Health Equity: A Central Tenet in Health Care Quality

Turner Healthcare Quality (THCQ) Consulting, Inc. launched in December 2019, only 4 months before the COVID-19 shutdown. The weight of the pandemic along with the social justice implications of the tragic murder of George Floyd on May 25, 2020, led to a societal awakening unmatched by anything witnessed in over a century.

What I bring to the topic of health equity, is my perspective as a Black male who grew up in a middle-class family in Detroit, Michigan. I was fortunate early on to have opportunities to travel, gain exposure to accomplished professionals who looked like me, and participate in a range of sports, including tennis, golf, basketball, and football. I was nurtured by a strong Black Baptist community and encouraged by loved ones to pursue my dreams as I learned to cope and excel in highly competitive academic environments. However, after moving to a predominantly white suburban area, these blessings were juxtaposed against the pain of racial discrimination and microaggressions I encountered from some school peers, teachers, and counselors and racial profiling I endured from store owners, law enforcement, and others.

As much as I dealt with racism, it seemed to pale in comparison to the experiences of many of my Black brothers and sisters and other minority groups across the U.S. Thus, the unmasking of ethnic- and racial-based health disparities by the COVID-19 pandemic combined with the social justice awakening heightened my drive to act.

It became my goal to meaningfully address racially based health inequities through each circle of influence I operated in within health care.

Sample View of The Extent of The Racial Health Disparity Problem in the U.S.

Disproportionate COVID-19 death rates in Blacks expose pre-existing health disparities among Black American communities.

Early into the pandemic, the disparities in COVID-19 cases and deaths for Blacks compared to other races were disproportionate. In my home state of Michigan, Black people make up 14% of the population but represented 41% of deaths related to COVID-19.

These statistics revealed the systemic racial inequities existing throughout the United States. Inequities that result in crowded living conditions due to multigenerational households, inequities that lead to overrepresentation in high-risk jobs unable to be performed remotely, and inequities that reduce access to quality education and healthy food sources, which contribute to lower health literacy and increased rates of chronic disease.

I hope we can all agree that, nationwide, optimal healthcare quality is not possible without widespread equity.

These stark disparities should serve as a clarion call for those of us in healthcare, especially those of us focused on quality. As we move into the wake of this pandemic, it is more than time for us to make profound changes that begin to bridge gaping inequities in care, access, and outcomes.

A Sample Case of Structural Racial Inequity Manifested in Clinical Trial Diversity

It is well established and documented that, for a variety of reasons, Black patient involvement in clinical trials is disproportionately lower than the representation of Blacks in the population. Knowing this, I was shocked when I was involved with a Janssen clinical trial with patients with schizophrenia with recent criminal justice involvement, and there was a higher percentage of Black patients enrolled than White patients (J Clin Psychiatry 76:5, May 2015). This landmark study changed my life and reshaped the lens through which I viewed health care as both a clinical scientist and especially as a Black male.

Why do we see a disproportionately higher representation of Black patients when factoring in recent criminal justice involvement? Without delving deeply into it, the reasons are manifold, with the most profound factor being the disproportionate incarceration of Blacks in the US, of which underlying reasons are well chronicled in Michelle Alexander’s The New Jim Crow.

Moreover, in 2014 and then again in 2022, Health Affairs dedicated two issues (The ACA & Vulnerable Americans: HIV/AIDS; Jails and Racism and Health) to healthcare, social factors, and race connected to the unusual result observed in the Janssen study. Indeed, these factors play prominently into racial-based health inequities that we both see and cannot see or choose not to see, but exist, nonetheless.

We need to challenge ourselves, societally, to motivate and incentivize researchers to ask necessary questions and build out robust data infrastructures to identify root causes of inequities.

Life science companies can aim to build health equity into strategic initiatives, partner with organizations driving health equity, use data and analytics to uncover and address disparities, and overall, acknowledge how these activities and more can help to bring more equitable products into the market. This can put us all on the path to sustainable social justice and clinical practice solutions that drive new standards of care, access, and outcomes for all people.

Our team’s passion and commitment to health equity – and patient-centeredness, as discussed in last month’s Health Care Quality Insights blog article – comes from what we each have experienced personally and professionally. Thus, health equity is a central tenet of our work at THCQ Consulting, Inc. and is a cross-cutting theme integral to all aspects of services we provide for life science companies striving for equitable representation in research and development, clinical trials, and market access.

Thanks for reading! Interested in hearing your thoughts.

QUESTIONS FOR YOU 

1. Why do you think the COVID-19 pandemic exposed the problem of racial health disparities and social injustice in the U.S? What are some solutions?
2. What do you see as a solution to the structural racial inequity established in clinical trial diversity given the history of how minorities have had limited involvement in research in the U.S.?
3. What role should life science companies play in combating racial/ethnic health disparities, both in the context of clinical trials and beyond in other aspects of their businesses?

Norris Turner, PharmD, PhD

President & CEO, THCQ Consulting, Inc.

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SUMMARY 

The racial health disparities spotlighted by the COVID-19 pandemic and social injustice, intensified my drive to make significant change within healthcare to address health inequities.

The disproportionate COVID-19 death rates in Blacks exposed pre-existing health disparities within Black communities in the US, including my home state, Michigan. These austere disparities should inspire all of us in healthcare, especially those of us focused on quality in healthcare, to end inequities in care, access, and outcomes.

From my experience as a Black male and clinical research scientist, I observed structural racial inequities demonstrated in clinical trial diversity, especially when it comes to mental health. By identifying the root causes of these inequities and working to address gaps in care, we can develop social justice and clinical practice solutions to work towards health equity in the US.

THCQ Consulting Inc. is committed to health equity and work that drives new standards of care, access, and outcomes for everyone.

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