Health Equity Investing: Access, Affordability, Outcomes

Half the world's population—nearly 5 billion people—lacks access to essential health services. Another 100 million are pushed into extreme poverty each year by out-of-pocket healthcare costs. These aren't just statistics; they represent a fundamental failure of markets to deliver one of humanity's most basic needs. For impact investors, they also represent a massive opportunity.

Understanding Health Inequity

Health disparities manifest across multiple dimensions:

• Geographic access: In sub-Saharan Africa, there are 2.3 doctors per 10,000 people vs. 33 in the US. Rural areas globally face severe provider shortages.
• Affordability: A course of hepatitis C treatment costs $84,000 in the US but is available generically for $200 in India. Insulin prices force rationing even in wealthy countries.
• Quality: Low-quality care causes more deaths than lack of access in many developing countries, with 5 million dying annually from poor-quality care.
• Preventive care: Chronic disease prevention is chronically underfunded, despite offering 10-15x return on investment.

The economic cost is staggering. The WHO estimates that health inequities cost the global economy $8.6 trillion annually in lost productivity. Addressing them isn't just ethical—it's economically essential.

Investment Thesis: Technology-Enabled Access

Just as mobile phones enabled financial inclusion, technology is enabling healthcare access at dramatically lower cost points. Several sectors are particularly promising:

1. Telehealth & Digital Health

Remote care delivery addresses both geographic and cost barriers. The pandemic accelerated adoption, but the structural shift is permanent:

2. Affordable Diagnostics

Early diagnosis dramatically improves outcomes and reduces costs, but traditional diagnostics are expensive and require lab infrastructure. New approaches change the equation:

• Point-of-care testing: Devices that deliver lab-quality results at the bedside or in community settings
• AI diagnostics: Machine learning enables diagnostic accuracy from smartphone images—detecting skin cancer, diabetic retinopathy, TB from chest X-rays
• Low-cost imaging: Portable ultrasound devices costing $2,000 vs. $200,000 for traditional machines

"Health is the ultimate impact metric. Every life saved, every disease prevented, every family protected from financial ruin—this is what impact investing should be about."

3. Community Health Models

Community health workers (CHWs) extend healthcare reach into underserved communities at a fraction of physician costs. Investment in CHW platforms includes:

• Training and support: Platforms that equip CHWs with knowledge and decision-support tools
• Supply chain: Last-mile distribution ensuring essential medicines reach remote communities
• Data systems: Digital tools for patient tracking, referral management, and outcomes monitoring

Living Goods, Medic Mobile, and Jacaranda Health demonstrate that tech-enabled community health can achieve remarkable outcomes at $5-10 per person per year.

4. Maternal and Child Health

Maternal mortality varies 100-fold between countries—from 2 per 100,000 in Norway to 1,150 in South Sudan. This is perhaps the starkest example of preventable death from lack of access:

• LifeSpring Hospitals: Affordable maternity care in India at 60% lower cost than competitors
• Jacaranda Health: High-quality delivery care in Kenya using lean operational models
• mHealth platforms: SMS-based maternal health education and appointment reminders

5. Mental Health

Mental health conditions affect 1 billion people globally but receive just 2% of health budgets. The treatment gap exceeds 75% in developing countries. Digital mental health is emerging as a scalable solution:

• Wysa, Woebot: AI-powered mental health chatbots providing 24/7 support
• StrongMinds: Group therapy model reaching 150,000+ women in Africa
• Mindoula: Tech-enabled behavioral health services for underserved US populations

Measuring Health Impact

Health equity investments can be evaluated using well-established metrics:

The Bottom Line

Health equity represents one of the clearest cases for impact investing. The market failure is evident—5 billion people lack essential care. The solutions exist—technology has dramatically reduced the cost of healthcare delivery. The returns are available—healthcare companies serving underserved populations can be highly profitable.

For investors seeking impact at scale, health equity offers the opportunity to address perhaps the most fundamental human need while building sustainable businesses. The question isn't whether to invest in health equity—it's which model best combines access, quality, and financial sustainability.