Leaning into health equity can be good for business and society

Jay Bhatt, D.O., managing director of the Deloitte Health Equity Institute and the Deloitte Center for Health Solutions, Deloitte Services, LP

It has been a year since Deloitte’s actuarial team pinned a $320 billion price tag to health inequities. We concluded that if health inequities aren’t addressed, this avoidable expense could triple to $1 trillion by 2040—or about $3,000 a year for every person (see The economic cost of health disparities). Other organizations have come to similar conclusions. In May, the National Institute on Minority Health and Health Disparities (part of the National Institutes of Health) estimated the cost of racial and ethnic health disparities at $451 billion.¹ Last September, the Satcher Health Leadership Institute, and Morehouse School of Medicine published The Economic Burden of Mental Health Inequities in the United States.² This report highlighted the cost of inequities in mental and behavioral health among indigenous populations and racial and ethnic marginalized groups.

Health equity is both a moral and financial crisis that likely can only be solved through a multi-stakeholder, ecosystem approach.

I recently participated in a panel discussion at the Aspen Institute’s 10th Annual Aspen Ideas: Health 2023 conference where we explored the root causes of health disparities and the role diverse and committed stakeholders could play in creating meaningful change. Sheila Davis, Ph.D., CEO of Partners in Health, a Boston-based non-profit, moderated the panel.

Julie Kim, president of the US business unit and US Country Head at Takeda, said that no company or sector can solve health equity on its own. Instead, it will require a commitment and collaboration from stakeholders from across the private-public spectrum. Megan Ranney, M.D., an emergency room physician and Dean of the Yale School of Public Health, agreed and said, “there is no way health inequities can be eliminated through a single-sector approach.” For example, while the Supplemental Nutrition Assistance Program (SNAP) benefits might make groceries more affordable, access to healthy food might also require a grocery store chain to identify food deserts and open stores in those neighborhoods. Employers might need to talk with workers to make sure they have access to affordable and healthy food or make healthy food available on-site. Non-profits could help ensure that people in their communities have access to culturally appropriate fresh food.

Tawana Thomas-Johnson, senior vice president and chief diversity officer at the American Cancer Society (ACS), said her organization is part of a $25 million, multi-stakeholder, four-year initiative to address health equity. A financial commitment from Bank of America helped to establish the Collaboration for Equitable Health (the Collaboration), which is now in its second year. Other participating stakeholders include the American Heart Association, the American Diabetes Association, and the University of Michigan School of Public Health. The Collaboration is working to advance health equity at the community level in 11 markets across the country,³ she said. It is focusing on the leading causes of death (e.g., heart disease, cancer, stroke, diabetes) within certain racial and ethnic populations. It is also looking at ways to improve health outcomes more broadly, including in mental wellness and nutrition.

Four things to consider when addressing health equity

During the discussion, my fellow panelists stressed several points that stakeholders should consider when trying to address health equity. Here are a few of them:

• Understand that some beliefs can be difficult to change: Structural racism can be a key factor in health inequities. Julie recalled a conversation she had with a young Black woman who had Crohn’s disease. Despite having symptoms of the disease, her physician told her that Black people don’t get Crohn’s disease and suggested over-the-counter medications. While Crohn's disease is most common among white populations, the disease is found in all racial groups worldwide.
• Measure the right outcomes: Megan noted that she volunteered with the Peace Corps before going to medical school. In an attempt to ensure access to clean water, aid groups installed water pumps. Despite the best intentions, the local population was not taught how to fix broken pumps, nor were they provided with spare parts. Rather than counting the number of people who had access to clean water, the groups only counted the number of pumps that had been installed. By that measure, the program was a success. Initiatives to improve health equity, she said, need to measure outcomes over the long-term. The ultimate measure of health equity is whether the initiatives reflect the needs of the community, she added.
• Share data and/or results with the community: Sharing the data with the community is important, but it's a step that's often overlooked when it comes to many of the research projects, Tawana said. She recalled working in a city that had high breast cancer mortality rates. Her colleagues went into the community to gather data from survivors. They learned later that community members were frustrated that they never heard anything about how the data was used or what was learned.  “The team had to spend a lot of time undoing the damage that had been done because data had not been shared with the community,” she said.
• Be aware of stakeholder dynamics: When working with a diverse group of stakeholders, it is important to be mindful of everyone’s perspective, talent, and contribution, Twana said. Megan agreed and said it is important to know when to take a step back and amplify the voices of stakeholders that represent the community.

Ecosystem approach could lead to more healthy years

Every organization that has employees is a health company. Along with helping to make health more equitable, an ecosystem approach—led by employers—might also help employees live longer, healthier, and more productive lives, according to our latest research (see How employers can spark a movement to help us live longer and healthier lives). We concluded that Americans could live 95% of their life in good health if employers create a healthy and positive work environment that considers the physical, mental, social, and emotional health of their workers inside and outside of the workplace. Such initiatives can increase employee productivity and retention—and help improve the overall success of the business. While employers can be the catalyst for change, they can’t do it alone. All ecosystem stakeholders—including employers, the life sciences and health care industries, public health, and individuals—will likely need to work together toward a common goal of improving the health of all employees.

Some people seem to think that changing the existing health care system is the key to making health more equitable. But Megan explained it is more than that. “Yes, we need greater representation of Black men and women as physicians, nurses, and social workers. And of course, we need to dismantle our historic and ongoing structural racism within the health care system and make sure people have access to great care in a place where they feel comfortable and safe. But that is the tip of the iceberg,” she said. In terms of creating health equity, systemic and environmental change is essential. But that is likely only achievable through multi-sector partnerships and financial commitments from the private sector, she said.

Deloitte, Takeda and the American Cancer Society are among the first 39 organizations to sign the Global Health Equity Network Zero Health Gaps Pledge at the World Economic Forum Annual 2023 Meeting in Davos. All organizations can play a role in advancing health equity and eliminating disparities in health and wellbeing outcomes between and within countries. This is a business strength and a moral imperative. People tend to look at health equity from a deficit mindset. Instead, it should be seen as an opportunity for growth. Value can be created when organizations lean into health equity.

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Endnotes:

¹ NIH-funded study highlights the financial toll of health disparities in the United States, NIH, May 16, 2023

² The economic burden of  mental health inequities, Satcher Health Leadership Institute, September 9, 2022

³ Collaboration between leading health organizations aims to improve health outcomes, press release, Bank of America, May 6, 2022

⁴ Crohn's disease in Black patients, National Institutes of Health

⁵ 39 organizations pledge to close gaps on global health equity, press release, World Economic Forum, January 19, 2023

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