Giving Compass' Take:
- Developing healthcare tools and resources to treat diseases can often have biases against people of color, and all processes need to incorporate steps that mitigate these biases through diversity, equity, and inclusion.
- How do bias and discrimination contribute to health inequity?
- Learn how racial and gender bias impact Black male health
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While innovations have contributed to the doubling of human life expectancy over the past century, there are significant disparities between countries. Populations in higher-income countries such as Spain, Switzerland, Italy and Australia, born today can expect to live on average more than 83 years, whereas those in the poorest nations, such as the Central African Republic, Nigeria and Chad, can expect to live less than 53 years. Within countries, inequalities in life-expectancy also exist amongst different populations, such as between socioeconomically advantaged and disadvantaged communities and between different ethnic groups; such inequalities are prevalent in higher-income countries, especially in the UK and the U.S.
Social determinants of health, such as education, living conditions, income, healthcare system access and infrastructure, are well-established drivers of these disparities and are receiving increasing attention in terms of research, policy and practice. Less attention, however, has been given to how innovations themselves—specifically healthcare innovations—can create or perpetuate health inequalities.
Take for example, the pulse oximeter, a small, non-invasive medical device that measures blood oxygen saturation by passing light through the skin (typically, on a fingertip). This device has been available since the 1980s and is widely used for assessing how well the heart and lungs are working to circulate oxygen throughout the body. The pulse oximeter gained renewed attention during the COVID-19 pandemic for detecting potential respiratory failure, allowing clinicians to intervene early and save lives. Despite the medical and societal benefits of the pulse oximeter, evidence also resurfaced during the COVID-19 pandemic that this device may over-estimate oxygen saturation in individuals with darker skin tone, particularly people of colour. In fact, this evidence first came to light in the late 1980s, with multiple studies published on this issue since. Yet, adaptations to the devices and the impact of biased pulse oximetry readings in people of colour have still not been addressed.
These inherent biases can be extended beyond medical devices to innovative approaches to healthcare service delivery, such as algorithms used to diagnose disease and to allocate healthcare resources. For example, while body-mass index (BMI) is used as a measure of obesity and in calculating risk for developing type 2 diabetes, a single BMI threshold has been historically used in clinical practice, despite evidence that people of colour, including Black and Asian people, tend to develop diabetes at a lower BMI. This practice can restrict timely access to treatment and management services for diabetes prevention. A 2019 study on the use of algorithms to inform decision-making in the U.S. healthcare system found that some algorithms widely used in U.S. hospitals to allocate healthcare were systematically biased against Black patients, assigning them lower risk scores and thus fewer resources. Gender-related biases also creep into innovation processes. For example, for many years research on treatments for heart diseases focused predominantly on changes that occur in male patients, impacting an accurate diagnosis in women and conversely, osteoporosis-related R&D has been disproportionately focused on women.
Read the full article about DEI in healthcare innovation by Sonja Marjanovic and Robert Romanelli at RAND Corporation.