Tuesday, Oct 12, 2021
Deloitte’s new Health Equity Institute urges a business solution to address a moral imperative
Asif Dhar, M.D.US Life Sciences & Health Care Industry Leader, Deloitte Consulting LLP
Most business leaders I talk with—particularly in health care and life sciences—want to do more to improve health equity, but they often don’t know where to start. Government, community, and leaders of non-profit organizations sometimes struggle with the best ways to organize the ecosystem so that improvements in health equity are sustained and significant. The first step is to recognize that health equity is an outcome. It’s not a program, initiative, or effort. It is the core business of life sciences and health care.
Health equity is the fair and just opportunity for every individual to achieve their full potential in all aspects of health and well-being. Health equity can be measured by health disparities, which are preventable differences in health outcomes across different population groups. Health inequity is especially apparent along lines of race, with Black, Indigenous, and People of Color (BIPOC) experiencing barriers that lead to poorer health overall when compared to white populations.
COVID-19 highlighted the stark health inequities in society. We see this both in the US and globally. In the US, Black, Latinx, and Native Americans have been dying at a significantly higher rate from the disease.1 Before we can improve health outcomes, we should first address health inequity. For example, if vaccination rates for BIPOC populations achieved parity with overall population rates, we are likely to see much lower rates of infection and fewer deaths across all communities.
Announcing the Deloitte Health Equity Institute
We believe we have a collective opportunity to address the challenges of the past, heal the present, and build a more resilient health care ecosystem for the future. Health equity is an issue we have been working to improve—internally and externally—for the past decade. Last summer, we published a blog acknowledging racism as a public health crisis. We are now investing in a more focused approach to help health care and life sciences organizations, their leaders, and their communities achieve health equity as an outcome.
The Deloitte Health Equity Institute will help identify and address challenges related to health equity. Why an institute? We have been doing pro bono work on racial equity and health equity and have been seeing patterns of impact. We recognize that health care and life sciences leaders are hungry for data, analytics, and insights. (There is no playbook for improving health equity). We see a need for a convener that can identify which approaches are most effective and openly share them within the health care ecosystem and the public. Through the Health Equity Institute, we will provide insightful data and relevant research that companies may find useful as they work to improve health equity.
8 questions for Kulleni Gebreyes, M.D., director of Deloitte’s Health Equity Institute
Deloitte is passionate about working to address the disease of racism in collaboration with our clients and broader communities. We want to open a dialog about effective and impactful strategies to prevent, treat or cure this disease. We established the Deloitte Health Equity Institute to share our most impactful learnings, to extend the efforts of others, and to make meaningful contributions to broader health-equity issues. I recently spoke with Dr. Kulleni Gebreyes, the Institute’s director, about the importance of health equity for our clients, their customers, and the communities they serve.
Asif: How is Deloitte responding to health care and life sciences organizations that are working to improve health equity?
Kulleni: Deloitte, in particular our health care and life sciences practice, has been working on equity-related issues for decades. This is not new. The confluence of the COVID-19 pandemic and the recent movement toward greater social consciousness made us realize that we need to be models for change. We also want to help business leaders who are ready to take the first, or next step. They shouldn’t have to wait for regulations and rules before they make changes…they have everything they need right now to lead change. We are demonstrating how we work collectively with not-for-profits, community-based organizations, governments, and communities to make an impact. The Health Equity Institute will provide financial support for many not-for-profits and community-based organizations to help them drive the same agenda. We are modeling the behaviors and the change we want to see in the world.
Asif: What are the challenges for health care and life sciences leaders who want to have an impact on health equity?
Kulleni: This is a vast and complex issue. One of the biggest challenges for business leaders is deciding where or how to start. Data can often help illustrate the barriers to health equity and the root causes of health care disparities (i.e., differences in outcomes). Business leaders should know what programs to implement and whether those programs are having the impact they anticipated. The investment of resources and time also should be aligned with their overall business strategy. For example, Deloitte has been leveraging our data to identify vaccine deserts, which can help our clients pinpoint where to establish vaccination sites and mobile clinics. We track hundreds of variables, including drivers of health (also known as social determinants of health), and other health access indicators. This helps us understand what matters and how it matters. We use this information—and other data from the ecosystem—to identify communities that can benefit from a wide array of health equity programs.
Asif: Recognizing that where and how to start is a big challenge. What guidance would you give business leaders who are ready to act?
Kulleni: We offer a construct to help business leaders consider the roles they can play and the challenges they should try to address. More specifically, we have identified four domains that health care and life sciences business leaders should consider as they continue their efforts to improve health equity:
- Our organization: How can we reimagine our approach to diversity, inclusion, and belonging to advance equity among our workforce, and to address their unmet social needs? Data gathered from an organization’s employees, for example, might be useful in designing more equitable employee-benefit programs. Some organizations might consider mandating cultural competency and implicit bias training for all employees.
- Our offerings: How can our products and/or services more effectively meet the needs of our patient population across demographic groups? A health plan, for example, might address health equity through its benefit designs, or use a value-based payment model to reward network providers that demonstrate equitable outcomes. Life sciences companies might use a health-equity lens when evaluating their R&D processes. All leaders should ask if equity is being incorporated into new products and services.
- Our community: How can we serve our local communities as health equity leaders? Every organization has a corporate and social responsibility. Health care, life sciences, and public health organizations should evaluate their community partnerships and look for ways to become better partners. Strategically investing in communities could build upon existing assets while also helping to fill gaps. Partnering with traditional competitors could help to magnify the impact on health equity.
- Our ecosystem: How do we strategically amplify our positive impact through our vendors, partners, and public platform? Consider diversity when selecting vendors and suppliers. Urging vendors and business partners to emphasize diversity could further amplify the overall health equity initiative.
Asif: As we think about “the organization” domain, what is the relationship between diversity and the workforce?
Kulleni: Diversity, equity, and inclusion, and health equity, are interrelated and interdependent, meaning that one can’t advance one without advancing the other. Health equity means everyone has a fair and just opportunity to achieve health and well-being. Diversity means that people of various races, ethnicities, and sexual orientations are represented in leadership and throughout the organization. But diversity doesn’t occur naturally. It has to be done intentionally. Organizations typically hire for cultural fit. Business leaders should rethink their talent-recruitment strategy when it comes to diversity.
Asif: The pandemic highlighted health inequities. How did equity factor into the development and distribution of the COVID-19 vaccines?
Kulleni: Let’s start at the beginning. A lack of diversity in clinical trials—and follow-on real-world data—creates multifactorial issues. COVID-19 moved those issues to the forefront. A human-centered, equity-based design requires that clinical trials for all drugs—and specifically the vaccines—should have appropriate representation. When clinical trials and real-world data include women and racial minorities, the product is no longer defaulting to a white male. Drugs that are primarily tested on white men might not have the same impact on women, or people of different ethnicities. For vaccine distribution, many organizations have tried to make doses available to communities. As you mentioned in your recent blog, Deloitte helped one state identify and evaluate vaccine deserts. We also worked with a major teaching hospital to set up vaccination clinics aimed at lower-income and/or mobility-challenged residents. Data that includes the diversity of research used to develop the vaccine might be useful in swaying people who are on the fence. If the trials weren’t diverse, some people might wonder if the vaccine will work for them, or if they will suffer different side-effects.
Asif: What do you see as the connection between health equity and the Future of Health?
Kulleni: Over the next 20 years, we expect that the definition of ‘health’ will be much broader than it is today. It will include mental, emotional, social, spiritual, and financial well-being, as well as physical health. Equity is at the center of this vision. We expect consumers will have access to their own health data, and interoperability. They will allow them to share this information with their clinicians, who will be focused on detecting and preventing disease…rather than merely treating it. The Future of Health is also an opportunity for health care and life sciences companies to improve health equity within their organizations. If you don’t have different groups represented in leadership and throughout the organization, it can be difficult to design equitable therapies, equitable products, or equitable services. In a future that is consumer-centric and focused on wellbeing and prevention, health equity can become a reality. A health equity lens is critical for better consumer engagement and a healthy community.
Asif: As a clinician, did you see the impact of health inequities?
Kulleni: Systemic bias and racism are being discussed openly today in a way that we haven’t seen before. But there are also subconscious biases and clinicians are no more immune to that than anyone else. When I was working as an emergency room physician, I saw the manifestation of health inequities through individual biases, structural biases, and barriers to care. Some patients received a different level of care based on their race, ethnicity, or gender. For example, some studies have shown that the type or amount of pain medication prescribed to a patient is influenced by race, gender, ethnicity, and language. There are also economic inequities that should be addressed. A low-income person might not have access to reliable transportation and might wind up missing important medical visits as a result. Environmental inequities also have an impact on health. Is the water safe to drink? Is the air safe to breathe? Where someone lives can influence their chances of getting cancer.
Asif: What are you hearing from clients? Are they moving with more of a sense of urgency?
Kulleni: Ten out of 20 health care CEOs that we surveyed recently say health equity is one of their top three priorities. Based upon interviews with 28 additional health care executives, we found that most organizations are starting at different points and are moving at different paces. However, they are all headed in the same general direction. Some organizations have had a chief health equity officer for a decade or more. Others have been focused on identifying the problem and areas where they can have an impact. For some life science and health care organizations, the pandemic converted health equity from a program and a set of initiatives to a strategic imperative for the overall organization and the board. Even executives who have always prioritized health equity realize that they can be doing more. There is a recognition that health equity is structural, institutional, and systemic. There also appears to be an understanding that opting to do nothing will likely only perpetuate this issue.
Government agencies, community groups, public health organizations, and life sciences and health care companies are growing increasingly passionate about having a meaningful impact on health equity. It is clear that we all need blueprints for action. We all require data, insight, and models that show us how to engage the entire ecosystem so that we can leverage disruptive technologies to make a nonlinear impact in health equity. The opportunity for exponential change is real and now.
1. COVID-19 hospitalization and death by race/ethnicity, CDC, August 18, 2020; Health equity considerations and racial and ethnic minority groups, CDC, July 24, 2020