Addressing health equity starts with trust
Whenever I hear the term “dystopia” I’m immediately transported back to the 90s and a little-known cult classic film named “Tank Girl” starring Lori Petty, Naomi Watts, Ice-T, and the king of dystopian nightmares himself Malcolm McDowell. The film follows a rag tag group of post-apocalyptic survivors on a mission to wage war against mega-corporation who control the last remaining water on dystopian Earth.
As an allegory on the “haves” and “have-nots” fighting for control of the dwindling supply of Earth’s most precious resource, I can’t help but think of McDowell’s greedy tycoon character of yesterday as a prequel to today’s Elon Musk and Jeff Bezos, who have their sights set on conquering a world beyond Earth. And to bring it home to our day to day in health we see the correlation to the health disparities U.S. “have-nots” facing lack of access to health resources, medical debt, and discrimination, while the “haves” are gaining more access to more exclusive medical treatments, health services, and personalized care.
When I treated myself to a Blockbuster night of rewatching this 1995 classic (okay, classic to me), the realization that this film is set in 2023 had me shook. The dystopian world that once used to be a far-off distant future now closer to the near-term. Hop into the tank with all of healthcare as we travel to our fifth prediction in Joe Public 2030, Disparity Dystopia.
Answering the health equity wake-up call
I know, sounds bleak, right? Much like in our own personal journeys of overcoming things we must name it, feel it, and understand it to heal and come out on the other side. Health disparities aren’t new, but what has changed is that the healthcare industry is speaking up more in earnest about advancing health equity.
The pandemic shed light on several things plaguing our society: The first – that communities of color were disproportionately impacted by COVID-19 and systemic racism in healthcare. The second a reckoning around racial injustices and the literal knee of racism on the neck of our society when we witnessed the murder of George Floyd, and how that galvanized society to take action.
So this brought terms like health equity, health disparity, and medical mistrust more prominently into the lexicon, to the point that hospitals and health systems sat up and paid more attention to this wake-up call.
The trust gap is growing, and systems need to build trust
The medical industry has given people reasons to mistrust. Nurses and doctors garnered good stewardship during the pandemic, but a history of documented missteps, racial and LGBTQ+ discrimination, vaccine hesitancy, and surprise billing continues to fuel mistrust. This history is well-known in the Black community and in fact is related to the dearth of Black physicians and other health providers of color that our nation suffers from today. The vaccine refusal we saw among White Americans is a reflection of the rise of health sects we learned about in the 4th prediction, whereas vaccine hesitancy in the Black community was a result of a well-founded lack of trust in the medical community.
It’s up to hospitals and health system to build trust among consumers. Clinicians can’t do it alone – the pandemic taught us this. Building trust is not a one-and-done, it’s a continuously interactive process. In addition, creating a strong relationship with various communities means listening to their needs, showing up in a way that demonstrates understanding, and an ongoing commitment.
Suggestionsfor Health Systems:
- Be vulnerable and acknowledge that the health systems has made some missteps. Ensure how the public feels is heard and demonstrate that you recognize how they feel, no matter how subtle or implicit. Without feeling acknowledged, people will find it difficult to overcome their resentment and be open to a stronger bond and sense of trust with their hospitals and health systems.
- Trust requires listening – Creating trust among communities of color is the health system’s burden, not the patients. Listening to the needs of overlooked communities and demonstrating an ongoing commitment by action
- Collect better data – Advocate for operations to collect better data, especially around race/ethnicity to better account for where health disparities lie and how the system can create an actionable plan to address
Redefining “community” and how systems show up in the community
Historically health systems have thought of the wealthy as benefactors, the middle class as coveted patients, and the poor as “the community,” but health systems need to turn this paradigm on its head. The community stretches across the economic spectrum and should stand shoulder to shoulder. In addition, your employees are the community, they represent the communities you serve and are also the ambassadors of your brand in the community
Health systems are thinking holistically about what it takes to promote recovery and health. In particular, what happens when people leave the hospital or clinic? Do they have access to everything needed beyond a prescription to regain wellness? What do they need and how can the health system be a catalyst? Systems are very much focused on “wrapping services around people so when they leave our care, they will have food and shelter.” Health system leaders revealed a focus on valuing a continuum of care rather than “transactions” with patients.
It is essential to remember that the local community, often overlooked when populated by people of color, is an important talent pool. This community is a vital part of recruitment programs as well as initiatives to develop the future medical and healthcare specialists needed to deliver quality care. Health systems can no longer be positioned as the unaffordable, moated tower in the middle of communities that have experienced a demonstrated lack of interest in them as potential patients and employees. Rather, understand that the onus is on health systems to get out into the community in a positive and impactful way.
Suggestions for Health Systems:
- Zones of Trust – The health system is more than a physical building, so need to go to the zones of trusts to meet people where they are out in the community (e.g. churches, grassroots organizations, HBCU and Black Greek alums, cultural corridors, etc.).
- Health systems incorporate previously overlooked talent of color from the neighborhoods they serve into their current and future employment. Not just of clinicians, but marketers and communicators as well. An example of this is Morehouse School of Medicine’s “Reach One Each One” which offers high school aged students a hospital-based, multidisciplinary medical mentoring program that introduce kids from underrepresented communities to STEM.
Marketing’s Role in Health Equity
During our ongoing conversations with health systems, an interesting dichotomy emerged: while formal patient satisfaction scores from all patients might be high, when asked informally, patient willingness to recommend the same hospital was very low due to past family experience or outcomes. So while the data might say a particular hospital is a great hospital, patients indicated that they would actively avoid that same hospital due to its past and their perceptions of that past. Past and perception has a direct impact on choice of hospitals by the consumer and that’s an area that is a great opportunity from a marketing perspective.
For those whose histories are directly tied to systemic racism, being frank and upfront is the best course. While this approach may be uncomfortable, it is low risk. Because when you think about it, your target patient knows anyway. If your brand in encumbered by history, the only way to improve your reputation is to improve outcomes and customer experience and be clear and consistent about where you have been – and where you are going.
Make consumers feel seen in your brand. Imagine what trust we could build and loyalty we can develop if we spoke directly to those that have felt ignored? Today, eeryone is everything – audiences don’t look like the clean boxes or traditional segments anymore because lived experiences are intersectional. When we as marketers demonstrate cultural awareness and sensitivity to patients’ and consumers’ lived experiences, we can make a more authentic brand connection.
Suggestions for marketers
- Relationships are key – Build stronger relationships with diverse populations by meeting them where they are in their living moments instead of expecting them to seek your organization out. Partner more with community relations teams to better understand the communities you serve, build relationships with them and their community leaders, and learn how to speak authentically to their needs to build trust and drive conversion
- Cultural sensitivity and communication – Recognizing that cultural sensitivity means that different cultures have different values, customs, and rituals that require different approaches such as end of life for Indigenous peoples. Learning how to communicate with specific local immigrant populations from across the globe in ways that are compatible with their cultures to be more effective in building a relationship
- Growth Potential – Listening increases understanding, cultural sensitivity and credibility that can lead to market share growth among neglected populations. Conduct consumer research to better understand how diverse populations experience your organization and inform marketing approach to speaking authentically to these various populations