Health equity means everyone gets the care they need to live a healthy life. It means care and medicines reach people no matter their race, age, money, or where they live.

Right now, many people do not get fair care. For example, more than two billion people in low and middle-income countries lack access to key medicines. In rich countries, some groups still face worse outcomes. Black and Hispanic patients often get later diagnoses and lower use of best treatments. Older adults and women also face gaps in care and in clinical trials.

Pharmaceutical companies can change this. They make the drugs and run the trials. They also set prices and work with health systems. That gives them power to improve who gets care and who benefits. Acting on health equity is the right thing to do. It also makes business sense. Reaching more people can improve health and grow markets.

This article will explain why inequity happens, how to measure it, and what pharma can do across the drug life cycle. I will share simple steps, short examples of success, and easy measures companies can track. The goal is to help leaders, teams, and partners take clear action now.

Key Takeaways

Over 2 billion people in low- and middle-income countries still lack access to essential medicines.
In rich countries, Black, Hispanic, women, and older patients often face delays, worse outcomes, or exclusion from trials.
Pharma companies control many levers of equity: R&D, pricing, access, and patient support.
Equity actions are not just ethical — they also grow markets, build trust, and improve health outcomes.
Simple measures like trial diversity, affordability, and patient adherence can track real progress.
Real-world examples (HIV, malaria, diabetes programs) prove that equity-focused strategies can save lives and expand access.
Clear KPIs and partnerships with local health systems, NGOs, and regulators make it possible to move from ideas to lasting impact.

Why Health Inequity Happens

Health gaps happen for many reasons. I list the main causes below in simple terms.

1. Not enough medical knowledge

Many groups stay underused in research. Most clinical trials include mostly white people. Older adults, women, and some ethnic groups join trials less. That means doctors know less about how drugs work for those groups.

2. Bias at the bedside

Doctors and nurses can make choices that favor some patients. Some choices come from old habits. Some come from wrong ideas about biology. Bias can change which tests a patient gets and which treatments a doctor offers.

3. Social factors

Where a person lives, their job, and how much money they have shape their health. Food, housing, transport, and schooling all affect health. People with low income find it harder to get care and buy medicine.

4. System limits

Health systems may not work well for everyone. Some areas have few clinics or no trained staff. Some medicines need special tests or cold storage that local clinics do not have. Rules and fees can also stop people from getting care.

5. Trust and awareness
Some communities do not trust the health system. They may avoid care or skip medicine. Others do not know which services or medicines exist in their area.

Quick facts

Over two billion people in low and middle income countries lack access to key medicines.
In some studies, Hispanic patients had much higher death rates from diabetes than white patients.
Older adults make up a large share of patients but join fewer clinical trials.

These causes appear at many points in a patient’s journey. That makes the problem hard. But each cause also gives a place to act.

How to Measure Equity

Measuring equity tells you where the gaps are and if your actions help. Below I explain simple tools and steps companies can use.

1. Use the concentration curve and index
A concentration curve shows who gets medicines from poorest to richest. The straight line means fair access. If the curve sits below the line, richer people get more of the medicine. The concentration index gives one number for that gap. It runs from negative one to plus one. Zero means fair access. This method works well in middle income countries and can use local data on who got medicines.

2. Build a simple SES score

Socioeconomic status means how rich or poor a person is. You can make a simple score using income, job, education, home status, and family size. The Iran study gives a clear way to score these items. Use one score to group people into poor, middle, and wealthy. That helps compare access between groups.

3. Track real world data

Real world data means records from clinics, pharmacies, and insurance. Use these data to see who gets a drug, who stops it, and who pays out of pocket. Link these data to age, sex, location, and SES groups. This shows where uptake is low and who faces extra costs.

4. Use equity-aware value tools

Health systems use tools like distributional cost effectiveness analysis and extended cost effectiveness analysis. These tools show how a drug changes health for different groups and how it affects money people must pay. They help payers and regulators see the equity impact, not just the average benefit.

5. Map the staircase of inequality

Break the problem into steps: who needs care, who gets offered care, who starts treatment, and who gets long term benefit. Measure each step. For example, count screening rates, treatment starts, and survival by group. This shows where the drop-offs happen.

6. Pick simple indicators to track now

Start with a few clear measures you can collect easily. For example: percent of trial participants from underrepresented groups, percent of clinics in poor areas that stock the drug, share of patients who pay out of pocket, and adherence rates by group.

7. Set a baseline and track over time

Measure current gaps first. Then repeat the same measures each year. That shows if your programs work. Share results with partners and regulators.

Pharma Role Across the Product Life Cycle

Pharma companies can act on equity at every stage of the drug journey. From research to patient support, their choices shape who benefits from medicines. Below are the key areas where action matters most.

1. Research and Development
Equity begins with who is included in studies. Many groups remain underrepresented in clinical trials and genetic research.

Design trials that welcome women, older adults, and ethnic minorities
Reduce barriers like travel costs and language gaps
Partner with community doctors to recruit diverse patients
Expand genome studies beyond European groups

2. Evidence and Market Access
After trials, companies must prove value to payers and regulators. Equity evidence strengthens the case for wide adoption.

Collect real world data on who uses and who misses access
Show how outcomes differ by income, age, or location
Use DCEA to weigh benefits for different groups
Apply ECEA in low and middle income countries to track financial protection

3. Pricing and Affordability
Cost is often the biggest barrier. Many families spend more on medicines than anything else after food.

Offer tiered or fair pricing by country income level
License drugs to generic makers in low income markets
Join pooled procurement programs to cut prices
Sign long-term supply deals to keep access stable

4. Distribution and Adoption
Approval does not guarantee use. Many health systems lack clinics, staff, or proper storage.

Train health workers to use new treatments
Create simple drug forms like dispersible tablets for children
Support telehealth and mobile health solutions
Run awareness campaigns to build trust and knowledge

5. Patient Support and Adherence
Many patients stop treatment because of cost, side effects, or transport issues. Support programs can help them stay on care.

Offer digital reminders and patient education apps
Partner with transport services for clinic visits
Provide financial aid for ongoing prescriptions
Use community outreach to build confidence and long-term trust

Proven Models and Case Examples

HIV Programs (Global Collaboration)

The global HIV response shows how partnerships can expand access in low and middle income countries. Governments, civil society, and drug makers worked together to create a “test and treat” approach that simplified care.

At the same time, pooled procurement lowered drug prices and voluntary licensing allowed generic companies to scale production. Public awareness campaigns helped patients understand treatment and trust the system. Together, these steps made HIV medicines more available and more affordable for millions.

Malaria Treatment (Child-Friendly Design)

In malaria, pharma and global health partners redesigned medicines to better meet patient needs. They introduced dispersible tablets that were easier for young children to take.

New suppliers entered the market to strengthen supply, and long-term agreements kept drug prices affordable. Training programs helped health workers move away from older, less effective treatments and adopt high-quality therapies. This effort saved lives, especially among children under five.

Diabetes Outreach by Merck

Merck focused on diabetes care for underserved groups in the United States. The company studied why many patients were diagnosed late and used data to map their health journeys. With these insights, Merck created culturally relevant outreach and screening programs.

More patients were then diagnosed earlier, giving doctors more time to manage the disease and improve outcomes. This shows how data-driven action can close gaps in detection and care.

Local Access Programs (Underserved Communities)

Some pharma firms tested practical solutions to reach patients in rural or low-income settings. Digital tools helped local doctors connect with specialists, while transport programs reduced travel barriers for patients.

Companies also created financial aid plans to make repeat prescriptions more affordable. In addition, they shared demand forecasts with suppliers to reduce shortages. These small but practical changes made it easier for patients to access and stay on treatment.

Practical Steps Pharma Can Take

Pharma companies can move health equity from ideas to real impact by following these actions.

1. Segment markets: Health systems differ even between neighboring countries. Companies should group markets by health system maturity and patient needs. This makes it easier to plan where to focus resources and adapt proven models.

2. Share licenses: If a company cannot enter a market quickly, it can license products to local generic makers. This allows more patients to gain access at lower cost while the company still benefits through licensing fees.

3. Use fair pricing models: Medicine costs stop many patients from getting care. Tiered or differential pricing lets rich countries pay more and poorer ones pay less. This keeps drugs affordable and ensures supply is not cut off.

4. Build local partnerships: Local NGOs, pharmacies, and community leaders can support distribution, training, and awareness. Working with these partners helps pharma reach people who may otherwise be left out.

5. Collect and share equity data: Equity gaps can only be fixed if they are measured. Companies should track trial diversity, medicine availability, and patient costs by group. Sharing this data with payers and regulators builds trust and drives better policies.

6. Set equity KPIs: Companies should set targets like increasing minority participation in trials or reducing out-of-pocket costs. Making these KPIs part of leadership reviews ensures accountability and ongoing focus.

7. Support patients directly: Barriers such as travel costs, poor health literacy, or side effects often stop patients from staying on treatment. Pharma can help with digital reminders, transport support, financial aid, and easy-to-understand patient education.

8. Invest in community programs: Equity also depends on social factors like housing, food, and education. Pharma can fund or support programs that address these needs in partnership with governments or NGOs.

Trade Offs and Challenges

Pharma companies have the tools to improve health equity, but they also face barriers. Knowing these challenges early helps build stronger and more realistic plans.

1. Cost Pressure: Offering lower prices, patient support, or wider trial networks can raise costs. In the short term, this may reduce profits. But in the long run, better access can expand markets and increase trust from governments, payers, and patients.

2. Regulatory Hurdles: Each country has its own rules for drug approval and reimbursement. In low and middle income countries, the process can be slow and unpredictable. This limits availability. Companies need to work with regulators, support harmonized standards, and provide local data to speed up approvals.

3. Data Gaps: Underserved groups are often missing from trials and health records. Without their data, companies cannot prove how drugs work for them. This makes it harder to convince payers and regulators. Collecting real world data, partnering with community clinics, and using digital tools can help close this gap.

4. Adoption Barriers: Even when medicines are available and affordable, people may not use them. Reasons include shortage of trained health workers, lack of awareness, cultural beliefs, or mistrust of the system. To address this, pharma must invest in health worker training, simple patient education, and local awareness programs.

5. Measuring Impact: Equity is complex and hard to measure. Many companies struggle to choose the right indicators. Tools like concentration curves, equity cost-effectiveness analysis, and basic KPIs (like trial diversity) can provide a starting point. Over time, companies can add more advanced measures.

6. Internal Alignment: Equity often fails when treated as one team’s job. For success, clinical research, pricing, marketing, and access teams must work together. Clear leadership, shared goals, and regular reporting help keep everyone on the same path.

Simple KPIs to Track Progress

Health equity cannot improve without measurement. Pharma companies should set clear indicators that show progress across trials, access, and patient use. These KPIs must be simple to collect, easy to explain, and reviewed regularly by leadership.

1. Trial Diversity Percentage
Measure the share of women, older adults, and minority groups in clinical trials. Compare these numbers against the actual patient population for the disease. This shows if trial results reflect real-world patients.

2. Medicine Availability in Target Regions
Track how many clinics, hospitals, or pharmacies in low-income or rural areas stock the medicine. A rising number shows better distribution and fewer supply gaps.

3. Out-of-Pocket Cost Reduction
Monitor the average amount patients spend on the medicine. Lower out-of-pocket costs mean the drug is more affordable. This KPI is especially important in low and middle income countries where many people pay cash for medicines.

4. Uptake by Underserved Groups
Measure how many patients from poor, rural, or minority communities start the treatment compared to richer or urban groups. If uptake is balanced, access is fair. If not, targeted action is needed.

5. Adherence Rates Across Groups
Track whether patients continue their treatment over time, broken down by income, race, or geography. Higher adherence among all groups means that support programs like transport aid or digital reminders are working.

6. Equity Index Score
Use a concentration curve or similar tool to calculate one score that reflects fairness in access. Zero means fair distribution, while positive or negative numbers show imbalance. This gives a single KPI that leaders can track each year.

7. Patient Awareness Levels
Survey patients in key markets to check if they know about the medicine and how to get it. Awareness is often the first barrier to adoption. If awareness rises, so does the chance of uptake.

8. Health Outcome Gaps
Track key outcomes such as survival, complication rates, or quality of life by patient group. The goal is to see these gaps shrink over time. For example, lower diabetes complications among underserved groups show that access programs work.

9. Community Partnership Projects
Count the number of active programs with local NGOs, clinics, or community leaders. Also track how many patients these programs reach. This shows if equity efforts extend beyond the company itself.

10. Internal Leadership Goals
Include equity measures in executive KPIs, bonuses, or annual reviews. Tracking how leadership is held accountable ensures equity stays on the company’s agenda.

Final Words

Health equity in pharma is both a moral duty and a business need. Millions of people around the world still lack access to essential medicines. Even in rich countries, patients face unfair gaps in trials, diagnosis, and treatment. These gaps harm outcomes, reduce trust, and limit the true value of medical innovation.

Pharma companies have the tools to change this. They can design diverse trials, use fair pricing, build local partnerships, and support patients directly. They can measure progress with clear KPIs and hold leadership accountable. Real-world examples, from HIV and malaria to diabetes outreach, prove that equity efforts save lives and strengthen health systems.

The next step is clear. Companies must move health equity from side projects into the center of their strategy. Leaders, researchers, and access teams should set equity goals and act on them across the full product life cycle. Every trial, every market plan, and every patient support program should be shaped with equity in mind.

If pharma takes these steps, health equity will no longer be an ideal. It will become a normal part of how medicines are developed, priced, and delivered. The time to act is now — for patients, for society, and for the future of healthcare.