By Angelina Esparza, MPH, RN
I frequently ask myself: "How can we reach the American Cancer Society goal of saving 1,000 lives per day, when so many people suffer and die from cancer due to disparities in health care?"
Cancer health disparities are complex and caused by persistent societal problems that result in greater suffering and more people dying from cancer.
We know issues of health equity are particularly pronounced among racial and ethnic populations, such as Latinos, African Americans, Asian Pacific Islanders, and Native Americans. Though April is recognized as National Minority Health Month, and the third week in April is National Minority Cancer Awareness Week, our efforts to end health disparities and save more lives are happening year-round.
We should regularly reflect on steps we can take to do our part to promote health equity. What's working well? Where can we be more effective? What do we need to learn to be better prepared?
So what causes health disparities? The answer is not a simple one. While we recognize ethnic and racial differences in health outcomes, it is important to recognize that there are other factors that contribute significantly regardless of race or ethnicity. These "social determinants" influence the health of our communities and of the nation.
Our health and well-being is influenced by many factors, some of which may not appear to be so obviously linked to health or the health care system. We typically think of lack of access to quality and consistent health care as a driving factor that may make and keep people sick; however, we must consider other influencing factors such as:
- Where and how we are employed and compensated (e.g. income and insurance)
- Social status
- Education and literacy level
- Where we live, in what kind of housing, and what's around us
- Early life experiences, like how often we see a doctor or dentist, or access to playgrounds and healthy food
- Racial bias and discrimination
- Access to nutritious food
- Individual behaviors and lifestyle factors like smoking and not getting enough exercise
Many of these conditions are shaped by the amount of money, power, or resources people have and almost all are influenced by both public and private policy forces, namely access to services and coverage for health care. These social factors play a significant role in an individual's ability to engage the health care system successfully and enjoy optimal health. In order to address these we must first understand their role and then learn to effectively discuss these points with policy makers to advocate for change.
As we work together for healthier environments, better cancer care, and to eliminate barriers to care for all communities, we must keep in mind that by reducing health disparities and promoting health equity, we stay on the fast track to achieving our goal of saving more lives and reducing suffering.
A complex problem will require innovative ideas, persistence, and continued support if we are to reduce health disparities. There are no simple answers.
We cannot change all aspects related to social determinants of health, but at the American Cancer Society we are striving to do our part to assure adequate support to address the issues through research, practice, and pursuing public policy changes. We are striving to do our part by becoming educated on the topic, learning how to effectively communicate about health disparities, assuring that all of our programs and services promote health equity and remove barriers to care, and by continuing to support public policies that ensure no person unduly suffers from cancer.
We are actively working to address current, documented disparities. For instance, the American Cancer Society is currently funding research studying such things as how patient navigators can help reduce barriers to care, how we can help medically underserved populations to get cancer screenings to find cancer early when treatment is most effective, and how to better help low-income smokers kick the habit. At the same time, we are looking forward with a long-term vision that takes into account demographic changes, workforce needs, and major reform in health care that will present new challenges and opportunities for health equity.
At the American Cancer Society, we believe everyone should be able to receive the care they need to get well and stay well. And we are not doing it alone. The good news is we have many national and local partners in this endeavor, such as government agencies, professional organizations, corporate sponsors, and generous donors.
For some key statistics about health disparities and why they're a problem, see the special section on disparities in Cancer Facts & Figures 2012.
Esparza is director of health equity for the American Cancer Society.