Health equity defined as the equal ability of all patients to access the healthcare and resources they need, when they need it—remains a global challenge, particularly highlighted by the COVID-19 pandemic. This public health crisis exposed and exacerbated weaknesses in healthcare systems worldwide.
In the United States, significant racial and ethnic disparities in health and healthcare persist across states, as highlighted by the Commonwealth Fund’s 2024 State Health Disparities report. The report indicates that Black individuals are more likely to die prematurely from preventable causes compared to their Asian American, Native Hawaiian, Pacific Islander, Hispanic, and White counterparts.
A report by the National Institute on Minority Health and Health Disparities (NIMHD) reveals the economic burden of these disparities. In 2018, health disparities among racial and ethnic minority groups cost an estimated $451 billion, or $1377 per person. Education-related health disparities added $978 billion, or $2988 per person. These costs were calculated based on excess medical expenses, lost labor productivity, and premature deaths. The disparities were found to vary by state, underscoring the uneven impact across the country.
HEOR Experts Advocate for Centralizing Health Equity in Research and Services
For researchers in the health economics and outcomes research (HEOR) field, health equity often appears as a secondary consideration. However, according to Mani Keita Fakeye, PhD, health equity research lead and technical advisor at Deloitte, health equity should be central to all research and health services. She emphasizes that health equity impacts the entire research and healthcare value chain, influencing strategic decision-making and the body of knowledge and evidence in the field. From a philosophical standpoint, Fakeye suggests that our understanding of health equity needs significant improvement.
Eliseo J. Pérez-Stable, MD, director of NIMHD, notes that the term “health disparities” refers to differences in health outcomes that negatively affect socially disadvantaged populations, influenced by social and structural factors rather than inherent racial or ethnic identity. The mission of NIMHD is to lead scientific research to improve minority health and reduce health disparities. Pérez-Stable, drawing from his experience at the University of California, San Francisco, highlights the critical importance of understanding these disparities and striving towards health equity, which he defines as ensuring everyone has optimal opportunities to achieve their best health by removing barriers to good health.
Fakeye’s perspective on health equity is shaped by her diverse experiences, growing up in Guinea, West Africa, and later moving to the United States. She advocates for diversity in research teams, arguing that a diverse team can handle a broader range of challenges more effectively, though it requires investment in consensus-building. Simply bringing diverse people together is not enough; the approach to fostering health equity must be as thoughtful as the goals themselves.
Data Accessibility Key to Advancing Health Equity, Experts Highlight
Khushbu Balsara, DDS, MPH, a postdoctoral research fellow at Johns Hopkins Bloomberg School of Public Health, emphasizes the need for accessible and comprehensive data to advance health equity. In her research, Balsara has faced challenges in obtaining complete and reliable data, particularly from clinics. She notes that often, data collection is insufficient or not reported, hindering efforts to evaluate the impact of new healthcare policies. Making data visible and accessible to researchers and the public is crucial for studying and addressing health disparities.
Pérez-Stable also highlights the limitations of data, particularly regarding the completeness of fundamental variables like race and ethnicity. During the COVID-19 pandemic, he noted that some health insurance entities lacked this critical information, relying instead on algorithms to impute data. He stresses the importance of accurate primary data in electronic health records for meaningful health equity research.
In 2023, the World Health Organization (WHO) released a comprehensive global collection of health inequality data, allowing for detailed tracking of health disparities across various population groups. This data repository is a significant tool for advancing health equity, demonstrating that targeted health services can substantially improve outcomes for disadvantaged populations.
A Critical Imperative for Addressing Disparities
HEOR researchers and health economists play a vital role in addressing health disparities. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) recognizes the importance of health equity, ranking it among the top trends in HEOR. ISPOR’s Health Equity Research special interest group focuses on developing methods to assess the health equity impacts of decisions, applying equity-informative cost-effectiveness analysis, and improving data sources for studying health inequities.
Fakeye suggests that health equity should be viewed as a fundamental aspect of value in healthcare, integral to considerations of cost, productivity, and quality-adjusted life years. Addressing health equity requires a comprehensive and intersectional approach, rather than a superficial analysis of race and gender.
In conclusion, achieving health equity necessitates a concerted effort to understand and address the diverse factors contributing to health disparities. Researchers, policymakers, and healthcare providers must work together to ensure that data is accessible, comprehensive, and used effectively to improve health outcomes for all populations. By integrating health equity into the core of healthcare research and practice, we can move closer to a more equitable and just healthcare system.
Resource: <a href="https://www.ispor.org/publications/journals/value-outcomes-spotlight/vos-archives/issue/view/health-equity/heor-as-a-signpost-on-the-journey-to-health-equity”>Professional Society for Health Economics and Outcomes Research, June, 2024
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