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
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TechTranscript
00:00 We have a veritable American flag up here today.
00:02 I love it.
00:03 Red, white, and blue.
00:04 But we're here not just to talk about America.
00:07 We're here to talk about global health and equity.
00:09 And I'm simply delighted to be among such an incredible group
00:12 of women, of clinicians, of researchers.
00:15 I want to start by defining health equity.
00:18 So if you could each briefly just explain to us,
00:21 what does health equity mean to you?
00:23 Well, I think of health equity as every individual person
00:27 having the opportunity to reach their highest health potential.
00:31 And as a physician, as an emergency medicine physician,
00:35 that is what I want for every single one of my patients.
00:38 And that motivates me to do the work that I do.
00:40 Thank you.
00:41 Hella.
00:41 When I think about health equity,
00:43 I always think about that tree, the fruit tree that's leaning.
00:46 Maybe some of you have seen this metaphor.
00:49 Imagine a fruit tree that's leaning,
00:51 and you have two people reaching for fruit.
00:53 Someone is able to reach the fruit more easily
00:56 than the other person.
00:57 Health equity is making sure they have custom tools.
00:59 So one person has a taller ladder than the other person,
01:03 so they can reach the same amount of fruit.
01:05 But hopefully, we also talk today
01:07 about justice, which is when you actually fix the fruit tree,
01:10 so everyone can access the fruit that they need.
01:13 And for me, health equity is about the fact
01:16 that people, regardless of where they live,
01:18 their socioeconomic class, their race,
01:21 their sexual orientation, should all have equal access to care.
01:26 And that includes 80% of the world's population
01:28 living in low and middle income countries.
01:31 So I want to turn the conversation
01:32 to an acronym that has come under a lot of scrutiny lately.
01:36 And that acronym is DEI.
01:38 There was a period of time where DEI was all the rage,
01:41 and everybody wanted to have some effort that
01:44 was advancing DEI.
01:45 And in recent times, it has actually
01:47 come under some scrutiny and has seen a lot of critics.
01:51 How do you think the state of DEI
01:54 today is affecting the work that you do?
01:56 Maybe I'll start with you, Dr. Glasser.
01:57 Yeah.
01:57 Well, yeah.
01:57 I mean, it's very personal for me.
01:59 So for some of you who don't know me,
02:01 I left a career in academic medicine
02:05 because I felt that as a DEI leader,
02:09 I could not do the work authentically the way
02:12 that I really wanted to do it.
02:15 And I left, and I founded Advancing Health Equity.
02:18 We're working with health care organizations
02:19 to create more diverse, inclusive workforces,
02:22 because we know ultimately that trickles down onto the care
02:25 that we provide our patients.
02:27 And so I would say the SCOTUS decision of last year
02:32 as it relates to admissions to higher education,
02:36 there was a federal piece of legislation called the Educate
02:40 Act that specifically targeted DEI in medical education that
02:44 said that if medical schools were going to have DEI
02:48 programs, that would lead to them not receiving
02:51 federal funds.
02:53 To me, that means we're in a crisis,
02:56 because we're talking about some of the most horrible statistics
03:00 now as they relate to health equity,
03:02 and then we're trying to reverse decades of advances
03:06 within medicine or within health care.
03:10 So that is very scary to me.
03:12 It is a terrifying prospect.
03:13 Hala, how are you seeing that impact
03:15 the work you're doing, in particular,
03:16 on the clinical research side?
03:18 Absolutely.
03:18 Well, I can say DEI leaders didn't sign up
03:21 for a performative DEI.
03:23 They want material change, and they
03:25 want to be empowered to do that.
03:27 In my work in oncology clinical trials,
03:28 I'm really focused on how do we advance access to research.
03:32 We recognize that not only does that
03:34 have immediate benefit for patients,
03:35 but certainly has a long tail benefit.
03:38 And in order to do that, you really
03:39 need to think about the social conditions,
03:41 the social determinants of health.
03:42 We heard a lot about social determinants of health
03:45 earlier with the centene conversation.
03:46 You really need to think about the conditions
03:48 in which patients live in order to make true transformation.
03:52 And DEI leaders are tasked with thinking about that
03:55 and are able to make transformation
03:56 if they have the power and the authority to do so.
03:59 Jay, we've talked a lot about the headwinds here in the US,
04:02 but it's a whole other ballgame when we're talking
04:04 about global population health.
04:06 What similarities or differences do
04:08 you see in the context of the work that you do?
04:10 So in the context of the work that I do,
04:13 I mean, we're in the business of making sure
04:15 that the pharmaceutical industry is
04:17 inclusive in their business to make sure
04:20 that their products are reaching patients all around the world,
04:24 specifically looking at 100 low and middle income countries.
04:28 So if you believe in DEI principles,
04:29 not only must your governance model and equal pay
04:32 be afforded to headquarter and C-level executives
04:38 around the world, but that needs to be available for also
04:41 their businesses in low and middle income countries.
04:44 So that means we look specifically
04:45 at governance models for the companies themselves,
04:49 how they improve access in low and middle income countries.
04:52 Do they actually reach different populations,
04:55 including vulnerable populations all around the world?
04:59 And finally, is that done in an equitable and a fair way?
05:03 So I think that has been extremely transformative.
05:06 And as an employer myself, I think,
05:08 and as a woman of color myself, I think for us,
05:11 it is really important that when we're
05:12 dealing with stakeholders who are engaged in driving
05:15 and empowering industry to do better,
05:18 that it's a diverse group that is brought forward
05:20 to make that change itself.
05:22 And you especially see that in certain sectors
05:24 of the health care industry, like in medical oxygen
05:27 that we evaluate.
05:29 The medical gas companies are very male-driven industries.
05:33 And now, they're really trying to make a big effort
05:37 in making sure that it's more diverse and more
05:39 inclusive of the different populations around the world.
05:42 It seems to me that there is a damning amount of evidence
05:45 pointing to the importance of diversity in clinical care
05:49 providers.
05:50 In fact, there was just an article a few days ago
05:52 in JAMA that was looking at the impact on women's health,
05:55 in particular with women care providers.
05:57 There is all sorts of data out there showing that impact
06:00 as well from a racial perspective.
06:02 And yet, there are so many forces
06:05 that are preventing those changes from happening.
06:08 How do you take on some of these headwinds?
06:11 Yeah, I mean, there's even a study--
06:13 I have to say, there's even a study from last year
06:15 from the Journal of American Medical Association
06:17 that showed that one US county, they
06:19 had one black primary care physician that
06:22 improved life expectancy for black people living
06:25 in that county and actually everyone else.
06:27 That's incredible.
06:28 I know.
06:28 So people underestimate the impact and the importance
06:32 of diversity.
06:34 I will say that, just like Holla said, many of us
06:38 that are in--
06:39 that are doing this work, it means very, very much to us.
06:44 We are working against practices and policies
06:47 that are centuries old.
06:49 One thing I wrote about was the Flexner report.
06:51 And that's a report that closed medical schools
06:53 at the turn of the 20th century.
06:56 It closed five out of seven of the black medical schools,
07:00 leading us to lose between 25,000 and 35,000
07:02 black physicians.
07:04 So one part is understanding that today in 2024,
07:08 why we may see some dismal--
07:09 these dismal numbers, part of it is because of the history.
07:12 So understanding that history, understanding
07:15 how other policy changes can improve or hinder
07:19 the statistics that we see now, and working
07:23 with the communities that need to be centered.
07:25 So I always say a lot of the answers,
07:27 as they relate to health equity and DEI,
07:29 really lie within the communities we serve.
07:32 Our patients, our community members,
07:34 they can tell us what needs to be fixed.
07:38 We just need to listen to them.
07:39 So I really would call on folks in this room
07:42 to really interact with the communities that you're serving.
07:44 I love that I heard so much about social determinants
07:47 of health on this stage, because that's
07:49 what we've been talking about for a long time.
07:51 Maybe not in this room, but we've
07:53 been talking about it as it relates
07:54 to health for a very long time.
07:56 And we know that those are the key drivers of what
07:59 leads to good health.
08:00 - Absolutely.
08:01 And like Uche Hale, you left a career in academic medicine
08:05 to start a company, actually, taking on this problem.
08:08 Why do you believe that a tech company is the solution
08:12 to advancing precision medicine?
08:15 - Yeah, so I realized that this was a hum in my back
08:18 and my mind that I just needed to react to.
08:20 And I felt that in some way, my academic career,
08:23 I was incrementally making progress,
08:24 but I wanted to make impact now.
08:26 And the moment was now, and the opportunity was now.
08:29 As an academic oncologist, I was seeing a few patients a day
08:33 and committing the rest of my time to science.
08:35 And there was an evidence base for how can we actually
08:37 move the needle on recruiting diverse patients,
08:40 making sure we're expanding access.
08:41 And our model is really focused on going to the provider.
08:45 77% of patients that enroll in an oncology trial
08:48 do so because of a provider recommendation.
08:51 So the question I started asking are,
08:53 who are the providers that are offering trials,
08:55 and who are not?
08:56 And why aren't they?
08:58 And so we started thinking about,
09:00 let's address the pain points that they experience
09:02 in their clinic, and let's ensure that we can give them
09:05 an opportunity to easily offer trials to patients.
09:09 And this led me to conversations with oncologists
09:11 all around the United States.
09:12 And I frequently ask a community oncologist,
09:15 how many patients do you see today?
09:16 And they'll say, 40 patients.
09:19 And so that's just a number, but I want you all
09:22 who aren't healthcare providers to think in your chair.
09:25 Imagine a day where you have 40 meetings,
09:28 and for every meeting you need to make a decision,
09:31 and you also need to document the data you collected
09:34 to make that decision, and also the justification
09:36 for that decision.
09:37 And you have to follow up for all the meetings
09:39 you had the day before.
09:40 That's the reality of a healthcare provider
09:43 in the community serving diverse patients
09:45 that we want to have enroll patients to trials.
09:47 So of course, they're struggling.
09:49 And so technology has a role.
09:51 Of course, there's other innovation
09:53 that needs to be at play, and that's what I get,
09:55 the pleasure of addressing every day.
09:58 - In just a moment, we're gonna turn to you all
10:00 in the audience for questions.
10:01 So raise your hand and a mic will come your way.
10:03 But Jay, before we do that, what role does Global Pharma
10:06 play in all of this?
10:08 - Well, at the end, Global Pharma is responsible
10:09 for developing and delivering the medicines
10:14 that we all need in order to treat the conditions
10:17 that we have and prevent the diseases that we have.
10:19 So, and Global Pharma plays a very strong upstream role.
10:23 If some of the biggest companies in the world
10:25 can make sure that their business is more sustainable,
10:27 more inclusive, more serving 80% of the world's population
10:32 in a fair and equal way, then they can make a huge impact.
10:36 So one of the things that we really push for
10:39 is that investors who invest in the pharmaceutical industry
10:42 also need to invest differently.
10:44 So we actually host the largest signatory
10:47 based of investors in healthcare in the world
10:49 with about 140 investment firms
10:52 that sign on to the principles of our work
10:54 and invest differently in the pharmaceutical industry.
10:57 So their shareholder resolutions are basically
10:59 trying to convince companies or demand that companies
11:02 need to expand the broader reach of their products
11:07 for patients all around the world,
11:10 make sure that their clinical studies are inclusive,
11:13 diverse, and around the whole world,
11:15 and make sure that their products are registered
11:17 and delivered in the world in an affordable way.
11:19 So that is the kind of transformative work
11:22 that we need to do in order to convince
11:24 some of the biggest companies in the world to move.
11:26 - Over to the audience now.
11:28 I think I saw a hand being raised earlier.
11:31 Any questions from the audience?
11:33 Yes.
11:35 - Hi, Joe Harrison, founder and CEO of Avail Health.
11:44 I just wanted to comment as a white man.
11:47 I was lucky that I started unlearning
11:50 and continue to, racism, classism, et cetera,
11:53 at a very young age, and I'm just thinking
11:56 about the powerful positions
11:58 and who's seating in those positions,
12:00 and I just wanted to ask for comments on
12:02 what are you seeing in terms of minds changing,
12:06 outlooks changing, understanding, like learning,
12:10 that I think has such an impact if it happens.
12:14 I have no line of sight on that,
12:15 and I'm wondering what your experience is
12:17 in the roles you're in.
12:18 - That's a great question.
12:19 - Yeah, I think that's a great question,
12:21 and I think in the work that I do
12:23 with Advancing Health Equity,
12:24 we're working with a lot of organizations
12:26 who already have buy-in from leadership,
12:28 but we always see that that's the key to success.
12:31 Like, the leaders who truly believe
12:33 in the importance of equity
12:35 and look at every decision that they make
12:38 or every part of their strategy through an equity lens,
12:42 those are gonna be the ones that really
12:44 care deeply about what their workplaces look like.
12:47 Like, what is the culture of their workplaces?
12:49 How does that associate with how care is delivered?
12:53 And so, we probably have a selection bias
12:56 in who decides to work with us,
12:59 and obviously, we would want more leaders
13:03 to be deeply concerned about the same issues,
13:06 but I think it's a matter of life and death.
13:12 We see people, and overall,
13:14 Americans are not living long lives.
13:17 Life expectancy continues to go down
13:19 for every racial demographic, especially people of color,
13:23 and so, really, I think everyone in health
13:25 needs to be committed to improving these outcomes.
13:29 - Another question over here, yes.
13:32 - Hi, Anil Mena.
13:35 I'm a chief medical officer with Simpler.
13:37 I'm a Hispanic internist in background.
13:41 I'm very proud to work for a company
13:43 that's very strong in DEI, but as an internist,
13:47 I think one of the things that you mentioned
13:49 was that the paper that was published
13:51 that showed difference in outcomes
13:54 based on the concordance of the care that's delivered.
13:57 I think that's the voice.
14:02 The voice should be about the science behind it,
14:04 the evidence that providing care in that concordance
14:07 can improve outcomes.
14:09 My question to you all is how do we raise that voice
14:11 to our corporate level to make it less corporate
14:15 and more about the medicine that we're delivering?
14:17 - I can take that.
14:19 So, I think there's a couple of solutions to it.
14:23 There needs to be quite a strong strategic embedding
14:28 of what it means to be an organization or a company
14:32 that is delivering in a diverse and equitable way,
14:36 and that comes really from the top,
14:38 but it cannot just live at the top.
14:40 It needs to be really embedded in the system.
14:42 One of the accountability tools that we use
14:44 is to measure that over time to see
14:46 whether there is progress being made
14:49 on any organization over time.
14:51 Is the CEO's bonus structure,
14:54 is that associated with performance
14:56 and access to medicine globally?
14:59 Other firms obviously look at diversity
15:03 and inclusion parameters at the leadership level
15:05 and across the company.
15:08 There's also a metric on clinical trial diversity
15:13 on top of the ethical components to it.
15:17 So, to me, I think it's really important as a company
15:20 to have a very strong policy in place
15:24 that is actually implemented globally.
15:26 It's also really important that today's workforce demands
15:29 that the leadership and a company's philosophy
15:34 is really breathed through its business itself.
15:37 For us, we find a lot of power in internal change makers
15:40 within any firms that really drive that change.
15:43 And then external pressure.
15:45 Right now, at least in the pharmaceutical industry,
15:47 the pharmaceutical industry is filling a gap
15:50 in education systems and in healthcare systems
15:52 by also supporting using funding
15:55 and when the primary work is delivering
15:57 on the medicines itself.
15:59 Keeping the focus to make sure that the primary role
16:02 of a company is in delivery,
16:04 I think it's important to maintain
16:08 and then additional additions to that can be added on.
16:11 So, a strong accountability mechanism needs to be paired
16:14 with sort of an overarching strategy.
16:16 - Thank you.
16:18 Oh, we're almost at that time,
16:19 so I'm just gonna do a quick fire round.
16:21 So, 10 seconds each and I'll start with this question.
16:24 Was COVID an accelerant of DEI in healthcare
16:28 or did it slow things down?
16:31 10 seconds.
16:32 - I would say accelerant.
16:34 I think it exposed the deep fissures
16:36 within our healthcare system.
16:38 Many of us knew what those fissures were,
16:39 but I think to a more general audience,
16:42 it exposed them in a way that it never exposed before.
16:46 - Yeah, I agree.
16:48 I think it emboldened organizations to talk about DEI
16:50 when they weren't interested
16:51 or had the bandwidth to do so before.
16:53 But I think now is sort of the time of reckoning
16:55 where they're starting to define what it means
16:57 and how they can consistently apply it
16:59 within the organization.
17:00 - Jay.
17:01 - So health equity has been an issue
17:03 that's a chronic issue for Time Immemorial already.
17:06 So COVID basically accelerated the understanding
17:09 of the situation and the barriers behind it,
17:12 but not a lot has changed in terms of
17:14 are people still receiving care
17:16 really at scale across the world?
17:18 So there's still a lot of work to do,
17:20 but it can be done.
17:20 And there are fantastic models out there
17:22 on how this can be done,
17:23 real life tested methods out there.
17:26 So it's about scaling that up.
17:27 - Excellent.
17:28 Well, you're saved by the bell.
17:29 I had another fire round of questions,
17:30 but we're at time right now.
17:31 So thank you all for a fantastic discussion.
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