The business case for health equity in life sciences

By Drew Wilkins, managing director, Deloitte Consulting, LLP

When I was 10 years old, I was diagnosed with Type 1 diabetes and hospitalized. I shared a room with another boy who had the same condition. We were about the same age, but the curtain dividing the room wasn’t the only thing that separated us. He was Black, and I am white, and we came from different socioeconomic backgrounds. I remember stark differences in the way we were treated. For example, the staff had a difficult time getting his blood sugar down. I could hear the nurses scolding him because they assumed his mother was sneaking in cookies or candy. (As far as I know, she wasn’t.) I’m sure that experience left a lasting impression on him…just as it has on me. I didn’t keep in touch with my hospital roommate, but I think of him often as I navigate my health, and whenever I read about racial disparities in diabetes. Given my race and background, I suspect that I have had an easier time accessing care and managing the disease.

Health equity is an issue that all stakeholders, including life sciences companies, have moral obligation to address. It is undoubtedly the right thing to do. But there is also a business case to be made in helping people access the care they need. We estimate that some of our life sciences clients could see at least a 10-to-1 return on investment by supporting access to care in underserved markets and by working to ensure that all patients—regardless of race, ethnicity, age, sex, or socioeconomic status—have access to the devices and therapies they need. Along with broadening the patient populations served, a focus on health equity could also enhance a company’s brand and reputation in the market.

Medical device manufacturers and biopharmaceutical companies spend billions of dollars developing and marketing new devices and therapies that are lifesaving or life changing. However, if those products don’t reach all of the people who need them, companies miss important (and potentially large) markets, thereby sub-optimizing their investment in the product. Making inroads into these new markets, however, will likely require novel approaches. Manufacturers should consider changing their approaches to be focused on grassroots, community-based efforts with patients, physicians, and community centers, but they must be designed to scale. Building trust, reducing unconscious bias, driving education, and creating personal connections could help companies step into new markets and extend the reach of their products.

Many life sciences companies are already working to develop products that are aimed at more diverse populations. Biopharmaceutical companies, for example, have recognized the importance of diversity in clinical trials and are increasingly focused on attracting a deeper pool of trial participants (see Enhancing clinical trial diversity). In addition, the Food and Drug Administration’s guiding principles for Good Machine Learning Practice for Medical Device Development highlights the importance of addressing and mitigating bias (see Rethinking when and how to use race appropriately in care delivery).

Costs of health inequities could top $1 trillion by 2040
 

Structural racism and systemic bias are among the underlying root causes of many inequities including economic inequality, limited access to health care, and food insecurity. Such health disparities have made certain ethnic and minority populations, as well as people who live in rural areas, more susceptible to preventable illnesses. Health inequities cost the US health system about $320 billion a year, according to an analysis of several high-cost diseases. If health equity isn’t addressed, the cost of health inequities could top $1 trillion by 2040 (see our report on the Economic cost of health disparities.)

Let’s consider diabetes: The US spends about $320 billion a year treating diabetes. Black adults are 60% more likely than white adults to be diagnosed with diabetes. Black people are also twice as likely as white people to die from the disease and are more likely to have end stage renal disease (ESRD).^{1, 2} Access barriers to leading treatments and technologies exacerbate the impact. Only 18% of Black young adults with Type 1 diabetes use technology to manage their diabetes (versus 72% of white Americans). Diabetes is a deadly disease, but it is highly manageable with the right tools. If treatments were equitable, about $15 billion a year could be saved, according to Deloitte research. More importantly, lives would be saved and changed.

Breaking barriers could open new markets
 

Health equity is a common topic when I meet with life sciences clients. While most of them understand the importance of addressing this issue, few of them see it as a business imperative beyond doing the right thing. I believe there is a strong business case for life sciences companies to drive health equity. Making equity a top priority will likely require companies to develop strategies to overcome the following barriers that can limit access to their products:
 

• Unconscious bias: Most physicians want to do the right thing. But unconscious biases among some physicians can make health less equitable for certain populations. For example, some doctors might not be willing to write a prescription if they don’t think the patient can afford it or won’t comply with the treatment protocol because of race, ethnicity, or socioeconomic factors.

Strategy: Life sciences companies should try to educate clinicians about the impact unconscious biases can have when it comes to prescribing medications and suggesting treatments. Peer-to-peer examples of success in reaching underserved populations can be a powerful tool.

• Technology: Digital technologies have made it easier to monitor and manage health conditions. But underrepresented populations that don’t have access to such technology can have poor health outcomes. As health care becomes more digital, the gap between the haves and the have nots could widen.

Strategy: Life sciences companies could educate clinicians about the value of digital tools for all patient populations. Clinicians should be able to explain how to use a device and waylay fears about technology.

• Trust: I’m not surprised that some people don’t fully trust the government, health care organizations, or life sciences companies. Historical atrocities (e.g., the Tuskegee Syphilis Study) fueled distrust in the Black community, which is amplified by everyday racism, negative personal experiences (like those of my former hospital roommate), rumors, or traditions.

Strategy: Life sciences companies might build trust by forging relationships with local community leaders and with trusted organizations (e.g., churches, barbershops) that serve those communities. (See Rebuilding trust in health care.)

• Language: At least 350 different languages are spoken in US homes, according to the US Census Bureau, and more than 65 million people in the US have limited English proficiency. Many medical devices are aimed at English-speaking consumers, and directions for prescription drugs tend to be written only in English.

Strategy: Companies should look for ways to tailor their products to the needs of diverse patients. In addition to language, they should also consider cultural nuances rather than translations from English alone.

• Health coverage: The tiered health insurance system in the US can make it difficult for everyone to have access to the same therapies and medical devices. High deductibles, for example, could put some devices and therapies out of reach for some patients. But putting off needed care could turn a preventable or treatable illness into one that is difficult and/or expensive to manage.

Strategy: Innovative access strategies designed to open doors to medications and technologies (including the education required to support them) are critical. This includes reducing immediate and lasting financial barriers.

It has been more than 30 years since I was diagnosed with diabetes. During that time, there have been some amazing advances in the way we treat the disease. However, health inequity was an issue back then and continues to negatively impact patients today. Life sciences companies have an opportunity to do the right thing, and to unlock growth, by helping all patients access medical devices and get the medications and treatments they need and deserve. My hope is that by demonstrating the positive business case for investing in health equity, commercial life sciences organizations will see the opportunity to do well by doing good.

Endnotes:

¹ National Vital Statistics Reports, Deaths: Final data for 2017, National Center for Health Statistics, June 24, 2019; National Healthcare Quality and Disparities Reports, Data Query

² Racial-ethic inequality in young adults with Type 1 diabetes. The Journal of Clinical Endocrinology & Metabolism, August 2020

This publication contains general information only and Deloitte is not, by means of this publication, rendering accounting, business, financial, investment, legal, tax, or other professional advice or services. This publication is not a substitute for such professional advice or services, nor should it be used as a basis for any decision or action that may affect your business. Before making any decision or taking any action that may affect your business, you should consult a qualified professional advisor.
 

Deloitte shall not be responsible for any loss sustained by any person who relies on this publication.

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