, choosing between rent and medicine isn’t a metaphor. It’s daily reality.
What’s Being Done-and What’s Missing
In 2017, the WHO launched its Medication Without Harm initiative, aiming to cut severe medication errors by half globally by 2022. It’s a bold goal. But equity wasn’t just an add-on-it was built into the framework. The plan looked at patients, providers, medicines, and systems. Yet, most hospitals still don’t track who’s being harmed, or why. A 2024 survey found only 32% of U.S. hospitals have formal programs to address medication safety disparities-even though 78% say it’s a priority. The Joint Commission, which accredits U.S. healthcare facilities, finally made equity a formal patient safety goal in 2023. That’s progress. But goals don’t fix systems. Real change needs action: language services that actually work, training that challenges clinician bias, reporting tools that ask not just what happened, but who it happened to. Some places are trying. The U.S. Office of the National Coordinator for Health Information Technology launched a $15 million project in 2024 to build AI tools that flag patterns of medication errors tied to race, income, or language. But AI can’t fix bias-it can amplify it. If the data feeding these tools is flawed, the outcomes will be too. That’s why community input matters. Patients on Reddit and Twitter are sharing stories of being told their pain was "just anxiety" or their confusion was "just old age." These aren’t anecdotes. They’re data points healthcare systems are ignoring.How Real Change Happens
There’s no single fix. But there are proven steps:- Require demographic data in every medication error report-not just to count, but to act. If you’re not tracking who’s being harmed, you can’t fix it.
- Expand professional language services with trained medical interpreters, not family members or Google Translate. Miscommunication kills.
- Train clinicians in cultural humility, not just cultural competence. It’s not about knowing every tradition-it’s about listening without judgment.
- Involve communities in designing safety programs. If you want to reduce errors among Latino patients, talk to Latino patients. Not just their doctors.
- Cap out-of-pocket costs for high-risk medications. No one should choose between their health and their rent.
Written by Felix Greendale
View all posts by: Felix Greendale