Life sciences firms can combine business with health equity

By Drew Wilkins, managing director, Deloitte Consulting, LLP, and Jenny Jarboe, manager, Deloitte Consulting LLP

The murder of George Floyd in 2020 was an instigating event. It inspired protests around the world and raised awareness about systemic racism and inequity. That event, combined with health disparities related to COVID-19, pushed life sciences, health care, and other industries to make investments—and assemble teams—to address health inequities. While results can be difficult to measure, these efforts do not appear to have generated a return on investment (ROI). As a result, some organizations have taken their foot off the gas.¹

While 16% of recently surveyed life sciences executives expect health equity will have a “great impact” on their organizations this year, 41% predicted it would have “no impact,” according to the Deloitte Center for Health Solutions’ 2024 Health Equity Outlook survey.

Health equity should not be viewed as a side project. It should be seen as a core part of the mission for life sciences (and health care) organizations (see our 2024 Outlook for health equity). Health equity is a pillar that can support the long-term commercial and purpose-related success of a company. It should be viewed a central part of the business’ ethos, strategy, and operations—similar to efforts to reduce a company’s carbon footprint.

Health equity and the ‘hype cycle’

There is often a good deal of excitement around an innovation or new idea. But after a while, that excitement can dissipate before it fully takes hold. This has been described as a “hype cycle”, which is what some health equity efforts appear to be experiencing.² Once the novelty of an innovation reaches its so-called “peak of inflated expectations,” interest tends to fall into the “trough of disillusionment” where questions arise about the ROI and whether the innovation can live up to expectations. It can take time to work through a new idea, figure it out, and build the right use-cases. Companies should continue to tie health equity to their core business efforts as they start to climb the “slope of enlightenment,” and, eventually, the “plateau of productivity,” where the innovation goes mainstream, and impact is realized. This cycle can take years to play out.

A cynic might say that some industry leaders gave up on health equity once they realized that making real change is too difficult. But an optimist would likely understand there is no easy fix to a challenge as complex and deeply rooted as health inequity. As we have written previously, there is a strong business case for ensuring that all patients—regardless of race, ethnicity, age, sex, or socioeconomic status—have access to the devices and therapies they need (see The business case for health equity in life sciences). Some life sciences organizations have only begun to help the people who might benefit from their products. The life sciences industry will likely continue to work through the trough of disillusionment and into the slope of enlightenment.

Specialty drugs, climate change, and AI can impact the health equity gap

The life sciences sector has made some progress in raising awareness and in improving health equity. However, there are a number of competing business issues that might seem more important, and easier to address. Such issues include the shift in portfolios to more specialized therapies, climate change, and the rise of artificial intelligence (AI). All three of these issues, however, are closely linked to health equity. Here is a look at actions company leaders can consider:

• Specialty therapies and health equity: The biopharma sector is increasing the number and proportion of specialized drugs in the pipeline to treat rare and complex diseases. Almost half of the products now in development are specialized therapies.³ These products tend to have smaller patient populations and can be more difficult to administer. This means biopharma companies may need to do more to get patients on a therapy and drive adherence. These patients may need support beyond traditional copay/free-drug programs such as access to diagnostic tests, help in navigating complex benefit structures, and financial support for time away from work or to cover travel logistics. This can be further complicated by the systemic challenges that exist in our system that magnify barriers to care. What can life sciences companies do to help ensure specialty therapies are accessible to everyone who needs them?
  
  Proposed action: Biopharmaceutical companies should examine the challenges that eligible populations may face in accessing specialized therapies. Those companies should consider building tailored strategies to help potential patients access treatments. This could be especially important for therapies that support small patient cohorts. While traditional strategies like copayment-support can be important, novel tactics that are tailored to an individual patient’s need can make the treatment more accessible and equitable. This can include patient-focused tactics and innovative financing mechanisms. It might also require pan-ecosystem solutions, like working with payers, providers, and community organizations to reach patients and to break down more systemic challenges (e.g., unconscious bias) at a wide range of health care settings (e.g., pharmacies, treatment centers, ambulatory care sites) and geographies.
• Climate change and health equity: A warming planet is putting some of the most vulnerable populations at increased risk. Climate change, for example, has had a negative impact on air quality and related respiratory diseases. It has increased the prevalence of heat-induced illnesses and allowed some infectious diseases to spread more easily (see, The Intersection of equity, health, and environment). In addition, climate change has also made supply chains more vulnerable (see Digitized supply chains are essential to biopharma's future). When supply chains are disrupted, it can be difficult to ensure that essential medicines, vaccines, and other supplies reach the people who need them.⁴ As companies implement strategies to counter climate change, they should consider the impact those strategies could have on vulnerable populations. For example, with an increased use of electric vehicles, we could see fewer gas stations.⁵ That could create new challenges for people who rely on older, gas-powered cars for transportation or who rely on gas stations for groceries. This shift has the potential to further isolate at-risk populations by creating health deserts, food deserts, and gas or electrical deserts. Efforts by life sciences companies to address climate change could also have unintended consequences.
  
  Proposed action: Companies should link their climate strategies to efforts related to improving health equity and access. This could include examining how health, food, and gas deserts could impact vulnerable populations. It also could include strategies that bring health solutions and access closer to patients (see Advancing health through alternative sites of care) . This may require working with ecosystem providers to broaden the definition of who can be considered a prescriber. Life sciences organizations should be able to help reach new patients who need treatments. This strategy might require companies to improve their community relationships and shift from transactional interactions to true engagement. Additionally, life sciences companies should evaluate supply chain risks that could arise with climate change and plan proactively to ensure vaccines and therapies can reach patients even when supply chains are disrupted. Resilient access and distribution processes should be able to withstand climate impacts on supply chains. Some pharmaceutical manufacturers, for example, are starting to recognize the importance of sustainable supply chains; 57% say they are in the process of designing sustainable supply chains (see Lowering pharma's climate impact).
• Artificial intelligence: Slightly more than half of low-income Americans, who make up roughly one-eighth of the population, have basic digital literacy.⁶ Additionally, a lot has been written about the potential for bias (including amplification of existing systemic biases) in AI that will likely impact populations that already face health inequities. If AI implementations are not built in transparent ways that engender community trust, the technology could further increase the digital divide and exacerbate existing health inequities. The rapid adoption of cell phones, for example, created disparities until cellphones became affordable for more people. Often major technological shifts create haves and have-nots. How can life sciences companies help ensure that biases don’t become integrated into this new technology while using AI to help reach populations who are not actively engaged in their health?
  
  Proposed action: Life sciences companies should consider using diverse teams in developing AI applications, including conducting bias evaluations. Generative AI could be used to help pinpoint personalized access and financial-support options and connect patients to care (e.g., via integration with hub models or development of new open-source search tools), which could help make care more accessible and equitable. AI and predictive analytics could also be used to identify and treat disease in the earliest stages, which can reduce long-term cost of care. The National Institutes of Health, for example, is funding predictive analytics of heart disease using AI, which could help people who are not able to regularly see a physician. Finally, ensuring the technology has been thoughtfully implemented, with community trust and education, is important to avoid making existing inequities worse.

Conclusion

Life sciences companies should continue to think about how commercialization models can allow them to reach all populations and help ensure that populations don’t become more isolated. Life sciences companies that figure this out are likely to gain a competitive advantage in terms of market size, revenue and, importantly, their reputation with patients, providers, regulators, and the general public. They could also put them in a better position to get their products to the patients who need them the most.

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Endnotes:

^{1_{Where is the $200 billion companies promised after George Floyd’s murder?, Forbes, October 17, 2022}}

^{2_{Gartner Hype Cycle, Gartner, Inc., 2023}}

^{3_{CDER continues to advance rare disease drug development, U.S. Food and Drug Administration, February 28, 2023; Nearly 800 new medicines in development to treat rare diseases, Pharmaceutical Research and Manufacturers of America, December 16, 2021}}

^{4_{The impact of climate change on the pharma supply chain, TannerPharma Group, January 20, 2023}}

^{5_{EV charging disparities linger in U.S. neighborhoods, Axios, January 17, 2023}}

^{6_{AMA releases guide to advancing health equity, November 1 2021}}

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