Pharma key to solve health inequalities that disproportionately affect people of color.

Among the issues confronting healthcare leaders perhaps none presents more challenges or opportunities than health equity. The complexity of the problem cuts across age, ethnicity, gender, and race. And it’s both an outcomes and access problem. The statistics tell the story:

Hispanic patients are 50% more likely to die from diabetes than white patients

Black patients are 25% less likely to be discharged from the hospital on a direct-acting oral anticoagulant than white patients

Women have a 20% higher chance of developing heart failure or dying within five years of their first heart attack than men

People aged 70 years or older account for 42% of cancer patients but just 25% of clinical trial participants

While health equity is largely viewed as the domain of governments, providers, and payers, pharmaceutical companies can — and must — play a role in closing gaps in medical access and outcomes. In fact, pharmaceutical companies are uniquely positioned to help reduce health disparities. From drug development and clinical trials to medication adherence, pharmaceutical companies have a reach that cuts across the entire health ecosystem and patient journey. While the sector has targeted disparities globally, the COVID-19 pandemic put a spotlight on prominent vulnerabilities in developed nations. To have an impact, health equity must become a priority as both a moral and business imperative – with commitments by corporate leaders to engrain health equity within the product life cycle.

ROOT CAUSES

A myriad of issues has led to the proliferation of health inequities. Some are deeply rooted within the healthcare delivery system; others are social determinants that require action by a broader set of stakeholders. In thinking about the pharmaceutical industry, we homed in on three categories:

Limited medical knowledge: Essential to understanding how to treat patient populations is knowing what to look for. Unfortunately, women and non-white populations are disproportionately understudied and underrepresented in clinical trials. In 2020, the US Food and Drug Administration found that 75% of patients involved clinical trials were white. By comparison, 6% were Asian, 8% were Black, and 11% were Hispanic. Just 30% of participants were 65 years of age or older. And researchers at Brigham and Women’s Hospital reported that women account for 41% of clinical trial participants; the figure drops to 22% when considering Phase I trials, according to US government data. As we strive toward personalized medicine, we need to get ahead of our gaps and broaden the diversity of mapped genomes. Currently, ~78% of the people in genome-wide association studies are of European descent, even though they only account of 16% of the global population.

Bias at the bedside: Conscious or unconscious, bias creeps into clinical decision-making. This impacts what tests patients are given, how they are treated, and, eventually, their outcomes. Some biases are institutional and have been in place for decades — the Institute of Medicine’s landmark 2003 report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care noted that Black and Hispanic people are less likely than whites to receive such cardiac medications, even after social determinants of health are considered. Personal biases also have an impact. For instance, 40% of first- and second-year medical students endorsed the notion Black people’s skin is “thicker” than white people’s skin, which leads to biases in how pain is assessed and treated. And the lack of medical knowledge outlined in the previous bullet contributes to biases. Further illustrating the point, a recent JAMA Network study highlighted the challenge US health systems face in developing population health strategies for underserved groups due to a dearth of family history information. But bias works both ways due to long-standing trust issues patients have with the healthcare industry. That lack of trust leads to patients disregarding clinical information and treatment protocols. Speakers at last month’s Oliver Wyman Health Innovation Summit detailed ramifications that eroding trust has on the industry and patients.

Social barriers: Where you were born or live is often a strong predictor of their medical history. Such social determinants as housing, food and nutrition, transportation, and employment status can affect 50% of health outcomes (some studies place it as high as 80%). People born in high human development countries live 19 years longer than those born in low human development countries. Researchers have also found a correlation between social determinants of health and the onset of chronic disease.

Gaps in these and other areas lead to a range of challenges in the patient journey (Editor's note - click on a box to see supporting statistics):