While we believe in our global health system, the unfortunate truth is that there are two very different worlds. The first is inhabited by people who trust more in medical institutions to treat them fairly. They are mostly male, non-disabled, white, and identify as straight. Most do not expect to face judgment or stigma for who they are.
The rest of the world does not have that luxury. Women, ethnic minorities, people with disabilities, and individuals who identify as LGBTQ+ are more likely to distrust health care providers—and the health care system as a whole.
These views may be shaped by perceptions of historical bias and abuse of power. But an alarming number of people from these marginalized communities also report personal experiences that undermine confidence: experiences where providers don’t listen, and make them feel unwelcome, judged, and even unsafe. And distressingly, patients believe they receive poor treatment because of who they are: age, income, ethnicity, gender, disability, or sexual orientation.
This stark difference emerged in a new poll commissioned by Sanofi. A global survey of 11,500 people from the US, France, UK, Japan, and Brazil provides the first look at how people from different backgrounds experience the healthcare system.
The results are worrying. In the US, 77% of people with disabilities, 69% of people from ethnic minority groups, and 70% of people from the LGBTQ+ community say they have had an experience that undermined their trust in the health system.
The survey also revealed the compounding effects of marginalization: People who fall into more than one of these groups are more likely to have a bad experience seeking care. For example, in the US, 80% of people have disabilities and identifying as LGBTQ+ reported losing confidence in the health system due to personal experiences, compared to 56% of people without a background.
This is unacceptable. This disparity can cost lives: People who don’t trust the system may be less likely to go in for preventive care or seek treatment for chronic illnesses. Widespread trust also makes it extremely difficult for public health officials to reach vulnerable communities with important information, as the COVID-19 pandemic has made clear.
It doesn’t have to be that way. Here are three steps to start closing the trust gap:
Diversify our healthcare workforce
Patients of all backgrounds need providers of all backgrounds. Studies have shown, for example, that black patients have better health outcomes when treated by black doctors. But only 5% of US doctors are black. Every stop in the pipeline — high school, college, medical school, residency program — should be on a mission to support a diverse healthcare workforce. And it’s not just about frontline providers: hospitals, research centers, and companies involved in health care must commit to, and invest in, various ranks.
In one promising initiative, the American Medical Association is working with medical schools across the country on strategies to recruit, admit, and retain a diverse class.
Invest in prevention
Much of our medical system is geared toward treating disease. That’s why it’s so important that clinical trials bring together patients from different backgrounds so we can understand how drugs work for different populations. But just focusing on treatment is not enough. Healthcare companies and hospital systems must also invest heavily in disease prevention by addressing the upstream drivers of health – all the factors in our homes, workplaces, and neighborhoods that can affect our well-being.
Kaiser Permanente, for example, has partnered with a preschool in Hayward, California to offer integrated health and medical care to low-income families in California and provides free resources to other schools to address the physical and mental health needs of staff and students. Working with the community in this way can build a lot of trust.
Listen, listen, listen
The number one reason patients say they lose trust is because they don’t feel the provider is listening. Of course, providers need more training in how to communicate clearly and empathetically. But that is not enough. They should listen too. It means identifying and overcoming unconscious bias, seeing each patient before him as an individual with dignity and worth, and taking the time to understand why each patient comes to seek care.
Healthcare companies and hospital systems can advance this work by creating platforms for marginalized groups to share their experiences—and make sure those with power listen.
These steps are not easy, quick, or cheap. Changing the system will take research and action from many institutions, decision makers, and individuals. But the potential payoff is huge. Restoring trust will help close huge disparities in health outcomes and move us steadily toward a fairer—and healthier—world for all.
Paul Hudson is the CEO of Sanofi. Michelle A. Williams is Dean of the Harvard TH Chan School of Public Health.
Opinions expressed in Fortune.com comment pieces are solely the opinions of the authors and do not necessarily reflect their opinions and beliefs. fortune.
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