Merck Makes a Business Case for Diversity and Health Equity—Inside and Outside of its Walls | Deloitte US has been saved
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A Q&A with Merck’s leaders of social business innovation and social determinants
By Jodi Reynolds, managing director, and David Rabinowitz, senior manager, Deloitte Consulting LLP
Each year, up to 80% of clinical outcomes are impacted by drivers of health (also known as the social determinants of health, or SDOH). These factors include food security and nutrition, education, accessible and safe housing, employment, and transportation. As Merck’s first executive director of Social Determinants and Population Health within the Social Business Innovation team, Conrod Kelly is working to make health care more equitable while also helping colleagues and other business leaders appreciate the importance of addressing the health disparities that exist across therapeutic areas and geographies.
We recently spoke with Kelly and Carmen Villar, Merck’s vice president of Social Business Innovation, who created the new position. They offer their thoughts on what business leaders can do to improve health equity by acting within their own organizations, through their products and services, in the communities in which they operate, and via the broader ecosystem.
Jodi: What can business leaders do to improve diversity, equity, and inclusion, as well as health equity (fairness) and equality (treating everyone the same), within their organizations?
Carmen: At Merck, we have done well with racial and gender diversity on our board and executive team, but there is always more that we can do to build a more globally diverse and inclusive workforce. One of the ways organizations can do this is by taking a holistic approach and ensuring that diversity and inclusion are integrated into the various aspects of the business. Our approach centers on four primary areas:
With regard to health equity, across the globe, gaps in health are increasing—many of them caused by barriers at all levels of our society.1,2,3 It's hard for people to be healthy when they face economic, housing, health care, health insurance, and food-security challenges. Health equity means increasing opportunities for everyone to live their healthiest life possible, no matter who we are, where we live, or how much money we make. Industry has a significant role to play in health equity through economic inclusion, fighting for social justice, and strengthening the global communities it serves.
Jodi: Why is it important to have a more diverse workforce, and what are the challenges in getting there?
Conrod: The core values of almost every organization demand it. At Merck, our core values of integrity, fairness, and treating people with dignity and respect are strengthened through our commitment to diversity and inclusion. Most leaders will tell you that their people are their greatest assets. Diverse teams tend to be more innovative and produce better business results. Having the right culture, systems, and practices for talent recruitment, development, and retention is critical for companies that compete in a world where top talent is increasingly scarce and diverse. Companies simply cannot afford to miss out on critical insights and opportunities that more culturally innovative and adept competitors will undoubtedly seize upon. Diversity, equity, and inclusion therefore are ethical and strategic imperatives. Some of the challenges that organizations face [in advancing a culture of diversity, equity, and inclusion] are sustaining the momentum to institutionalize changes, developing and deploying organizational capabilities, building D&I capabilities in 1st and 2nd line managers, and managing the convergence of workplace ideals and beliefs.
David: You’ve said that business leaders might be able to reduce health disparities by supporting health equity. How are they connected?
Carmen: If you look at oncology as an example, there are racial health disparities in breast, prostate, and lung cancer outcomes,4 just to name a few. Companies with a presence in oncology should be taking steps to offer education focused on prevention and support efforts to increase access to screening, clinical trials, treatment, and survivor and caregiver resources to try to help more people survive—or even avoid—cancer. In the US, with a growing minority population that is disproportionately impacted by these cancers, there needs to be a sense of urgency by both public and private sectors. If some cancers are diagnosed in the earliest stages, we may be able to improve outcomes for patients and reduce health care costs.
Conrod: I want to emphasize a point Carmen made. Early diagnosis and treatment are especially important. People who don’t seek care for a disease until it gets serious might not be able to receive treatment that could have helped them better manage or even cure that condition. Addressing social determinants—and encouraging people to seek care earlier—can help ensure that a larger group of people benefit from screening, diagnosis, and the most effective treatments at the right time.
Jodi: What is the secret sauce to getting business leaders to buy into this idea?
Conrod: The first step is to provide the business case. The second step is to develop a small, cost-effective experiment with multiple stakeholders to demonstrate the impact of an intervention. If there is a positive outcome, then the idea should be scaled in a disciplined fashion. The ability to partner is critical to success. We’ve learned that no single organization is positioned to address the full range of needs associated with an SDOH solution, so the ecosystem is critical. What has been great about our efforts in this space has been the ability to collaborate with other organizations on potential SDOH solutions. For example, we are currently testing out a solution where we are partnering outside of Merck to assess and address the social determinants of patient health.
David: How has the COVID-19 pandemic helped to highlight the need to address health disparities and the social determinants of health?
Carmen: People in our industry, and people who work in public health, have been talking about social determinants of health for years. But the health disparities and health inequities we have seen with COVID-19 have really brought this issue to the forefront.
Conrod: The people who have been most directly affected by the pandemic—including essential workers—often live in poverty. They are living in multi-generational households. They are working essential jobs for low pay. They might not have reliable transportation, internet, or access to care. This is the root cause of higher infection rates in certain communities. It has often been said, “until all of us are safe, none of us are safe.” That’s particularly true for COVID-19. Unless we all have access to health, we are all going to be affected by the social and economic impact it creates.
Jodi: Some of the companies developing a COVID-19 vaccine are promoting the diversity of their clinical trials. Will this change how clinical trials are conducted in the future? Will they be more diverse?
Carmen: I would like to think so. We are working with providers to make our clinical trials more diverse. I think it could change how patients see clinical trials. It could lead to greater participation and different expectations. If potential clinical trial participants don’t see clinicians and researchers who look like them, why would they want to be involved in that trial? That is a key issue that we need to address—not only for COVID-19 trials, but as an industry as a whole.
Conrod: COVID presents a significant opportunity, but also poses some risk. I cannot remember another time in history when discussions about clinical trials, especially diversity in those trials, dominated the news cycle. This creates an amazing opportunity to talk with people about the value and risk of clinical trials. However, there will undoubtedly be misinformation on the subject as well. Overall, I believe it is net positive that consumers will want to know about the gender and ethnic diversity in the clinical trials for an approved drug. I see this as being a component of reducing health disparities.
David: How can you help business leaders understand the importance of health equity?
Carmen: I took for granted that everyone understood these issues. Growing up, inequities were just a part of daily life. I grew up with my grandmother waiting for her monthly Social Security check, and I watched how she had to carefully manage her spending. But if you haven’t ever had that type of experience, it might be difficult to understand the impact social determinants have on access to health care.
Conrod: Helping business leaders understand the importance of health equity begins with aligning everyone around an agreed upon definition. Some definitions exclude the important aspect of removing obstacles to health and reducing—and ultimately eliminating—disparities in health that adversely affect excluded or marginalized groups. Pursuing equity often involves a lengthy process that must strategically engage diverse stakeholders, each with their own agenda, making it easier to go off course. Once you have alignment, you need the one-two punch of data and personal stories or experiences, like Carmen’s, to activate the heart and mind. It really helps to take company leaders into these communities to experience the realities that individuals and families face. Walk the neighborhood, go into their homes, listen to their stories, and bring their insights back to the office to help inform solutions.
This article is part of an ongoing series of interviews with health executives. The executives’ participation in this article are solely for educational purposes based on their knowledge of the subject and the views expressed by them are solely their own. This article should not be deemed or construed to be for the purpose of soliciting business for any of the companies mentioned, nor does Deloitte advocate or endorse the services or products provided by these companies.
1. Tracking the COVID-19 recession’s effects on food, housing, and employment hardships, Center on Budget and Policy Priorities, November 9, 2020
2. Removing barriers and disparities in health: lessons from the COVID-19 pandemic, Nature, October 7, 2020
3. Failing another national stress test on health disparities, JAMA, April 15, 2020
4. Cancer disparities, National Institutes of Health/National Cancer Institute, November 17, 2020