Sustainable Investing
Tackling inequality and inequity in healthcare
5 min read 7 Jan 25
Access to decent healthcare is a basic human right. Race, gender, background and beliefs should not preclude people from receiving treatment for their medical needs. However, in reality, inequity and inequality are all too common within the global healthcare system. The picture is not entirely bleak though. As impact investors, we have identified several solutions providers finding ways to reduce and overcome the barriers to healthcare. Fund managers Thembeka Stemela Dagbo and Jasveet Brar explore how.
According to the US Centers for Disease Control and Prevention (the CDC), the maternal death rate for black women is more than twice that of white women. The CDC has stated that “structural racism” and “implicit bias”1 play a role in this discrepancy.
Fertility and maternal health
Fertility outcomes also vary according to ethnicity. US fertility benefits firm Progyny (an investee company in our public equity impact funds) asserts that black women, indigenous women and women of colour have higher levels of infertility than their white counterparts. There are a number of reasons for this; for example, fibroids are more prevalent in the black female population2. Despite this, black women are less likely to access fertility care than white women3.
“Access to effective treatments is significantly influenced by socioeconomic and demographic factors.”
Enhancing access to fertility benefits (through better medical cover) could improve outcomes for ethnic minorities. Progyny helps to reduce barriers to treatment, partnering with employers to deliver fertility benefits in a cost-efficient manner. The company’s offering not only helps women (especially women of colour), but also strengthens inclusivity by supplying options for non-traditional families (such as single parent families and LGBTQ+ families).
Inequality in clinical trials
Inequality in clinical trials has also resulted in poorer outcomes for underrepresented groups. There are now swathes of missing data on women due to lack of female participation in medical trials over the years. GSK, an investee company in our public equity impact funds, is committed to increasing diversity in clinical trials. GSK states: “most early research into coronary heart disease (CHD) was conducted on men, despite the fact 80% of women between the ages of 40 and 60 have one or more risk factors associated with CHD – a leading cause of death for women – and experience life-threatening symptoms of heart attacks differently”4.
Dr Tania Small, Vice President of global medical affairs for oncology and the Chair of Diversity, Equity and Inclusion for the R&D Council at GSK, asserts, “if you look at any disease, the percentage of women that actually have the disease should be represented in your clinical trials”5. Despite this, it was not until 1993, that the National Institutes of Health stipulated that women and minorities must participate in research funded by the government.
“Managing unconscious bias has a crucial role to play in the recruitment of a broad range of candidates for clinical trials.”
GSK believes that managing unconscious bias has a crucial role to play in the recruitment of a broad range of candidates for clinical trials. This involves providing training for doctors to ensure an array of patients are enlisted in trials. Such changes should lead to more effective treatments for all. Thermo Fisher, an investee company in our public equity impact funds, has learnt from past clinical trial practices the importance of trial diversity and the role it plays in scientific and medical breakthroughs.
Discrepancies in disease rates and treatment
Access to, awareness of and take-up of effective treatments are significantly influenced by socioeconomic and demographic factors. For example, non-white patients are statistically half as likely to undergo cochlear implant surgery to improve hearing loss than white patients7. Even when covered by private medical insurance, black and Hispanic children are less likely than white children to receive cochlear implants under the age of two8.
“Better treatment would not only improve hearing outcomes for non-white patients, but also significantly improve children’s standard of living in emerging countries.”
Cochlear, an investee company in our public equity impact fund, engages with audiologists in developed and emerging markets to enhance knowledge of cochlear implants. The company is aiming to broaden the treatment options available to those suffering from acute hearing loss. It hopes this will lead to a wider application of these devices, another step in the democratisation of the healthcare system.
Better treatment would not only improve hearing outcomes for non-white patients, but also significantly improve children’s standard of living in emerging countries. Furthermore, increased awareness of cochlear implants should lead to the allocation of more funding to this area in emerging markets. These devices can further benefit the ageing population, improving the quality of older people’s lives.
The treatment of kidney disease is also significantly marred by inequality. In the US, African Americans have a greater predisposition to kidney disease; this is partly because diabetes is more prevalent in this community. In the UK too, South Asian and black people have higher rates of diabetes. According to Diabetes UK, “family history, and social and environmental factors”9 play a part in these statistics. However, the organisation goes on to assert that “it is still not clear why people from certain ethnic backgrounds have an increased risk (of diabetes)”10.
“We aim to invest in companies that are not only driving vital innovation within the healthcare system.”
Fresenius Medical Care, an investee company in our public equity impact funds, provides kidney dialysis services. It is conscious of the widespread inequality in healthcare, and recognises the important role data can play in combatting this issue. It has therefore, created two dashboards. One of these dashboards enables the company to analyse inequalities arising in the areas of home dialysis and transplant care11. Meanwhile, the second dashboard attempts to evaluate who receives referrals for transplant evaluation12. In 2023, Fresenius Medical Care signed the Zero Gaps Health Pledge at the World Economic Forum, reflecting its commitment to health equality. We will monitor how the company acts on and responds to this pledge.
As impact investors, we aim to invest in companies that are not only driving vital innovation within the healthcare system, but also finding ways to promote access to good healthcare. This could be through their products or services. While much work is still needed to create a fair and equal healthcare system, we are hopeful about the work being done by the companies held in our funds and the progress being made.
1CDC, ‘Working Together to Reduce Black Maternal Mortality’, www.cdc.gov, April 2024
2Progyny, ‘Inequality in Infertility; Black, Indigenous and People of Color’, https://progyny.com/, December 2020
3Progyny, ‘Inequality in Infertility; Black, Indigenous and People of Color’, https://progyny.com/, December 2020
4GSK, ‘‘We’re not a world of men – it’s as simple as that’: how gender diversity in clinical trials improves health outcomes for women’, www.gsk.com, March 2023
5GSK, ‘‘We’re not a world of men – it’s as simple as that’: how gender diversity in clinical trials improves health outcomes for women’, www.gsk.com, March 2023
6The Guardian, www.theguardian.com, ‘Immortal cells: Henrietta Lacks’ family settle lawsuit over HeLa tissue harvested in 1950s’, August 2023
7National Library of Medicine, ‘Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program’, https://pubmed.ncbi.nlm.nih.gov/, April 2020
8Sage Journals, ‘Racial and Insurance Inequalities in Access to Early Pediatric Cochlear Implantation’, https://journals.sagepub.com/, September 2020
9Diabetes UK, ‘Ethnicity and Type 2 Diabetes’, www.diabetes.org.uk, accessed on 21 November 2024
10Diabetes UK, ‘Ethnicity and Type 2 Diabetes’, www.diabetes.org.uk, accessed on 21 November 2024
11Fresenius Medical Care, ‘We are committed to advancing global health equity’, www.freseniusmedicalcare.com, accessed on 21 November 2024
12Fresenius Medical Care, ‘We are committed to advancing global health equity’, www.freseniusmedicalcare.com, accessed on 21 November 2024
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