Reducing Cancer Disparities in Maryland: from Observations to Solutions

Jean G. Ford, M.D.

Director, Community-based Research

Sidney Kimmel Comprehensive Cancer Center

at Johns Hopkins

Eighteen years ago there was a pressing need to focus attention on the particular health problems of the Negro

and to concentrate efforts in a national Negro health movement. Today, we know that this movement has been

successful…so successful that there is not the same urgency to emphasize separate needs. Rather the trend now is for all groups to work together for mutual welfare. The National Negro Health Week movement has helped

materially to gain general acceptance of the idea that “health is everybody's business.”

(National Negro Health News, 1950).

Overview

Cancer disparities in Maryland

Pathways to disparities

Reducing cancer disparities through community partnership

Maryland Cancer Incidence and Mortality, All Sites Combined

Race /Ethnicity Dates Overall Incidence

Overall Mortality

African American

1995-1999 527.6 276.9

White 1995-1999 492.9 210.3

Hispanic/Latino 1999 284.1 38.3

Asian/Pacific

Islander

1998-1999 203.1 101.6

American Indian / Alaska Native

1998-1999 144.0 134.5

Rates are per 100,000 and are adjusted to the 2000 US populationSource: Maryland Cancer Registry

Race STAGE AT DIAGNOSIS

Localized (%) Regional (%) Distant (%)

MD White 43.3 20.9 16.1

MD Black 34.8 22.7 19.4

Distribution of New Cancer Casesby Stage at Diagnosis and Race In Maryland

Source: Maryland Cancer Registry, 1999

Pathways to Cancer Disparities

CancerPhysiologic:

Altered Susceptibility

Behavioral:Health care seeking

Genetics

Environmental Exposures:Smoking, alcohol, diet, exercise, occupation

Cultural FactorsPsychologic State

Lack of Social Support Ineffective Coping Strategies

Medical Care

Pathways to Cancer Disparities

CancerPhysiologic:

Altered Susceptibility

Behavioral:Health care seeking

Genetics

Environmental Exposures:Smoking, alcohol, diet, exercise, occupation

Cultural FactorsPsychologic State

Lack of Social Support/ SES Ineffective Coping Strategies

Medical Care

Fundamental Social Causes (e.g., discrimination)

Age-adjusted Prostate Cancer Ratesin Baltimore City, 1999

Incidence Mortality

0

50

100

150

200

250

Black men White men

Per 100,000 population

Source: Maryland Cancer Registry, 2002

237

169

77

37

Baltimore City: Significant Facts

25% of residents have no health insurance.

African-Americans twice as likely uninsured.

57% of uninsured men age >40 report having no health coverage in over 5 years.

Source: City of Baltimore, 2000

Source: City of Baltimore, 2000

Source: Maryland BRFSS, 2001

Baltimore City Cancer Planat Johns Hopkins

Plan Overview

Partnership with established local organizations

Identification of community resources– Community-Linked Asset Mapping (CLAM)– Additional partners

Increase community capacity for cancer education and screening (PSA and DRE)

Public Health Grant Progress

Total educated 20071

Total screened 1101 –FY04 Screening Goal by June 30, 2004 500–Total screened since July, 2003 (FY04) 200

Achieving Sustainability

CLAM (Community-Linked Asset Mapping)

Avon Breast Research and Care Program ($10.1 million)

Development of research agenda

Perspective on the Baltimore City Cancer Plan at Johns Hopkins

A model for delivery of health services to a truly hard-to-reach population

Entry point into health care system

Enormous potential for community capacity-building

Further impact through new collaborations

How Do We Reduce Cancer Disparities?

CancerPhysiologic:

Altered Susceptibility

Behavioral:Health care seeking

Genetics

Environmental Exposures:Smoking, alcohol, diet, exercise, occupation

Cultural FactorsPsychologic State

Lack of Social Support/ SES Ineffective Coping Strategies

Medical Care

Fundamental Social Causes (e.g., discrimination)

Necessary Components of a Pathway to Reduce Disparities

Benefit to the community

Mobilization of community resources

Ongoing critical evaluation

Sustained community partnerships are essential