Social Determinants of Health: Why Should Pharma Care?
Social determinants of health (SDOH), or the “non-medical factors” which affect how “people are born, grow, work, live, and age” can perpetuate health inequities, act as predictors for healthcare outcomes, and ultimately affect patient access to innovative medicines. Evidently, the peak of the COVID-19 pandemic brought SDOH to the forefront, where the links between economic, food, and housing security were implicated in mortality and morbidity of the disease. In reality, however, SDOH affect the provision of care in every disease group and therein become a key determinant of end-user uptake of novel medicines.
If SDOH factors fall outside the remit of traditional Pharma, and perhaps even outside the remit of traditional healthcare, then why should Pharma even pay attention? I would argue that the answer lies in Pharma’s volume-to-value paradigm shift – the shift from simply selling pills to becoming providers of holistic healthcare solutions that consider safety, quality of life, and adherence in tandem with clinical efficacy. In Pharma’s efforts to become ‘providers of value’, Pharma can succeed by considering every aspect of patient care, including socio-economic factors affecting healthcare access. Are under-served patients aware of their disease risks? Do patients live in proximity to their healthcare provider? Are patients able to attend routine hospital appointments for treatments? Ultimately, SDOH can act as a “last-mile” barrier to assuring that all patients are able to access innovative launched Pharma therapies.
How is Pharma Reaching the End Customer?
If Pharma is to thrive under the new normal of ‘volume-to-value’, the lens of stakeholder engagement must also change. For instance, Takeda has an algorithm for holistic patient engagement which considers patients’ external support systems and their personal circumstances (e.g., food and economic security) that contribute to their ability to (continue) access to innovative medicines. Initiatives from this approach include expanding patient support services for branded products to furloughed workers during the pandemic.
Another avenue of engagement is through targeted population health actions, especially in those disease groups affected by lifestyle factors such as cardiovascular disease. Here, following a clinical trial specifically in African American US patients for heart failure drug Corlanor, Amgen continued to hone in on SDOH factors by partnering with the Association of Black Cardiologists to “remove the barriers to care and provisioning appropriate treatment options” and spending $13M in local health equity initiatives.
In the mission to deliver value to their stakeholders, Pharma must consider the “last-mile problem” of end-patient access and doing so will inevitably require the addressing of SDOH. Outside of the relatively pristine conditions of clinical trials, manufacturers should question whether they have the ‘follow-through’ of addressing real-world healthcare barriers to ensure that all patients have access to the medications they need, independent of their socio-economic circumstance.