Contributing authors: Gale Pryor, Desirée Duncan, Chelsea Rice
“Of all the forms of inequality, injustice in health is the most shocking and the most inhuman.”
Rev. Dr. Martin Luther King Jr., National Convention of the Medical Committee for Human Rights, Chicago, 1966
To move health equity from a mission statement to a business imperative, it’s time for health marketers to stop buying these excuses and take action.
Health disparities among vulnerable populations — older and poorer people, those with complex comorbidities or marginalized by their race, ability, gender or sexual orientation — is an injustice. We know that. Yet, leaving it there is an easy out: Addressing a vast injustice is a job for society, not our overworked health marketing team.
The truth is, that addressing health disparities is more than a moral mandate. It’s a business imperative – no excuses.
Disparities due to race alone have led to $93 billion in excess medical care costs and $42 billion in lost productivity annually, according to a 2018 analysis by the W.K. Kellogg Foundation. In a year when more than half of hospitals are operating with negative margins, we cannot overlook the draining cost of health disparities. Healthcare’s financial crisis is fueled, in part, by the health disparity crisis.
If your mission is growth, addressing health disparities is your swim lane. If your job is building awareness and trust in your brand, reducing health disparities must be your priority. If shifting perceptions through smart communications is your superpower, then shift your organization’s view of health equity from a mission mandate to a growth strategy.
For achieving health equity to be a growth strategy, however, first we must shed the beliefs that have become excuses for inaction. A few engrained excuses are holding back hospitals and health systems from turn good intentions into effective action. We’ve identified 10 common excuses that healthcare organizations tell themselves about health disparities – excuses that prevent progress. Let’s get them out of the way, so that you can get to work.
Excuse 1: We can’t address health disparities when financial stability is also an urgent crisis.
The first excuse we tell ourselves? As healthcare marketers, we must choose between addressing health disparities and regaining financial stability. The truth? You can’t accomplish one without the other. The finances of health systems and the health of the communities they serve are entwined. Health systems create healthier populations. Healthy populations drive economic growth for communities and their health systems. Healthier communities have bigger pools of qualified healthcare professionals to care for more patients. Healthy communities have more buying power and attract more businesses that provide good jobs (with commercial insurance that covers elective surgeries). Good health enables all else, including financial stability for both consumers and hospitals, in a virtuous cycle.
Excuse 2: We don’t feel we can own the conversation about health disparities because we’re not doing enough about the issue as an organization. We haven’t earned the right.
You need to start somewhere. If your organization hasn’t yet led in this area, then help mend that by earning the right to lead yourself, one step at a time. Marketing teams are already experts on consumers’ experience, needs and how they interact with your health system. Combine your understanding of your consumers to identify an internal aspect of health disparities where you can make progress.
Here’s one opportunity. The doctor-patient relationship relies on trust, and consumers, as a whole, trust physicians more than anyone else in healthcare. Yet, when it comes to specific populations, physicians themselves can undermine that trust. For example, a recent study in Health Affairs revealed that some physicians consider providing care for patients with physical disabilities “burdensome.” One physician said these patients “create a big thing out of nothing,” and another called them “an entitled population.” When people with disabilities — and their families and friends — encounter these attitudes, it’s like throwing a grenade at growth and branding.
Marketing teams, however, can proactively assess physician attitudes and patient experiences within their own organizations to identify mindsets that erode the well-being of individuals and communities. Working with internal communications you can, for example, distribute robust materials with guidance on the needs of patients with disabilities and ADA requirements to create the kind of positive change that a highway of billboards can’t replicate.
Excuse 3: Our leadership isn’t very diverse; it’s mostly made up of white men. How can we make real progress on health equity if we don’t look the part?
Baked into this excuse is an assumption that white men in leadership can’t be held accountable — or don’t want to be involved — in health justice. Where can you push back on that false narrative? Start by ensuring that your leadership team has a respectful and actionable understanding of the health disparities your community faces. Help them to engage with appropriate community leaders to continue deepening that understanding. Make sure they are prepared to speak to these issues.
Then go further: Encourage your leadership to share their visibility and platforms with diverse community leadership and use your system’s prominence to turn up the volume of those voices. Your community will feel more engaged and welcomed by your system hearing more diverse voices. Continue to make those meaningful connections by bringing these leaders on to your board and into your C-suite. The business case is clear. As McKinsey reports, “the relationship between diversity on executive teams and the likelihood of financial outperformance has strengthened over time.” To get there, leadership needs your communications and research skills to integrate health equity into all business processes and prioritize health equity investments. Together, you can move the needle on reducing disparities that are rooted in patient access and experience — but they need you to show them the way with data and strategy.
Excuse 4: We don’t have enough patient data by race/ethnicity to understand the true diversity of the communities we serve. We can’t act on what we don’t understand.
Using data to identify outcome disparities in your patient population is the foundation of creating health equity. With data-driven visibility into your consumers’ lives and needs, you can design targeted, effective interventions to remove barriers, improve outcomes, and grow trust in your brand. And if that data isn’t being collected in your hospital, nothing can be done, right? Wrong.
As the American Hospital Association advises, look beyond clinical data to build a comprehensive profile of a population. In addition to annual community health needs assessments, patients’ self-reported experience and outcomes data can be collected. Screening data can reveal social needs, along with data from public health agencies and community partners. When diverse data sets draw a complete portrait of your population, it becomes clear that race-based data alone is just a single brush stroke. The picture of disparities is far more complex than a single data point — and any data you can access are likely to deepen your understanding of the people you serve.
Excuse 5: Addressing health disparities feels like boiling the ocean.
To use a different image, health disparities is the house-sized boulder in your path and all you’ve got is a chisel. What can one marketing and communications team do to reduce a vast, complex, intractable challenge? Chipping away at a monumental problem creates more than a pile of dust: Action of any size can change perceptions of what is possible. And who better than the communications and branding experts on your team to open minds and create possibility?
How to start? Make a business case for cultural awareness training for frontline workers. Use the data outlined above to start building the business case for health equity into your 2023 objectives. Create a common health equity lexicon for use across your organization. Foster community partnerships that enable you to collect those diverse data sets, so that you can design targeted outreach to build the access and trust that fuel growth.
Excuse 6: Underserved communities are too challenging and complex to consider a viable market for growth. Any investment is philanthropic and provides little true business value.
The truth? Addressing health disparities does not always equate to serving a population covered by Medicaid. It can also mean addressing healthcare disparities, which affect many populations across socioeconomic levels. As the Kaiser Family Foundation points out, “A ‘health disparity’ refers to a higher burden of illness, injury, disability, or mortality experienced by one group relative to another. A ‘healthcare disparity’ typically refers to differences between groups in health insurance coverage, access to and use of care, and quality of care.” Therefore, when you address issues of access, use, and quality — or healthcare disparities — you are also working to reduce health disparities.
When you expand your health systems’ reach via alternate sites of care, virtual health and digital tools, and community partnerships to bring your medical expertise into consumers’ daily lives, you improve all consumers’ access to care. You are also expanding your footprint and broadening awareness in your community, essential aspects of any growth strategy.
Excuse 7: Our patient satisfaction scores indicate we’re doing fine.
Patient satisfaction scores certainly matter. After all, high HCAHPS mean higher Medicare reimbursement. The Hospital Consumer Assessment of Healthcare Providers and Systems survey measures adults’ perception of the quality of care they received as inpatients across multiple measures, and the overall score is factored into CMS reimbursement rates. Yet, beneath that total score lies information that can reveal opportunities for your own organization to address health disparities — if you look for them.
For example, in January 2022, Press Ganey analyzed HCAHPS survey data to reveal a divide between Black women’s experience in maternity care and that of other women. Almost universally (i.e., regardless of insurance status), Black women reported less satisfactory experiences. The largest disparities in discharge preparation, responsiveness, care transition, cleanliness, and likelihood to recommend the hospital. That’s an obstacle to growth as well as an injustice. It’s also an opportunity to bring your team’s consumer expertise to the table, both to improve the experience of Black mothers and your hospital’s reputation in the community.
Excuse 8: Our clinical leadership insists every patient is treated equitably.
A growing body of research indicates that implicit bias — or attitudes about ethnicity, gender, ability, or other characteristics — among healthcare professionals is relatively common. Without conscious intent, these attitudes impact patient encounters and contribute to health disparities. In one study, reports The New England Journal of Medicine, “48.7% of U.S. medical students surveyed reported hearing negative comments about Black patients by attending or resident physicians, and those students demonstrated significantly greater implicit racial bias in year 4 than they had in year 1.” A similar 2022 analysis published in Health Affairs found that Black patients were two and a half times as likely as white patients to have at least one negative descriptive term used in their electronic health record. Physicians also used higher rates of negative descriptors in notes in the health records of unmarried patients, those covered by Medicare or Medicaid, and patients in poor overall health — regardless of race.
Implicit bias among clinicians is an issue in which adopting a common lexicon (in an initiative led by communications experts) can have a profound impact on the patient encounter. By banning vague and stigmatizing terms like “noncompliant” or “non-adherent,” clinicians can be guided to find more specific language around why a patient may not be “cooperating.” Did the medical team inquire about financial barriers, transportation difficulties, or identify language or literacy challenges or other obstacles to treatment? Can your team help develop a guide to language that does not assume the blame lies with the patient?
Excuse 9: We don’t have the staff to address health equity, and the staff we do have are already overwhelmed.
When health equity is redefined as a business imperative and a strategy for growth — when it is put at the center of the awareness and reputation work your team is already doing — it becomes the lens through which every team member sees their work. Consider the days when digital marketing was still new. Many marketing teams assigned digital work to digital specialists. Now, we understand that all marketing and communications staff must understand digital and function with it as a primary lens on all marcomms work. Health disparities demand the same pervasive adoption. It’s not about adding staff but about bringing your existing team up to speed.
As marketing and communications leaders, we have standing assignments we own, whether brand positioning, patient loyalty, margin optimization, service line marketing, physician referrals, consumer insights, or internal communications. Addressing health disparities ties into each of those functions and more when we employ an inclusive mindset as we execute on these responsibilities. Take your organization’s brand. Who is not being reached by your brand? How could you boost your brand awareness by speaking authentically and directly to untapped markets like minoritized communities who are commercially insured? Who does your team envision as “desired patients”? Who could be missing from that picture? How can your brand show up in their community? How can you make these overlooked consumers feel seen and understood?
Excuse 10: If healthcare institutions admit to implicit bias or a history of racism, they will make Black patients more distrustful.
While it is not unusual for healthcare institutions to have a history of racism, it is rare for them to acknowledge and face their histories. Historic racism and racism today, however, are not mutually exclusive; one indicates the other. Therefore, public recognition of history (followed by action) is foundational to earning the trust of all the people you serve. And trust is an essential aspect of health. People who say they distrust healthcare organizations are less likely to take medical advice, keep follow-up appointments or fill prescriptions. People who say they mistrust the system are much more likely to report being in poor health. Distrust is a primary driver of health disparities.
If you are facing an institutional history or other issues that fuel distrust among Black consumers, it’s essential to start and lead a public conversation about those issues. But talk must be accompanied by action as you identify meaningful ways to show your community that you take these issues seriously. Host a conversation with community leaders and employees to address the issue, make meaningful donations or contributions to these causes, and share updates on internal or organizational changes around diversity, equity and inclusion efforts.
For those patients who feel dismissed or misunderstood in clinical encounters, work on internal communications and policies to earn trust through an empathetic and respectful culture. Create welcoming, safe places by training everyone — from receptionists to attendings — in trust-building language and behavior. Build relationships between patients and clinicians outside the exam room and its inherent power imbalance. Validate mistrust by acknowledging and affirming experiences of discrimination. Work to create systems and feedback opportunities that respect patients’ thoughts, behaviors, and emotions as justified — and as guidance for your own actions.
Respecting and responding to lived experiences
Addressing health disparities is deep-rooted, pervasive work that goes far beyond diverse imagery in advertising. Representation matters — but action matters most. To prevent implicit bias in marketing, always ask, “who is missing?” That answer not only relies on ethnicity, age, or gender identity, but also lived experience of each individual, their whole person regardless of ethnicity, age, ability, or gender identity. Does your organization welcome, respect and respond to the individual lived experience of every person?
Healthcare is the business of life. It’s life giving and life sustaining. And when healthcare organizations fail to care for all lives, they may well fail as businesses, too. If you’re ready to execute on a growth strategy to reduce health disparities, let’s talk.
