In health care, equality can be a life-or-death issue, and addressing it is imperative not only for public policy and health systems but also for health care businesses. A common approach is for health care companies to add diversity, equity, and inclusion (DEI) positions or departments, but these efforts may not lead to impactful change on their own. As the U.S. becomes increasingly multicultural and given that certain diseases have a higher prevalence in minority populations, it’s time for health care businesses to take meaningful action to address the longstanding inequity in the health care system. 

Enrique Caballero, MD, an endocrinologist at Brigham and Women’s Hospital and the faculty director of International Innovation Programs in the Harvard Medical School Office for External Education, has been a longtime advocate for productive change and improved care for minority populations. He has researched type 2 diabetes in the U.S. Hispanic population living in the United States and the importance of transcultural diabetes care. 

“I would say that everybody's interested in DEI. Now, whether they do something about it or not, that's a different story,” Dr. Caballero says. “I don't think people really have a good sense of the strategies that could help them become corporations that are champions in this field.”

To improve minority access to care, businesses and organizations throughout the sector need to buy in and participate in reform. All companies have a role to play, for example, by connecting with individuals who could be most impacted by their product, facilitating minority access to health insurance, or listening to diverse voices at the market research stage. Starting the conversation and taking action with impacted groups at the decision-making table are important steps for individual companies to take sooner than later.

Here’s why it’s important for health care businesses to truly walk the walk when it comes to DEI initiatives:

Companies operate in a multicultural marketplace.

In the coming decades, census data shows a likely turning point in U.S. demographics. Experts predict the U.S. will become a minority-majority country (that is, non-Hispanic white people become the minority) in 2045. There is already an abundance of cultural diversity in the U.S., and the projected increase only reaffirms how important it is for companies to improve communication with people of all backgrounds —and soon. After all, it’s a good business move.

“The reality is that everybody's interested in knowing how to reach different communities,” Dr. Caballero says. “Why? Because they want to sell their products to everybody.” 

In a multicultural society like the U.S., that means communications like advertisements must appeal to different audiences in different ways, whether in a different language, on a different medium, or with different cultural references. To do so, having a diverse and culturally aware team is pivotal. 

It’s also important that health care business leaders are aware of potential blind spots and unconscious biases that could seep into their work. Being culturally aware doesn’t mean people need to know everything, but they must have the humility to turn to another teammate for insight when someone else’s expertise is better suited for a given situation.

Products may be more relevant to certain groups, depending on the populations most impacted by a disease or condition.

Certain diseases are more prevalent in specific populations, so health care companies that target those groups effectively will reach an audience more in need of their services. For example, diabetes is more common in the Black (13.3%), Asian (11.2%), and Hispanic (10.3%) communities than in the white community (9.4%).  

“If [pharmaceutical companies] have medications for diabetes, obesity, hypertension, cardiovascular disease or renal disease, which usually go together, they need to have a strong presence in minority communities because that's where most of the patients are going to be,” Dr. Caballero says.

The same is true for many other health measures and conditions. Black, Hispanic, American Indian, and Alaska Native (AIAN) people tend to fare worse than white people on measures related to health coverage, access, status, outcomes, and social determinants of health, according to the Kaiser Family Foundation. The COVID-19 pandemic exacerbated and may have widened many of these disparities. 

Health care companies need to reach consumers to be able to help them improve their health. The first step is to know who the audience is, and creating linguistically and culturally relevant communications is the next step. Companies also have to think about where those communications appear, depending on the audience. Are these individuals more likely to watch cable TV or use a streaming service, see a billboard while driving, or glance at advertisements while riding the subway?

To communicate effectively with the target groups, business leaders need to be aware of considerations related to DEI and be committed to hiring a diverse staff.

Health care inequity is a longstanding issue that companies may be able to help correct. 

Health inequities occur across a broad range of dimensions — race and ethnicity, gender, socioeconomic status, language, sexual identity and orientation, disability status, citizenship status, geography, and more — and have a variety of consequences. 

The 2019 National Healthcare Quality and Disparities Report notes that “compared with white patients, racial and ethnic minority patients are less likely to receive evidence-based cardiovascular care, kidney transplants when indicated, age-appropriate diagnostic screening for breast and colon cancer, timely treatment related to cancer and stroke, appropriate mental health treatment, and adequate treatment when presenting suffering from pain.” 

A 2019 study out of Brigham and Women’s, “Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center,” found that Black and Latinx patients were less likely than white patients to be admitted to cardiology for heart failure care and more likely to be admitted to general medicine. 

Research during the pandemic also elucidated inequities. LGBT people reported experiencing worry and stress from the pandemic at a higher rate than non-LGBT people (74% vs. 49%). People of color in the U.S. have had higher rates of infection, hospitalization, and death due to COVID-19, according to data from the CDC. As of April 2021, Black and Hispanic people were less likely to have received a COVID-19 vaccine than white people, which may highlight a lack of linguistic and cultural relevancy in vaccine promotion efforts.

“I wouldn't say there's intentional discrimination, but I think we have to accept that there are reasons why people are not treated the same,” Dr. Caballero says. “We definitely have biases (conscious and unconscious) that are part of our own development, and the system does not have the infrastructure to treat all patients equally. The reality is these things are happening and they could be addressed.”

Health care businesses aim to improve consumer health via their product or service. To achieve that goal equitably, leaders must recognize inequity and problem-solve to reduce disparities. Only then can companies begin to resolve the health challenges they set out to fix, including improving the health of minority customers. 

To put it bluntly, until companies address inequity head on, they may be at risk of exacerbating the problem.

Above all, leaders must be sure they are doing more than simply talking the talk. As Dr. Caballero puts it, “this is an area of great opportunity,” but only when health care leaders step up to the challenge.

Harvard Medical School can help your business leaders address DEI and other pressing challenges and opportunities facing health care. Begin by exploring our Corporate Learning programs. Additionally, learn more about our new Harvard Online course, “Reducing Racial Disparities in Health Care.”