The COVID-19 pandemic exposed a number of cracks in the American health ecosystem, but none so wide as the one separating the health haves from the have-nots. By catapulting deep-seated disparities into the spotlight, the pandemic — and the disproportionate rates of infection in Black and other minority communities —served as a call to action within the public health community, spurring pharma to pursue actionable efforts toward reversing health inequity.
Johnson & Johnson and Bristol Myers Squibb have been among the organizations leading the charge. In 2020, the drugmakers committed $100 million and $300 million, respectively, to boost diversity within their executive workforces and relieve health inequities for communities of color, pledges that outlined actionable and measurable goals.
But are medical marketers truly stepping up to the plate? Many agencies launched their own internal initiatives aimed at aggressively diversifying workforces to more accurately reflect the racial and ethnic makeup of the population outside their office doors. Take Heartbeat, at which 46% of the agency’s new hires were from diverse backgrounds and 56% of 2020 promotions were given to employees with diverse backgrounds.
“You have to invest in those individuals and promote them,” says James Talerico, Heartbeat’s co-president and executive creative director. “They have to be in leadership positions in order to help make decisions that are going to address the populations that need us most.”
Taking their internal DE&I initiatives a step further, agencies have also implemented unconscious bias training and robust anti-racism education programs to address issues at the organizational level.
“It’s not just something that exists outside our industry. It exists inside our industry and reflecting on that is going to help us get better over time,” says Klick SVP and managing director Ari Schaefer. His Klick colleague, SVP of diversity strategy Amy Gomez, agrees, adding that “medical biases are widely documented.”
Conscious or unconscious, these biases have a profound impact on quality of care. According to a 2019 report from the Centers for Disease Control and Prevention, Black, American Indian and Alaska Native women were three to four times more likely to die from pregnancy-related complications than white women of similar ages. In many cases, those deaths are preventable.
“A more overt recognition and exploration of how our personal biases as marketers keep us from adequately supporting multicultural patients and caregivers makes us better equipped to find solutions,” Gomez stresses.
The twin tragedies of COVID-19 and the deaths of George Floyd, Breonna Taylor and so many other Black people at the hands of law enforcement have forced marketers to take a hard look in the mirror. Beyond systemic biases, the events of 2020 shone a light on numerous social determinants that underpin disparities in access to and utilization of care — from food deserts and residential redlining to employment and education, many of which are drawn along racial lines.
As a result, medical marketers are finally making more concerted efforts to understand how their work impacts diverse populations. And they’re taking what they’ve learned into account when creating new client programs or updating existing ones.
“Historically, it would be impossible for us to think about diabetes without considering the relevance of those social determinants, but other diseases don’t necessarily have the same lens or focus,” Schaefer explains.
Klick is working with clients to apply a similar focus to other diseases. This effort has manifested itself in client conversations about updating and expanding patient support programs beyond their traditional financial assistance focus. Such programs will now “consider the broader social determinants that may be impacting that need,” Schaefer notes.
By way of example, he points to Klick’s recent work on a patient support portal for an autoimmune disorder. For people with autoimmune diseases, he says, “Social connectivity during COVID-19 became an additional focal point for patient support.” So rather than merely elevating COVID-related messages around drug accessibility options, the team worked on a broader set of initiatives addressing the challenges of social distancing. It also sought to connect these patients to social groups and programs.
As part of their efforts to address health inequities, marketers are also emphasizing to clients the value of cross-cultural marketing in bridging the care gap. In the wake of the pandemic, clients are finally listening. While advocates of such approaches were previously met with resistance — “the system wasn’t accustomed to it,” says Victor Paredes, VP of creative strategy at venerable multicultural agency UWG — pharma clients are now welcoming it.
As obvious as it may sound, the key to making these programs impactful is creating them from scratch — as opposed to tacking on a multicultural component to a broader effort that already exists. Prior to now, Paredes notes, “Materials were just ceremoniously translated into Spanish, which tokenized inclusion.” It was obvious to Black and Latino communities that they were an afterthought.
But now marketers are using a more targeted, culturally nuanced approach to addressing underserved communities, one that takes into account variance in life experiences. For example, in light of the realization that Black and Latino people are more likely to be caregivers, marketers are creating ads that target — or nudge — younger caregivers seeking information on behalf of a family member. In addition, physicians are being targeted with information on how to best prepare for and manage three-way conversations with patients and caregivers.
“Whether it’s through social listening, through custom surveys, through going out and actually talking to people, marketers are taking the time to understand people better and gain a more precise understanding of the patient journey,” says CMI Media president Susan Dorfman.
Then they’re relaying what they glean to clients and using it to build more nuanced, culturally competent work. “It’s a matter of understanding how a community’s core cultural values influence the health decision-making process,” explains Rebecca Rosen, senior research analyst at Hispanic-centric multicultural marketing agency Zubi. “By looking at those decisions through a cultural lens, our pharma clients will be better poised to help patients make better decisions and achieve better health outcomes.”
Marketers are also playing a significant role in helping pharma clients boost diverse representation in clinical trials, an area in which the industry’s track record isn’t exactly impressive. Black and Latino patients have long been grossly underrepresented, even when it comes to the condition states that disproportionately affect them. The pandemic made the industry’s failures strikingly visible; remedying that is a major focus of many pharma initiatives related to health equity.
Diverse representation in clinical research is crucial to delivering adequate and equitable care to BIPOC communities. To boost inclusivity and participation, marketers and pharma companies must take into account various barriers to access, including inherent mistrust, hard-to-reach trial site locations, low levels of health literacy and a lack of familiarity with the clinical trial process, says Angela Rochelle, account director and head of diversity initiatives in clinical trials for Publicis-owned firm Langland.
Rochelle works closely with clients to ensure materials and communication pieces developed for clinical trials are relatable, readable and easily understood. “Most importantly, communities of color should see themselves in those materials,” she says.
Rochelle notes that Langland is focusing on boosting education and awareness within areas that are impacting communities of color, such as Lupus and Alzheimer’s disease. She points to MT Pharmacy, a collaboration between Sanofi and the Center for Information and Study on Clinical Research Participation, as an example.
The effort involved the creation of a pop-up pharmacy with completely barren shelves, designed to illustrate what pharmacies might look like if clinical trials didn’t exist. Visitors were asked to write down the names of medications and products they wished were available on the shelves, giving marketers the opportunity to better understand the needs of the targeted community.
“It pulled people of communities of color into the space,” Rochelle says. “It gave [the client] a chance to hear and understand and really visualize the impact they could have.”
While experts acknowledge the road to health equity is going to be long and filled with vast, complex and tangled challenges, they remain committed to making the journey.
“Unfortunately, when you have a systemic problem, you can’t one-off it,” says Paredes. “You have to go into each aspect of the machine and issue a corrective and measurable action.”
Marketers are honing in on one major hurdle: helping their clients restore trust in the medical establishment among minority communities that have been historically underserved by pharma. How do they reverse the mistrust that festers in the wake of decades of neglect and inequitable treatment, not to mention unethical testing? “It’s a big thorny question, because trust is never one-and-done,” Gomez responds. “It’s interactive. It’s incremental.”
COVID-19 has reinforced that pharma can’t just show up in a community with a solution — even a life-saving one — and expect that community to trust what it has to say, given the absence of a prior relationship. “You have to acknowledge them, you have to engage with them and you have to meet them where they are,” Rochelle says.
Bridging that gap requires medical marketers to take the time to understand core values and develop closer relationships with trusted voices of authority (by, say, partnering with advocacy organizations within these communities). And building that trust will require transparent communication and a consistent community presence.
“It’s about more than just casting actors of color in your marketing materials or translating them into Spanish,” Gomez stresses. “It’s not executional. It will take time and commitment.”