New Cancer Health Promotion Strategies to Reduce Social Inequities in Health among Culturally and Linguistically Diverse Populations

Carolina Casares, MD MPH

What We Know Cancer is the second leading cause of death in

the United States

Suffering and death could be prevented by more systematic and innovative health screening and promotion.

A disproportionate number of minority and other medically underserved populations are not fully benefiting from available resources.

Underlying causes of cancer disparities are interrelated and complex

Health disparities are differences in:

Incidence Prevalence Mortality Burden of disease and Related adverse health conditions

and are…beyond what would be expected under equitable circumstances and are directly influenced by the social determinants of health.

- Adapted from the National Cancer Institute, Division of Cancer Control and Population Sciences

Social Determinants of Health

They are the economic and social conditions under which people live which determine their health, such as:

Income Wealth

Health Insurance, Access to Care

Social Status, Education Level

Physical Environment -unhealthy environments

Available Health Services, Risky Behaviors

Employment/WorkingConditions

Social Environments,Health Literacy,Language Barriers

Biology Genetic Makeup

Sexism, Cultural Bias,Ageism, Racism/Bias

Stress Coping SkillsControl

Causes of Cancer Disparities

Can be linked to the social determinants of health, such as:

Inequalities in access to care, Language barriers, Unhealthy environments, and Racial discrimination

Disparities In Outcomes Are Related With:Disparities In Outcomes Are Related With:

1. Disparities in Treatment… Minority* groups are more likely to be living in poverty and are less likely to

receive recommended treatment.

2. Disparities in Screening… Minority groups are more likely to be uninsured and are less likely to receive

timely screening.

3. Disparities in Incidence… Minority groups are more likely to be diagnosed with later-stage preventable

cancers.

4. Disparities in Mortality… Minority groups are more likely to earn a lower income and are more likely to die

from preventable cancers.

5. Disparities in Risk Factors… Minority groups are more likely to report cancer related risk factors.

Eliminating disparities in cancer screening,

diagnosis, treatment, and mortality is an essential step toward achieving

health equity, increasing access and improving health outcomes for patients with cancer

Rx/Prescription for Better HealthRx/Prescription for Better Health Don't be poor. If you can, stop. If you can't, try not to be poor for long.

Don't have poor parents.

Own a car.

Don't work in a stressful, low-paid manual job.

Don't live in damp, low-quality housing.

Be able to afford to go on a foreign holiday.

Practice not losing your job and don't become unemployed.

Take up all benefits you are entitled to, if you are unemployed, retired, sick or disabled.

Don't live next to a busy major road or near a polluting factory.

Learn how to fill in the complex housing benefit application forms before you become homeless and destitute.

Source: D. Gordon, Ten Tips for Better Health, 1999. Message posted on the Spirit of 1848 Listserv.

Increasing the trust and credibility of the Society among populations of color.

Ensuring that effective disparities reducing practices are being provided through strategic guidance and resources.

Enhancing and strengthening our capacity to enable community-based engagement, mobilization and outreach in diverse and low income communities.

Diversifying our volunteer, staff, leadership and donor base through all levels of the organization to achieve the Society’s disparities goals.

What Are We Doing?

How Are We Doing This?

Developing the appropriate tools to effectively communicate health information and resources as it pertains to reaching minority and underserved populations

Strengthening our current partnerships and creating new collaborations to do the work in the community

The Challenges

Relevance in the community

The development of evidence based culturally appropriate and effective health policies and programs

Disparities data and cancer-specific data need to be in formats and at a geographic resolutions that are useful for program development

Communications strategies need to be tailored to the community

How Will We Get There?Evidence-based Program and Policy Development Implement programs proven by empirical and experiential evidence to be effective disparities

reducing activities Acknowledge health disparities from a broad-based systems perspective while focusing on access

to care as a central theme.

Data Refine the current data collection methodology with national data, demographic, social

determinant and market data and infrastructure indicators to enable detailed needs assessments and program evaluation. MapPlace is the proposed tool for this objective.

Communications Strategies Determine the appropriate and culturally relevant messages and delivery mechanisms for the

target audience. Web portals, etc.

Strategic Partnerships Identify high-level partners who can assist in trust-building, program implementation and extend its

credibility among populations underserved by the Society.

Cultural Competency Build the Society’s ability and comfort at all levels to engage low income, rural and minority

populations and communities in a manner that is meaningful, respectful and communicates the Society’s long-term commitment to meeting their needs.

Personal/Organizational Objectives Develop performance evaluation criteria, suitable metrics and business processes to ensure the

health disparities goals of the Society are met.

What tools will we use to achieve this?

MapPlace A web-based mapping and reporting environment that

will help support mission related strategic planning and resource allocation at ACS related to cancer disparities.

Generate maps and other special visuals that will illustrate specific cancer disparities and associated social determinants of health and help ACS identify and implement evidence based cancer disparity reducing initiatives more effectively.

Web portals Designed and developed to be culturally and linguistically

appropriate for the diversity of communities we serve.

African American Breast Cancer Mortality Rates in the US by County

African American Breast Cancer Mortality Rates by Region and County

Mortality Rate for Breast Cancer by County - Black Female (2002-2006)

           Edgefield

County

           

County FIPS 45037

County Name Edgefield County

Black Female Mortality Rate, Breast Cancer

52.9

Black Female Mortalities, Breast Cancer

12

Black Female Population

Edgefield County

Edgefield County

African American Female Population and Breast Cancer Mortality Rates by County

Web Portals

Working on the development of culturally and linguistically adapted web portals for each community, that will help promote community cancer awareness, increase positive imaging of the Society among diverse groups and motivate this segment of the population to become involved by volunteering and supporting the organization.

Not just a web-site, but rather an experience that is tailored to the needs of the community

We are intently looking at more efficient ways to utilize resources at all levels of service by defining the issues, identifying feasible projects and aligning activities.

So What?

The intent is to strategically increase trust and credibility among communities and encourage civic engagement and corporate social responsibility around cancer health promotion.

©2010 American Cancer Society, Inc. No.0052.19

THANK YOU