By Nzinga H. Broussard

Race unjustly affects our health from the moment we are born until we die. The data show that Black people throughout the United States experience higher rates of illness and death across a wide range of health conditions, including diabetes, hypertension, and obesity when compared to their White counterparts.¹ Life expectancy for Black Americans is 6 years shorter than White Americans.² Maternal and infant mortality rates are 3 times higher for Black women and infants than for White women and infants.³

Data indicates that traditional means of addressing the Black-White health gap have failed and require a rethinking of how we pursue health equity. This new way of thinking can be spearheaded by the private sector. In the wake of the murder of George Floyd, the impact investing community has become increasingly interested in creating funds and financing innovations that address racial inequities in the U.S., including racial health disparities. An Urban Institute study estimated that between June 2020 and May 2021, racial equity commitments from companies and philanthropic institutions reached $200 billion.⁴ However, interested investors need guidance to determine what type of investments will have a measurable impact on racial health disparities. To help provide this guidance, NMSC investigated the root causes of the Black-White health disparities in the U.S., reviewed the evidence on interventions that have attempted to narrow these disparities, and interviewed health experts and investors.

In the paper, we discuss four factors that influence health outcomes in the U.S.: the nonmedical factors that influence health, also known as the social determinants of health, clinical care, health care access and affordability, and research and development. More importantly, we show how these factors are disproportionately worse off for Black Americans, contributing to the Black-White health gap. For example, Sickle cell disease, a recessive inherited disorder, which primarily affects people of African descent and affects millions globally, has had few breakthroughs in treatments. In comparison, another recessive genetic disease, cystic fibrosis, which affects primarily people of Caucasian descent, receives 7 to 11 times the research funding per patient even though cystic fibrosis affects far fewer Americans (30,000 compared to 100,000 Americans with sickle cell disease).⁵ Or the finding that individuals with at least some medical training held and use false beliefs about biological differences between Blacks and Whites to inform medical judgments.⁶ For example, physicians holding racial biases in pain perception are likely to have racial biases in pain treatment recommendations.

In our review of interventions that have demonstrated evidence of impact on improved health behaviors and outcomes of Black Americans, we found that more evidence of impact was needed and many proposed solutions to the Black-White health gap had no evidence of effectiveness. However, our research did identify a few evidence-based interventions that should be considered by investors interested in advancing racial health equity. Specifically, impact investors should:

• Finance real estate development projects that utilize co-location models (two organizations operating at one location) or single-service provider models that promote primary care access and improve health by addressing social needs such as affordable housing and healthy food.
• Invest in companies that develop innovations in health information technology, the processing, storage, and exchange of health information in an electronic environment.
• Invest in high quality early childhood initiatives.
• Finance the development and expansion of Black-owned or led birthing centers.
• Finance the development, expansion, and upgrades of health centers serving people of color in medically underserved areas, i.e., those lacking sufficient capacity of physicians and health services

In addition to backing evidence-based solutions, we encourage impact investors to invest in innovative solutions, i.e., new delivery models, technologies, and medical insights that prioritize and benefit people of color. Investment opportunities exist in early-stage high-impact companies that are driving innovation, access, and equity in the health sector. When considering opportunities, we recommend that the private sector take action to:

• Diversify the pool of decision makers and asset managers who determine what and who gets funded. This includes diversifying the governance and ownership of investments and decisions. Center the expertise of Black community members to create inclusive solutions that relate to the specific challenges and context of their communities. Allow them to define their own challenges and propose solutions that address key needs as defined by them. Fund those solutions.
• Fund and scale interventions that have demonstrated evidence of effectiveness. This includes expanding our definition of “evidence” to encompass community-defined evidence practices. Financial resources are scarce, so it is important that effective interventions are scaled to reach and benefit more peopl
  
• Invest in innovative solutions that prioritize and benefit Black people. Solutions that disrupt existing approaches to health care and the root causes of the Black-White health gap offer substantial benefits. While the private sector may be limited in its ability to address the structural racism in health care policy, persistent racist medical practices and beliefs contribute to a Black-White health gap. Interventions that only target the economically disadvantaged will be limited in their ability to narrow the Black-White health gap. Identifying solutions that can prevent the racial biases held by medical practitioners from impacting medical decisions can significantly improve health outcomes of all Black patients.
• Generate evidence of effectiveness in order to know which interventions work, understanding that the metrics to prove success will take time to generate. While in the short term there may not be any financial benefits of impact evaluations, these metrics can help free up financial resources from ineffective solutions and redirect them to effective efforts that deliver social and financial benefits.

We recognize that racial inequity is a pernicious legacy of America's history of slavery and systematic discrimination, and so closing racial health gaps will be a multigenerational project. Still, we see enormous potential in the private sector's capacity to improve health equity through the strategies described above.