In a perfect world, everyone would have access to affordable and high-quality care, as well as opportunities that support healthy and productive lives—regardless of socioeconomic status, race, ethnicity, gender, sexuality, or other demographics. Unfortunately, if we look Hospital standards, Maternal death, Burden of disease associated with smoking, Distribution of organ transplants, Cancer treatment servicesOr dozens of other statistics, we see that this is not the case.
While solving such a complex problem requires input from many stakeholders, it is the pharmacist who is often overlooked. Pharmacies are the most accessible health care sites in the United States, for nearly 90% of Americans Live within 5 miles. This uniquely positions pharmacists to address the needs of healthcare consumers earlier in the care journey, building interpersonal relationships and community trust, as well as leading institutional and public policy reforms.
Fragmented health equity strategies fail to treat the whole person
Despite efforts by organizations across the health care ecosystem to promote greater health equity, inequities persist. In our reportAdvancing Health Equity: Practical Solutions to Addressing Disparities in Care;” published in collaboration with Health Leadership Council (HLC), ZS identified 3 areas of improvement for healthcare stakeholders seeking to address health disparities:
- Better integration. Organizations are often leading ad hoc health equity initiatives. To create greater accountability, organizations must build an official structure that integrates with existing organizational governance and business processes.
- Informed goals. Organizations must better analyze data and do so systematically, to identify areas of greatest need or potential impact and create prioritized goals based on these insights.
- Adjusted interventions. Too many organizations miss the opportunity to replicate successful pilots or one-time partnerships with larger patient segments or geographies.
To this, we add the fourth area of improvement: it is necessary to pay more attention to treating the patient in general.
Healthcare companies create products, services and experiences for real human beings who lead complex, highly individualized lives and struggle with diverse physical, cognitive, social, cultural and emotional needs. However, too many companies have designed fragmented health equity strategies that only address 1 or 2 needs in line with the organization’s business objectives.
Focusing on health equity interventions using Maslow’s hierarchy of needs
For companies looking to design solutions that address individual needs holistically, we recommend employing Maslow’s Hierarchy of Needs as a guiding principle (Figure 1). In Maslow’s hierarchy, lower needs in the pyramid must be met before an individual can attain higher levels.
To see how this applies in the real world, consider a safety net primary care facility that refers a patient with diabetes to a food pharmacy for advice on diet and exercise. Patient has 3 kids, works 2 jobs, and living wage to pay.
Her mother helps at home but prepares meals that are not suitable for managing diabetes. According to Maslow’s hierarchy, this patient must develop 3 basic levels—physiology, safety and security, and love and belonging—to successfully experience a new health condition.
In other words, without financial stability, strong social support, and self-reliance, the patient may struggle to adhere to her own personal well-being plan. As a result, despite this clinic’s best efforts and intentions, it sees little or no change in patient outcomes.
In order to design more appropriate interventions, companies must recognize that addressing diseases and unhealthy behaviors is only the tip of the iceberg when designing solutions to improve public health. The conditions in which people live, work, love and learn have a profound effect on health outcomes. We need to jump below the surface to understand the major factors that affect health and build resources that address the causes of health disparities.
What it takes to influence the behavior of an individual patient
To drive meaningful health changes across a broad population, companies must better align their business objectives with the lives and needs of individual healthcare consumers. The ecological model shows how an individual’s environment influences their attitudes and behavior (Figure 2).
On an individual level, we are influenced by our friends, family members, and cultural traditions. Institutionally, we are influenced in our schools and workplaces. The presence (or absence) of local parks and grocery stores represent community-level influences, while laws and regulations represent examples of public policy-level influences on individual behavior.
The more influential organizations target for intervention, the greater the likelihood of driving change. Using this ecosystem model, organizations can expand the reach and impact of their health equity strategies by implementing a “surrounding voice” approach. By dividing social care into different levels of influence, we actively engage consumers in their environment and deliver appropriate resources so they can progress quickly up Maslow’s hierarchy.
Pharmacists are uniquely positioned to influence individual behavior.
As in many communities, pharmacies can be a center of social care that drives change through the impact it has on the lives of every individual. To do this, pharmacies and pharmacists must actively work to build trust with the communities they serve. Here’s how:
Build interpersonal relationships. Pharmacists communicate directly with community members in need. Information about drugs, vaccines and clinical advice. To create rapport and trust, pharmacists should expand their training to better practice Traditional humility and to acquire additional skills such as motivational interviewing and trauma-informed care techniques.
Advocate for institutional reform. Community and retail pharmacies can expand their services by hiring community social workers and health coaches. Pharmacies should consider hiring staff from their communities and investing in their staff’s professional development to support internal promotions. With community members in middle and senior management, organizations can identify inequities and design solutions that best meet community needs—building community trust.
Build community trust: In order to center the voices that face injustice, pharmacies need to investigate the health and safety of the community in their communities. Pharmacies can use these insights to create strategic partnerships with community-based organizations, other health care stakeholders, and those outside of health care to connect consumers with appropriate resources. Pharmacies may consider offering educational opportunities to members of the communities they serve, such as college scholarships for minority students seeking health care careers.
Advocate for public policy changes: Pharmacies and pharmacists can advocate for laws and policies that promote health equity, such as requiring reimbursement for nonmedical services and the continued use of telehealth to provide care across state lines. In addition, pharma can and should advocate for health equity to reduce regulatory barriers that prevent or hinder their collaboration with life science companies.
Although they are positioned to help reduce various health disparities, pharmacies cannot (and should not) do it alone. All sectors of the healthcare industry must design practical interventions that ensure healthcare consumers have access to the resources they need at multiple touch points. We suggest as much in the HLC report linked above.
Why prioritizing health equity is a good investment.
We recognize that there are financial obligations that make companies wary of disrupting the status quo. However, companies have a moral responsibility to ensure that their business activities support the betterment of their communities. Some notable examples of purpose-driven companies contributing to the greater good include:
- Moral benefitCVS’ prohibition of tobacco product sales in low-income communities has made it easier to recruit and retain talent and sign more business partners who share CVS’s new brand values.
- Economic benefitRecently, Eli Lilly reduced the cost of insulin and reduced patient costs by $35 to increase access to affordable diabetes medication. The share price has increased.
- Social benefitResponsible capitalism is emerging outside of the healthcare industry, where organizations are devoting company wealth to social and environmental initiatives that build the future. In fact, 90 percent of publicly traded companies in the United States use an organization’s impact on people and the planet to determine strategic priorities, such as achieving economic goals such as revenue growth and maximizing shareholder value.
The world we live in is complex, ambiguous and dynamic. In a perfect world, healthcare companies would understand each healthcare consumer as a unique individual and use this understanding to design person-centered solutions, advocates would proactively reach individuals in their communities, and companies would realize the benefits of diversifying their products and services. To meet different needs. In order to move towards the just world we want to see, we must pay attention to the complexity of the problem, support each other and build together for change.