Hardly a day passes without news of another disruptive healthcare alliance or collaboration focusing on data. If it’s not Amazon sharing its health IT savvy with JPMorgan and Berkshire Hathaway1, it’s Google Cloud teaming up with the National Institutes of Health (NIH) to bring troves of biomedical data to the screens of researchers across the U.S.2 Indeed, the three collaborative research pillars of the 21st Century Cures Act—Precision Medicine, the BRAIN initiative in neuroscience, and the Cancer Moonshot—all hinge on finding meaning in the vast rivers of healthcare information.
Big Data in healthcare isn’t new. But one clear consequence is the enhanced ability to zoom in on the needs of disadvantaged communities and the social determinants of health—and this happens to be a high priority for patients, physicians, healthcare businesses, and policymakers. Consider the way Congress is implementing the 21st Century Cures Act. One of the goals is to understand how education level, socioeconomic status, and other social determinants affect health outcomes for underserved populations. Speaking before a House committee in late July, leaders of both the NIH and the Food and Drug Administration (FDA) emphasized that all data-gathering under the Cures Act must take stock of multiple populations.
Furthermore, under an initiative called “All of Us,”3 the NIH is enrolling one million American volunteers in the equivalent of a crowd-sourced biomedical data repository. Pooling information from electronic health records (EHRs), blood samples, records of environmental exposures, and culture and behavior patterns, the program will create the first-ever research database that truly reflects the nation’s race-, age-, gender-, and socioeconomic diversity. The database is designed intentionally to “oversample” minority communities that, until now, have been underrepresented in biomedical research.
The fascination with social determinants and the emerging preoccupation with research data that looks like America has profound, positive implications for pharmaceutical marketers.
However, along with opportunities, the trend also brings new imperatives. In the past, pharma marketers might be content if a disease awareness campaign spurred patients to talk with their doctors. This no longer hits the mark. Today, in a best-case scenario, the marketing group would work across company silos with smart people in clinical and market-access divisions to identify the needs of underserved populations and craft innovative initiatives that might help.
The following questions may help frame the context for such a campaign:
- Does the initiative help level the playing field by ensuring everyone is speaking the same language? Perhaps the campaign can help shore up health literacy of the target populations.
- Does the initiative bring diverse patient voices to the table and/or promote diversity research? When you start marketing a new drug to racially or ethnically diverse groups, could you also run an education program that will lead to more diverse enrollment in your clinical trials—and explain to stakeholders why that’s important?
- Does your product campaign help restrain drivers of mistrust that keep vulnerable populations from engaging in the healthcare system? Partnering with businesses that enjoy the trust of local communities might be one way to draw people in.
- Have you applied the best principles of marketing in terms of promoting behavior that’s associated with good health outcomes—as opposed to simply emphasizing the importance of medication adherence? Maybe you can help rebrand health and make it “cool” in a way that cuts across diverse demographics, so you are not simply marketing a new pill or injection.
- Have you had enough internal conversations about what multicultural marketing means before you take the product to the market? (Hint: It’s not just about translating label information on a Facebook page or hiring multiracial actors in a TV ad.)
No healthcare sector offers greater opportunity for biopharma companies to tackle social disparities than the area of mental health. As highlighted in a June 2018 blog post from the American Psychiatric Association (APA),4 the problem isn’t simply that severe mental illness can result in the loss of friends, jobs, and homes. It’s that social determinants such as socioeconomic status, as well as the experience of racism or gender bias, can contribute to depression and post-traumatic stress disorder, and even increase the odds of developing dementia later in life.
In mental health, as in other arenas, the private sector can help by unlocking—and funding—creative solutions to these complex challenges. In 2015, Sunovion Pharmaceuticals, a manufacturer of treatments for bipolar depression and other conditions, launched a national initiative called “Be Vocal: Speak up for Mental Health,”5 which gives individuals, families, and communities powerful digital tools to tell their stories about mental illness. The central tenet of the campaign, co-created with five leading mental health advocacy groups, is that visibility can help combat prejudice and stigma, which is both a consequence and a cause of mental distress and also a barrier to care.
For other companies in this space, there are abundant opportunities to pair marketing initiatives with programs that address social determinants. Nineteen states now require Medicaid managed care plans to record relevant socioeconomic data and/or provide referrals for social needs, according to the APA. Working with such a program, a pharma marketer could help educate families about social services that are available—bearing no relation to the company’s products—and help individuals access those services. The APA also notes that a growing number of public programs aim to improve access to transportation, education, and nutrition. Such programs provide openings for marketers to step in and help.
Disrupt…or Be Disrupted
Once a pharma company’s marketing team and its cross-disciplinary collaborators see how reducing disparities in access to care matches their marketing mandate, opportunities are unlimited. In Chicago, the Cook County Health & Hospital system created a program called The Tiniest Listing, which uses true stories to increase awareness around premature births and raise funding for families that can’t afford a neonatal intensive care unit (NICU), where charges may run as high as $4,000 a night.6 The stories have a powerful emotional appeal. A manufacturer thinking outside its comfort zone could partner with a hospital in a program like this, not only to reduce disparities in access to the best NICUs, but also to educate the public on medical innovations, including pharmaceuticals, found in such facilities.
There’s another important reason pharmaceutical marketers must generate socially attuned marketing ideas that are outside their comfort zones: If the drug industry doesn’t disrupt and innovate in the area of social determinants, other industries will. An example is the Uber Health dashboard service that lets hospitals and physicians book rides for patients needing care—and pay for those who can’t afford it.7 Instead of a hospital, Uber’s partner of choice might just as easily have been a pharmaceutical company. Better yet, pharma could have gestated the idea and pitched it to Uber!
Diversity in research is also fertile ground for initiatives that radiate—authentically—beyond public relations or marketing. Already, some manufacturers are stepping up to the plate. In 2015, Novo Nordisk began piloting a program in Washington, D.C., to increase minority representation in trials for type 2 diabetes drugs, recognizing that responses to treatments often vary depending on the patient’s race, ethnicity, gender, or age.8 According to the best data at the time, African Americans, who accounted for 13% of the population overall, made up just 5% of participants in type 2 diabetes trials. Admittedly, sorting out the complex interplay of race, gender, age, and socioeconomic factors in a study is no simple task. Still, sponsors hope that increasing minority participation will illuminate variations in subgroup responses and ultimately spur development of more effective treatments.
Talking about disparities also holds risks for marketers, to be sure. If drug companies misuse this terminology or go overboard in leveraging patient data under the banner of socioeconomic analysis, they might find their efforts tarred in a media exposé. This summer, ProPublica and NPR ran an investigation alleging that insurers track everything from an individual’s race and education level to TV preferences, social media activity, and net worth and then use algorithms to predict how much the individual’s healthcare usage could cost the payer.9 MedPage Today, a respected health news outlet, ran the investigation under the headlines: “Social Determinants of Health Draw Insurers’ Interest” (Subhed: “Sucking up data on customers buying and social habits—but for what purpose?”)
An occasional media sting comes with the territory. The simple fact is, policymakers and the private sector are determined to formulate policies around the social determinants of health. It’s time for pharmaceutical companies to re-imagine their marketing initiatives in ways that help dismantle barriers, level disparities, and increase access to care. As long as the marketing teams remain committed to authenticity, their success will serve everyone’s best interest.
1. See, e.g., April 2018 Reuters article here: https://reut.rs/2Jj2uW1.
2. For explanation of Google Cloud and NIH STRIDES, see: https://bit.ly/2NZITvw.
3. For NIH “All of Us” initiative see: https://tinyurl.com/yboetgar; For coverage of recent 21st Century Cures hearings, including “All of Us,” see Modern Healthcare: https://bit.ly/2v87uqp; And for more on 21st Century Cures and Social Determinants, see guest commentary in same publication at https://bit.ly/2ArsD4y.
8. Forbes: https://bit.ly/2LSTACK.