Tech companies must engage marginalised patients, embrace diversity as a business imperative, and could become powerful ‘anchor institutions’ within local communities, says NHS England’s Professor Bola Owolabi. She speaks with Matthew D’Arcy and calls for health tech sector action.
Narrowing healthcare inequalities has long been a focus for Professor Bola Owolabi. As the director of NHS England’s National Healthcare Inequalities Improvement Programme, she is driving forward commitments in an area of increasing strategic importance.
This includes the highly regarded national Core20PLUS5 approach she has spearheaded – aimed at improving access, patient experience, and clinical outcomes for the most deprived and marginalised parts of society.
Professor Owolabi’s passion for healthcare equity has transcended decades. During the pandemic, she worked with government ministers to ensure Covid-19 vaccines reached ethnic communities. Her career has seen incentives introduced to help young teenage mums to quit smoking. She has led national work around equitable healthier ageing. And she helped to design the internationally adopted Derbyshire Frailty Model.
As a GP, she continues to work in the same communities where her career began: “I’ve always practised in the ex-mining villages of Derbyshire – places where the industry has been hollowed out,” she says. “There are very high levels of poverty, and the associated toll of ill-health. That is where I feel I can make the greatest contribution.”
Prominent in policy – time for health tech to act
During her time at NHS England, the need to reduce healthcare inequalities has become increasingly prominent in strategies, policy papers and legislation. It is now a priority for the government and board tables throughout the NHS.
“The Health and Care Act has significantly enhanced health inequalities duties on NHS England, integrated care boards, and NHS provider organisations,” says Professor Owolabi.
But it is not only government and NHS commitments that interest her. “Reducing health inequalities is everyone’s business – not only the NHS,” she says. And she believes that responsibility extends to health tech companies.
Tech can part of the solution, but can exacerbate inequalities
“Technology is an enabler and accelerator for narrowing the gap on health inequalities – handled well,” says Professor Owolabi.
Achieving the “handled well” part of that statement requires health tech companies to engage in effective co-design, she says. That means involving “underserved, seldom heard communities” at the “design phase, the deployment phase, the rollout phase and the evaluation phase – across the whole product life cycle”.
“There is a tendency to reach out to the articulate user,” adds Professor Owolabi. “If we do that, we are just going to exacerbate health inequalities.”
She calls for an “inclusive by design ethos” – where technological innovations are delivered in equitable, affordable and accessible ways that respond to unmet need. “There are large swathes of the community that might have poverty of devices, poverty of data and connectivity, or poverty of the built environment,” she explains. “If we adopt inclusive by design as a meaningful way of ensuring digital inclusion, that is another way that technology companies can leverage their position to be allies in our work to address health inequalities.”
Tech companies as ‘anchor institutions’
Tech companies are also urged to invest in the communities they serve, where they have an opportunity to become “anchor institutions”. “Employing people from the local community, procuring from the local community, making their estates useful to the community where they operate, can be a really powerful way of technology companies fulfilling their roles as anchor institutions, and by doing so, addressing the wider determinants that drive health inequalities”, says Professor Owolabi.
“There is also something about the decision on where they site their business,” she adds. “I was at a device manufacturing company, with its headquarters in Sheffield. Its presence is vital to the community’s commercial viability.”
Diversity is a business imperative
Workforce diversity in the innovator ecosystem, is another factor companies providing health tech solutions might consider.
There is an opportunity to “make that ecosystem more accessible to communities hitherto underrepresented in that space”, says Professor Owolabi.
“Diversity at board level is not a tokenistic, moral, ethical imperative,” she adds. “The most profitable companies understand that diversity of thought and representation is a business imperative.”
Overcoming a question of bias in reference data
Technology companies must also be open in tackling inherent challenges around the data on which products are developed.
“The reference data upon which AI algorithms are being trained, and genomics interventions are being designed, is up to 96% European ancestry,” says Professor Owolabi. “That is a challenge the industry needs to be very clear-eyed about, and understand the inherent bias in many of the technological products we are designing, constructing and deploying on the basis of that reference data.”
“In a post-pandemic world, we saw in the most brutal terms what happens in a public health emergency if you have inequity baked into your infrastructure,” she adds.
“A macro, maybe even meta question to the industry: what is the answer to that?
“Otherwise, we are in danger of moving into the next public health emergency, if we haven’t been clear eyed about this particular challenge.”
Moving from a sales conversation, a health tech inclusion charter
Despite challenges, the opportunity is significant for health tech businesses to help leaders across the NHS respond to strategic priorities around healthcare inequalities, believes Professor Owolabi.
“If I sat on the board of a technology company, I would look at my product pipeline and the extent to which there are solutions to those strategic priorities,” she says.
“If there are solutions to those priorities, the landing of the message becomes more straightforward. If it resonates, aligns and provides answers to the strategic objectives of the NHS, it becomes a collaborative, collegiate conversation rather than a selling conversation.”
She issues a call to action for the health tech community, to ensure technology has a positive impact on healthcare equity: “There is a real opportunity for the digital and technology industry to come together to create an industry code of conduct around digital inclusion,” she says. “And building on that to have a charter on digital inclusion. And then an industry digital inclusion framework. Then you have a statement of intent and a vehicle for implementation.”
