Pharma USA 2021

May 25, 2021 - May 27, 2021, Digital Conference, Networking and Exhibition

North America’s premier gathering for pharma pioneers and health innovators

Building a health equity culture

Health inequities, often a legacy of racism, lie heavy on the healthcare sector in the US and beyond. Fixing the problem will require long-term effort on multiple fronts



If ever there were a time to begin to seriously address the issue of health equity it is now. 2020 is the year the Black Lives Matter movement caught the world’s attention and COVID-19 disproportionately laid low people from certain ethnicities, highlighting the inequities suffered in particular by Black Americans.
 
Harvard-trained emergency medicine physician Dr. Uché Blackstock, one of the leading voices on health disparities and equity in the US, urges the entire healthcare sector not to let this opportunity to drive lasting change slip away.
 
“It's an unprecedented moment and we're having conversations that we haven't had in my lifetime, in a very candid and open way,” says Blackstock. “I'm hoping that out of this moment we can create some change that will actually benefit everyone. Racism harms all of us in multiple ways, whether we realise it or not.”
 
A dramatic year has shone the light on injustices that are long term and deeply entrenched. The data are clear that some communities fare far worse than others when it comes to health outcomes, says Blackstock.
 
The experience of Black Americans is an especially salutary example of the healthcare costs of a deeply engrained legacy of racism and disastrous social engineering. Arguably the most insidious has been the policy of ‘red lining’ - the 1930s house zoning policies that entrenched inequality, notably for Black Americans. Its legacy still holds these communities back almost a century later.
 
The resulting problems today are broad. “Neighbourhoods that were redlined in the 1930s, today have the shortest life expectancies, have the highest asthma and diabetes rates, the highest infant mortality rates,” says Blackstock.
 
These communities face worse access, may be reluctant to engage because of a lack of trust in healthcare and pharmaceutical sectors, have little representation inside such sectors, especially at a leadership level and have much lower participation rates in trials.
 
What should the healthcare and life sciences sectors do about inequality that is so broad, deep and multifaceted? 
 
Blackstock, who conducts racial equity and culture assessments and audits for a range of organisations, including evaluating policies and practices, including hiring, retention and promotion, has a range of suggestions for creating an environment where a diverse workforce can be nurtured.
 
Think in decades-long timescales
Making the deep and lasting structural changes that will improve access and outcomes is a process that will take years and decades, says Blackstock. “This is a long-term commitment. We have a paucity of healthcare professionals of colour. This is not going to change overnight, so it's going to take a long-standing commitment.”
 
Set the tone from the top down
This process must be led from the top but also embedded throughout the organisation, she says. “It starts with the leadership. It has to be a value and a priority of whoever is leading that organisation [so that] it ultimately trickles down to the rest of the organisation.
 
“And it has to be intentional. It cannot be an afterthought. A lot of times organisations think by hiring a chief diversity officer that is going to fix things but that is merely a Band-Aid. You cannot put centuries of work on one person. It has to be embedded in almost every role of the organisation.”
 
Set the right metrics and track them
Every organisation should establish mechanisms for assessing how it is performing to its long-term health equity goals over time, says Blackstock. “That top down looking at practices and policies, keeping track of the data in terms of the kind of representation you want to have within your organisation in terms of women, in terms of people of color.”
 
Surveying the communities you want to serve better to gather metrics on outcomes that matter to that community is an important part of this process, she adds. “It's important to think about the communities that healthcare professionals are engaging with. Getting the perspective of people who use your products, people who come to your healthcare institutions is incredibly important.
 
“Whether you do that in terms of surveys, in terms of focus groups, in terms of interviews, you need to collect that data because you need to make sure that you're not missing potential blind spots.”
 
This should also include looking at metrics on different groups within a particular community are doing in terms of their health outcomes, she says. “How are diabetics doing? How are patients with hypertension doing?  I know a lot of organisations are doing that and then just aggregating it by different demographics, such as race, gender, socioeconomics, to actually see if everyone is receiving equitable care.”
 
Engage to broaden research participation
The lack of participation among Black Americans in particular in clinical trials is a long-standing failure commonly acknowledge in the healthcare and life sciences sector. Fixing this requires engaging closely with under-represented communities.
 
Suspicion of research work among them, given a history of profiteering, abuses and downright atrocities that are well known. Overcoming suspicion is possible, however. “A lot of the data shows that if participants are fully informed about the benefits of a trial to them as an individual, to their communities, to the greater good [then] actually Black and Latin X patients are more [likely] than white patients to sign up for the trials,” says Blackstock. 
 
But this cannot be done without the right outreach and messaging, she adds. This means engaging with community-based organisations that are already on the ground in these communities, that are led by trusted leaders.
 
Reaching the doctors serving these communities is also important. “Usually it's the physicians that are enrolling patients and their community physicians. How do they talk to their patients? How do they recruit them?”
 
The practical difficulties these communities face in participating in trials also matters, adds Blackstock. “It’s important to think about what these participants need to be able to engage in the trial successfully. 
 
“If they're working during the day, do we need to have after hours where the clinic is open so they could come and participate. Do they need resources for the bus or the train to actually get to the clinical site?  All the social determinants of health, it's all linked to whether or not these participants can, can engage with a trial.”
 
Create opportunities for minority groups
A big part of the problem of a lack of representation among minority groups is the lack of role models to which young people within them can aspire. Fixing this catch-22 is important, she says. 
 
“We have to think about the pipeline of people going into medicine, and also the care that we're providing. The reasons we have racial health inequities are the same reasons why we have a paucity of black physicians.”
Progress has been especially slow here, as she knows first hand from family experience. “The numbers haven't really budged that much over the last few decades, even since my mom was in medical school.”
 
Levelling the playing field will include re-examining existing selection processes and criteria that may include hidden biases that contribute to the exclusion of minority groups, says Blackstock. “We need to think about how to give other people opportunities, people who have not been traditionally in that role a chance. 
 
“Having structured processes, having predetermined interview questions or, predetermined criteria to evaluate employees is really important because a lot of times whether we realise it or not, we bring our biases into these situations.”
 
Affirmative action is an important component of addressing healthcare inequities, Blackstock believes. “My mother was one of the first classes at Harvard medical school to benefit from these, diversity initiatives, essentially affirmative action policies. 
 
“We know these policies have become, incredibly controversial, but I am a huge proponent of affirmative action especially in healthcare, because we've seen what happens when we don't have healthcare professionals that look like their patients. We have these very profound, appalling, health inequities.”
 
Dr Blackstock was speaking to the NYC Health Business Leaders network (www.nychbl.com). See the full interview here: https://www.youtube.com/watch?v=GPx-v9p2cxE&feature=youtu.be
 

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Pharma USA 2021

May 25, 2021 - May 27, 2021, Digital Conference, Networking and Exhibition

North America’s premier gathering for pharma pioneers and health innovators