Conversations regarding health equity are sprouting up all over the medical community in light of the disparities in COVID-19 outcomes, but there are still a lot of misconceptions about the topic.
“I think that some of the orthodoxies we have about health equity we need to debunk. One of them, especially in this highly polarized political environment that we are living with, is that health equity is a political issue. What we really start with is that health equity is a moral imperative that requires a business solution,” Dr. Kulleni Gebreyes, director of Deloitte’s Health Equity Institute, told MobiHealthNews.
There is also a lack of ownership around who should be addressing these issues.
“The second largest barrier that stands in our way is there is a notion somewhere in the back of our heads that health equity is a public health issue and not necessarily a healthcare organization, a life science organization or business [issue]. I’m always stating that if you are in business and you employ people, if you are a taxpayer, if you are an individual taking care of your family, we are all in the business of healthcare. Health equity is important to all of us.”
Gebreyes and her team at Deloitte pinpointed four main focus areas for organizations to focus on when it comes to addressing health equity. The first focus is looking internally.
“So it’s understanding who’s in my workforce. Do I have appropriate representation? Do I have equitable policies to advance people, to train, to recruit?” she said. “Are my employees dealing with issues related to social determinants of health?”
Next she recommends companies look at the products and services they are delivering and evaluate if they meet the needs of their target population. For example, are health systems operating in the hours when their patients can make an appointment?
“The third one would be community, which is for any community that an organization has offices or where their employees live. Are they being good citizens? Are they supporting community initiatives? Are they partnering with local organizations to have the right partnerships?”
Gebreyes also encourages companies to pay attention to who they work with to promote health equity.
“Each one of us as an organization has vendors and has relationships with other suppliers. And so, how are we propagating our value system and the ability to deliver on health equity by having supplier diversity, by engaging with companies that are focused on sustainable ways of doing business?”
The medical community still has a long way to go when it comes to equity. A recent Deloitte study found that 55% of patients of color surveyed reported a negative experience where they lost trust in a healthcare provider.
Gebreyes said that listening is a key part of learning. Questioning the status quo is also important.
“What I would ask all business leaders to do is, (A) when you’re designing and making decisions of operation, process experience, what is the ‘normal’ that you’re designing around? And perhaps that should be diversified? Number two is to make sure that your workforce actually represents the community that you serve, because you will have more appropriate representation and ideas that come to you that help you understand how others might perceive or experience care,” she said.
One of the patient priorities that emerged from this survey was seeing doctors or providers with similar backgrounds. In fact, the report said that two out of three participants that identified as Black or African American, and half of Asian or Hispanic responders, said it was important to see a healthcare provider similar to them.
Gebreyes said there is often a misconception that, if you are caring for large populations of Asian, Hispanic or African American patients, there aren’t enough competent providers and professionals to match that background.
“That simply is not true. And so, what I would ask organizations to do is think about where they are recruiting from? What schools are they going to? Which professional associations are they going to, which recruiter companies are they tapping onto?”
“There’s also data that shows that not only is a provider more likely to show empathy or at least make the recipient feel like empathy, clinical outcomes are also different and fatalities higher where there is racial discrepancy.”
To tech or not to tech?
When it comes to health equity, there has been a lot of conversation around how digital health can help. However, if not implemented correctly, tech can create disparities.
“I look at technology the way that early humans looked at any tool,” Gebreyes said. “You can have a hammer or a sling or any other tool and you can use it for good, or you can use it to cause harm. And so I think technology has the potential to actually address some of the core issues that we have in health equity, such as access to care. It has the ability to make information more readily available for all. It has information to help us deliver culturally competent care.”
On the other hand, she said that there can be issues with delivering care digitally. For example, not all folks have access to broadband. There are also a number of concerns when it comes to artificial intelligence. Specifically, algorithms can be developed based on biased data.
“Digital enablement is critical for us to both improve quality and lower the costs. But we have to do it in a way that has equity principles at the center. Otherwise it will unintentionally call additional disparities and not equity,” she said.