In October 2022, the Pharmaceutical Research and Manufacturers of America (PhRMA) released a chart pack on health equity, with information on health equity in three sections. Health equity means that all patients have the opportunity to reach their highest health potential and having access to health services supports and medicines is an integral part of the equation.
The three sections covered by the chart pack include: A Snapshot of Health Disparities in America; Inequities in Access to Screenings and Medicines Allow Health Disparities to Persist; and PhRMA’s Commitment to Building a More Equitable Health Care System for All.
Snapshot of Health Disparities
The disparities in health outcomes and access to health care exists across diverse populations. For example, when compared to non-Hispanic whites, Hispanic men and women are twice as likely to be diagnosed with and die from liver cancer and stomach cancer. Additionally, the maternal mortality rate for Black women is 3x higher than that of white women and Asian American and Pacific Islander women are 2.5x more likely to die from stomach cancer compared to white women.
Looking at the COVID-19 mortality rates, many people of color experienced higher rates of COVID-19 infection, hospitalizations, and mortality while having disparate access to health care and treatments. The COVID-19 mortality rate was highest among American Indian/Alaska Native populations.
It isn’t just disparities based on racial and ethnic differences but also patients with disabilities face a myriad of barriers to access care, such as physical barriers to entering health care facilities and lack of accessible equipment.
PhRMA also noted that health disparities not only have an impact on individual patients and their communities, but also on the overall health and economy of the United States. Racial disparities in the United States cost $93 billion in direct medical care costs and $42 billion in lost productivity costs in 2021.
Access to Screenings and Medicines
PhRMA also noted the importance of increased diverse representation in clinical trials to health equity, as it provides a more holistic and evidence-based understanding of how potential therapies work in diverse populations and it grants patients’ access to other quality care, including provider visits, screenings, and additional medicines.
When it comes to data, PhRMA compared the 2020 FDA Drug Trial Snapshot with the United States Census Bureau – 2020 estimates, and found that while Black individuals represent about 12% of the total United States population, they only make up about 8% of clinical trial representation. Hispanic individuals represented about 19% of the United States population but only 11% of the clinical trial representation. Asian individuals were even, at 6% of clinical trial representation and 6% of the United States population and white individuals represented 75% of the clinical trial representation but only 62% of the United States population.
PhRMA also provided information on “pharmacy deserts,” defined as a community with both low income and low access (having more than 33% of its population live more than a mile from a pharmacy or poor access to a vehicle and live more than half a mile from a pharmacy). In more than 40% of United States counties, patients are required to drive at least 15 minutes to reach a nearby pharmacies. Rural states such as Kansas, Montana, South Dakota, and Nebraska have the largest number of counties with pharmacy deserts. Taking Chicago as a specific example, 54% of predominantly Black communities are pharmacy deserts while less than 5% of predominantly white communities are pharmacy deserts.
PhRMA also noted that implicit bias continued to contribute to inequity in patients’ access to medicines and health care services and that lower medication adherence among disadvantaged patients hampers health equity.
PhRMA’s Commitment
Since the 1985 publication of the first study of racial and ethnic health disparities in the Heckler Report, there have been steps taken to reduce health disparities, including a 10-15% point decrease in the share of uninsured Black and Hispanic adults from 2013 to 2018 and more than 800 medications in development for diseases that disproportionately impact racial and ethnic minority communities.
PhRMA cited its Principles on Clinical Trial Diversity, including building trust and acknowledging past wrongs to encourage clinical trial participation, reducing barriers to clinical trial access, using real-world data to inform medicine uses for diverse populations beyond product approval, and enhancing information about diversity and inclusion in clinical trial participation.
In releasing the Chart Pack, PhRMA affirmed its commitment to partnering with entities across the health care system to ensure that every patient, irrespective of where they live, has equal access to quality health care, treatment, and cures. Some of the entities that are working to enhance clinical diversity in a “sustainable way” are Morehouse School of Medicine, Yale School fo Medicine, Vanderbilt University Medical Center, and RCMI Coordinating Center, funded by a grant from PhRMA.
PhRMA Board Chair, Ramona Sequeira, said, “Equitable access to quality medicines and care will meaningfully transform the lives of millions of Americans – particularly those in our most vulnerable and underserved communities. By collaborating across the public and private sectors, we can build capacity, identify and remove barriers and leverage technology to enable health care systems that work for all, not just some.”