10 Simple Rules in Biomedical Research Design to Ensure Health and Healthcare Equity

Introduction:: Health inequities, which are also referred to as health disparities, are understood as preventable population-specific differences in the burden of disease, health outcomes, or access to healthcare. Health inequities are not just based on race, ethnic, and cultural groups, but also encompass age, gender, sexual orientation, lifestyle choices, socio-economic, and environmental differences. Statistics on health disparities are staggering and unjust, for example: babies born to Black women in the United States die at more than double the rate of babies born to white women[1]; American Indians and Alaska Native populations experience increased rates of cardiovascular disease and related risk factors[2]; and women, especially Black women, have higher rates of adverse prognosis after myocardial infarction[3]. These instances illustrate the prevalence of health disparities in diseases, with racial and ethnic minority patients being 1.5 to 2 times more likely than white patients to have major chronic diseases[4].

It is important to distinguish the difference between health inequities and healthcare inequities. Healthcare inequities refer to the differential access to and use of medical care and quality of that care. The role of how social determinants of health and implicit bias serve as drivers of health disparities is well documented in the literature, however the impact of biomedical engineers who develop healthcare technologies that further propagate these inequities has only been implicitly stated. Researchers have the propensity to optimize new technologies and therapies, be it unknowingly or not, in a way that excludes minority populations and renders the technology either ineffective or potentially hazardous.


Materials and Methods:: As researchers in this area we are poised to either improve the health disparity landscape or further widen the gap. Here, we have created 10 simple rules for researchers to follow in order to establish equitable healthcare and healthcare technology in new developed products. These rules encompass how to identify research disparities for underserved communities, how to design technology that can be implemented for all populations of people, considerations for experimental testing to ensure equity, and future perspectives of how to shift the research culture surrounding these issues. We aim to educate engineers and researchers on how to better approach and solve these issues.

Results, Conclusions, and Discussions:: The rules that will be discussed include:

1. Use systematic tracking to evaluate equity in healthcare technology. By first establishing baselines and measurable outcomes, measurable improvements can be made.

< !2. Increase research on underserved diseases and conditions. Many groups of people or diseases/conditions that affect them are often neglected in research such as: infants and children, elderly, physically disabled, and women’s health.

< !3. Ensure diversity in research teams. Diversity in teams broadens the range of perspectives, approaches and information to solve a program. In addition, it is more likely to include diseases that affect diverse groups if diverse groups are leading the charge.

4. Consider health care access and cost of production and storage. The cost of the product should be considered as passed to the customer and to the government.

5. Make designs that promote diverse community adoption. Get input from diverse groups to make user friendly designs and improve compliance. Ensure traditional practices and language communication barriers.

6. Evaluate diverse populations in experiments. Clinical demographics should include all groups of people.

7. Consider sex determinants of health. Sex determinants of health are not considered when taking into account new devices/ technologies although they are prevalent and been shown to have effect on presentation of many diseases/ conditions.

8.Examine ancestral biological determinants. Differences in patients can be identified on a genetic basis and therapies evaluated in various groups.

< !9. Examine geographical determinants. Likewise, demographic differences in patients can be considered.

<110. Teach and expose the next generation to health inequities/community awareness. Perhaps, most importantly, spreading awareness about health disparities can inspire new ideas in new groups of people.