Each year, the South by Southwest (SXSW) conference draws inspiring and innovative creative thinkers and doers from around the world – and each year, Intouch is there. And even though this year meant a virtual conference — last year’s was canceled due to concerns about COVID-19 — there was much to learn and discuss. Our team saw three themes align under one central topic: The 2020s have begun with a “crisis stack” – and to address it, we must address inequity, the intentional use of technology, and mental health.
INTRODUCTION
In his SXSW session, “Designing for the Cluster,” designer Bruce Mau described the past year as a “crisis stack”: the COVID-19 pandemic; the fight for racial justice; the climate crisis and resulting environmental disasters, food insecurity, governance … the problems that have taken over our headlines and our minds. They need to be understood as an ecosystem, not as standalone problems, “knitted together into the greatest challenge in history.” And design, he offered, is a methodology of caring: design that centers all of life, not the individual. Throughout SXSW, we heard urgency expressed about issues across the entire crisis stack. Following, we have focused on the three themes that we saw arise from the sessions and discussions in which
the team participated:
- Inequity: the many profound imbalances that have contributed to the crisis stack and how we can begin to address them
- Intentional Technology: how to minimize the burnout many feel from the constant use of communication technologies that have helped us continue to work, communicate, and relate over the past year
- Mental Health: the emotional and psychological impact of the past year, and what that means for our audiences, ourselves, and our work
As individuals, as healthcare brands, and as a society, we no longer have the luxury of sitting back and hoping that others will act first to make things better. We must innovate at the speed of the pandemic, with small actions that add up to enormous change.
We have both power and responsibility to create changes in the system.
INEQUITY
The theme of addressing systemic inequality ran through many SXSW sessions, and Intouchers in attendance were paying special attention to how the facets of inequality (including, but not limited to, race, age, and gender) manifest in our healthcare industry. In our after-hours discussions, it became clear to us that, through our influence as healthcare marketers working on over 150 therapeutic products, we have both power and responsibility to create changes in the system.
One resonant statistic provides simple proof of health disparities: white Americans have a life expectancy several years longer than Black Americans. This is neither arguable nor coincidental. In a session titled “Anti-Racism in Cancer Care,” Dr. Cardinale Smith of Mount Sinai pointed out the many ways in which racial inequity exists “throughout the cancer-care continuum”: prevention efforts, screening, diagnosis, treatment, outcomes, palliative care, and end-of-life care. She pointed out that the disparities were mediated by patient, system, structural, and clinician-level factors. Patient distrust can be fueled by many examples of racism – Dr. Smith offered the Tuskegee Syphilis Experiment, the use of the cells of Henrietta Lacks without her consent, and the gynecologic surgical experiments of Dr. Marion Sims as three.
Here, however, we’ll identify and focus on two other categories of issues: logistical unfairness and systemic bias. Much can be done in these areas to improve care, improve trust, improve use, and thereby level outcomes.
Logistical Imbalance
In his keynote session, U.S. Secretary of Transportation Pete Buttigieg pointed out, “It’s our responsibility to get back to local logistics. How do I make sure everyone has equal access to getting to a hospital, when they don’t have a bus line to their neighborhood or access to a car?”
Problems with logistics and inequity are myriad, but access to care is among the most challenging to overcome. Insurance, location, travel: all of these barriers can prevent people from getting the care they need. Information and technology access can also create intangible – but no less intractable – barriers to care. Language barriers; lack of wifi; lack of experience using digital technology: all of these can get in the way. Many examples were offered at SXSW, including a patient whose lack of experience using a FitBit made the device impossible to use as adjunct therapy; a family who drove to the hospital to use wifi for a virtual appointment (which was only addressed when the doctor happened to recognize the wall behind them, and pulled them in for a live appointment); or a disabled parent with a child who needed a medical visit (which was able to be addressed through a visit with both the school nurse and a translator).
Solutions to logistical problems are out there. But all too often, today, if they’re addressed, they’re ad hoc, as with the examples above. Systemic solutions need to be instituted, and they can include:
- Telehealth. It has broken down barriers to healthcare, opening access to Black and brown communities. But, telehealth remains disproportionally tilted toward wealthier, insured people with access to computers and wifi. We must take extra care to balance the system for underrepresented groups: offering translators and culturally aligned nursing support; loaning or gifting wifi-enabled technology for after-care assessments (along with the training); ensuring telehealth platforms are easy to access from smartphones, and that appointments don’t require registration through a portal for access.
- Hands-on assistance for underrepresented groups would help their experience. Consider preparing office staff to call patients before appointments to offer video support and practice using their Zoom link, and/or changing patient support messaging to ask questions about barriers, and then offering support with language and/or technology.
- Considering digital literacy when developing patient materials. Pharmaceutical brands attempt to differentiate by creating unique experiences, slicker and more impressive UX for their digital tools, etc. But this excludes groups who may own smartphones but who don’t have the ability to use or understand complex content. We must more purposefully consider digital literacy, age, and language use in use cases, and create versions of tools to accommodate varying needs.
- Leverage community as channel. Few brands can afford mass awareness; most have moved spends to digital channels, battling category competitors for those precious keywords and endemic content. But underrepresented communities are also underrepresented in these channels. They get their information from their communities, from their churches, from their local clinics. How can we leverage those to spread awareness?
Health is a local issue, not just a global or national one, and needs to be addressed as such, with public health solutions at all levels. To understand what challenges patients – and HCPs – are faced with requires understanding who they are, where they live, where they work, and what their everyday includes. As we heard at SXSW, health is an issue that requires community efforts to make change. When we think about it too broadly, we risk creating solutions that only work for the richest and most privileged, and leave behind the people who need them most.
Systemic Bias
Systemic bias is no less insidious than logistical bias. It can be less obvious because, to fix bias in a system, you have to know the system well.
For example, clinical trials are not regulated against racial balance, and recruitment takes place with inherent bias. Trials are often recruited through leading hospitals, physician relationships, and online, which selects for those with access to those worlds. As a result, the medicines being created are often, statistically, only proven to work on white people, or at best are less effective in non-white patients. This can support the narrative among patients of color that these advanced novel treatments are not for them. For instance, COVID trials, done at speed, did not include significant numbers of non-white enrollees – which is being cited as a reason for distrust in the vaccines by people in these populations, in addition to the aforementioned extensive, horrific history of medical racism.
Also, HCPs retain racial biases that can lead to unequal care. Just five years ago, a study found that half of medical students and residents held false beliefs about biological differences, i.e., pain tolerance, between Black and white people. The burden lies with the medical community to correctly train new – and existing – HCPs to begin to remove bias from their care. As the “Anti-Racism in Cancer Care” session noted, HCPs have to be better trained in how to effectively communicate with people who have had life experiences different from their own.
And, of course, pharma marketing can be rife with systemic bias. It can be in the development of targeting and testing approaches. It can be in AI, our “digital detritus,” or, at least, the detritus of someone who is well-off enough to have smartphones, smart TVs, and therefore is likely to be insured – and white. It can be in the development of marketing briefs that list one primary target and one campaign … one approach for all, despite varying audiences who need to know about the medicine. A Geena Davis Institute talk explicitly called out the act of mentioning diversity in a creative brief as a way to begin to effect change.
When moments of racism arise – and we’ve had far too many, particularly recently – we want to rise up and denounce them. We saw many consumer brands produce emotional advertising about equality. But it’s on us to bring that energy into our daily work – not just in moments of crisis.
This isn’t about stock photography or diverse focus groups – it has to penetrate every step of the process and every level. We must develop more diverse clinical trial designs, and recruit for them with more inherently inclusive approaches. We must push our market research design to ensure we have diverse representation to inform our marketing. We must make sure diverse populations are represented when we choose what to communicate in marketing. And once we do all that, then we can be better equipped to tell personal stories that truly connect.
This craving for intentional, authentic interaction is causing us to almost reject technology, because it’s the only option we have left to connect.
INTENTIONAL TECH
When the pandemic has managed to burn out even the SXSW crowd on the idea of “technology for technology’s sake,” you know it’s real. But after a COVID-caused year of technology-mediated communication, nobody is that excited about another screen interaction – not even the tech fiends of SXSW, who are known for lining up for blocks each year to play with the latest and greatest (and, sometimes, the wackiest) new gizmos. We all just miss hugs. That primal homesickness for fellow humans that’s being felt around the world, and what that’s helped us to discover about technology, was covered in quite a few SXSW presentations – all delivered, of course, virtually. This craving for intentional, authentic interaction is causing us to almost reject technology, because it’s the only option we have left to connect.
We Still Need Tech to Stay Connected
As Yuval Noah Harari said, “Just like AIDS didn’t kill sex, COVID won’t kill hugs.” In-person interactions can’t be replaced by technology – but the judicious use of tech can still help us get by.
Livestreams can help us feel more connected than asynchronous recordings. Audio and video (as well as AR) can give more emotional context to interactions. Livestreams like the Verzuz series have proven this out, as has the metaverse – the world of interactions that take place in virtual (often transmedia) spaces. The Intouch SXSW team itself met for one debrief in Gather, a customizable online space that looks a bit like a cross between Zoom and Legends of Zelda. New apps like Dipso aim to help us live in the moment – Dipso constrains your phone camera like a roll of film, taking your photos but not letting you see them til the next day.
Technology that forces us to “look up,” to see who we are with and what we are doing in a new way, is powerfully helpful. And technology that helps us tell a good story better is what matters – not technology that is the story itself.
What does this mean for pharma marketers’ use of technology?
Authenticity Is More Than Just a Buzzword
It’s a renewed call to be human people, not salespeople. It’s a reminder that credibility and intention go hand in hand. It’s a gut check that “authentic” isn’t a buzzword but a way of being. The documentary “Introducing, Selma Blair,” which premiered at SXSW and shows the actress adapting to life after her multiple sclerosis diagnosis, was an example of this – Variety called it “eye-opening and empathetic,” as well as “warmly self-aware and self-deprecating, with a mordant sense of humor.” It’s hard to tell difficult, complicated, varying stories – ones that, like life, don’t always follow the expected path. But they’re the ones that make the difference. All too often, brands and influencers hope they can show an audience what they think the audience wants to see, rather than real narratives, complete with real human emotions – and their work is lesser for it.
While people might come to online platforms because of their interest in a topic (any topic: e-sports, exercising, gardening, etc.), they stay because of the community and the authentic relationships they’ve created.
What does this mean for healthcare brands like yours?
- We have to use our platforms to tell authentic stories intentionally. This is more than just having a presence: it’s conducting the research, understanding the audience, and doing something to help people. And it’s not forced. We found examples at SXSW of healthcare brands attempting to break into newer tech platforms and missing the mark, and noticed two key errors to learn from:
- First, they didn’t give themselves enough time to truly understand the platform or its users.
- Second, they tried to maintain an outdated level of control on the situation.
- We also found examples of intentional tech working well for healthcare, like the New York Times visual storytelling “This 3-D Simulation Shows Why Social Distancing Is So Important.” Technology can be put to work behind the scenes to make a complex story more intuitively graspable and rapidly digestible. In our space, MOA videos can help brands do similar things for HCPs and patients.
- Often, brands that are succeeding on newer platforms like TikTok or Twitch are those that have taken the time to learn how the new realms function; that take the risk to join in and be present; and that are in honest conversation with influencers, without trying to stage-manage a communication. One recommended path to success was for a brand to research and find influencers who already have a degree of success on the platform, and recruit their support, rather than inserting the brand entirely.
- A discussion that particularly resonated with Intouch creative director Soyoon Bolton was the awareness of community evolution – the fact that online communities are growing and changing more rapidly during the pandemic, and the insight that this change is borne of the desire for authentic, intentional interaction. While people might come to online platforms because of their interest in a topic (any topic: e-sports, exercising, gardening, etc.), they stay because of the community and the authentic relationships they’ve created. Are we creating places where human connection can happen?
- It can also help to look backward. What mistakes were made when pharma created its first website? When the industry took its first steps into social media? What lessons can we learn from those moments so we can use new technology platforms more intentionally, more adeptly, and more authentically from now on?
- Privacy remains a concern with technology, of course, and we saw much of that ongoing discussion play out, as thinkers considered the different approaches being taken in different countries, and the fine lines between policing and protecting. Good intentions aren’t enough, and as the pace of technology continues to speed up, the pace of regulation needs to match that.
SXSW provided us many different lenses to see how intention can make a difference with the use of communication technology. As U.S. Transportation Secretary Pete Buttigieg noted, intentional vocabulary choices matter when you communicate. As Twitter’s client solutions team found out in a 2020 analysis, their platform offered HCPs a place to express emotion and to reach patients with information. And as TikTok fans know, “authenticity is noticeable.” We have to reach people where they are. And where we all are, these days, is online. But we have to do it with intent.
Even as we’re living with the pandemic in the moment, we can see the psychological effects it’s having on us.
MENTAL HEALTH
“It’s a comorbidity of existence in a pandemic.” That’s how Intouch EVP Angela Tenuta described the mental health challenges we’ve all been weathering over the last year. Statistics bear this out. So, too, do the views expressed by the speakers and sessions at SXSW.
Studies show the damage being done to the public at large. A Kaiser Family Foundation (KFF) report found that the percentage of American adults reporting symptoms of anxiety or depression quadrupled during the pandemic, from 11% to 41%. Worse yet, our most at-risk groups are being harmed most here, too:
- People of color: Data have demonstrated that COVID-19 has disproportionately hit people of color in the United States. The racial injustice of the past year has, of course, also been traumatic. And statistics bear out the toll it is taking. In February, the CDC reported on “racial and ethnic disparities in the prevalence of stress and worry, mental health conditions, and increased substance abuse among adults during the COVID-19 pandemic.”
- Elderly: The KFF noted, “the effect of the coronavirus pandemic on the mental health of older adults is important to consider, particularly because
of the increased rates of social isolation, loneliness, and bereavement that older adults may face due to the pandemic.” - Adolescents: Recently, NPR reported on clinicians finding that “the levels of distress, including suicidality, in their adolescent patients are among the highest they’ve seen in their careers” – “because the pandemic is making it hard for teenagers to meet basic developmental needs.”
From celebrities to healthcare workers to NASA, speakers across the week of SXSW addressed this. Olympic runner Alexi Pappas talked with comedian Bill Hader about “Becoming a Bravey,” her term (and book title) describing mental fortitude, and they compared notes on their personal struggles. In their session, “Pushing Our Bodies and Minds Beyond the Limits,” astronaut Bonnie Dunbar and sports psychologist Ryan Pittsinger talked about the challenges of staying healthy while isolated. A panel of experts in “Caring for the Caregiver: Are We Doing Enough?” discussed the particular challenges experienced by caregivers – both professional, and, as they put it, “recruited” loved ones, and how their challenges have grown over the past year.
But perhaps the most succinct summary came in the title of “The Looming Mental Health Crisis Tsunami.” This session included speakers from the American Medical Association, Columbia University’s division of Child and Adolescent Psychiatry, and the National Council for Behavioral Health. They discussed the shock, sadness, anxiety, and helplessness that we’ve all felt over the past year, and the effects that strain will have going forward.
The pandemic has been more widespread and enduring than any disaster in living memory. Even as we’re living with it in the moment, we can see the psychological effects it’s having on us, on our loved ones, and on society. We can predict the aftermath. But very little has, at yet, been done to ameliorate that.
How can healthcare help? Furthermore, what can healthcare brands do to help ease the burden?
- A stronger health infrastructure to support and offer mental health resources. As brands, we can seek to expand mental-health support in patient-care programs, and to provide new and stronger resources for patients, caregivers, and families.
- A focus on science, rather than politicization, to guide these efforts. We can seek, compile, and analyze data on mental health concerns, just as we do with other aspects of our brand work. And we can work to remedy the trust gap that exists – within vaccine hesitancy, but with the pharmaceutical industry at large – with transparent, comprehensible, careful communication. As we heard in the session, The Pulse on Trust and Global Health, “on top of having a pandemic, we have an infodemic.”
- Particular outreach to communities at most risk, such as people of color, young people, and the elderly. We can create new and better ways to specifically reach communities of color and begin to address the systemic lack of access to these types of tools and programs.
- Move beyond fear-based marketing. While motivating people via scare tactics is as old as the hills, these days, it hits a little different. When fear is ever-present and fully rational, it can be far more powerful to offer help, information, and solutions, rather than more worry.
- Give our own creative efforts time. We are in an unusual situation in that we’re not just looking from the outside at patients affected by a condition – which is the normal situation for healthcare marketers. No one is not living through a pandemic right now. To do the best we can, we need to give ourselves the processes, allowances, and grace that will make it possible to still be brilliant, thoughtful, and creative. Our work matters, and it needs as much.
- Look at our audiences differently. If you’re communicating to HCPs (or patients) the same way you did a year ago, without taking into account the emotional trauma and financial stress they may very well be under, you’re missing the mark.
Good healthcare requires authentic, profound emotional connection, even at the best of times … and these are not the best of times. As the speakers put it: “It’s not mental health that’s fragmented. It’s not even healthcare that’s fragmented. It’s the world we live in. We have to bring people together.”
Contributors: Hailey Allen — Account Supervisor, Soyoon Bolton — Creative Director, Sarah Morgan — Consultant/Writer, Brendon Thomas — Director of Innovation
For the complete recap, download the PDF.