The Cultural Deficit in the Pharma Industry in the Era of COVID-19

As the President & CEO of the Multicultural Healthcare Marketing Group, I know all too well the challenges that exist to close the health disparities gap for people of color. The problems are many, which is why I have spent more than two decades designing marketing, media, and health education programs for racially diverse populations and cross-cultural educational programs for healthcare professionals addressing those challenges. It is also why I have partnered with the Institute for Healthcare Optimization (IHO), independent non-profit research, education and service organization focused on bringing science and the practice of operations management to healthcare delivery, as well as working on behalf of the top 50 pharmaceutical companies throughout North America, Western Europe, and Latin America in communities of color focusing on their health and healthcare.

Sheila Thorne

What I know is multicultural campaigns crafted explicitly for diverse populations are insufficiently funded before return on investments (ROIs) can be seen, and these campaigns do not see the same kind of support other mainstream campaigns do simply because of the very nature of what makes these campaigns different – they’re ethnic niche markets in industry speak. Here is the kicker, the complexion of the nation is browning, which strongly suggests this is plain bad business for pharma. The good news is there are plenty of brave souls out there willing to partner with them and redirect the ship. The question is, will pharma wake up and recognize the changing world ahead?

In 1960, the population of the United States was 88% white, according to the U.S. Census. In the last two decades, there has been a diversity explosion in America. Unparalleled, unprecedented, irreversible, seismic demographic shifts have changed the complexion of America. It is getting darker.

Census 2010 was a wake-up call about the "browning" of America. Blacks, Latinx, and Asians accounted for 92 percent of U.S. population growth during the previous decade, with Latinx accounting for over half of that increase. Over 75 million millennials are now 44 percent of color and the most diverse generation in American history. Before the middle of this century, there will be no white majority population in this country.

While most Americans are healthier than ever before due to technological advances, preventive medicine, and access to health care, racial and ethnic groups are less healthy, receive more inferior care, and die prematurely from preventable, treatable diseases, even among the middle class and insured.

From the groundbreaking 1985 Heckler Report that documented for the first time health disparities in America to the 2002 landmark National Academies of Sciences "Unequal Treatment" Report to the 2015 Congressional Black Caucus Health Braintrust Kelly Report on Health Disparities to the annual reports from 2003-2018 from the Federal Agency of Healthcare Research and Quality (AHRQ), health disparities data are undisputed.

The alarming number of infections and deaths in communities of color because of COVID-19 was no surprise to enlightened healthcare professionals. "Institutional racism in the United States contributes to the disproportional impact that the coronavirus pandemic has had on the Black community," said Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID), and a member of the Trump Administration's White House Coronavirus Task Force.

"The disproportionate prevalence of underlying conditions within the Black community, such as high blood pressure, diabetes, obesity, chronic lung disease, and kidney disease, puts African Americans at much greater risk of suffering the deleterious consequences of COVID-19, including death," continued Fauci.

The reasons for health disparities are complex. However, the race is now considered a significant risk factor for many chronic diseases. But the voices of pharmaceutical industry leaders have been conspicuously silent during the robust conversations among key national stakeholders about disparities solutions. Add to this, the death of George Floyd has also made the conversation about race even more impossible to ignore. It presents an extraordinary opportunity for pharma to trade its silence for bold, targeted strategies that support its collaborative partners dedicated to everything from diversity recruitment and training to data collection.

One would think that the accumulation of compelling disease prevalence and mortality data among people of color would drive business and, more importantly, a moral imperative for pharmaceutical industry leaders to get involved.

I have worked on developing and implementing multicultural publicity and promotional campaigns for big pharma for more than two decades. Unfortunately, these initiatives are scant, not sustained, and not commensurate with the disease prevalence data among people of color.

Far too many pharmaceutical marketing directors and brand managers overlook, ignore, and underfund health promotional campaigns targeting people of color. Multicultural marketing initiatives are not woven in the fabric of pharmaceutical brand business plans or promotional and publicity campaigns. They are afterthoughts.

Far too many pharmaceutical executives paint racially diverse groups, consciously or unconsciously, with the same brushstroke – poor, uninsured, uneducated, health illiterate, non-compliant, and challenging to reach.

The passage of the milestone Affordable Care Act (ACA) in 2010 enabled more than 20 million to join the ranks of insured Americans. The number of uninsured Blacks went from 20% to 11% and Latinx from 31% to 19%. Many more Blacks, Latinx, and Asians now have access to health services, more contacts with physicians, need more medical procedures, and more pharmaceuticals.

It is shocking that few industry leaders only consider disparities solutions from a philanthropic perspective. When the data revealed that people of color were becoming infected and dying at alarming rates from COVID-19, the response was 'blame the victims' for poverty and poor health habits rather than taking a serious look at the pervasive inequities in America's healthcare system as barriers to getting preventive and quality care.

It is perplexing that brand teams are stuck in a pilot program mentality rather than a market development strategy to build corporate and brand equity engines for organic growth to reach new customers. So-called ethnic "niche" markets have become "majority-minority" markets. So-called ethnic "sub-populations" have become the "new mainstream" in urban, suburban, and rural areas.

Time and time again, I have heard from courageous pharmaceutical professionals with a passion for working in racially diverse populations that it is a struggle. Because of insufficient funding, multicultural campaigns have often met their demise long before realizing a return-on-investment. 

Time and time again, innovative pharmaceutical marketers have lamented the enormous pressure to deliver unrealistic goals for multicultural campaigns with little funding and no support from senior management. Many have chosen to abandon the effort out of frustration. Many pharmaceutical marketing professionals of color consider working on multicultural campaigns "career killers."

The devastation of COVID-19 in communities of color and the horrific murder of George Floyd have illuminated the longstanding inequities and inequalities in America. The pharmaceutical industry's cultural deficit reflects the cultural deficit, injustices, and disparities in American society.

Corporate statements from CEOs denouncing racism, bias, and discrimination are now permeating all society levels in America. Large corporate donations to organizations working on social and criminal justice are flowing freely. Human Resource Departments and ethnically focused Employee Resource Groups are speedily spearheading anti-bias, sensitivity training programs, and listening sessions to raise awareness about the impact of racism on people of color's daily lives.

The pharmaceutical industry spends billions of dollars and devotes many years in research to produce pharmaceuticals that have saved millions of lives because of all lives matter. But when you look at how little the industry spends, comparatively speaking, on health education and publicity campaigns to reach communities of color, the question is: Do the lives of people of color matter, too?

Now is the pharmaceutical industry's time to step up to the plate to fulfill its unique corporate responsibility as a key stakeholder in eliminating racial and ethnic health disparities. Engaging racially, ethnically, and linguistically diverse populations – virtually untapped markets – is the new frontier for organic growth in the pharmaceutical industry.

Now is the time for U.S. clinical research teams to prioritize increasing diversity in clinical trials so that physicians are confident that drugs produced are safe and effective in all Americans.

Now is the time to go beyond just putting black, brown, and yellow faces on patient education materials, populating websites with ethnic faces and expedient direct, word-for-word translations that are linguistically sub-standard.

Now is the time for marketing teams to budget for ethnic print, radio, and social media to communicate health information to communities of color.

Now is the time to achieve health equity and outcomes through better healthcare operations. To that end, the Institute for Optimizing Health and Healthcare will launch an Annual Eliminating Health Disparities Report Card to monitor the level and quality of pharmaceutical companies' commitment to eliminating health disparities.

The report is designed to provide communities of color with insight into community health programs as a resource and encourage brand loyalty to the pharmaceutical companies dedicated to providing support to develop and distribute culturally relevant health education information and materials.

In partnership with my firm, the Multicultural Healthcare Marketing Group, the Institute for Optimizing Health and Healthcare is also launching the Pharmaceutical Cultural Competency Training Program. This secondary resource provides tools that aid pharma in training and recruiting diverse teams, creating sustainable diversity programs, and moving out of piloting programs to invest funding beyond these initial programs and, instead, realize meaningful ROI that allow growth for future programming.

It is morally and the ethically right thing to do. It makes good business sense. It is the smart thing to do. It is no longer an option when conducting medicine in America's increasingly diverse multicultural society in the era of COVID-19 and beyond.

Sheila Thorne is the President/CEO, Multicultural Healthcare Marketing Group, LLC, and is one of the nation's leading experts in multicultural healthcare marketing.