Health disparities in the U.S. were amplified by the pandemic, which has disproportionately affected Black and Latino communities. But their underlying drivers — including systemic racism, inequality and inadequate access to healthcare — have long been embedded in the fabric of the country.
Building a more equitable health system requires addressing issues that are complex, intertwined and that often extend far beyond the realm of the physician’s office. Take redlining and pollution, to name just two factors that contribute to disparities. According to a 2017 report, Black Americans are 75% more likely to live in areas near facilities that produce hazardous waste than other Americans. It goes without saying that this can give rise to devastating health consequences.
“There is a 20-year swing in life expectancy gap at the ZIP code level in key cities across America,” says Publicis Health Media president Andrea Palmer. A person’s environment and circumstances, she adds, “have more to do with their health and their outcomes than their genetics. That’s telling.”
And yet there is frequently a lack of understanding from healthcare and marketing professionals about the full range and impact of these forces, not to mention the stark difference in individuals’ lived experiences, says Dr. LaMar Hasbrouck, a public health physician and former director of the Illinois Department of Public Health. The very ability to be proactive about one’s health can be a luxury in itself.
Given the nature and scale of the problem, Dr. Maureen Lichtveld, a professor at Tulane University School of Public Health and Tropical Medicine and the president of the Hispanic-Serving Health Professions Schools, believes that “to begin to address the historic burden of health disparities and inequities, it’s key to take a systems approach, not a one-off approach.”
To that end, here are a few actions needed to course-correct.
COVID-19’s outsized impact on the Black and Latino communities “has something to do with the virus, and everything to do with underlying conditions, such as diabetes and hypertension,” Lichtveld says. “It has everything to do with food safety and food security. It has to do with how far you live from a hospital. It has to do with economic disparity.”
Addressing these systemic issues requires long-term commitment and investment, rather than sporadic or temporary responses each time a new crisis exacerbates existing fractures. This can be difficult to achieve, of course, given the patchwork, under-resourced nature of the U.S. healthcare system. Nonprofits and foundations that strive to fill the numerous gaps often depend upon unreliable sources of funding, which can lead to an inconsistent presence in the communities they serve.
A steady, consistent presence helps build trust. “Even when your funding is gone, investing in your community and staying in touch and volunteering goes a long way,” Lichtveld says.
Hasbrouck agrees, adding, “Once you can develop a trusting relationship, everything else moves faster. Once a community feels like it is being heard and empowered, its members are more likely to listen to what you have to say.”
Community input and involvement.
Bringing in members of a community and engaging with them are important parts of any public health initiative, Lichtveld says. Often, this takes the form of recruiting and training healthcare workers who live in the neighborhoods they serve, as these individuals best understand the concerns and needs of the community on a personal level.
Similarly, integrating local physicians, health workers and marketers can bolster community research teams. Any work that emerges from their efforts is more likely to be perceived by a community as valuable — as opposed to making those who participate in studies merely feel like “the subject of research,” Lichtveld explains.
Just as long-term investment evinces a commitment that can lead to increased trust and adherence, so too can the presence of community healthcare workers spur similar gains. Healthy equity, as Hasbrouck points out, is about far more than access to care.
By way of example, Hasbrouck notes that a doctor’s visit may be covered by Medicaid. But if patients aren’t given the resources to navigate what can be an unfamiliar, complicated and biased system, a positive experience isn’t likely. “You haven’t really improved access,” he says.
Take sickle cell anemia, a condition that disproportionately affects Black communities. Too often, physicians jump to unfair and racially biased conclusions, such as that a patient is simply seeking pain medication, Palmer says. “Those types of behaviors have led to communities having this innate distrust.”
Identifying and addressing biases and obstacles to care require a focus on on-the-ground work. “We have to look at the way teams are built” and do a better job of incorporating community members throughout the healthcare continuum, says Erica Rivera, VP of engagement strategy at AbelsonTaylor.
Yes, some pharma companies have created community-focused positions, but they are in the minority and have addressed problems inconsistently. “This is a long game. Community trust erodes very quickly,” Hasbrouck says.
Healthcare has long struggled with diversity, which affects virtually every facet of the industry. The ripple effects of this neglect shape not just the care patients receive but the way healthcare campaigns are designed and distributed.
“There’s much talk about the importance of diversity in marketing — but it really is a crucial start point,” says Claire Gillis, international CEO of WPP’s health practice. “Marketing simply must be driven by diverse and inclusive teams that best represent our society, and nowhere is this more important than in health.”
Because biases are varied and often ingrained, a surface-level approach isn’t going to cut it, Rivera says. “It’s not just layering onto the current system and saying, ‘How do we fix it?’ We need to take a look starting at the base.” What that means for healthcare companies: Fundamentally restructuring hiring and internal practices to build organizations that better reflect the country’s racial and ethnic makeup.
Health equity can be a difficult topic to discuss because its drivers are at once numerous and interconnected. They form a complex root system that underpins a steeply tilted playing field. Fixing healthcare means addressing a range of broader issues — including but not limited to housing access, the racial wealth gap and segregated schools — which have long contributed to an unequal society.
“These are heavy lifts,” Hasbrouck acknowledges. He believes that fixing them requires not just a concerted effort from the industry, but “a groundswell of political will, political activism, sometimes community organizing and other things to make lawmakers begin to divert resources to where they need it most.”
A first step, then, might be taking the time to understand the true scale and significance of the issue. “The better we can frame the problem, the closer we are to a solution,” he says.