April 2025 • PharmaTimes Magazine • 18-19
// INEQUITY //
Get real
Addressing inequalities – good for society, good for business
The current political landscape may have prompted some organisations to shift their focus away from equity objectives. But for the health sector, to think that addressing existing inequalities is no longer mission critical would be not just ethically questionable but also very bad for business.
Realisation that significant disparities in underlying risk, access to care and health outcomes exist across the UK dates back several decades, and these gaps have persisted over the years across multiple conditions.
Cancer death rates, for example, are nearly 60% higher among people living in the most deprived areas of the UK compared with the least deprived.
Recent reports have also suggested that these trends are not going away anytime soon – and, in fact, are on the rise. By 2040, over 50% of people in the most deprived areas are expected to be living with major illness or to die by the age of 70, as compared to less than 30% in the least deprived areas.
These trends have a significant bearing on the future profile of patients. In the coming years, a significant majority of people living in ill health will be living in areas where gaps in access to quality care are the most pervasive and levels of health literacy are poorest.
What’s more, as socioeconomic disadvantage is often intrinsically linked to factors such as race, ethnicity and the presence of disabilities, disparities in health outcomes between these groups are likely to continue unless concrete actions are taken to address them.
New balance
These disparities highlight the importance of taking a person-centred approach to care. A 60-year-old woman living in one of the poorest areas of England has a level of diagnosed illness equivalent to that of a 76-year-old woman in one of the wealthiest areas, and this gap is ten years for men.
Understanding the life circumstances of the patient in front of them will thus continue to be fundamental for healthcare professionals to ensure they are offering appropriate information and care that is tailored to that person’s needs. The social determinants of health should become an integral part of clinical training.
For any company delivering products or services in health, understanding the underlying characteristics of the populations it serves is essential if it wants its products to perform optimally on the market.
‘Women taking cardiovascular medication are more likely to experience side effects and adverse reactions than men’
Efforts made in recent years to ensure that people enrolled in clinical trials reflect the diversity of the population that will ultimately use the treatment is a huge step in this direction.
But even before this, reliable epidemiological studies are needed to understand the underlying risk factors, care pathways and outcomes for different conditions across the population, so that public health messaging, doctor–patient communication and care pathways can be developed to meet the needs of the populations targeted.
These studies should be co-designed with representatives from the communities affected by different conditions, with results shared to co-create lasting adaptations to information materials and care pathways that will help pre-empt barriers to optimal information and care, and deliver better outcomes for all.
Data day
With data on existing inequalities having multiplied over the past few years, the challenge that remains – and is perhaps the most difficult to address – is to understand the causes of any observed inequalities.
This was brought home in research funded by the British Heart Foundation, which showed that between 2003 and 2013, the deaths of 8,000 women in England and Wales could have been prevented through more equitable cardiac care.
The charity’s studies found that women fared worse than men at every stage of their heart attack experience. Women often delayed seeking help for their symptoms, which reduced their chances of survival. They were 50% more likely to receive an incorrect diagnosis when having a heart attack and were less likely to receive the same standard of care as men.
They also received poorer aftercare following a heart attack and were less likely to be prescribed proven medicines (such as statins and beta blockers) to reduce their risk of a subsequent heart attack or stroke.
Untangling the causes behind these data sets is complex. They include the health beliefs and care-seeking behaviours of women, differential attitudes and clinical behaviours among healthcare professionals based on gender, and potentially deep-rooted structural barriers to equitable treatment of women with heart disease across the system.
What is needed is both greater awareness of and attention to women’s risk of heart attacks and conscious efforts to improve their care.
Equally, it is important to understand where a differentiated approach is needed. Risk factors for heart disease are often more deadly for women, with high blood pressure, for example, increasing women’s risk of heart attack 80% more than men’s.
Women taking cardiovascular medication are 2–2.5 times more likely to experience side effects and adverse reactions than men taking the same medication but, despite this, healthcare professionals continue to use the same dosage for both populations
Role play
While unravelling this complexity is critical for the health system, life sciences companies have an important role of their own to play.
Adherence to medication varies between 30% and 80% for most conditions, and uncovering the reasons behind this – along with finding ways to encourage better adherence – remains a key priority.
More broadly, the life sciences industry can be an important partner in innovative observational studies that ask the right questions to investigate existing disparities and what causes them.
Getting this right will require working in close partnership with the communities they are serving, to see the care journey through their eyes and try to understand where things might go wrong – and to implement changes together.
Data from studies like this can help to future-proof health systems against long-standing barriers, support people to engage in health-seeking behaviours and participate in the health system, and increase the likelihood of preventive care, early intervention and treatments being adopted by those who need them most.
This will enable a higher rate of return and impact for medicines and health services – both for those who produce and deliver them and for society as a whole.
This is not just a good deed that can be performed to improve ESG ratings but a business-critical goal.
Suzanne Wait is Co-Founder and Managing Director at The Health Policy Partnership
PharmaTimes
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