By Kassandra I. Alcaraz, PhD, MPH
During National Minority Cancer Awareness Week and National Minority Health Month, the American Cancer Society, health agencies, and other organizations seek to raise awareness of health disparities, or health inequities, among racial and ethnic minority groups. Most of us have probably seen or heard the phrase "health disparities." But what, exactly, does this phrase mean? And why is it important?
The U.S. Department of Health and Human Services defines a health disparity as "a particular type of health difference that is closely linked with social or economic disadvantage."
These disadvantages include things like racial discrimination, racially-segregated neighborhoods, and social stratification (the inequitable distribution of privilege, power, wealth, and resources in our society), and they have resulted in unequal access to quality health care, health information, and health programs for racial and ethnic minority groups. These "root causes" not only make the nation unhealthier as a whole but also present real challenges to eliminating disparities.
Although health disparities are not limited to racial and ethnic minority populations, this particular month gives us a dedicated time to better understand disparities among these groups. In the United States, racial and ethnic minority populations bear a disproportionately high burden of disease such as cancer. Generally these groups have worse outcomes than non-Hispanic whites when diagnosed with the same disease.
What's working to end the problem?
Hearing about health disparities and their root causes (as above) might make us feel powerless to do anything about them. Eliminating these disparities does require targeted efforts to ensure all people can attain their best possible health. Despite the challenges, there is much we can do to help eliminate disparities in health.
As a scientist, I know what we've done and learned so far is helping the nation move toward health equity. We've recognized that addressing health disparities requires unique approaches across multiple sectors such as medicine, social science, public health, and education. As a nation, we're now more equipped than ever to address disparities in health. Through specialized education and training programs, there are now experts in health disparities at universities, research centers, and health care organizations throughout the nation who are working non-stop to end this problem. Research with racial and ethnic minority groups has revealed not only which disparities exist but also what can be done to overcome them.
Through health disparities research we've identified effective strategies for communicating health information to racial and ethnic minority groups. For example, we've learned that health information is better received by these groups if messages about health are framed in terms of progress or potential rather than problems or deficiencies (example: instead of saying, "black women are more likely to die from breast cancer than white women," it's more effective to say, "breast cancer deaths among black women are decreasing; even more deaths could be prevented)." Given the recent implementation of the Affordable Care Act (ACA), identifying effective communication strategies is especially relevant. The ACA aims to increase access to preventive services such as cancer screening, so targeted communication strategies can help populations that historically have poor access to health care get the services they need. And that can help reduce disparities.
As another example of how health disparities research can have-real world impact, I recently learned that researchers in Delaware worked to eliminate disparities in colorectal (colon) cancer by developing and implementing a plan to address this health issue at the state level. The plan sought to increase early detection of colon cancer through screening, enhance access to timely and quality treatment, and provide assistance utilizing the health care system by using patient navigators. Prior to implementation of the plan, blacks in Delaware were less likely to be screened for colon cancer, more likely to be diagnosed with colon cancer, and more likely to die from colon cancer than whites in the state. In only about 7 years, rates of colon cancer screening, incidence, and mortality were nearly equal among black and white Delawareans. This model holds promise for reducing disparities in colon cancer mortality throughout the nation.
These are just a couple of examples, but many more exist.
Still more to do
So we know things are working, that we can reduce or eliminate health disparities. But what else can we do?
1. On an individual level, we can learn about, share, and follow recommendations for staying healthy, including eating right and getting physical activity. The American Cancer Society has guidelines to help you stay well and reduce your risk of dying from cancer. While education and behavior are only part of the solution, improving health awareness and prevention behavior among racial and ethnic minority groups can go a long way to reduce disparities.
2. If you're a member of a racial or ethnic minority group, consider participating in health disparities research studies, especially those seeking to understand how to prevent disease in racial and ethnic minority populations. Many universities, hospitals, and organizations like the American Cancer Society are conducting health disparities research studies and are in need of participants. If you're a researcher, increase efforts to recruit a racially/ethnically diverse group of participants into your studies. Better representation of racial and ethnic minority groups in health research can help identify effective strategies for reducing disparities. This will become increasingly important as the demographics of the nation continue to shift.
3. Similarly, if you're a member of a racial or ethnic minority group, consider a career in health disparities research or practice. Individuals from racial/ethnic minority backgrounds are likely to have insightful questions about and approaches to preventing and eliminating disparities in their own communities. Increasing representation of racial and ethnic minority groups in health care and health science can help eliminate disparities by bring new perspectives to address the problem.
4. Health care researchers must strive to identify the factors in racial and ethnic minority groups that may protect against disease and adverse health outcomes. We tend to focus on "what's wrong" in communities, but all communities have strengths that -- when garnered -- can help improve health.
5. Those of us in the health care and research fields should partner with or seek insights from racial and ethnic minority healthcare practitioners, researchers, institutions, and communities. Again, diverse perspectives, experiences, and expertise can only benefit our work in achieving health equity.
6. And all of us can support health and social policies that will help the nation eliminate health disparities. Organizations such as the American Cancer Society Cancer Action Network (ACS CAN) are committed to identifying disparity-reducing policies that can have real-world impact.
Eliminating health disparities and achieving health equity requires fairness and justice for all populations. By recognizing National Minority Health Month, the American Cancer Society joins other organizations and agencies in increasing awareness of racial and ethnic disparities in health. It is our ultimate goal that such efforts will facilitate more dialogue and problem-solving to improve the health of the nation and eliminate disparities that have persisted for decades.
Dr. Alcaraz is the director of health disparities research for the American Cancer Society.