Improving healthcare equity and inclusivity with technology

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Healthcare

Improving healthcare equity and inclusivity with technology

Suvera’s founder, Ivan Beckley, shares his insights on how tech can combat racial bias in healthcare. 

Healthcare is an essential human right. But healthcare isn’t the same for everyone. It isn’t always equitable or inclusive. And the healthcare system can often fail to meet the needs of all patients.

In this article, I’ll be exploring the inequity Black patients and those from other minority groups face in relation to healthcare, and how tech is helping to change things for the better.

Here is an indication of how the health service underperforms for certain patient groups:

  • Women with dementia stay on antipsychotic medication for longer than men
  • Men living in deprived areas of the UK are 3.6 times more likely to die from an avoidable cause than those living in more affluent areas
  • 1 in 7 LGBTQ+ people avoid seeking healthcare because they fear discrimination

Stats related to Black patients are similarly concerning. The majority of Black people say they face discrimination from healthcare staff. They can’t count on the same health access and outcomes as other patient groups.

The following statistics highlight this struggle:

  • Black women are five times more likely to die in pregnancy and childbirth than White women
  • Black people are four times more likely to be detained under the Mental Health Act (1983)
  • In America, five-year skin cancer survival rates for Black people are 24% lower than they are for White people

We wouldn’t accept this racial disparity in any other environment. So why do we accept it in healthcare? For clues, we can look to healthcare history.

A history of racism in healthcare

Medicine was developed by those who had power. And there are lots of medical procedures and research studies that have a disturbing past.

The Tuskegee Syphilis Study

The Tuskegee Syphilis Study began in the 1930s on behalf of the United States Public Health Service (PHS) and the Centers for Disease Control and Prevention (CDC). The aim? To find out how syphilis progressed in African-American men.

Study doctors offered free medical care in exchange for participation in the study. But the participants – 600 Black men from an extremely deprived area of the US – didn’t give informed consent.

Their condition and available treatment options weren’t explained to them. And doctors never gave the men penicillin, a recognised treatment for syphilis from 1943 onwards.

Incredibly, the study went on for 40 years until an article in The Washington Star caused a national outcry. Over the course of the study, over 100 men died of syphilis, 40 wives contracted syphilis and 19 children were born with congenital syphilis.

The Father of Gynaecology

James Marion Sims is known as the Father of Gynaecology. He set up the first women’s hospital in the United States in New York in 1855. He also developed new gynaecological techniques.

Sims found a way to operate successfully on a vesicovaginal fistula, a severe problem caused by an obstructed childbirth.  

But Sims made his medical discoveries by exploiting Black women. He bought slaves or agreed terms with slave owners. He then performed experimental surgery on enslaved Black women without anaesthetic and without their consent.

Spirometry bias

Samuel Cartwright was a doctor and slave owner in the American South. He was the first person to use a spirometer – a machine that measures lung capacity – to record lung function in Black people.

Cartwright concluded that Black people had lower lung capacity than White people. He used this finding to justify forced labour, saying that strenuous activity helped to vitalise the blood of Black slaves.

Cartwright’s lung function test didn’t take into account any environmental or economic factors. But a race-related difference in lung capacity is still widely accepted as medical fact, nearly two hundred years later.

Many spirometers in use today have a setting that corrects for race. In the US, there’s a standard correction of 10-15% for Black patients and 4-6% for Asian patients. 

Lung conditions in Black and other ethnic minority populations could be missed by clinicians because racism is built into the medical equipment they use.

  

Building a brighter, more equal future

Bias and discrimination influence the way healthcare is delivered today, and a long history of inequity affects the trust Black people have in the healthcare system.

But things are changing. We fix the inequalities that currently exist by changing who has control over how healthcare is delivered. And there are now a lot of people working to build healthcare services that are more fair and just.

It’s not just the people working at the top of healthcare organisations who can make a difference. We need to examine the knowledge base we use to make medical decisions, and we need to harness the power of technology.

Together, people, knowledge and technology can change the way we deliver care. And there are plenty of reasons to be hopeful.

People

Cityblock is a US healthcare provider, founded by Dr. Toyin Ajayico in 2017. Dr. Ajayico wanted to create a new kind of service. One that prioritised the patients healthcare systems have historically left behind.

Cityblock now manages thousands of people who are on low income and need better healthcare. And by 2030, it aims to provide primary care, mental health care and social services to 10 million patient members.

By directing its services at marginalised groups, Cityblock hopes that more people will seek care. And that those who’ve felt ignored or neglected by the healthcare system will enjoy better healthcare experiences and outcomes in future.

Knowledge

There’s racial bias in pain assessment. A 2009 study showed that Black patients in American emergency rooms were half as likely to get pain medication as White patients. Clinicians regularly underestimate and undertreat the pain of Black patients.

False ideas about the biological differences between Black and White people lie behind this inequality, but new research is questioning those assumptions.

A 2021 paper shows how artificial intelligence (AI) and knee X-ray images are being used to detect and quantify the pain of patients with osteoarthritis. This tech shows doctors that the pain patients (specifically Black patients) describe is real and in need of treatment.

Technology

Another health-tech company committed to creating equitable healthcare is Spora Health. Again, based in America, Spora Health provides virtual primary care services for people of colour.  

The service is based on a philosophy of “culture-centred care”. Patients know they’re entering a space where clinicians understand and respect their health needs in a holistic sense.

Tech is helping to make this happen. It’s not a lottery, with patients wondering if their clinician will be unbiased and sympathetic. As a virtual-first primary care service, patients see doctors who are trained to provide care in line with their cultural needs.

Using tech to fix healthcare inequalities

With the right people, knowledge and technology we can address the racial bias in healthcare. Tech, as a leading power in society, has a particularly big role to play. And we’re already seeing companies like Google, Apple, Amazon and Meta moving towards healthcare services.  

The powerful combination of tech and healthcare lies at the heart of Suvera. We’re a virtual care company, contracted by the NHS to manage patients with long-term conditions, remotely from home.

As part of our healthcare service, we’re committed to fixing inequalities. And we do this with a focus on three key principles.

Access

We make primary care appointments more accessible. Virtual care removes the physical barriers of having to travel to have one’s blood pressure taken, for example. Digital, borderless delivery of quality care overcomes the limitations that exist in particularly deprived or rural areas, and localities that have lower healthcare capacity. Furthermore, our clinicians are available out of hours. We recognise that people are working and need healthcare that works around their busy lives.

Our healthcare app is also designed to be inclusive and accessible. Rigorous accessibility testing ensures that all patients – regardless of their tech ability – can get the most from our app and our healthcare services.

Integration

We believe that fragmented care leads to worse health outcomes. So we don’t work against general practice, we work with it. Suvera integrates with GP practice systems so we can securely share health records and ensure the right level of care.

Crucially, however, Suvera is not the NHS. We’re integrated. But we’re a separate healthcare organisation. For patients who feel let down by traditional healthcare services, this makes a huge difference to their trust and willingness to engage.  

Intelligence

There’s always the risk that technology programmed by humans ends up picking up some of the same racial biases. This gets in the way of equitable healthcare.

To address this, we’ve built our own dashboard and we validate algorithms internally. We’re alert to the risks posed by biased algorithms. This means we won’t repeat the mistakes of other healthcare systems. These are the benefits of building from the ground up.

In summary

Tech democratises.

With it, we can take something inaccessible or overly expensive and turn it into something that everyone can use and benefit from. 

When we apply this to healthcare, we close the gap – between Black and White, between rich and poor patients – to ensure equitable health access and outcomes.

Healthcare was built by those who had power. But with technology, we have the power to rebuild.

For more insight into racial inequalities in healthcare, check out Ivan’s award-winning podcast The Bias Diagnosis. And for all things health and tech, head over to the Suvera blog