July 13, 2022
Strategy Business
By Ron Chopoorian and Sarah Butler
Sometimes it takes a crisis to drive change.
The shock of seeing longstanding global health inequities worsening health, economic, and social outcomes in the most vulnerable communities during the COVID-19 pandemic spurred creative thinking and innovative solutions to address those gaps.
This momentum provides a unique opportunity for the global healthcare system, along with governments and the private sector, to build on the advances achieved during the crisis and apply them to other diseases and the social determinants that drive health inequity. As outlined in our report Closing the Health Equity Gap, the pandemic experience has provided four key lessons that can shape this effort: (1) collecting and analyzing data must be the first step; (2) approaches should be tailored to the community; (3) digital technology is an essential tool; and (4) partnerships amplify impact.
COVID sparked unprecedented efforts to collect and analyze data to understand the disease, track its spread, develop treatments, and evaluate their efficacy. A case in point is the data-sharing agreement between Pfizer and Israel. It enabled the collection and analysis of real-world evidence that not only showed the Pfizer vaccine’s efficacy but continues to deliver insights that inform our understanding of the virus and vaccination and help shape public policy.
The data know-how acquired and deployed during the pandemic has applications well beyond COVID. Healthcare players can—and are already beginning to—put data to work to discover where disparities exist so that outreach and response efforts can target communities in need and track how well the resulting initiatives work.
The rapid spread of disinformation about the virus, coupled with vaccine hesitancy—much of it stemming from the skepticism that past unethical medical research had instilled in many minority communities—made it clear early on that community engagement would be necessary to build trust among marginalized populations. That kind of engagement was essential in making sure accurate information, testing, and vaccination services reached the most vulnerable. From pro-vaccine social media campaigns aimed at the Maori in New Zealand to vaccination trucks sent into underserved areas in Brazil, a host of tailored community-engagement initiatives sprung up during the pandemic.
Such initiatives have enormous potential to improve health outcomes in a variety of contexts. For example, patient advisory panels can help pharmaceutical companies identify and overcome potential access barriers among certain patient populations as early as the product-development stage. A public health initiative targeting obesity could partner with local gyms or grocery stores.
Perhaps the most obvious consequence of the pandemic was the rapid acceptance and use of virtual healthcare. Another was pharmaceutical companies shifting toward remotely conducted drug trials. In both cases, the pandemic-induced adoption of digital technologies has ramifications that extend well beyond COVID, enabling rural and underserved communities to gain access to care and participate in clinical trials.
These digital technologies’ full potential can be achieved only if vulnerable populations can afford access to them. This is a perfect example of how social determinants, in this case income and access to high-speed networks, can feed health inequity.
No single organization can tackle these inequities on its own. Here again, the pandemic has illuminated the way forward: partnerships. Take the unprecedented collaboration between governments and the pharmaceutical industry that resulted in the rapid development of COVID vaccines. Or consider the outside-the-box thinking that allowed businesses to deploy their skills and resources in conjunction with partners in healthcare and other industries so that vulnerable communities could receive personal protective equipment (PPE) and COVID tests, treatments, and vaccines. In Australia, for example, a mining company used its supply chain infrastructure to deliver hand sanitizer and face masks to remote towns. In the US, a ride-share company offered free rides to vaccine appointments for people without transportation. Outside the pandemic context, these kinds of innovative, socially oriented solutions can offer organizations the opportunity to develop new ways to deliver on environmental, social, and governance (ESG) promises.
Tackling health inequity, and the social determinants that drive it, requires investment, but doing so will ultimately deliver enormous returns—in the form of better individual health, a more productive workforce, and a reduced economic burden from chronic disease thanks to improved access to healthcare products and services.
The pandemic illustrated that health equity isn’t just nice to have; it’s essential to a well-functioning society and economy. Building the creative thinking and innovations sparked by the pandemic into our ongoing recovery would not just improve human health but help the world emerge stronger socially and economically. And it would put us in a better position to lessen the impact of future public health crises, no matter their origin.
The rate of Americans diagnosed with diabetes isn’t slowing down, and the Covid-19 pandemic only exacerbated the risks and concerns for this debilitating chronic disease.
According to the American Diabetes Association, 1.5 million people will be diagnosed with diabetes this year. So why aren’t more people talking about it? The pandemic may have shifted the collective focus. After all, a nation in health crisis mode can only focus on so many problems at once. Yet hospitalizations and deaths due to diabetes or related complications were right behind the elderly and nursing home residents.
Aside from the pandemic pileup, the disease was not getting the attention it warranted, partly because of how the stigma attached to diabetes impacts our concern, even as it affects more people each year.
Between 1980 and 2014, the number of people with diabetes rose from 108 million to 422 million. “Prevalence has been rising more rapidly in low and middle income countries,” reports the World Health Organization. Diabetes can lead to blindness, kidney failure, heart attacks, stroke, and lower limb amputation.
Why Aren’t More People Talking About This?
“Diabetes is always swept under the rug because, in so many people’s minds, they just associate it with bad health habits and being overweight,” says Deena Fink of New York City. The Long Island native bartends in the West Village in addition to running a small online knitting business.
Most days, her Type 1 Diabetes doesn’t slow her down. It’s a disease she has been living with for sixteen years. “What really has to change is the stigma of diabetes,” Deena explains in an interview with Wealth of Geeks.
She is grateful for her health care plan, despite the roadblocks she often faces to receive her medication. “They have to start actually treating it as a chronic illness.”
Like many others during the first months of the pandemic, Deena was afraid to leave her house. “I didn’t even want to leave the house to go grocery shopping,” she says. The risks are different for someone with a chronic illness. “Just getting a cold, I am knocked out for several days.” She also could not get to a doctor’s office.
“You’re supposed to get your A1C done every quarter,” she explains, but she couldn’t see her doctor for a year and a half. So instead, Deena had to estimate what those numbers would be. The A1C test provides a three-month average of what blood sugar levels should be. It’s how a person with diabetes keeps themselves in range.
Deena faces a monthly battle with the insurance company just to receive her regular dosage of three insulin vials. Without insurance, she would have to pay $175 per vial.
The Global Factor
While lifestyle changes such as maintaining a healthy weight and diet, engaging in physical activity, and not smoking may decrease the health risks associated with diabetes, it does not guarantee that the disease won’t have harmful symptoms over time. Additionally, Covid-19 increases these risks across the globe.
Diabetes was responsible for 6.7 million deaths in 2021, according to the International Diabetes Federation. In addition to the 537 million adults living with diabetes today, an additional 541 million have Impaired Glucose Tolerance, a condition that places them at high risk of Type 2 Diabetes.
And what about the financial side? WHO reports that “diabetes caused at least 966 billion dollars in health expenditure – a 316% increase over the last fifteen years.”
As more people are diagnosed, the opportunity for visibility and change grows. Those with diabetes often become advocates for change.
“Stigma can result when you take an ‘invisible’ condition like diabetes out into the open,” says diabetes advocate Michael Donohoe of Ohio. When he was diagnosed with Type 2 Diabetes, he was also diagnosed with a heart condition. “I try to improve awareness and understanding by being as open about my diabetes as possible. I also advocate loudly for people who are newly diagnosed or severely impacted,” he says.
Covid Collision
Although the elderly and nursing home residents were hit hardest by the virus, people with diabetes were right behind them. This news comes to light as the total number of deaths in the United States nears one million.
“People with poorly controlled diabetes are especially vulnerable to severe illness from Covid, partly because diabetes impairs the immune system but also because those with the disease often struggle with high blood pressure, obesity, and other underlying medical conditions,” reports the New York Times.
Those with diabetes have to keep up with their disease constantly. “It’s a disease that’s a pain,” says Deena, “because you never stop taking care of yourself. Every decision you make for every day of your life will affect your diabetes.”
“It’s so much work,” she says, “but it keeps you alive.”
With diabetes diagnoses soaring across the globe, it is only a matter of time before the world stops hiding from this health crisis and confronts it head-on.
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