Point of care is the place where treatment and education or marketing messages collide most often. And while the setting can facilitate ultra-effective communication, it sometimes serves to spotlight the industry’s racial and gender gaffes.
Brochures and leave-behinds typically star “a white upper-middle-class family,” notes Dr. Stephen Keith, medical director at Syneos Health. “There’s a man and a woman, 2.5 kids and a dog. Maybe they’ll be hiking or walking along a beach.”
But if it’s a condition with some sort of stigma attached to it, such as HIV, or anything with a lesion? “There’s going to be a Black male in it, guaranteed,” Keith adds.
As patient awareness about racial and gender disparities increases — a welcome byproduct of the unwelcome COVID-19 era — negative stereotypes perpetuated at the point of care become harder to ignore.
The disparities, and the way they reveal themselves in marketing, have always been there, says Andre Williams, COO of PatientPoint’s Health Equity Foundation. “The past two years have made many so much worse, as families have been turned upside down. People who once shopped in supermarkets now go to food banks. Those who once had doctors now use clinics,” he notes.
Almost every divisive issue in today’s headlines highlights the widespread gaps, whether in cancer care or cardiovascular disease or maternal outcomes. Abortion bans weigh heavily on communities of color, as does gun violence in schools, churches and supermarkets. And shortages in mental-health resources disproportionately affect individuals in poorer communities.
“One of the saddest statistics is that young Black Americans are much more likely to die of all conditions,” says Denyse Ferguson, CEO and president of the foundation.
The more people become aware of such disparities, the more they’re put off by pharmaceutical images of golf-club swinging men and baguette-toting women, the kind of bland “wellness” imagery that has long been POC marketing’s bread and butter.
And it’s not just about patient images in messaging — it’s providers, too. When patient advocate and journalist Loriana Hernandez-Aldama sat in an Atlanta waiting room with her sister, who is undergoing treatment for breast cancer, she couldn’t stop staring at an ad for the provider system. It was headlined, “Our hands are at the heart of what we do.” The photo showed a number of those hands — which were all male and all white.
“I know that the percentage of Latino and African-American leadership in healthcare is still very small,” Hernandez-Aldama says. “But shouldn’t these materials reflect what the numbers should be, and the diverse waiting room of patients they serve?”
Brands and agencies are endeavoring to fix the broken messaging and imagery. Akeia Blue, an account supervisor at JPA Health, says the obvious first step is “basic preparatory research. Simply asking members of the target audience, ‘Hey, is this the right language? Is this the right tone?’ is important.”
Blue is especially proud of No One Missed, a JPA campaign designed to educate Black and Hispanic populations about the importance of biomarker testing for lung cancer.
“We assumed ‘biomarker testing’ language wouldn’t resonate, and we were correct,” she recalls. “A big part of the effort was finding what words would work, understanding the concerns and then making sure we explained it properly. We had to be clear that this wasn’t an experiment but a screening.”
Saying too much also presents a risk, Blue adds. “Patients sitting in an office or exam room probably have other concerns that are top-of-mind. Throwing information at them is just going to be a missed opportunity.”
PatientPoint, which operates a network of screens in HCP offices across the country, is conscious of these and other concerns, says EVP for content and creative Kate Merz.
“Of course, we’re careful about images and anatomical drawings, but we’re trying to be mindful that people come to healthcare appointments with a diversity of experience,” she explains. “We try to take complicated health information and make it easy to understand. The goal is to empower patients to speak up and own their healthcare experience.”
Novartis’ More Than Just Words, a campaign highlighting stark disparities in breast cancer screening and treatment, takes a similar approach, according to Keri McDonough, VP, medical and scientific strategy at Syneos and head of its Patient Voice Consortium. The campaign’s point-of-care materials coach patients on spotting subtle signs of racism (such as hints that they should be able to endure more pain) and urges them not to hesitate to ask for another doctor.
While Keith admires efforts such as this, he says they’re few and far between. “Campaigns like these get celebrated and they get recognized, but they’re not the average.”
He adds, “when Black people are shown, they’re typically light-skinned. Let’s just say [the actress] Viola Davis doesn’t get a chance to do many of these ads.”
Then there’s a deep divide created by income disparity, which similarly rears its head at points of care. “POC materials that suggest a patient should get X test or take Y medicine, when they might not be able to afford them, are tone-deaf,” Blue says.
That’s why PatientPoint is focusing its attention on nontraditional provider environments, such as community clinics.
Founder and CEO Mike Collette is surprisingly candid about the challenges his organization has faced. “Our mantra is ‘We make every doctor/patient engagement better,’ and right now we’re not delivering on the ‘every’ part. We were making every engagement better for those patients or practices on our pharma partners’ target list,” he says.
Through the company’s Health Equity Foundation, started in the wakes of COVID-19 and the murder of George Floyd, PatientPoint can work more effectively with inner-city practices that aren’t as well-funded as suburban ones. Collette reports that PatientPoint’s in-office education in more traditional office settings has helped improve colonoscopy screening rates by 20% and flu vaccination rates by 28%, and has sparked a 43% increase in people seeking tobacco cessation counseling.
Collette thinks big pharma is finally coming around. “I’ve been in nine client meetings this past week. There’s a level of receptivity I’ve never seen before,” he notes, contrasting the current environment with an attempt five years ago to get pharma companies to help fund community health centers in Ohio. At the time, none were interested.
“It is very different now. They want to support health equity. They just need to expand their lens beyond how they’ve traditionally looked at that,” Collette adds.
On the other hand, Ferguson usually frames her case for venturing into poorer communities in the context of doing the right thing. But when those arguments fail? “I use math and statistics — cold hard numbers,” she says. “We ask, ‘Who are your patients going to be in 2050?’ If companies don’t have the answer, we educate them from a demographics perspective.”
Another number that impresses pharma companies? “$135 billion. That’s the dollar amount that would be saved if racial health disparities were eliminated,” Ferguson reports. “That gets
Blue says that if she had a magic wand, she’d use it to convince pharma companies that the sooner they acknowledge systematic factors fueling health inequities, the more quickly they’ll be able to close gaps at the point of care. She believes that level of honesty would help marketers be more candid “about where the burden and the fault lie.” Otherwise, she says, it’s too easy for messages such as “Being Black puts you at risk for X” or “Being Hispanic puts you at risk for Y” to sneak into marketing-speak.
“Being Black does not inherently make you more at risk; it’s the systemic factors,” Blue stresses. “If it’s not a true biological risk, then it shouldn’t be framed that way.”
Indeed, Hernandez-Aldama notes, individuals in communities of color shouldn’t be made to feel that it’s their responsibility to address disparities. Many are “still intimidated by doctors, and that means there isn’t the level of shared decision-making that there should be.”
That said, she hopes patients and caregivers will continue to speak up about misguided point-of-care materials. “We need to give our feedback. We need to say, ‘This does not reflect my community.’”
As an advocate, Hernandez-Aldama encourages patients to “be a pain in the neck …. I want them to ask many questions, push for answers and get a second opinion.”
She believes that responsibility carries over to everyone responsible for the messages conveyed to patients at the point of care: pharma companies, ad agencies, doctors, administrators, operators of screen networks, you name it. “We have a moral obligation to use our platforms to educate patients to improve health literacy,” she adds.
True, there’s no such thing as a perfectly representative point-of-care campaign. Capturing every single ethnicity, gender and income level in just a few images or paragraphs is impossible.
“It can go too far,” Keith warns. “If the only images you see for a certain condition are people of color, you might get the impression that everyone else doesn’t have to worry about it.”
The point is that brands and their agencies need to do more to create materials that reflect the reality of patient populations in ways that are genuine. “At the end of the day,” says Williams, “we all want to be celebrated, not just tolerated.”