Health equity: our greatest barrier to a well-care era
The future of the healthcare industry relies not on being better at treating people when they are sick but preventing them from getting ill altogether. The ‘well-care era’ that we at Janssen are on a mission to create, is all about a healthcare sector that prevents or more quickly diagnoses illness and supports people in maintaining their own health.
But before we can make this well-care era a reality, there are improvement points in the current system that we must address: the most significant of which is equitable access to healthcare. We can’t overhaul and improve our current system without first fixing fundamental issues around inequity and inequality. Healthcare must be for everyone.
The multiple structural issues of inequity
Gender and ethnicity biases
The greatest barriers to health equity are global and systemic. A significant proportion of many populations face reduced access to healthcare services. In the EU, women are still highly vulnerable to unmet healthcare needs and underrepresented in clinical trials that would provide the data needed for better treatment.
Culturally, access to healthcare can also be limited by language barriers, cultural differences, and technological access, which have a similar effect in putting healthcare out of reach.
These major factors - both gender and ethnicity - prevent many EMEA citizens from accessing the healthcare they need.,
We know that, culturally, education plays a major role in reducing inequities and improving access for many populations. Healthcare must work to understand the needs and drives of different communities, open up dialogue between doctors and community leaders, and build trust as well as understanding.
While it is beyond pharma to address these challenges alone, we can do our part to help. The most important task – and the first step - is redressing the balance of power within healthcare: our industry’s workforce must be representative, inclusive, and equal to adequately serve the many, not the few. Bringing more women and minority populations into senior healthcare positions is vital - currently, women make up only 25% of leadership roles and there is evidence of substantial under-representation of minoritized communities in senior health leadership positions too., Addressing this imbalance will help create an inclusive, representative system that works for everyone, reducing barriers to access. This, in turn, can ensure the health needs of those populations are represented, and bring us further towards a well-care system that works for everyone.
Economy and geography
Closely tied to gender and ethnic inequities, socioeconomic status has a significant effect on access to healthcare, both in countries which require health insurance and in places with public healthcare. The structural inequities faced by certain groups, including minority and ethnic communities, mean they disproportionately work in low-quality, low-paying jobs. Not only do these jobs harm their health, low-income households have less access to sick pay and the ability to take time off., This creates a hard-to-break cycle: low quality-jobs leading to increased sickness, but do not provide the job security or financial security to treat it.
In addition to socio-economic status, simply being far from clinical trial locations also excludes many EMEA citizens from being able to access the treatments they need, which in turn limits effective disease management and options.
These inequities faced by underserved populations are exacerbated during pandemics, as COVID-19 showed. While cases have been made that biological differences account for the imbalance we saw in COVID-19 infections and deaths, it is likely that some populations were significantly more affected due to already established inequities. These imbalances of geography and economy meant certain populations had poorer health, less access to medicines, and a disproportionate number of low-quality jobs which led them to be on the frontline of the pandemic fight. This, combined with the factors we have already discussed, means that future health crises will be disproportionately worse for those already suffering lower healthcare access.
Until we can provide global citizens with safe, healthy living and working environments – with the ability to pay for, and access, health services - the well-care era cannot come to fruition.
Regulation and pricing
Beyond bias or discrimination, many populations face inequities through regulation, policy, treatment availability or other factors. Due to uneven regional or national policies, individuals can enjoy unequal levels of access to healthcare. The amount of public resource spent on healthcare and health access also create significant variations between countries in terms of number of clinics available, and cost and availability of treatment.
We must do what we can to improve access to healthcare for people around the world. The COVID-19 pandemic has shown us that collaboration is crucial to creating better access: we saw governments, researchers and volunteers work together to bolster research, streamline time-to-market, and create quicker access solutions for those in need. Together we are better than the sum of our parts, and what we need now is keep this collaboration going to improve policies and reduce pricing further.
Moving towards a World of Well
There is a huge, unaddressed undercurrent of issues at play – that ultimately prevent equitable and equal access to healthcare. This spectrum includes bias, geography, education, and pricing, combined with basic economic inequities, that mean that as many as 90% of people in low-and-middle-income countries cannot access basic treatment and surgical care. Without the right policies, resources, and education, it is impossible for anyone to maintain their own health and wellbeing. We become stuck in a perpetual cycle of waiting for people to fall ill and treating them only when they are critical.
The well-care era we want to create has the potential to transform both how healthcare is practised and how we as people manage and sustain our own health. As transformative as this change would be, we cannot move towards the World of Well while such significant inequities still exist in our healthcare system. Only by addressing these issues, and working proactively to remove them, will we create the environment necessary to move fully towards the well-care era.
 Hojat LS. Breaking down the barriers to health equity. Ther Adv Infect Dis. 2022;16(9):20499361221079453
 EIGE-2021 Gender Equality Index 2021 Report: Health. Available at: https://eige.europa.eu/publications/gender-equality-index-2021-report/ge... [Last accessed: June 2022
 Ravindran, TKS, Teerawattananon, Y, Tannenbaum, C, et al. Making pharmaceutical research and regulation work for women. BMJ 2020;371:m3808
 Szczepura A, Access to health care for ethnic minority populations. Postgraduate Medical Journal 2005;81:141-147
 Hamed S, Thapar-Björkert S, Bradby H, Ahlberg BM. Racism in European Health Care: Structural Violence and Beyond. Qual Health Res. 2020;30(11):1662-1673
 Popham F, Iannelli C. Does comprehensive education reduce health inequalities? SSM – Population Health 2021;15:100834
 Gender, equity and leadership in the global health and social workforce. Available at: https://www.who.int/docs/default-source/health-workforce/ghwn-geh-policy... [Last accessed: June 2022]
 Ethnic inequalities in healthcare: A rapid evidence review. Available at: https://www.nhsrho.org/wp-content/uploads/2022/02/RHO-Rapid-Review-Final-Report_v.7.pdf [Last accessed: June 2022]
 Inequalities in access to healthcare: A study of national policies 2018. Available at: https://ec.europa.eu/social/BlobServlet?docId=20339&langId=en [Last accessed: June 2022]
 What the quality of work means for our health. Available at: https://www.health.org.uk/publications/long-reads/the-quality-of-work-an... [Last accessed: June 2022]
 Henseke G. Good jobs, good pay, better health? The effects of job quality on health among older European workers. Eur J Health Econ. 2018;19(1):59-73
 A healthy labour market: Creating a post-pandemic world of healthier work. Available at: https://www.ippr.org/files/2022-02/healthy-labour-market-feb22.pdf [Last accessed: June 2022]
 Syed ST, Gerber BS, Sharp LK. Traveling towards disease: transportation barriers to health care access. J Community Health. 2013;38(5):976-993
 Núñez A, Sreeganga SD, Ramaprasad A. Access to Healthcare during COVID-19. Int J Environ Res Public Health. 2021;18(6):2980
 Mathur, R, Rentsch, CT, Morton, CE et al. Ethnic differences in SARS-CoV-2 infection and COVID-19-related hospitalisation, intensive care unit admission, and death in 17 million adults in England: an observational cohort study using the OpenSAFELY platform. Lancet 2021;397(10286):P1711-1724
 Addressing health inequalities in the European Union. Available at: https://www.europarl.europa.eu/RegData/etudes/IDAN/2020/646182/EPRS_IDA(2020)646182_EN.pdf [Last accessed: June 2022]
 Orzechowski, M, Nowak M, Bielinska K et al. Social diversity and access to healthcare in Europe: how does European Union’s legislation prevent from discrimination in healthcare? BMC Public Health 2020;20:1399
 Meara, JG, Leather, AJM, Hagander L et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 2015;386(9993):P569-624