Released at WEF 2017: New Research on The Great Health Divide

On January 17, Oliver Wyman hosted a panel discussion during the World Economic Forum Annual Meeting in Davos, Switzerland. “Vulnerable Populations and The Great Health Divide” examined a critical issue in global healthcare and detailed the many disadvantages vulnerable populations encounter when accessing health information.

At the event, Oliver Wyman and Altarum Institute shared findings from new Robert Wood Johnson Foundation (RWJF)-funded research. “Right Place, Right Time: Health Information & Vulnerable Populations” was a year-long study focused on the needs of lower-income consumers, Medicaid beneficiaries, the uninsured, caregivers, and Spanish speakers. It found that most vulnerable healthcare consumers struggle to understand their options, their costs, and even the language around their care. The research also explored marketplace perceptions of these consumers’ health information needs and discovered a gap between stakeholder impressions and consumers’ reality.

At the Davos discussion, panelists Helen Leis, Oliver Wyman partner and study lead, and Donald Schwarz, Vice President of Programs at RWJF, provided an overview of the study. They then engaged attendees from non-governmental organizations, academia, and a variety of Fortune 100 healthcare and technology companies in conversation around how to build an inclusive healthcare system for all. Here, Oliver Wyman Partner Crispin Ellison, who served as panel moderator, summarizes the discussion.

Takeaway #1: In developed nations, more attention must be given to how information is relayed.

As the “Right Place, Right Time” study found, vulnerable consumers experience healthcare differently – whether it is feeling disrespected by doctors, having difficulty finding sources of information, or fearing stigmatization for being immigrants. Most vulnerable healthcare consumers feel disconnected from available healthcare information sources, and struggle to understand their options, their costs, and even the language around their care.

For example, according to the study, almost half of Spanish-speaking respondents said that language issues present a significant barrier when communicating with doctors; and if resources are not offered in native language, they are reluctant to ask for them.

The room agreed that stakeholders need to be more aware of the barriers vulnerable consumers face in accessing information, and then work to correct current shortcomings. As example: The group noted that research found that vulnerable health consumers in the United States rely on mobile phones for Internet access. Health websites that are not mobile friendly, therefore, are inaccessible to vulnerable consumers. And an important communication channel is rendered useless.

In addition, attendees discussed healthcare’s overuse of complex terms. Too often, the reading level of the intended audience is ignored, and materials that are intended to be informative end up beyond the grasp of people with lower literacy levels, limited English, or behavioral health challenges such as dementia.

Takeaway #2: In developing nations, the focus should be on empowering local health workers with reliable, accessible information.  

The discussion also considered the obstacles faced by vulnerable individuals in the developing and emerging world. There, a major challenge related to health information is Internet access. While 81 percent of people in developed nations are Internet users, just 15.2 percent of people in the least-developed countries are Internet users.

The point was made that while vulnerable consumers in developed nations typically access the Internet via mobile devices, there is much lower smartphone penetration in emerging nations. For example, nearly 75 percent of US adults report owning a smart phone, according to Pew Research Center. In contrast, just 4 percent of adults in Ethiopia, 11 percent in India, and 14 percent in Tanzania report owning a smart phone. In many corners of the globe, therefore, the only connection to health information is a community health worker.

But an additional challenge for many vulnerable individuals – as pointed out by the group – is the shortage of healthcare professionals. For example, sub-Saharan Africa, with a population of over a billion people and 25 percent of the world’s disease burden, has less than 3 percent of the global healthcare workforce.

Because it will take years to overcome the infrastructure, cultural, and financial obstacles related to empowering consumers with Internet access, not to mention the huge structural healthcare workforce inbalance, the focus should be on improving health information for community workers, attendees agreed. Empowering these local workers with Internet access – so they can be connected with experts remotely – and information that is relevant and accessible to them will be key to improving health of vulnerable individuals in their respective communities.

Digital distribution of information is becoming increasingly important to disease management; however, just 15.2 percent of the population of the least-developed countries are Internet users. In comparison, 81 percent of the population in developed nations are Internet users. The economic toll of this health epidemic is significant: The estimated loss in economic output in developing countries is US$7 trillion for 2011-2015, according to a Harvard University study.

Takeaway #3: Trust is everything.

Recently, we’ve seen a significant global decrease in trust in society, government, and industries like healthcare. The new Oliver Wyman research found that trust is a particular issue with vulnerable individuals and the healthcare system. For example, the study found that nearly 40 percent of low-income consumers in poorer health felt disrespected by health providers. And patients feeling disrespected were three times less likely to believe their doctor. Lack of trust leads these consumers to ignore medical advice, and that has obvious and profound implications both on an individual’s health and health costs overall.

Meanwhile, in the developing world, many people distrust “Western” methods and medicine, and may seek more traditional tribal care.

The Davos discussion concluded with the group agreeing that the key to overcoming the great health divide is trust. Whether a patient is a low-income individual in an urban US city or a rural resident in sub-Saharan Africa, the first priority should be establishing trust. Without it, even the best health information initiatives will falter.