When I started pursuing a graduate degree in Health Policy and Management this year, little did I know that public health, and the ensuing spotlight on health inequities, would be front and center in 2020. With the disproportionate impact of COVID-19 pandemic on people of color (POC) and the Black Lives Matter movement, it has become imperative that we take a look at systemic racism as a root cause of racial health inequities in the US.
Relationship of systemic racism and health inequities
One of the first things we learn in our public health courses are the social and environmental factors that impact health outcomes, called “social determinants of health”. These are the conditions in which we are born, grow, live and work and include socio-economic status, education, employment, physical environment (e.g. neighborhood), as well as access to healthcare and food, among many others. While there remains some level of reticence to acknowledging racism as a cause of health inequities in health policy discourse, there is a growing body of evidence that shows systemic racism has been a driver in poorer health outcomes among Black and Latinx Americans.
An example is an analysis of the 2010 US Census data which revealed that most residents in the US continue to live in racially and economically segregated neighborhoods. Studies on residential segregation have shown that there are higher concentrations of dilapidated and insecure housing in neighborhoods that people of color live in, greater exposure to pollutants and toxins, limited opportunities for employment and high-quality education, as well as restricted access to healthy foods and healthcare. These factors all have indirectly and directly impacted health outcomes, including increased risk of chronic diseases, higher rates of adverse birth outcomes, increased exposure to crime, and shortened life expectancy.
In market research interviews, we regularly hear US physicians lament on how they are hampered by the healthcare system from providing the best care possible. Public health insurance policies often limit what they can prescribe to treat a condition and patients are frequently required to try and fail several lines of treatment before they can be prescribed a medication that may help, exposing them to various side effects, poor efficacy, and decreased quality of life. Unfortunately, this is the treatment experience for many patients of color who are dependent on Medicare or Medicaid for their healthcare coverage because of their lowered socio-economic status, lack of employment or disabilities.
Occasionally, a patient of color would reveal that they felt they were being discriminated against when receiving medical care. Instances of symptoms being ignored or reported pain levels being questioned by healthcare professionals are a few examples that show that people of color are not always given the respect or sympathy they deserve. One interview that have stayed with me was with a Black American woman suffering from ovarian cysts. She recounted a time when she went to see a physician about her excessive menstrual bleeding and severe pain, but the physician simply dismissed her complaints as her being “dramatic”, which led her to feel that she was not being taken seriously because of her race. She eventually found a doctor that understood her and took her seriously, but her experience reveals that physicians hold unconscious racial biases that prevent them from truly providing respectful care. This has been proven several times with studies showing how patients matched with physicians of the same race achieve better health outcomes.
More recently, federal data on COVID-19 has shown that it has affected more people of color than white people. Black and Latinx Americans are three times more likely to be infected than their white counterparts and are twice as likely to die from the disease. These increased risks can be attributed to how systemic racism has disadvantaged these communities. Many of them have jobs that cannot be done remotely, have to take public transportation to get to and from work, and live in crowded conditions or multi-generational homes that reduce their ability to socially distance. Additionally, there have been outbreaks in prisons, which are disproportionately populated by Black and Latinx Americans. High prevalence of chronic diseases, such as obesity, diabetes, and heart conditions – which have been known to be caused by factors outside of the patient’s control, such as access to healthy food and good medical care – in these populations also put them at increased risk of poor outcomes if infected. Yet, while these underlying conditions play a major role in COVID deaths, it is the fact that Black and Latinx Americans are more likely to be exposed to the virus because of their work and social environment that increases their mortality risk.
How can market research be more inclusive?
Racial health inequities are not easy to solve nor will they be quickly eradicated. It will likely take the efforts of public and private sectors, and society, in general, to tackle this problem. However, I feel that pharmaceutical market research can take small steps to shed light on the issues and place greater significance to addressing needs of minority and marginalized groups of patients. These steps can include, but are not limited to:
- Ensuring racial/ethnic diversity in patient research to understand the various experiences patients may have due to their racial/ethnic background
- Include providers who primarily practice in underserved communities in HCP sample
- Consider biases that influence physicians’ treatment decisions and relationship with their patients
These may not be applicable to every market research conducted and may not always be possible because of regulations around personally-identifiable information, but I believe that by being more open to diversity in our studies, we can provide a more nuanced view of the healthcare landscape, grant our clients closer access to reality, and be more inclusive in our strategic insights.
By Victoria Grefiel