Driving Towards More Inclusive Clinical Trials by 2030

RACmonitor, Silas Buchanan

February 25, 2022

Action without strategy is aimless, strategy without action is powerless.

EDITOR’S NOTE: This piece originally appeared in Health Affairs on May 6, 2021. This article will form the basis of the Global Health Equity Symposium during the annual HIMSS conference, scheduled to begin on March 14, 2022. It is being reproduced here in recognition of Black History Month.

Systemic racism is the monster under our collective bed, built into our most fundamental social structures and institutions. For underserved community members and community members of color, it impacts where we live, the quality of our education, how likely we are to encounter unethical policing, our access to voting, and crucially, our ability to access quality healthcare.

Consequently, any authentic discussion on improving inclusive engagement in clinical trials, as we plan for 2030, must, at a minimum, acknowledge systemic racism in our healthcare system as a precursor. For instance, COVID-19 is negatively impacting all of us in obvious ways. However, as the pandemic shines a bright light onto systemic racism, it is disproportionately impacting many of us in ways that are not always easy to see, measure, understand, or even acknowledge.

Systemic racism is itself a root cause of health disparities, and therefore it is one of the social determinants of health (SDoH). SDoH are the conditions in the places where people are born, live, learn, work, pray, play, age, and die. These conditions explain, at least in part, why some community members are healthier than others, and why many underserved community members are disproportionately impacted by a wide variety of chronic illnesses. The morbidity and mortality rates of community members of color are exponentially higher across almost every chronic illness. These chronic illnesses, in turn, leave underserved community members more susceptible to infectious diseases.

In fact, the Centers for Disease Control and Prevention (CDC) reports that community members of color have been and continue to contract and die from COVID-19 in disproportionate numbers. African Americans, Native Americans, and Hispanic Americans are hospitalized at rates approximately four times higher, and dying at rates almost three times higher, than white, non-Hispanic persons.

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