In this article, Elliott discusses the challenges and complexity in achieving diverse representation and treatment in healthcare in APAC; Steps that healthcare institutions can take to start prioritising diversity and inclusivity in practice; How technology can both be a driver and barrier to bridging inequality gaps; How innovative outcomes are only as good as the data put into the algorithms and importance of implementing inclusivity at the design stage of healthcare practice, from research to treatment.
Workplace discrimination remains a fundamental problem in society, and healthcare institutions are no exception. It not only manifests itself as a barrier to healthcare access, but also impacts the quality of services — even marginalising populations from getting the required assistance.
According to the World Health Organisation (WHO), healthcare should be provided to everyone regardless of race, ethnicity, age, gender, religion, or social status.
In the past few years, awareness of the importance of equal representation has become widespread. According to a 2021 Google survey1, Asia-Pacific in particular has been slower in embracing diversity, equity and inclusivity, as compared to other regions, especially across dimensions such as mental health, LGBTQI+, and race and socioeconomic status, despite being one of the most diverse regions in the world.
To improve our experiences as patients and health outcomes for everyone, it is important to be aware of existing challenges to inclusivity and ways healthcare institutions can prioritise diverse representation and cautiously consider technology to eradicate barriers to universal healthcare access.
Achieving diverse representation faces hurdles in almost every healthcare institution.
While educators in learning institutions are aware of and can act as proponents of inclusive practices, often the topic of diversity is not implemented within academic curriculums. There is also a lack of confidence and readiness to discuss diversity within lectures and course work. The challenge is not a lack of awareness, but limited funding and diverse representation.
According to a paper published by Elsevier on COVID-19 research conducted during the first wave of the pandemic, appropriate levels of racial and ethnicity reporting were not factored into the results, despite general awareness of racial disparities and inequity. For example, during the pandemic, vaccine trials included less than 5 per cent of Asians on average in their samples.
In APAC countries where populations tend to be dominated by a single race or ethnicity, practicing inclusivity can prove to be rather challenging. Due to the lack of exposure to caring for certain populations, ethnic minorities in Vietnam, for example, tend to face communication barriers2 and receive non-specific and non-contextually adjusted health information.
Raising awareness on the importance of inclusivity through education is a critical step towards equipping future healthcare practitioners in Asia, with the necessary skills to recognise bias and treat patients from diverse groups equally.
Implementing the framework of inclusivity within curriculums, beyond learning about the science of healthcare, can help student doctors and nurses practice care with empathy. Another approach would be to model inclusivity into medical schools at every level; from the board, management and faculty, to the student body.
In APAC, more than 258 million people live with rare diseases, and many still receive limited funding and allocation3. Increased financing and prioritisation in the research field within APAC will help such patients receive adequate care.
Beyond equitable funding, it is also important to ensure that clinical samples are fair and representative of population demographics, which will allow research into the varying responses and risk factors for specific ethnic groups.
Recognising that many efforts to achieve diversity have fallen short due to passivity, it is necessary to set concrete benchmarks. Ideally publicly, with aggregated data where necessary, to make progress measurable and trackable, for greater accountability
In the digital first world, technology has become closely integrated with our daily lives. Technological solutions have permeated the healthcare industry, driving significant change and impact. While technology can support healthcare institutions by streamlining the data collection process, aiding the development of innovative treatments and improving communication across demographics, its Achilles heel remains the fact that technology is dependent on data.
Technological outcomes will only be as good as the data put into them, and depend on how the data is used. Specifically, algorithms which are derived from a majority pool of Caucasians will not be as accurate when applied to
patients from a racially marginalised group4
To make healthcare truly inclusive, tech products within the healthcare field should be truly representative. They must consider the needs of all patients and support the delivery of empathetic care based on individual patient needs.
Working with inclusive technology and intelligence platforms, or partnerships with institutions like Elsevier’s Health Research Development programme, can help advise practitioners on the adoption of good practices and global standards: from design, through its undertaking, and until the publication of study results — thus resulting in the collection of representative data.
Investing in diversity is critical to ensure that all patients receive the care they need. All healthcare institutions, including universities, hospitals, and research facilities, must intentionally implement inclusive frameworks within their systems.
To this end, it is important to move away from the concept that it is optional. Rather, a minimum requirement and standard should be set and made mandatory.
On an individual level, healthcare professionals can play an active role to advocate for change, be early adopters and change makers, to influence and enact change within their sphere of influence.
Ultimately, the goal is to be able to provide not only robust and comprehensive care to patient populations, but one that is tailored to their diverse needs, aided by the latest, most-inclusive and innovative solutions.
References:
1 https://www.thinkwithgoogle.com/intl/en-apac/future-ofmarketing/management-and-culture/how-inclusion-andequity-lag-behind-diversity-in-apac
2 https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-017-0687-7
3 https://www.weforum.org/agenda/2021/11/how-toremodel-universal-healthcare-in-the-asia-pacific/
4 https://link.springer.com/article/10.1007/s40273-017-0578-1
