April 04, 2023
7:44 pm
The Report of the Secretary’s Task Force on Black and Minority Health was released in 1985, serving as a catalyst for the U.S. Department of Health and Human Services (HHS) to begin addressing health disparities, and Congress to form the Office of Minority Health within HHS the following year. Today, much of the progress in this arena is taking place in the private sector. The healthcare industry is taking steps to achieve health equity with considerable vigor and with some lessons learned under its belt. The Healthcare Leadership Council (HLC), representing all health industry sectors, released a report in January 2023 with ZS, entitled, “Addressing Health Equity: Practical Solutions to Address Variations in Care,” identifying multiple structural barriers in both the private and public sectors that contribute to existing health disparities. The report was followed by a release stating HLC members’ commitment to shared principles aimed at eliminating health disparities. HLC also recently hosted a webinar, “Breaking Down Barriers to Achieve the Highest Level of Health,” in which representatives from its member companies discussed current strategies and overarching philosophies. The panel was made up of three participants:
- Joneigh Khaldun, MD, Chief Health Equity Officer, CVS Health
- Josette Gbemudu, Executive Director, Health Equity and Social Determinants of Health, Merck
- Keith Dawson, Principal Science Leader, Global Health Equity and Population Science, Genentech
Dr. Khaldun opened by describing CVS’s enterprise-wide health equity strategy, highlighting the need to empower all employees by educating them about systemic inequities and providing tailored training for cultural competency. Dr. Khaldun also talked about measuring what matters to uncover inequities and utilizing these insights to design programs and policies to address them effectively. Examples of specific programs included CVS’s Community Equity Alliance, which aligns academic, community and healthcare partners to expand and integrate community health workers into care teams, and its workforce innovation training centers, which support job training needs across the country. Dr. Khaldun noted that disparities took centuries to develop, and that health equity is a journey that will not be achieved by one initiative in a short period of time.
Josette Gbemudu echoed Dr. Khaldun in that there must be internal integration of health equity across an entire business and not just through one initiative. She pointed to Merck’s $650 million commitment to improving maternal health globally and how it is using the learnings to embed health equity into its core business functions. Citing numerous statistics to show the broad range of disparities, Josette shared that Merck is not just focused on addressing social determinants of health barriers such as food insecurity, health literacy and health access, but it is dedicated to strengthening the entire health ecosystem. Merck Foundation launched a $20 million initiative to advance equity in U.S. cancer care. Josette emphasized that many communities have historically been unable to access screenings, which leads to later diagnoses and poorer outcomes. The alliance is utilizing a collaborative approach to build community partnerships in order to address barriers to care.
Keith Dawson discussed Genentech’s efforts to develop solutions that will broaden inclusion of historically underrepresented groups in clinical research so that all patients can realize the full benefits of personalized healthcare. He stressed that clinical research is not benefiting all groups equally, that genomic data is not diverse enough and that Blacks and Hispanics are not informed about clinical trial opportunities. The diversity of patients enrolled in clinical studies is highly correlated with site personnel diversity, he pointed out. Keith stated that Genentech prioritizes fostering belonging and cultivating an environment where all are included. The Advancing Inclusive Research Site Alliance Partnership was created to develop an ecosystem based on trust and meeting patients where they are. This alliance uses an external council of advisors and patient and provider partnerships to provide educational tools to improve awareness of clinical trials. It also distributes grants to external organizations striving to address inclusive research, equity in care and workforce diversity.
January 24, 2023
2:01 pm
Cancer is one of the leading causes of death across the globe and affects the lives of millions every year in the United States. As advances have been made in screening, diagnosing and therapeutics, providers have been able to utilize new technologies and precision medicine to achieve improved outcomes. The Healthcare Leadership Council hosted a webinar to highlight the commitment to medical research and discovery and the most recent accomplishments of some of its member companies. The webinar, “What’s New in Cancer Innovation?”, included three panelists:
- Dr. Qasim Ahmad, Head of US Oncology Medical Affairs, Novartis
- Dr. Harlan Levine, President, Health Innovation and Policy, City of Hope
- Victoria Raymond, Senior Director of Medical Affairs, Guardant Health
Ms. Raymond described Guardant’s focus on blood-based diagnostics as a less invasive way to screen for specific cancers. This method of screening can assist in early detection as well as ensuring appropriate therapy selection. Dr. Ahmad concurred that there has been a shift from making the patient fit the treatment, to making the treatment fit the patient. He presented Novartis’s strategy to harness the power of targeted therapy, immunotherapy, cell and gene therapy, and radioligand therapy to attack cancer using multiple approaches and provide the best outcomes for patients at every stage of the disease.
Dr. Levine noted that the rate of change in oncology exceeds the ability for most oncologists to keep up with the advances in each subtype of cancer or surgical technique. He stated that while with precision medicine and genomics we are able to identify tumor types and DNA signals, we still address value-based oncology with tools that were developed decades ago as though cancer is a single specialty with only a handful of chemotherapy agents. Reliance on these generic tools will limit the benefit of emerging technology and propagate disparities.
The discussion underscored the lack of diversity across clinical trial sites, doctors, study investigators and trial participants. A map was provided as a visual to portray how one’s survival is directly impacted by one’s zip code. The need to innovate the system so that it is accessible and equitable is vital to improving cancer care. The panelists acknowledged efforts to increase diversity in clinical trials and addressing barriers that hinder trial participation and access to treatment. Educating the public on opportunities is just one piece of the puzzle. Finding easier ways for people to follow through with what they know they need to do is the next challenge.
Finally, the Inflation Reduction Act (IRA) was raised as a hindrance to cancer research, which require long-term commitments and significant investments. There is a need for broader understanding of the investment required to subsidize clinical trials for cell-based therapies and the potential impact of the IRA in discouraging that investment. Policy measures that result in reduced research and fewer trials, ultimately limiting access to new therapies, is harmful to patients and society as a whole.
June 01, 2022
2:19 pm
Across the healthcare industry work is taking place to address health disparities. The Healthcare Leadership Council (HLC) has delved specifically into social determinants of health, broadband access, disparities in care delivery, vaccine acceptance, behavioral health, and workforce and clinical trial diversity. Amgen, an HLC member, is a leader in improving clinical trial diversity as a means to ensure better outcomes for those of diverse racial and ethnic backgrounds. This recent post below lays out the company’s comprehensive strategy, strengthened by collaboration, to address systemic issues which affect participation in research.
Improving Diversity in Our Clinical Trials for Long-term Health Equity
Darryl Sleep, Amgen’s senior vice president and Global Medical and Chief Medical Officer
Last April, Amgen stood with PhRMA as the first-ever industry-wide Principles on Clinical Trials Diversity officially took effect. The goals of these Principles are to expand participation among diverse patient populations by increasing understanding and awareness about clinical trials and improving access. Since then, we’ve already seen two very significant positive outcomes. First, improving diversity and representation in clinical trials has evolved from a niche issue into a core industry commitment. Second is the development of enthusiastic, industry-wide initiatives to improve how sponsors approach and improve diversity and representation in clinical trials. We are sharing best practices and de-identified aggregated clinical trial data to continue advancing this work via our cross-industry collaborations and partnerships. In this purpose, there is no holding back; we are all dedicated to making long-overdue changes that will result in diversity and representation in clinical trials becoming a reality and not just an ideal.
Clinical trials are a critical part of the long and careful process of developing new medicines. This research is complex and multidisciplinary and there isn’t a single accelerator that can be used to address the systemic issues that deter people from participating. Instead, we need a range of different levers to update decades-old processes and create new best practices.
I want to use the one-year anniversary of the PhRMA Principles to share some highlights about the data-driven efforts we’ve taken at Amgen to lead the way in breaking down barriers and help us find new medicines supported by clinical trials that are representative of all patients who suffer from serious illnesses.
We have a dedicated team
While the push for more diversity and inclusion in clinical trials is not new to Amgen, we accelerated our efforts in 2020 with the formation of RISE (Representation in ClInical ReSEarch), a team dedicated to addressing the systemic issues that deter people from participating in research, especially those who have been historically excluded due to race, ethnicity, sex, age, and other factors. We have significant momentum with our goals as programs and teams across Amgen, including RISE, Global Medical, Advocacy, Compliance, and Global Development, trial execution and data & analytics teams work together to create greater equity through diversity and proportional representation in clinical trials.
Ongoing learning to gain understanding and insights
Communication and information-sharing are fundamental to driving change. The output from our Health Equity Summit: Disrupting Health Disparities through Partnership and multiple Community Advisory Boards focused on direct insights from Black, Indigenous and People of Color (BIPOC) which provided information on barriers, strategies, and tactics that can apply across communities. We are using these insights to directly inform the design and implementation of a long-term, study-agnostic community engagement plan – a critical step in building sustainable, trusted relationships. Additionally, our patient-focused advisory councils with representation of racial and ethnic minorities will inform our clinical trial design and execution.
Building foundational capabilities
Logistical and financial barriers, gaps in awareness, and lack of trust all impact participation in clinical trials. We are partnering with organizations and diverse suppliers to thoughtfully build our enrollment support capabilities, including providing transportation, and other potential support capabilities, as well as finding optimal ways to support staff at clinical trial sites. Taking a holistic approach to tackling these industry-wide issues will help us move the needle.
New partnerships and collaborations
Collaborative partnerships play a significant role in advancing understanding of the science and our ability to positively engage patient communities in clinical trials. Toward that end, we are engaged in a number of efforts including:
- A pilot program of the American Cancer Society Cancer Action Network to test a trial eligibility screening intervention intended to increase and diversify patient enrollment in cancer clinical trials, including navigators to help patients address logistical and financial challenges to enrolling and completing those clinical trials.
- The CEO Roundtable on Cancer’s Going for Gold initiative, in partnership with Historically Black Colleges and Universities (HBCUs) and Hispanic Serving Institutions (HSIs), that focuses on equitable cancer care.
- A collaboration with The Digital Medicine Society (DiMe) to drive inclusion in digital clinical trials by providing the tools and framework necessary to successfully engage underrepresented populations during the planning process for clinical trials that include a technology device for participation.
- Creation of the HBCU BioTech Fellowship program, a professional development program that will prepare and empower 50 students (and soon-to-be graduates) from Historically Black Colleges and Universities for careers at Amgen.
Measuring progress in our own trials
We have undertaken important steps including a baseline study that will help us measure progress for trials currently underway as well as for new trials on the horizon. Additionally, we have a number of tools in development to help us measure and evaluate best practices for improvement in enrollment of participants from diverse racial and ethnic backgrounds.
Recognizing differences in disease incidence, exposure and response to medicines
We have long been committed to unlocking the potential of biology for all patients suffering from serious illnesses using advanced human genetics to unravel the complexities of disease. Accordingly, we are using data on human diversity in our own labs and with research partners. Together, we will better understand incidence of obesity, cardiovascular disease from risk factors such as elevated Lp(a), inflammatory diseases such as atopic dermatitis and lupus, and multiple cancers in diverse populations.
In addition, we are seeking to understand and actively address the social determinants of health (SDOH) that contribute to wide health disparities and inequities that impact disease burden and access to healthcare.
Reaching the finish line will allow us to get new medicines faster to patients who need them. It will also help doctors assure their patients that the medication they’re being prescribed was studied in people like them, with results that indicate they are likely to benefit. We’re not there yet, but we’re taking informed steps with care, with the scientific expertise for which we are known, and with humility. Every day, we dedicate ourselves to serving patients by transforming the promise of science and biotechnology into therapies that have the power to restore health and save lives. As we work to fulfill our own values and PhRMA’s Principles, we’ll get closer to serving all patients, beginning with clinical trials that include people of all races and ethnicities who will benefit.
For more information, please visit Clinical Trial Diversity & Representation.
April 15, 2020
5:51 pm
During times of crisis, a point of structural weakness becomes glaringly visible and vulnerable. The COVID-19 pandemic has placed a spotlight on the inequities that exist in this country when it comes to health and well-being. The importance of the social determinants of health is more apparent than ever.
As concerns grew about the virus spreading, the predominant proportion of white collar workers could storm the grocery stores and then settle in for the long haul in front of their laptops. Meanwhile, blue collar workers began losing jobs and health protection, or were forced to work in hazardous conditions, constantly at risk of exposure to the virus. Available data is making clear the socioeconomic divide that COVID-19 has laid bare. In New York City, the bottom income quadrant accounts for 36 percent of all coronavirus cases in the city while the top quadrant accounts for just 10 percent.
Those who have no choice but to risk exposure in order to receive a paycheck, or conduct daily life activities like visit a laundromat or make frequent trips to the grocery store because they don’t have the money to stock up the pantry, are the ones who have the least access to quality healthcare to protect their lives. People in low-income jobs, or who have lost their job during the pandemic, face hospitalizations with high out-of-pocket costs if they become sick. They also frequently don’t have the support systems to help them in the event of serious illness.
As this virus has a greater impact on those who are less able to achieve social distancing, it’s creating a greater awareness of the work that needs to be done on social determinants. The World Health Organization has provided examples of the factors that, besides clinical care, play a role in population health. Safe and affordable housing, access to education, public safety, availability of healthy foods, local health services, toxic-free environments – all have a tremendous effect on our health and longevity and too many Americans are lacking some or all of these determinants.
The good news is that the healthcare industry is devoting considerable resources and attention to addressing health disparities and the social determinants of health. The Healthcare Leadership Council has held a national summit on the issue and issued a report with specific recommendations. And, on the ground, we’re seeing multiple initiatives that are demonstrating how community health programs, telehealth services, and expanding the definition of health benefits to include commodities like housing and transportation are making a difference in the lives of vulnerable populations.
The COVID-19 crisis is making it clear that we need to accelerate these efforts.
September 19, 2019
4:19 pm
September 16-20 is National Obesity Care Week (NOCW). NOCW is a source for science-based information on obesity. More than 93 million Americans are affected by obesity, with an estimated cost of $480 billion to the healthcare system. The Healthcare Leadership Council (HLC) has joined as a partner of NOCW, advancing our conviction that people who struggle with obesity deserve access to quality care and must be treated with dignity and respect.
Recently, HLC has been focused on how the healthcare system can utilize research on social determinants of health so that essential socioeconomic and environmental factors can be considered and addressed in addition to one’s clinical care. At the beginning of this week, HLC hosted a Hill briefing that had an expert panel present on reducing disparities in health. While this particular briefing looked at the whole patient from a pediatric and senior perspective rather than zeroing in on obesity, there is a strong relationship between obesity and low socioeconomic status that cannot be ignored.
Many HLC members have recognized the need to reach out and invest in the well-being of surrounding communities:
- BlueCross BlueShield of Tennessee has taken many avenues to encourage healthy lifestyles of Tennesseans, such as revitalizing neighborhoods with parks, and repaving the roads with bike lanes.
- The Bristol-Myers Squibb Foundation provided resources to establish one of New Jersey’s largest and most comprehensive children’s hospitals which includes a clinical center of excellence dedicated to the study and treat childhood obesity.
- Fairview Health System launched a new 24-week Healthy Lifestyle Plan that combines evidence-based weight loss strategies with one-on-one lifestyle coaching. This approach can address medical issues that make it hard for someone to lose weight on their own, such as hormone levels, the side effects of prescription drugs, or chronic conditions like sleep apnea.
- Teladoc Health has invested in a personalized virtual care platform for physical and behavioral health, addressing the root of the problem for chronic disease with digital therapeutic interventions and sustainable behavioral change.
It is promising that across the healthcare spectrum there have been a variety of solutions offered to address obesity, but much progress must still be achieved to make a lasting impact on the health of millions of Americans. Many people do not know that obesity is a disease, and education is the just the first step to achieving NOCW’s goal of access to comprehensive obesity care. More voices are needed to enact change. Additional information about ways to take action is available on ObesityCareWeek.org/ACTION.
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