The institution of medicine in America has not been kind to Black Americans. In 2016, according to data from the Centers for Disease Control and Prevention, Black Americans had lower life expectancy than their white counterparts; they had higher rates of hypertension and diabetes; and higher rates of maternal mortality. This discrepancy is largely due to a difference in the care they receive.
Now, Spora Health, a startup that spun out of a combined TechStars and UnitedHealthcare accelerator, is trying to change that reality by providing primary care designed specifically for people of color. In December, Spora Health launched a telehealth platform offering access to culturally competent doctors, nurses, and physicians’ assistants. While the care platform itself has the potential to reach populations that historically have had a difficult time accessing care, the small startup is also attracting attention for its training institute. Spora Health has built an internal program that trains doctors on how to deliver better care for non-white Americans, a curriculum which it hopes to offer for doctors outside the company in the future. The goal is to provide Black Americans with access to doctors who will take their medical issues seriously and develop a healthcare plan that is sensitive to their background.
The healthcare industry is increasing embracing the idea that doctors should take into account the personal and environmental factors patients live with when prescribing a health plan. This includes their circumstantial ability to exercise, eat well, take medication, and manage their health—which can be informed by their race and gender identity. For example, insurer Oscar Health is helping patients to find doctors with a similar racial or ethnic background and is building telehealth networks to support transgender members. Spora provides all of its doctors with a two-day training that explains how to practice medicine that is trauma-informed, collaborative, and considers a person’s cultural background when coming up with a care plan.
What that means in practice is being less prescriptive. “I find that a lot of it is related to food and I also do find that it is related to medication,” says physician assistant Alysha Henry-Johnson, who joined Spora Health in November. She says, for example, her husband’s family is from Jamaica and they eat a lot of rice—rice and peas, specifically. If someone in his family were diabetic, she might recommend cutting back on rice. “But when you say, ‘Hey, you need to cut out the rice,’ they’re gonna look at you like, ‘You want me to do what?'”
Addressing dietary restrictions in this context is difficult, because food is so embedded in the culture, she says. The key here, she says, is compromising with the patient. Rather than asking them to cut out a beloved food entirely, they can try substituting. “Maybe you can substitute it for something like cauliflower rice or do a third of your normal portion,” she says. “These small changes can give them a better outcome in the long run.”
Working with patients in this way could go a long way towards correcting a history of racism in the medical community. Earlier this year the American Medical Association released an 86-page report on how it would root out white supremacy in its organization. In it is a documented history of racist behavior in the organization. For years it kept Black doctors from becoming members. Its members and leaders also had a track record of racist behavior. The 1876 president of the AMA rose to prominence as a gynecologist by conducting experimental vaginal surgeries on Black enslaved women without anesthesia. There is also the infamous Tuskegee experiments, where hundreds of Black men with syphilis were enrolled in a study without consent and left untreated so scientists could see what the disease does to the body.
These histories continue to reverberate today. Black Americans disproportionately suffered some of the more severe aspects of COVID-19 in part because of longstanding social inequities that have contributed to higher rates of hypertension and diabetes in this group. One retrospective study also found that Black Americans were more likely to delay seeking care not just because of an inability to access care earlier, but also because of a distrust of the medical system.
So far, Spora Health operates in Virginia, Pennsylvania, Tennessee, and Florida. Access to the platform’s doctors costs $10 per month or $120 per year and the company is in the process of signing a deal with a major insurer in Florida, where Black and Latino patients often have difficulty getting to a doctor. Spora Health recently raised $3 million from Led by Refactor Capital, M13 Capital, and MaC Venture Capital on the heels of a $1 million seed raise last year.
Spora Health CEO Dan Miller says that Spora’s curriculum is currently only used internally, but he’s in conversations with several companies to expand it more broadly. “The curriculum is something that can be scaled in a really short time period,” he says.