Toward Equitable Innovation in Health and Medicine A Framework (2023) / Chapter Skim
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A central emphasis of the report is that users of the innovation system include not only those who have typically been active in STI, such as innovators, research funders, investors, and health care experts, but also those who may not always have seen themselves as involved stakeholders and rights holders with rights in the system's functioning and outputs, including members of underserved communities and scholars from such disciplines as the social sciences and humanities. To help achieve the goal of such an innovation system, this report seeks to advance an understanding of opportunities and responsibilities across the processes by which innovation in health and medicine arises and is governed.
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In January 2020, the National Academy of Medicine established the standing Committee on Emerging Science, Technology, and Innovation in Health and Medicine (CESTI) to consider potential societal, ethical, legal, and workforce implications of emerging science, engineering, and technology, and to incubate ideas for a governance framework aligned with ethical principles.
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These choices include such decisions as funding and research approvals; identification and management of intellectual property; continued investment and scale-up; performance evaluation to support public availability; cost, insurance coverage, and other factors affecting product access and availability; and analysis of postmarket impacts and responses. The framework is depicted as a circle rather than a linear progression to recognize that information gained from prior research, development, and use ideally feeds into and informs future innovation efforts, along with the discovery of new knowledge and the incorporation of other sources of information, including community knowledge.
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should be used to guide choices and actions depicted in a simplified conceptual model of the innovation life cycle (center) to support the desired outcome of advancing equitable innovation (right)
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The report also offers six recommendations for supporting an equitable ecosystem for STI in health and medicine. An important thread running through these recommendations is the need to convene those individuals, organizations, and groups doing thoughtful work in these six areas as a next step in building the coalitions necessary to accomplish these goals -- whether in the development of equity science, the establishment of substantive community partnerships, the crafting of context-specific guidance, or other key areas.
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Create and Promote • Develop and disseminate specific • Enhanced implementation of a Context-Relevant guidance targeted to particular roles governance framework for aligning Equity Playbooks in the technology life cycle, types of emerging science, technology, and (Recommendation 6) inequity, or particular areas of emerging innovation with equity through science and technology.
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The EBI Task Force should also partner with the broader community of biomedical innovation stakeholders, including underserved communities, to provide insight on benchmarks, measures, and metrics that can be incorporated at each point of the life cycle to achieve greater equity in the innovation process. Culture of Innovation Actors across the innovation ecosystem have roles to play in its governance.
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The implementation guidance for this recommendation provides examples of actions that can support or enhance alignment with equity, including use of equity-focused proposal requirements and scoring elements; partnerships with historically underserved and marginalized communities in research codesign, credit, and benefit; use of funding, tax incentives, public–private partnerships, and other models to spur targeted investment in new technologies or alternative designs for existing technologies to address an identified need or inequity; emphasis on maintaining patent quality and transparency and on intellectual property and licensing arrangements that align with equity; use of postmarket surveillance to identify and understand any inequitable distribution of medical benefits and risks; and other actions.
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Conveners appropriate to stages of the innovation life cycle in health and medi cine should bring together experts and practitioners in effective community engagement, participatory research and codesign, inclusive design principles, and participatory tech nology assessment, along with leaders of model engagement partnerships, to analyze lessons learned from these efforts and identify best practices, standards, and tools for designing and maintaining bidirectional engagement with members of marginalized or underserved communities. No single actor is responsible for convening across the suite of issues relevant to different phases of emerging science, technology, and innovation in health and medicine, although critical roles can be played by the EBI Task Force proposed in Recommendation 1; federal agencies carrying out their respective activities in research, technology development, and innovation; and philanthropic organizations.
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Innova tion stakeholders in professional, government, and community settings should strongly consider developing equity playbooks providing strategies, key questions, and advice targeted to particular roles in the technology life cycle, types of inequity, or specific areas of emerging science and technology, including context-specific guidance on incorporat ing equity science into technology assessment (see Recommendation 5)
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LOOKING TO THE FUTURE: AN ACTION AGENDA Table S-2 provides a high-level summary of opportunities for actors throughout the ecosystem of emerging science, technology, and innovation in health and medicine to help translate the above recommendations into practice. TABLE S-2 An Action Agenda for Stakeholders Actors Actions Desired Outcomes White House Office • Identify priorities for aligning emerging • An innovation system that catalyzes of Science and biomedical science, technology, and the discovery, translation, and use Technology Policy innovation with the report's governance of emerging science and technology (OSTP)
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• When relevant, require postmarket analyses to identify whether inequities have arisen, and take action to address them. Health care payers • Include equity science metrics and • More equitable access to new and delivery analysis in purchasing, use, and technologies and more equitable stakeholders coverage decisions.
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• Context-specific guidance on equity • Consider how information learned tools and strategies targeted from the development and use of a to particular fields, roles in the technology provides new conceptual innovation life cycle, or equity understanding or new problem considerations. formulations or identifies future research needs.
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