COVID-19 highlighted long-standing disparities in healthcare—throughout the pandemic, historically marginalized populations faced significantly higher rates of infection, hospitalization and mortality. This spurred greater attention to and investment in equity in healthcare, particularly as climate concerns exacerbate existing inequalities and encourage calls for change.

Understanding Health Equity

The Centers for Disease Control and Prevention (CDC) defines health equity as “the state in which everyone has a fair and just opportunity to attain their highest level of health.” The CDC considers any disparities in this a result of the disadvantages owing to “social or economic status, geographic location, and environment.”

Achieving health equity means reducing barriers to access. For example, several studies tie systemic racism to disparities in healthcare and inadequate social support systems that further contribute to poor health. People with disabilities and some minority groups may also face unique barriers to healthcare.

Underscoring Healthcare Inequalities during COVID

The COVID-19 pandemic evinced that not all have equal access to healthcare, innovation, and education. Findings by the CDC show that hospitalizations, death rates, and access to care unequally fell along racial and ethnic lines. In particular:

• Hispanic patients were more than 2.5 times more likely to test positive, and Black and Asian patients were nearly twice as likely to test positive compared with white patients.
• Black and Hispanic patients accounted for a larger share of COVID-19-related hospitalizations (48.6%) compared with white patients (38.8%).
• Indigenous Americans died at the highest rate (as a share of their population), followed by Pacific Islander and Black Americans.

Outside of race and ethnicity, economic inequalities left the poorest communities—already lacking access to quality healthcare services—overwhelmed by COVID. Not only did these communities bear more of the health burden, but the pandemic’s repercussions are only widening inequality.

Tracing How Climate Change Affects Health Equity

Climate change has also encouraged new migration, which has its own consequences for equity in healthcare as populations move in response to the effects. This only looks to increase: a 2022 UN Refugee Agency report projects an additional 660,000 additional asylum seekers to Europe each year by 2100.

The xenophobia, discrimination, and poor housing and working conditions migrant communities can often face all contribute to inadequate access to health services. Immigrant populations are less likely to have health insurance and use healthcare; those who do often receive a lower quality of care than US-born populations.

Many disadvantaged communities face direct threats to their health as a result of environmental factors:

• Living in areas vulnerable to climate change
• Inhaling and ingesting higher doses of pollution, compounding issues like asthma
• Working to understand and engage in the local language
• Recovering poorly from a disaster, owing to a limited ability to relocate or rebuild

Climate change impacts everyone, but it is becoming increasingly clear that those at a socioeconomic disadvantage feel unique obstacles to health equity.

Confronting Societal Disparities in Healthcare

Limiting—or at least not increasing—underserved populations’ access to affordable, high-quality care has a substantial impact both on health outcomes and spending. Besides lower life expectancies, higher instances of certain diseases, and a poorer quality of life, Deloitte reports that in the US, “health inequities account for approximately $320 billion in annual healthcare spending” and “roughly $42 billion in lost productivity per year, not including additional economic losses due to premature deaths.” Fostering equity in healthcare could not only lead to less human suffering but also reduce widespread economic impacts.

Facing Health Equity Challenges for Business

According to a 2022 report by the World Economic Forum, 52% of leaders state that health equity is a very high priority for their company. However, they cite that the top barriers to integrating health equity into ESG are a lack of standardized measurement (33%) or a clear business case (31%).

The report describes financial or business motivations for supporting health equity, for example, by providing businesses with a healthier, more productive workforce. Furthermore, it argues that businesses should invest in and design goods or services that help to eliminate health inequities, “not only because their consumers will demand offerings that eliminate inequities . . . but also because the livelihood and sustainability of their business’s revenue depends on a steady stream of healthy consumers and workers.”

Acknowledging that data is key to supporting a business case for equity in healthcare, the report calls for measurements that are “meaningful, transparent, comparable, and reliable” to give insight into a company’s performance and how their contributions to health equity—or their lack thereof—affect business performance. Finally, the report urges companies to rely on more long-term cost-benefit analyses and shift from measuring outcomes to assessing value.

Supporting Health Equity for the Future

Efforts to support equity in healthcare in the aftermath of COVID have seen movement as new health policy initiatives developed to address disparities in healthcare. For example, the Global Health Equity Network was established with the mandate “to shape a healthier and more inclusive world through mobilizing executive leadership and commitment across sectors and geographies to prioritize health equity action in organizational strategy and purpose.”

Others taking steps to address health equity include medical technology association AdvaMed, which issued a set of principles to guide the industry and individual companies in promoting equitable healthcare. On the public side, many promote value-based payment models as a way to address and fund social healthcare needs.

More direct avenues include supporting organizations such as the Health Equity Initiative, a nonprofit organization dedicated to building “a global community that engages across sectors and disciplines to advance health equity.” Similarly, the National Collaborative for Health Equity aims to equip historically marginalized and excluded communities with the tools to improve the conditions that shape their health, such as its Healing through Policy: Creating Pathways to Racial Justice initiative.

Technology also plays a role in allowing for data-driven decisions and the dissemination of evidence-based health information to a wider population:

• Google’s Health Equity Tracker, created in 2020, combines up-to-date demographic data from the hardest-hit communities. The company provides this free service to “leverage[e] the power of data and technology to identify, understand, and respond to health inequities in our communities.”
• Socially Determined offers a similar cloud-based platform providing social risk analytics and data visualization solutions for the healthcare industry.
• The World Telehealth Initiative takes a more direct approach—providing robotic devices to clinics around the world that allow doctors in any location to donate their time to treat patients and consult with local doctors.

Finding Various Avenues of Investment

ESG investors have a variety of ways to support equity in healthcare, including supporting organizations working specifically on health equity, advocating for government policy efforts, and pushing for private organizations to incorporate health equity measurement and reporting standards into ESG frameworks. They can also invest in companies that support health equity. Ultimately, all three elements of ESG contain avenues to advance equity in healthcare.

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