Solving health inequities requires intentional, front-end actions

Andis Robeznieks , Senior News Writer

Ensuring that augmented intelligence (AI) and other digital health tools are integrated into health care practice in a way that advances health equity rather than diminishing it is a priority of the AMA.

“If we don't fix the foundational problems in technology design and development at the front end, if we're not intentional about eliminating bias and incorporating better data sets at the very beginning of the process, we're simply going to perpetuate these longstanding biases,” said AMA President Jesse M. Ehrenfeld, MD, MPH, an anesthesiologist who co-chairs the Association for the Advancement of Medical Instrumentation’s AI committee.

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“We have to make sure that we don't widen health inequities when we bring digital products, such as wearables, into the marketplace without an alternative for patients who either don't know how to use them, can't use them—especially for differently abled people—or don't have the resources to afford to use them,” he added.

Dr. Ehrenfeld discussed these issues during “Rethinking Health Technology for Equity,” a webinar produced by the HLTH Community, which is a platform focused on health innovation and transformation.

Along with other panelists, Dr. Ehrenfeld talked about how digital health, data science and AI (often called “artificial intelligence”) have had a transformative impact on health care, but the benefits of this technology are unequally distributed and widening the digital divide.

AMA policy defines health equity as “optimal health for all,” including through technology. Dr. Ehrenfeld discussed AMA efforts to promote equity in the health technology space.

This includes serving as the lead sponsor for the In Full Health Learning and Action Community, which encourages development of digital solutions that address the needs of historically marginalized communities while ensuring that new tools don’t unintentionally create new inequities.

In Full Health was based on the Principles for Equitable Health Innovation developed with guidance from the AMA External Equity and Innovation Advisory Group that helped build a business case for investment in equitable health innovation.

Dr. Ehrenfeld cited a report that found reducing racial health inequities could generate an estimated $135 billion annually. This includes saving $93 billion in excess medical costs and gaining $42 billion in untapped productivity.

“Healthier workers have fewer sick days, are more productive on the job, and have lower medical care costs,” the report says. “A healthier population saves everyone in insurance premiums and health-related public spending.”

Dr. Ehrenfeld made note of that dollar figure.

“Think about that, $135 billion a year in economic growth if we can do the right thing finally, for all of our patients,” Dr. Ehrenfeld said.

“The current models of health innovation, resource allocation, how we develop evidence, how we design solutions, and how we select markets, do not incorporate an equity lens,” he added. “And unfortunately, those processes, those models, fail to realize the potential gains—and unfortunately, continue to risk making worse racial and social injustice.”

That is why, despite decades of growing investment in health innovation, health-outcome data shows the U.S. continuing to lag behind other high-income countries, Dr. Ehrenfeld said.

He also noted that women and Black, Hispanic, and Indigenous people are underrepresented in health-solution investment, development and purchasing decisions. They also get less than 10% of new venture capital for technology and manage only about 1.3% of new investment dollars.

“Our vision for health innovation is pretty simple: We should prioritize resource allocation to launch and scale solutions that are meaningfully advancing racial and social justice and health,” Dr. Ehrenfeld said.

“Ultimately, the race, ethnicity, sexual orientation and gender identity of investors and innovators ought to mirror that of our nation—in both proportional representation and allocation of resources,” he added. “I'm optimistic about where we can go, but the entire industry really needs to pivot if we're going to do this right.”

Dr. Ehrenfeld is scheduled to speak Feb. 27 at HLTH’s ViVE 2024 conference being held at the Los Angeles Convention Center. The AMA serves as a strategic partner for the event.

Purchasers, investors, solution developers, funders and any others interested in learning more or participating in influencing the ecosystem of health solutions, ensuring equity in innovation, advancing equitable opportunities and investments, and allocating resources are invited to join the In Full Health Learning and Action Community