If you have been to the emergency room lately – or have had COVID-19 – you’ve probably had a device clamped over your index finger, a pulse oximeter, to measure the oxygen concentration in your blood. That number is a vital sign clinicians use to inform care decisions on the spot.
If you’re Black or African American, the chances are the reading is wrong. An FDA Advisory panel recently convened to urge the agency to change how it regulates pulse oximeters because their design is flawed. The light sensors that are the heart of the devices “see” correctly through white skin, but not through brown or black skin.
The same problems exist in the faulty “race correction” factors applied to diagnose conditions that are more prevalent in Black patients, from hypertension to kidney disease. For example, race correction algorithms routinely overestimate the kidney function of Black patients, leading to late diagnoses of impending kidney failure or delayed access to dialysis and transplants.
Black and African Americans are more likely than whites to suffer and die from heart diseases, stroke, cancer and other serious conditions, according to the U.S. Office of Minority Health.
These are vestiges of America’s long history of healthcare racism, something that still adversely affects the health and life expectancy of Black Americans. From mis-designed medical devices to a lack of medical resources in their local communities, our healthcare system consistently delivers inferior outcomes for people of color.
Add to that an enormous sense of distrust of the healthcare system in the Black community, which plays a role in these outcomes. From the Tuskegee Experiments to the development of gynecology, Black Americans have been exploited and made test subjects – without their knowledge or consent.
If we are truly to improve health outcomes for Black Americans, we must not only overcome distrust but also address the systemic biases in care that continue to diminish Black health. To succeed, it will require both significant investment in and significant collaboration with the Black community.
That’s why Novartis and the Novartis US Foundation consulted with Black and African American community leaders to identify where the pharmaceutical industry can collaborate to improve the health of Black Americans. The result is Beacon of Hope, our innovative 10-year, $50 million collaboration with 26 Historically Black Colleges and Universities, including Morehouse School of Medicine, Howard University College of Medicine, Meharry Medical College and Charles R. Drew University of Medicine & Science.
Among the goals we set are to work together to increase diversity among clinical trial participants and investigators, and increase the number of investigators of color – so that underserved communities will embrace innovation in health care via clinical trials. It’s also vital to increase the research dollars and expertise applied to conditions that have an outsized effect on the Black community. For example, we need better understanding of the racial differences in response to statin therapy used to reduce cholesterol levels that in turn contribute to a 30% higher death rate for Blacks from heart disease.
Finally, the collaboration will target the urgently needed overhaul of those race correction algorithms that amplify race-based health inequities rather than reduce them. We’ve set up the Morehouse School of Medicine Race Correction in Medicine Data Standards Center of Excellence to specifically examine how those algorithms can be recalibrated to support unbiased treatment decisions and improved outcomes.
Yet, the healthcare industry alone cannot bring about these changes. Health inequity in America today is a result of centuries of inequity for people of color across every aspect of life. As a society, we must address other insidious issues that conspire to keep Black Americans less healthy and more susceptible to chronic diseases. That includes everything from the lack of healthy and affordable fresh food in Black neighborhoods to air, water and other environmental factors that plague low-income neighborhoods. Dealing with those factors requires, among other things, overcoming disparities in income and generational wealth that have been a major impediment to a better quality of life for Black Americans.
This is my vision for Beacon of Hope: to train a new generation of Black healthcare leaders in their own communities, both practitioners and researchers, who can make enormous contributions to science and rebuilding trust and to make a positive impact on generational wealth and health.
The continued struggle for equity in healthcare for Black Americans is a political, social and moral failure. With more long-term collaborations between the healthcare industry and the Black community, we can right the wrongs of systemic racism in health care and be a catalyst for generational change, health equity and racial justice.
Patrice Matchaba, M.D., is head of U.S. corporate responsibility at Novartis and president of the Novartis US Foundation.
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