Government investment and encouragement of innovation needs to expand its scope to consider the social and economic effects on marginalized groups. In a paper published by The Next System Project, Ford School public policy professor Shobita Parthasarathy outlines the ways in which current policymaking around innovation harms those populations, and proposes ways to address the negative consequences.
In organizing the patent system and providing direct support for research and development, policymakers have relied on the expertise of scientists and market players, which has expanded the technical workforce, increased the numbers of scientific publications and patents, and produced macroeconomic growth. However, she writes, “The benefits for the population are less clear: there is growing social and economic inequality and the needs of marginalized groups are invariably ignored.”
Parthasarathy, director of the Science, Technology, and Public Policy program, identifies four harms of the current approach, specifically for health equity. “It does not consider concerns of accessibility or affordability, defining these as health care, rather than innovation, problems. It limits the range of innovators, and also distorts innovation incentives. Finally, it tolerates harmful, and even biased, innovation.”
“If the last year and a half has taught us anything, it is that our health innovation policies are not benefiting all of us, and that low-income individuals, historically disadvantaged people of color, and otherwise marginalized communities are often paying a large price,” she writes.
“Perhaps the most visible drawback of the US’s market-driven approach is that the resulting diagnostics, treatments, and devices are often inaccessible to the most vulnerable,” either because they are expensive and unaffordable, or because they are not distributed equitably. “Simply characterizing this as a health care rather than an innovation problem is political, driven by a definition of innovation as primarily producing scientific and economic output. And it has real costs for communities.”
To achieve greater equity in health innovation, fundamental changes are required in how innovation and innovators are evaluated, and approaches to research funding and intellectual property need to keep equity centrally in mind. That process also requires engaging a much broader array of experts and populations and considering non-market approaches to innovation.
She proposes four strategies for addressing the issue:
- Interdisciplinary health innovation, requiring the NIH and other funding agencies to focus on interdisciplinary research that brings together life science, engineering, sociological, public health, economic, and other expertise. “This approach would ensure that social context is taken seriously in both understanding disease causation and developing solutions to improve health outcomes.”
- Explicitly engaging marginalized communities as experts at every step of innovation. “Values are endemic to both technologies and policymaking, but innovation and innovation policy can better address and ameliorate inequality if the most marginalized communities are included and respected as central decisionmakers.”
- Creating equity impact assessments should be a component of every research funding agencies’ requirements. NIH and others funding health and biomedical innovation should examine design equity, distributional equity, procedural equity and also look at the historical legacy of previous innovations.
“Data to inform these assessments would likely be both qualitative and quantitative. They will require science funding agencies to ensure that grant reviewers have appropriate expertise so that they can assess proposals properly. This may be challenging, but such assessments have transformative potential to create a health innovation system truly dedicated to public priorities,” she writes.
Parthasarathy notes that the Biden administration has proposed a new Advanced Research Projects Agency for Health (ARPA-H), designed to produce breakthrough advances for common diseases. The $6.5 billion budget for ARPA-H is large, “but in order for it to further, and not harm, the administration’s strong equity objectives, it must foster innovation that is based in interdisciplinary and community insights and transferrable beyond the marketplace.”
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