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“You’re a unicorn,” the investor said.

The first time she called me that, I responded with a nervous laugh and downplayed her comment. But that didn’t stop her. She went on to explain that she called me a unicorn because I’m a physician, I’ve had a successful academic career, and I’ve been in the C-suite of a venture-backed digital health company that scaled and recently had an IPO.

She didn’t even add the obvious: I am also a Black woman.

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Since then, I’ve been described as a unicorn too many times to count. I no longer bristle at the term, but continue to be bothered by its implications. A unicorn is a mythical creature. I’m a real person and there are others like me.

Using the unicorn lens to define my identity narrows the scope of what is possible for people from underrepresented groups, so I am on a mission to make sure that they are valued and included as we work to transform health care.

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Representation matters

Who greenlights funding, who gets funded, what efforts get attention, and how effective those efforts are in reducing cost or improving outcomes among specific groups all matter.

The digital health ecosystem is more active than ever, and so far in 2020 U.S. companies have raised more than $9.4 billion from venture capital. But the lack of diversity in digital health leadership furthers the likelihood of creating solutions that worsen already existing health disparities. If we are truly going to transform health care, we must address this problem head on and with eyes wide open.

To drive meaningful change, it’s important to understand where we are today. In early 2020, I partnered with Rock Health on a Diversity in Digital Health initiative to measure the baseline state of racial and ethnic diversity among U.S. digital health startup leadership teams. Between July and September 2020, we surveyed more than 650 founders and leaders. This was in the midst of the Covid-19 pandemic, which has tragically highlighted the health disparities experienced by communities of color, and the Black Lives Matter social justice movement, which has shone a spotlight on the systemic racism causing these disparities.

Though the results of the survey were as expected in some areas, they indicated opportunities to improve across the board.

The survey showed significant differences in how digital health founders across different races, ethnicities, and genders funded their companies:

  • More than half of white and Asian founders were backed by venture capital, compared to 24% of Black founders.
  • Black founders were more likely to have bootstrapped their companies than their white and Asian counterparts.
  • Black founders were more likely to be from the South (38%) and Midwest (20%) than from the West (4%) and Northeast (9%), the two regions in which the Rock Health Digital Health Funding Database shows capital concentration. For example, the average digital health deal size (from January through September 2020) was $36 million in the West versus $20 million in the South. This suggests Western founders are accessing more capital than their counterparts in the South, where there is much greater Black representation.

The survey also revealed a lack of people of color among leadership teams. Compared to their representation among the U.S. population, Asians were overrepresented in digital health (20% of survey respondents compared to 6% of the population), while Black leaders (8% of respondents compared to 13%) and Hispanic leaders (6% of respondents compared to 19%) were underrepresented.

There was also greater non-white diversity among company founders than among other leadership roles, with less Asian, Black, and Middle Eastern representation among non-founder leaders.

Digital health entrepreneurs surveyed reported different challenges and experiences. Black leaders reported more difficulty accessing capital than their white or Asian counterparts. And 83% of Black respondents indicated that inclusion in the digital health industry has stayed the same or worsened since they started working — compared to less than half of white respondents saying that.

Now is the time for digital health to get diversity right

The convergence of accelerating technology adoption with an unprecedented public health crisis is rapidly reshaping our health care systems. If we don’t intentionally use this moment to diversify digital health leadership, we lose out on an opportunity to make health care better for everyone. You can’t build the future of health care without understanding exactly what’s wrong with its past and present — or without those who have been left out of the ranks of leadership.

For now, I am still the unicorn in most digital health settings. But it shouldn’t take referencing a mythical creature to define my presence and identity in the digital health space. By establishing a data-driven baseline, we open the door to conversations that can lead to increased support for entrepreneurs of color and new innovation to meet the needs of diverse communities. If we commit ourselves to digging deeper on why these discrepancies exist and how we can address them, I believe we can leave the unicorn reference where it belongs, in stories of myth and fantasy.

Ivor Horn is an angel investor with Pipeline Angels and Portfolia’s Rising America Fund, a pediatrician, former professor of pediatrics at the University of Washington School of Medicine, and former chief medical officer at Accolade. She is a board director at Care Academy and on the advisory boards of Way to Wellville, Change Healthcare, and Onboard Health.

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