Name: Brainstorm Health 2024: Keeping Health Equity a Priority
Uploaded: 2024-05-21
Duration: 17 min 39 s
Description: Dr. Uché Blackstock, Founder and CEO, Advancing Health Equity Dr. Hala Borno, Associate Professor, Medicine, University of California San Francisco; Co-founder and CEO, Trial Library Dr. Jayasree Iyer, Chief Executive Officer, Access to Medicine Foundation Moderator: Deena Shakir, General Partner, Lux Capital; Co-chair, Fortune Brainstorm Health

Dr. Uché Blackstock, Founder and CEO, Advancing Health Equity Dr. Hala Borno, Associate Professor, Medicine, University of California San Francisco; Co-founder and CEO, Trial Library Dr. Jayasree Iyer, Chief Executive Officer, Access to Medicine Foundation Moderator: Deena Shakir, General Partner, Lux Capital; Co-chair, Fortune Brainstorm Health

Brainstorm Health 2024: Keeping Health Equity a Priority

Conferences

Dr. Uché Blackstock, Advancing Health Equity, Dr. Hala Borno, University of California San Francisco; Trial Library, Dr. Jayasree Iyer, Access to Medicine Foundation, Deena Shakir, Lux Capital

We have a veritable American flag up here today. I love it. Red, white and blue, but we're, we're here not just to talk about America, we're here to talk about global health and equity. And I'm simply delighted to be among such an incredible group of women, of clinicians of researchers. I want to start by defining health equity. So if you could each briefly just explain to us what does health equity mean to you? Well, I think its health equity as every individual person having the opportunity to reach their highest health potential and as a physician, as an emergency medicine physician, I think that is what I want for every single one of my patients. And that motivates me to do the work that I do. Thank you, hea When I think about health equity, I always think about that tree, the fruit tree that's leaning, maybe some of you have seen this metaphor. Um imagine a fruit tree that's leaning and you have two people reaching for fruit, someone is able to reach the fruit more easily than the other person. Health equity is making sure they have custom tools. So one person has a taller ladder than the other person. So they can reach the same amount of fruit. But hopefully, we also talked today about justice, which is when you actually fix the fruit trees so everyone can access the fruit that they need. And for me, health equities about uh the fact that people, regardless of where they live, their socio-economic uh class, their race, their uh sexual orientation should all have equal access to care. And that includes 80% of the world's population living in low and middle income countries. So I want to turn the conversation to an acronym that has come under a lot of scrutiny lately. And that acronym is de I, there was a period of time where AD E I was all the rage and everybody wanted to have some effort that was advancing DE I and in recent times, it has actually come under some scrutiny and has seen a lot of critics. How do you think the state of de I today is affecting the work that you do? Maybe I'll start with that? Well, yeah, I mean, it's very personal for me. So for some of you who don't know me, I, I left a career in academic medicine because I felt that, you know, as um ad I leader, I could not do the work authentically the way that I, I really wanted to do it. Um And I left and I found that advancing health equity, you know, we working with health care organizations to, to create more diverse, inclusive workforces because we know ultimately, that trickles down onto the care that we provide our patients. And so, um I would say like, what, you know, the, the scotus decision of last year as it relates to um admissions to higher education, um There was a federal piece of legislation called the Educate Act that specifically targeted um de I in medical education that said that if medical schools were going to have D I programs that would lead to them not receiving federal funds. You know, to me, that means like we're in a crisis because we're talking about the most, some of the most horrible statistics now as they relate to health equity and then we're trying to reverse decades of advances within medicine or within health care. So that is very scary to me. It is a terrifying prospect. Hela, how are you seeing that impact the work you're doing in particular in the clinical research side? Absolutely. Well, I can say de I leaders didn't sign up for a performative de I they want material change and they wanna be empowered to do that in my work in oncology, clinical trials. I'm really focused on how do we advance access to research? We recognize that not only does that have immediate benefit for patients but certainly has a long tail benefit. And in order to do that, you really need to think about the social conditions the social determinants of health. We heard a lot about social determinants of health. Earlier with the Centene conversation, you really need to think about the conditions in which patients live in order to make true transformation. And de I leaders are tasked with thinking about that and are able to make transformation if they have the power and the authority to do so, Jay, we, we've talked a lot about sort of the headwinds here in the US, but it's a whole another ball game. And we're talking about global population health, what similarities or differences do you see in the context of the work that you do? So in the context of the work uh that I that I do, I mean, we're, we're in the business of making sure that the pharmaceutical industry is uh inclusive in, in their uh in the business to make sure that their products reaching patients all around the world. Um specifically looking at 100 low and middle income countries. So if you believe in the E I principles, not only must your, your governance model and equal pay be, be, be afforded to headquarter and, and the sea level executives around the world, but that needs to be available for also their businesses in low and middle income countries. So that means we look at specifically at, at sort of governance uh model for um for the companies themselves, how they improve access in low and middle income countries do they actually reach different populations, including uh vulnerable populations all around the world. Um And, and finally, is that, is that done in an equitable and a fair uh way. So I think that has been extremely transformative and as an employer myself, I think, uh and, and as a woman of color myself, I think for us, you know, it is really important that when we are dealing with stakeholders who are engaged in driving and empowering industry to do better, that is a diverse group uh that is brought forward to, to make that change itself. And you especially see that in sectors of the health care industry, like in medical oxygen that we evaluate. Um the medical gas oil companies are very male driven uh industries. Um And now, you know, they're, they're really trying to make a big effort in, in making sure that it's more diverse and more inclusive of the different populations around the world. It seems to me that there's a damning amount of evidence pointing to the importance of of diversity in clinical care providers. In fact, there was just an article a few days ago uh in Jama that was uh looking at the impact on women's health, in particular with women care providers. There is all sorts of data out there showing that impact as well from a from a racial perspective. And yet there are so many forces that are preventing tho those changes from happening. How do you take on, on some of these headwinds. Yeah, I mean, there's even a study, I have to say this even study from last year, from the Journal of American Medical Association that showed that uh one US county, they had one black primary care physician that improved life expectancy for black people living in that county and actually everyone else. That's incredible. I know. So like, you know, people underestimate like the, the impact and the importance of diversity. Um I, I will say that, you know, just like how that many, many of us that are in that, that are doing this work, it means very, very much to us, right? Um We are working against practices and policies that um are centuries old. Like one thing I wrote about was like the Flexner report and that's a report that closed medical schools um at the turn of the 20th century, um it closed five out of seven of the black medical schools leading us to lose between 25 and 35,000 black physicians. So one part is understanding that today in 2024 while we may see some dismal these dismal numbers, part of it is because of the history. So understanding that history, understanding how other policy changes can improve or hinder the statistics that we see now and working with the communities that need to be centered. So I always say a lot of the answers as they relate to health equity and D I really lie within the communities. We serve our patients, our community members, they can tell us what needs to be fixed. Um We just need to listen to them. So I really would call on folks in this room to really interact with the community that you're serving. I love that. I heard so much about social determinants of health on this stage because that's what we've been talking about for a long time time. Um maybe not in this room, but we've been talking about it as it relates to health for a very long time. Um And we know that those are the key drivers of what leads to good health. Absolutely. And, and, and like you left a career in academic medicine to start a company actually taking on this problem. Why do you believe that a a tech company is the solution to advancing precision medicine? Yeah. So um I realized that this was a home in my back of my mind that I just needed to react to. And I felt that in some way, my academic career, I was incrementally making progress, but I wanted to make impact now and the moment was now and the opportunity was now um as an academic oncologist, I was seeing a few patients a day and committing the rest of my time to science. And there was an evidence base for how can we actually move the needle on recruiting diverse patients, making sure we're expanding access. And our model is really focused on going to the provider, 77% of patients that enroll in an oncology trial do so because of a provider recommendation. So the question I started asking are, who are the providers that are offering trials and who are not and why aren't they? And so we started thinking about let's address the pain points that they experience in their clinic and let's ensure that we can give them an opportunity to easily offer trials to patients. And this led me to conversations with oncologists all around the United States. And I frequently ask a community oncologist, how many patients do you see today? And they'll say 40 patients. And so that's just a number. But I want you all who aren't health care providers to think in your chair, imagine a day where you have 40 meetings and for every meeting, you need to make a decision and you also need to document the data you collected to make that decision and also the justification for that decision. And you have to follow up for all the meetings you had the day before. That's the reality of a health care provider in the community, serving diverse patients that we want to have enrolled patients to trial. So of course, they're struggling. And so technology has a role, of course, there's other innovation that needs to be at play and that's what I get the, the pleasure of addressing every day in just a moment, we're gonna turn to you all in the audience for questions. So raise your hand and a mic will come your way. But Jay before we do that, what role does global Pharma play in all of this? Well, at the end, global Pharma is responsible for uh developing and delivering uh the medicines that we all need in order to, to um you know, treat the conditions that we have and prevent the diseases that we have. So, and global Pharma plays a very strong ups upstream role. If some of the biggest companies in the world can make sure that their business is more sustainable, more inclusive uh more serving, you know, 80% of the world's population uh in a fair and equal way, then they can make a huge impact. So one of the things that we really um you know, push for is that investors who invest in the pharmaceutical industry, we also need to invest differently. So we actually host the uh the largest signatory base of investors in health care in the world with about 100 and 40 investment firms that sign on to the principles of our work and and invest differently in the pharmaceutical industry. So their shareholder resolutions are basically trying to convince companies or demand that companies need to expand their, the the broader reach of, of their, of their products in, in, in uh for patients all around the world. Make sure that their clinical studies are inclusive, diverse and um around the whole world and make sure that their products are registered and delivered in in in the world in an affordable way. So that is the kind of transformative work that we need to do in order to convince some of the the biggest companies in the world to to move over to the audience. Now, I think I saw a hand being raised earlier. Any questions from the audience? Yeah. Hi, Joe Harrison, uh founder CEO of Avail Health. Um I just wanted to comment as a white man. I was lucky that I started unlearning and continue to racism, classism, etcetera, very at a very young age. And I'm just thinking about the powerful positions and who's sitting in those positions. And I just wanted to ask for comments on, you know, what are you seeing in terms of, you know, minds changing, um outlooks, changing, understanding, like learning um that I think has such, you know, such an impact if it happens, I have no line of sight on that. And I'm wondering what your experience is in the roles you're in. It's a great question. Yeah, I think that's a great question. And I think in the work that I do with advancing health equity, we're working with a lot of organizations who already have buy in from leadership. Um But we, we always see that that's the key to success like the the leaders who truly believe in the importance of equity and that look at every decision that they make or every part of their strategy through an equity lens. Those are gonna be the ones that really care deeply about what their workplaces look like, like, what, what is the culture of their workplaces? How does that, how does that uh associate with how care is delivered? Um And so we probably have a selection bias um and who decides to work with us. Um And, you know, obviously we would want more leaders to be deeply, you know, about the same issues. But um I think, you know, it's, it's a matter of life and death, you know, we, we see people and we took overall Americans are not living long lives like life expectancy continues to go down for every racial demographic, especially people of color. Um And so really, I think everyone in health needs to be committed to improving these outcomes. Another question over here. Yes. Hi, I mea, I'm a chief medical officer with Simpler. I'm a Hispanic uh internist background. Um Very proud to work for a company that's a very strong in D I. Uh but as an internist, I think one of the things that you mentioned was that the paper that was published that showed difference in outcomes uh based on the concurrence of, of the care that's delivered. Um I, I think that's, that's what the voice, the voice should be about. The science behind it, the evidence that providing care in that concurrence can improve outcomes. My question to you all is how do we raise that voice to our corporate level to make it less corporate and more about the medicine that we're delivering? I can take that. And so I think there's, there's a couple of solutions to it, right? Um There needs to be quite a strong uh strong strategic embedding of, of, of what it means to be a uh an organization or a company that that is delivering in a, in a diverse and equitable way and that comes really from the top, but it cannot just live on at the top. It, it needs to be really embedded in the system. And one of the accountability tools that we use is to measure that over time to see whether there is progress being made on any organization over time. The CEO um uh bonus structure is that associated with performance and access to medicine um globally. Um Is there uh is there and other firms obviously look at uh diversity and inclusion parameters at the leadership level and across across the, the the company. Um a metric. Uh there's also a metric on uh clinical trial uh diversity um uh on top of the ethical uh components to it. So to me, I think it's really important uh as a as a company to have very strong uh a very strong policy in place that is actually implemented globally. It's also really important that today's workforce demands uh uh that the leadership and a company's philosophy is really breathes through its business itself. And, and for us, we find a lot of power in internal change makers within any firms that really drive, drive that change. Um and then external pressure, I mean, you know, right now, at least in the pharmaceutical industry, the pharmaceutical industry is filling a gap in, in education systems and in health care systems, but also supporting, using funding. Um and when the primary work is delivering on the medicines itself, so keeping the focus to make sure that the primary role of a company is in delivery, I think it's, it's, it's, it's a, it's, it's important to, to maintain and then additional additions to that can be added on. So a strong accountability mechanism needs to be paired with, with sort of a overarching strategy. Thank you. Oh, we're almost at that time. So I'm just gonna do a quick fire round. So 10 seconds each. Uh uh and I'll start with this question was COVID an accelerant of DE I and health care or did it slow things down? 10 seconds, I would say accelerant, I think you expose the deep fissures within our health care system. Many of us knew what those fissures were, but I think to a more general audience, it exposed them in a way that had never been exposed before. Yeah, I agree. I think it emboldened organizations to talk about de I when they weren't interested or have the bandwidth to do so before. But I think now is sort of the time of reckoning where they're starting to define what it means and how they can consistently apply it within the organization. Ok. So health equity has been an, an, an issue. That's a, that's a chronic issue for time, a memorial already. So COVID basically accelerated the understanding uh of, of the city and the barriers behind it, but not a lot has changed in terms of are people still receiving care really at scale across the world. So there's still a lot of work to do um but it can be done and there the fantastic models out there on how this can be done in real life tested and um methods out there. So it's about scaling that up. Excellent. Well, you're saved by the bell. I had another fire round of questions, but we're at time right now. So thank you all for a fantastic discussion.