The Power of Diverse & Inclusive Research to Improve Health Disparities

Guest editor Ashwini Zenooz, MD and Chief Medical Officer at Salesforce, explores three imperatives we must strive for to achieve more diversity and inclusion in healthcare research and education.

The convergence of the coronavirus pandemic and our national reckoning with racism have pulled back the curtains to reveal what has been a long, evidence-based history of racial inequity when it comes to public health. Recent data showing the grave—and sometimes hidden—extent to which communities of color are being devastated by coronavirus have made the conversation around health disparities more mainstream. But among the healthcare ecosystem, the somber litany of data illustrating gaps in health outcomes isn’t new. The deep rifts within our healthcare and social structures contributing to these disparities are well-documented, but we still find pervasive biases today.

One such foundational element to more equitable health outcomes: inclusive healthcare research. An article in The Atlantic highlighting this issue cites research showing “since 1993, fewer than 5 percent of respiratory studies funded by the National Institute of Health (NIH) have included reports on racial or ethnic minorities... Neglected by research, African American children have died from asthma at 10 times the rate of non-Hispanic white children.”

Amid our global race to fight the spread of COVID-19 and develop effective treatments and vaccines, it’s vital to ensure that diversity & inclusion (D&I) is integrated into this important work. Do a quick Google search of ‘covid toes’—perhaps unsurprisingly, you will see images of only white toes. For a disease that is devastating communities of color at greater rates, the focus of findings has skewed toward white communities; unfortunately, another example in a long history of bias in healthcare research and education. In my own experience in medical school, I can recall learning how to identify the malar rash of Lupus—a disease with higher rates of prevalence in the Black population; all images in textbooks were on primarily white skin and not much has changed. Today’s Google image search shows the top 40 images of the lupus rash on white skin.

We’ve made incremental and important improvements but these should have been baseline. The Washington Post recently ran a story in their ‘Inspired Life’ category headlined, “A medical student couldn’t find how symptoms look on darker skin. He decided to publish a book about it.” Malone Mukwende, a Black medical school student in London, similarly found his medical education to be un-inclusive of his community: “I’m not learning anything that could help my family at home.” Harnessing the power of today’s data sharing, this student’s viral project is re-energizing the focus on needed progress for more diversity and inclusion in healthcare research and education.

In this transformational moment in time, there are three imperatives we must strive for while committing to addressing our own biases and systemic biases within the healthcare system through continued education and training:

1. We need diverse participant pools for inclusive studies and clinical trials

    While proactive groundwork in communities will always play an important role, technology can be leveraged to ensure more equitable access to participate in studies. Healthcare and life sciences organizations should consider the role of the digital front door to recruit and engage patients that are truly representative of the general population of research focus. And as the virtual care ecosystem matures, including remote trial capabilities, organizations should take a keen eye to prioritize strategies of engagement for diverse communities. Teams of scientists leading studies should be diverse themselves to engage with participants in a culturally competent way.

    2. We need equitable funding for diverse researchers and health disparity studies

      This issue has been well documented with an illuminating 2011 report revealing Black or African-American applicants were 13% less likely to receive research funding compared to white applicants for one of the oldest and most widely used research project grants. This issue is of course prevalent beyond the NIH which has prompted recent grassroots movements like #ShutDownSTEM. Ultimately, greater accountability across the multiple scientific communities will be necessary to instill meaningful progress against health disparities.

      3. We need to thoughtfully apply technological solutions in the digital age

        Technology advances in data sharing and advanced computing have enabled us to unlock new insights through research and can help drive more equitable health outcomes. But even well-intentioned research technologies like AI can be racially biased (HBR). Leaders and scientists will need to continuously bring the lens of diversity and inclusion to their work as well as decision-making, including in the application of technology solutions.

        The convergence of COVID-19 with our global reckoning on race has set the cultural stage for us to make meaningful strides to address some of the glaring inequities within our healthcare community and society at large. This is ever important as healthcare undergoes a historic digital transformation for the way quality healthcare is accessed and delivered. It is individuals like Malone Mukwende that make me hopeful we’ll continue to see more action and more accountability—but he can’t be the only one, we are all responsible for creating a more equitable and accessible health care system for all. Together with the scientific and clinical ecosystems, let's hold ourselves accountable to championing these necessary diversity and inclusion efforts and pioneer this necessary shift.

        - Ashwini Zenooz, MD; Chief Medical Officer and SVP of Global Healthcare and Life Sciences, Salesforce

          At Wheel, our cultural value is to show empathy every day. Follow along with our series on diversity and inclusion in healthcare to learn more.