Health Inequity is a Chronic Condition | Deloitte US has been saved
By Jay Bhatt, D.O., managing director of the Deloitte Health Equity Institute and the Deloitte Center for Health Solutions, Deloitte Services, LP
During a recent snowy Saturday in Chicago, I had the opportunity to moderate a panel on health equity at the annual Kellogg Business of Healthcare Conference at Northwestern University.
While it is typically discussed in terms of race and ethnicity, health equity is much broader. It can extend to gender, people who have disabilities, veterans, and the 20% of Americans who live in rural communities (see Advancing health equity through community-based ecosystems). Everyone, regardless of who they are or their circumstances, should have an opportunity to achieve their highest potential for health and well-being.
Health inequities are particularly apparent in kidney care, said Danelle Radney, director of health equity at DaVita, a kidney care company. She noted that about 99% of dialysis patients have access to health insurance.1 But despite health coverage and support from social workers and dieticians, there are “huge inequities within the kidney care space,” she said. While Black Americans represent 13% of the US population, they make up more than 30% of the kidney disease population.2
Consider this: Over the past 20 years, the estimated Glomerular Filtration Rate (eGFR) has been widely used to determine kidney function. It combines a blood test with a patient’s characteristics (e.g., age, height, gender, weight, and race).3 The method has been shown to be inherently imprecise and biased because it assigns Black patients a significantly higher kidney function than white patients. This makes the kidneys of some Black patients appear healthier than they are, which can delay diagnoses and treatment. It can also negatively affect where patients are on organ transplant lists, according to the National Kidney Foundation.
Despite the algorithm’s proven bias, it can be difficult to convince some organizations to change. Derek J. Robinson, M.D., chief medical officer at Blue Cross and Blue Shield of Illinois (a Division of Health Care Service Corporation), recalled a March 2021 conversation he had with physician leaders at a national laboratory that still used the race-based modifier in lab reports to calculate kidney function. “The company tried to convince me—an African American practicing physician—that this race modifier was actually good for Black patients because doctors would be more likely to prescribe the diabetes medication Metformin to those with diabetes,” he said. “Systemic racism in health care is insidious and far reaching. We must have the courage to have difficult conversations and lead the change that is necessary. I have seen it happen and we should celebrate these successes.” 4
Can barriers to health equity be broken?
The panel raised questions about some of the systemic and structural barriers that may contribute to health inequities and offered thoughts on how those barriers might be removed. Here’s an overview of some of the topics we discussed:
Health equity is everyone’s business
The cost of health inequities is $320 billion today, which could more than triple to $1 trillion by 2040 if no changes are made (see our report on the Economic cost of health disparities). Danelle said the private sector has a responsibility to look for ways to improve health equity. “Health equity should be integrated into the fabric of how we do health care,” she said.
Over the past year, the Deloitte Health Equity Institute (DHEI) has launched numerous cross-sector collaborations to help advance health equity. An article in the latest issue of the Journal of Health Care for the Poor and Underserved, highlights a collaborative effort between the DHEI, CommonSpirit Health, and Get Well that helped boost COVID-19 vaccination rates in two geographically distinct locations (see Multi-sector collaboration leads to successful vaccination-outreach program). Early this year at the World Economic Forum’s Annual meeting in Davos, Switzerland, Deloitte Global joined 38 other organizations in signing the Global Health Equity Network Zero Health Gaps Pledge. The Pledge is a commitment to help advance health equity and support better health outcomes. Participants included a wide range of companies from the private sector.
Health inequity is a chronic condition in the US. As organizations work to try to make health more equitable, they should consider the following steps…and questions:
Kristin told attendees that achieving health equity seems like an insurmountable challenge, but added that “many small steps, over time, in the right direction, can eventually turn into huge leaps.”
1 Insurance and costs for dialysis, American Kidney Fund
2 Race, ethnicity, and kidney disease, National Institute of Diabetes and Digestive and Kidney Diseases
3 Removing race from estimates of kidney function, National Kidney Foundation, March 9, 2021
4 Chronic Kidney Disease: Examining Health Disparities in Communities of Color, Blue Cross and Blue Shield of Illinois, June 24, 2022; Rethinking race modifiers, Blue Review, September 21, 2021
5 Housing and health: A roadmap for the future, the American Hospital Association, March 2021
6 Higher bills are leading Americans to delay medical care, The New York Times, February 16, 2023
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