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Health Equity, Part 2: Optimizing Digital Strategies to Increase Data Representation

From as early as the 16th century, humans have been using the scientific method to collect data points and make decisions based on objective observations. As societal systems have advanced, methods for data collection have also expanded, ranging from surveys, interviews, focus groups, and secondary data analyses. Still, these methods were not designed to adjust for the stratifying systems of our current society—such as ableism, racism, sexism, classism, and colonialism—leaving significant room for error to exclude historically marginalized populations, and in the case of health outcomes, lead to larger health disparities. 

We look to data to counter inaccurate beliefs with science and facts. Building a strong evidence base of data has become a precursor to driving important, strategic decisions. Today, data is everywhere. How do we make the most of it?

Principles For Data Equity 

The solution is twofold: we must 1. find ways to make the data more representative of the populations being served and simultaneously 2. include the narrative around the data that cannot be collected. For a more equitable dataset, the CDC Foundation’s Principles for Using Public Health Data to Drive Equity provides tools to center equity in the data life cycle, hinging on recognizing and defining systemic factors, using equity-mindedness for language and action, and allowing for cultural modification.

At mPulse mobile, we embed these equitable practices throughout our data lifecycle to bring a focus on health equity, prioritize deeper community engagement strategies, and address the social and economic factors that affect health outcomes.

When Numbers Don’t Tell the Whole Story 

When a group is not represented in data collection—whether they are accidentally excluded, non-responsive, or dropped out because they have more barriers to engagement—there is a sampling bias in the data that can have long-lasting consequences for entire communities. 

This happens when data is unavailable for a marginalized group and is not accounted for in adjustment methods. It translates into data analyses and reporting, and consequently, excludes these groups from key decisions. This can lead to already marginalized groups being overlooked in program design, policymaking, resource allocation, funding, and more, systemically putting them at an even further disadvantage. Historically, this has led to race neutral policies, such as grandfather clauses, literacy tests, and redlining. When these decisions are made across housing and built environment, education access, economic stability, and food policy they also affect an individual’s overall health outcomes.  

An example of this is the race and ethnicity data collection process. As the US population demographic has diversified, the racial designations on surveys have not: all Asians are grouped together along with Pacific Islander. They do not account for the many various identities that exist within these populations. Inclusivity needs to intentionally be built into data collection methods, to ensure that people who are not a part of the demographic majority are also represented within the data. 

In a data-driven world, it is crucial to use an equity lens throughout data collection, analyses, and reporting. This can drive better decisions, efficiency, increase revenue, and arguably most importantly, even help lower premature illnesses and preventable deaths.

Overcoming Barriers: Reducing the Burden 

Health equity work is a gradual process of undoing harmful, institutionalized rules and making new rules striving toward justice. This begins with making sure everyone’s data points are included: 

  1. Recognizing the barriers that prevent populations from being a part of the narrative and 
  1. Providing means to overcome these barriers 

Digital outreach has vastly improved data collection methods—it overcomes multiple barriers such as the time it takes to get to a location, saves on transportation, can offer multiple languages, etc. 

mPulse Select Outcomes
mPulse Select Outcomes

Data Equity: Building Trust and Striving to Justice 

One barrier that has proved harder to overcome is medical mistrust. Stemming from the adverse treatment dating back to exploitation of enslaved Black bodies to do scientific research, there is a deep-rooted distrust among Black Americans towards medical professionals. This medical mistrust results in underutilization of services, weathering, and missing data. While there is no quick fix, promoting and supporting doctors of color, teaching cultural humility, and updating medical guidelines are a start to building more equitable practices within health systems. 

Black and brown patients are now poorly represented in clinical and drug studies, leading to a large data—and knowledge—gap, that translates to misdiagnoses. For example, literature has taught medical professionals what skin symptoms look like on white skin, but have not shown how they may look different on black and brown skin. The missing data points result in missing information and knowledge gaps for providers, subsequently leading to misdiagnoses, and ultimately creating greater health disparities for people with darker skin.

Data to Impact Journey (famously known as Information vs Knowledge)— Source: Gaping Void

Data to Impact Journey (famously known as Information vs Knowledge)— Source: Gaping Void

When looking at data, we cannot rely on the raw numbers alone. It is equally important to analyze who is not fairly represented and qualitatively share the barriers that have led to their data exclusion. If we cannot remove barriers in data collection, there are other ways to uplift the unheard voices into the overarching narrative. To glean more useful insights from the population trends and patterns we collect, it is critical to understand the context behind the numbers.

Digital Solutions: Practical Approaches to Representational Fairness 

Health equity is central to the creation of our HEDIS gap-closure oriented Engagement Solutions: they promote health literacy, demonstrate cultural competency, increase accessibility, and address social determinants of health by: 

Our engagement strategy intentionally uses data disaggregation to ensure representation of marginalized populations and address social determinants of health (SDoH). Using a proprietary SDoH Index, which leverages a weighting system to maximize its predictive ability, we provide tailored, relevant, and empathetic conversations to members. These solutions are designed to be comprehensive, multilevel, adaptable, and culturally appropriate for populations experiencing health disparities. Insights gained from outcomes can be funneled back into existing Engagement Solutions to provide targeted, relevant outreach to maximize gap closure potential. These tailored digital Engagement Solutions implement an equity-minded approach to close health gaps for groups that have been historically excluded, exploited, and marginalized, and ultimately promote a fair and just opportunity for everyone to reach their optimal health. 

To learn more about using digital engagement to build more equitable health data, register for Activate2023: Designing Customer Journeys for Health Equity.

Health Equity, Part 1: How Can Digital Engagement and Conversational AI Promote Health Equity?

When COVID-19 overwhelmed our nation’s healthcare system, a stark reality emerged: health inequity. As people of color experienced a disproportionately high burden of COVID-19 cases and deaths, highlighting a gap in our system, the topic of health equity surfaced across public health agencies, policy makers, healthcare systems and providers, and employers alike, and the possibility of digital health solutions bridging these gaps and make quality healthcare more accessible came to the forefront. 

To promote health equity, it is vital to begin with a universal definition. The Centers for Disease Control and Prevention defines health equity as “the state in which everyone has a fair and just opportunity to attain the highest level of health.” Achieving this aspiration requires uplifting communities that have been minoritized and excluded and promoting affordability and accessibility to quality healthcare and other social services. First, let’s start by looking at equity and how it is different from equality.

Equality vs. Equity: The Road is Long 

While these terms may sound similar, equality and equity are not synonymous! Creating equitable solutions over equal solutions has the profound impact to uplift marginalized populations. 

Imagine that you must go five miles down the road. In an equal society, everyone who needed to travel this distance would be given the same bicycle. What determines who makes it down the road and who makes it quickest?

  • Personal conditions, such as their biking skills, what they are carrying, and whether they have the ability to pedal with their feet.
  • Circumstances of the environment such as whether the road is bumpy, inclined, or flat.

In an equal society, while everyone may have a bicycle, they are not truly equipped with the resources they need to succeed

In contrast, in an equitable society, everyone is set up to reach the end of the five miles at the same exact time, regardless of conditions. In a scenario of equity, each person has a bicycle that has been developed for their unique needs, such as a motorized vehicle for wheelchair users or a bicycle with more traction to endure the bumpy roads.

Visualizing Health Equity: One Size Does Not Fit All Infographic
Robert Wood Johnson Foundation, 2022

When it comes to healthcare, the same logic follows: a uniform approach will not work across populations. True health equity will require providing each member with the tools they need to overcome barriers and ultimately achieve their highest level of health. There are a few key digital engagement strategies that can be especially effective in addressing health inequities among member populations. 

Streaming Health Content

diabetes eye exam streaming health content in SpanishHealth illiteracy is one of the biggest barriers to equitable healthcare, and in response, streaming health content is an effective method for health literacy promotion. It borrows from the best of digital content strategy, behavioral science, and instructional design to create powerful learning experiences to address health literacy barriers in a consumer-friendly format and to encourage hard to reach members to take control of their health outcomes. Instead of telling people what they need to do, we are educating them on why it’s important, which serves to develop intrinsic motivation to get care and take healthy actions. Everyone has the knowledge needed and everyone can make health decisions with all the information available.

Interested in learning more about our approach to health literacy? Register for Activate2023: Designing Customer Journeys for Health Equity »

Conversational AI and Natural Language Understanding

With the use of artificial intelligence, conversations can be programmed to understand responses in any language and intelligently respond in that same language. It can also allow plans to respond automatically to barriers created by inequitable circumstances, such as transportation, cost, or health literacy issues. Then it can provide real time solutions to move the member forward toward the desired action. This serves to create more equitable health experiences for those members who aren’t starting on a level playing field.

Social Determinants of Health (SDoH) 

Research shows SDoH have a greater impact on health and well-being than medical care. This is because where a person lives, learns, works, and plays can affect their health in many ways. There are many non-medical factors that affect health and wellness:

  • Economic Stability: employment, income, expenses, debt, medical bills, and support 
  • Physical Environment: housing, transportation, safety, parks, playgrounds, walkability Education: literacy, language, vocational training, pre-schools, higher education 
  • Food: hunger, access to healthy, affordable options 
  • Community: social support systems, community engagement, discrimination, stress 
  • Healthcare System: health coverage, provider access, provider cultural competency, quality of care

These factors commonly overlap to affect health outcomes (health status, mortality, and morbidity).

Technology can bridge the gap created by SDoH. At mPulse mobile, we believe SDoH can be addressed directly using disaggregated data, which ensures representation of marginalized populations. We created a proprietary SDoH Index which leverages a weighting system to maximize its predictive ability. Factors such as food insecurity, transportation access, neighborhood, and environment are taken into account for each individual member to provide a more tailored, relevant, and empathetic conversation.

Bridging Gaps: Our Commitment to Equitable Health

Digital interventions can also be a powerful tool to bring communities together during a crisis (such as quick response to the COVID-19 pandemic), spread education, send interventions in multiple languages, and find different ways to get people the resources they need.

The digital platform can be used to spread health education in engaging ways (e.g. videos, courses), utilizes behavior science to break down fears and misinformation, and uses a multicultural lens to provide multiple languages and ensure cultural sensitivity. Together, this technology can bridge inequities early on, and in turn, can help mitigate preventable, deadly health consequences. 

Ultimately, we aim to close gaps in care and eliminate preventable health disparities by integrating health equity competencies across all of our work, and allow all people a fair and just opportunity for the highest level of health.

To learn more about the impact digital engagement can have on health equity, read part 2 of this blog series next.