Addressing Healthcare Diversity from All Angles

Addressing Healthcare Diversity from All Angles

April 20, 2021

Covid-19 sparked much-needed dialogue on the importance of healthcare diversity. But we must be mindful not to push meaningful progress on this matter aside once the pandemic abates.

The health inequities exposed this past year have taken root since America’s infancy. And they will continue to sow damage for historically marginalized populations if we fail to take stock of every corner of our health system.

Take, for instance, a recent report on the gender gap in the life sciences industry. Deerfield Management investigated 140 early-stage, venture-capital-backed firms — covering everything from diagnostics to healthcare information technology.

Women were found to hold just 10 percent of director positions among these firms, half of which had zero female board members. Given that venture capital firms tend to have a say in the boards of companies they back, it’s not surprising that their makeups mirror one another. But it’s a disheartening reflection of the gendered concentration of power in healthcare investment and decision-making.

America’s most prestigious medical journals are hardly immune to failures of diversity either.

After reading a racially insensitive piece in one such journal, Columbia cardiologist Dr. Raymond Givens examined the editorial boards of 100 medical journals. That included the esteemed Journal of the American Medical Association (JAMA) and New England Journal of Medicine (NEJM). Out of 49 total editors at JAMA, only two were Black and two Hispanic. At the NEJM, there was one Black and one Hispanic editor on an editorial board of 51.

That deeply entrenched racial disparity has dangerous downstream effects. Medical journals essentially decide what issues, studies, and people are given a platform in the medical community. It is imperative that they represent and understand diverse narratives, else we risk reinforcing the homogeneous thought that landed us in this state of inequality.

Since Dr. Givens’ report, journals have pledged to do better. NEJM recently hired its first Black deputy editor along with four other people of color to lend varied perspectives to its editorial board. But this merely scratches the surface on the issue — intentional, diverse recruiting and hiring practices over the long-term is the only way to implement institutional-level change.

Even clinical trials have historically excluded people of color. Black Americans comprise 13 percent of the population but just 5 percent of clinical trial participants. Meanwhile, only 1 percent of clinical trial participants are Hispanic, even though Hispanic Americans account for close to one-fifth of the U.S. population. Underrepresentation has contributed to the lack of trust many communities of color have in the medical community and to the “one-size-fits-all” approach we have to treatments.

Covid-19 accelerated necessary reflection on these structural inequities. Just a few days ago, the first-ever pharmaceutical industry-wide principles on increasing clinical trial diversity took effect. It’s an important step in the right direction and one that could directly save lives. But companies must continue to be held accountable to ensure their actions align with their written commitments.

To improve health outcomes for all members of society requires looking at the broader picture. Holistic changes that address the interconnected facets of our healthcare system are key to advancement.