Achieving Equity in Health Care Begins with Caring

The United States spends significantly more (40% more) on health care than any other developed country. Despite this fact, health care outcomes for U.S. citizens aren't noticeably different from those of other developed nations. Why is that? Several issues come into play, from higher therapy costs to extensive administrative fees. Another critical factor is inequity in our health care system.

Health equity is defined as helping everyone attain their full potential for health and well-being. Health inequities due to discrimination and lack of resources prevent many people from achieving their best health. Like a lot of health care leaders , I believe we all have a responsibility to make health equity a priority. Yet that prospect can quickly become overwhelming. What does health equity really mean? How pervasive is the problem? What part does each of us play in improving things? In this blog, I'd like to answer those questions with a few examples from my own point of view – both professionally and personally.?

What does health equity really mean?

According to the Centers for Disease Control and Prevention (CDC), we achieve health equity when "every person has the opportunity to attain his or her full health potential, and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances." Health equity isn't necessarily about treating people equally. It's about giving people what they need. For example, a clinic could practice health equity by charging people for individualized care based on their ability to pay vs. charging everyone the same thing.?

When people don't get the health care they need, they experience shortened lives, increased disease, and limited access to treatment. To illustrate this point, here are a few real-life examples of what health equity is not:

• Dr. Susan Moore , a 52-year-old Black woman, died of complications of COVID-19 after a doctor seemed to downplay her complaints of pain.?
• Paula Chambers Raney , a gay woman in her 40s, felt doctors dismissed her due to her sexuality and race, putting off screenings for what turned out to be colorectal cancer.
• Earlier this year, my own mother's hospital pharmacist assumed she didn't have health care coverage for an expensive, low-risk blood thinner and instead prescribed a risky, more affordable drug that could have killed her.?

That last example is close to my heart. After the pharmacist substituted an inappropriate medication for my mom, I asked, "Would you give that drug to your mother?" He quickly switched the meds – and his approach. That experience showed me that true health equity will only take place when we gain full awareness of the problem – and work toward treating all patients with the same care we'd want for our own loved ones.?

How pervasive is the problem??

In a nutshell, it's big. According to The Commonwealth Fund, a foundation that promotes an equitable health care system, profound racial and ethnic disparities in health and well-being have been the norm in the United States for a long time.?

The examples I shared above are all Black women, but according to the Kaiser Family Foundation, many people of color face longstanding disparities in health care and coverage, including disproportionate rates of illness and death during the COVID-19 pandemic.?

Here's a local example that hits home. Did you know that in Indiana, only about 37% of Black people have received COVID vaccinations, a rate lower than any other ethnic group??

Some people believe the reason for that is vaccine hesitancy, but in a recent NPR report, Dr. Rhea Boyd, a pediatrician and public health advocate talked about how the primary barrier to COVID-19 vaccination is access . "We sometimes blame individual patients or patients of color, like Black folks in particular, for many of their health ailments," she said. But the real problem may be the fact that "in this country, one out of five Black adults are unlikely to have a regular provider. They don't have somebody that they go to who they trust for their clinical care." Other barriers include lack of access to reliable internet and inflexible schedules. But the most important factor may be trust.

To build trust, we must create a more inclusive and diverse health care system. One way to do that is through clinical trials. Clinical trials help create funding justifications for research to bring forward medical innovations and breakthroughs that improve the quality of care. More inclusive and diverse clinical trials could help ensure those improvements are for everyone – not just certain populations.

To conduct diverse clinical trials, you need diverse trial participants. Since patient outcomes and responses to treatment often vary among people of different races, ethnicities, and genders, clinical research needs to include people from different backgrounds.?

Dr. Gary Puckrein, President & CEO of The National Minority Quality Forum, and his organization are making progress in this area using data. They've created a database that includes five million patient records, including 38,000 US ZIP codes and 8,000 ZIP codes that represent diverse populations. Having this data in hand – and knowing who to target – empowers researchers to drive tangible results. We just need to connect the dots. To those who say it's too difficult to find people of color to take part in clinical trials, I say: Where are you looking?

What are we doing about it?

Health equity in clinical trials is an important area of focus to me and my colleagues at Roche. In fact, we've set a goal at Roche Diagnostics to achieve broad coverage and access for new diagnostics, supported by inclusive clinical trial design, within five years. And the Roche Group aims to double patient access to new, high-medical-value diagnostics solutions in 10 years.?

By setting goals like these, we show that, at Roche, health equity is not just a nice-to-have. It's a transformative business imperative. To support that imperative, in March, my team formed a Health Equity Squad to set goals and build committed, long-term coalitions that help build trust in communities. We're focused on the areas of cardiac health, women's health, Alzheimer's disease, and oncology. I already feel inspired by the dynamic leaders I've met as we've worked together to develop our strategy. Here are some of the exciting things we've been hearing:

• Quita Highsmith, VP and Chief Diversity Officer at Genentech, a member of the Roche Group, is leading a similar effort to improve health equity from a pharmaceutical perspective.
• Also, at Genentech, Nicole Richie, global head of health equity and population science, and Jenn Pangilinan, vice president, Genentech research and early development clinical operations, are talking about inclusivity in clinical trials .
• Dr. Jerome Adams, former U.S. Surgeon General, is Purdue University's first executive director of health equity initiatives and professor of practice in the Pharmacy Practice and Public Health departments.
• At Quest Diagnostics, Ruth Clements, vice president, general manager, Infectious Diseases & Immunology and Mandell Jackson vice president, general manager Quest For Health Equity, established Q4HE to build community coalitions and partnerships to close gaps in health equity in historically marginalized communities.?
• During the #2022 AACC Roche Idea Lab, Dr. Octivia Peck Palmer, President-Elect AACC, Dr. Gary Puckrein, President & CEO, National Minority Quality Forum, and Dr. Samira Saad, medical access partner, Roche Diagnostics, discuss: Inclusive by Design: How the lab can drive health equity and improve access. ???
• Dr. Brownsyne Tucker Edmonds, a clinician and health services researcher at IU School of Medicine, has been leading a task force on diversity, inclusion, and health equity in both leadership and research. Here's a podcast about her work building community coalitions .
• At Community Health Network, where I serve as a board member, Diane McDaniel, chief diversity, equity, and inclusion officer and Joyce Irwin, President and CEO, Community Health Network Foundation are creating a roadmap for equity and inclusion.

What can you do about it?

Health equity is a big topic, but don't let it intimidate you.

The first step toward improving equity in the health care system is to simply become more aware of the issue. If you haven't thought much about health equity – and inequity – lately, or if you've put it off, you've already made a first step by reading this blog. Thank you! I hope you'll keep reading about the topic.

Take a second step by digging deeper and finding out what's happening in your own community. Find one space or issue – even if it's small and local – and learn more about it. Bring up the topic where you work, worship, and volunteer. Talk to people. Make connections. Support diversity in your own health care choices. When you make charitable donations, consider supporting groups that work to improve health equity. Then keep tabs on how those organizations are making an impact. Not sure where to start? Here are some ideas from the Robert Wood Johnson Foundation.?

Another thing you can do is practice empathy. Think about how you'd like to see your own loved ones treated in a health care situation. Shouldn't every person – regardless of their background or the color of their skin – get the same treatment??