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Equity and Healthby Caren E. Blinka and Angelina Esparza
Cancer, like many diseases, affects anyone regardless of race, creed, color, income, education, or profession. Although the disease is considered a great equalizer, cancer diagnosis and treatment are not equally available to everyone. “Health disparities”—the recognition that some parts of our population fare worse than others—is a growing concern. Numerous government reports, including “The Unequal Burden of Cancer” and “The Unequal Treatment Report,” both from The Institute of Medicine, document that inequality in health care is a national problem. Many questions, such as what factors affect the incidence and mortality rates of cancer among minorities and the medically underserved, remain unanswered. Lovell A. Jones, Ph.D., and his colleagues at M. D. Anderson’s Center for Research on Minority Health (CRMH) want to answer those questions. As director of the CRMH and a professor in the Departments of Gynecologic Oncology and Biochemistry and Molecular Biology, Dr. Jones feels that the solution to health disparities will require a more holistic approach, one that takes into account cultural beliefs and practices, use of services, socioeconomics, language, and social injustice. “The tendency is to assume that health disparities are due solely to lack of healthcare access, but the answers are much more complicated. Health disparities arise from the interaction of multiple influences,” Dr. Jones said. The hallmark approach of the CRMH is to incorporate the community as a partner in research development—science that benefits the community. Judging from recent U.S. census data and other demographics, the diversity of Houston’s populations serves as a model for what the nation will look like in 20 years. To address healthcare holistically, providers and researchers need to communicate effectively with people and understand their various cultures and beliefs. The CRMH African American Nutrition for Life (A Nu-Life) study is an example: its goal is not only to answer the question of why breast cancer has a higher incidence in young African-American women, but also to provide the community with tools to implement behavioral changes after the study is completed. “Another example is a project we’re doing with Houston’s West African community. As with our other studies, we asked the community about its needs before designing a research agenda. Community leaders expressed the need for a speakers’ bureau that would provide cancer information to community members. So we set up a speakers’ bureau,” Dr. Jones said. “Over time, we’ve transitioned from using CRMH speakers to using speakers from within that particular community. Even if we do not launch a study in the West African community for several years, we have provided them with something that is sustainable; there is an infrastructure in place that provides us with long-term opportunities to conduct research with direct community involvement.” In addition to seeking real-time solutions to community needs, the CRMH also considers future indicators of disease, such as long-term exposure to environmental toxins. The CRMH recently received a $4.2 million grant from the National Institutes of Health to investigate the role of gene-environment interaction in migrant farm workers and their families. “Most epidemiological studies have focused on the health impact of isolated chemicals; however, understanding the interplay between individual chemicals, the environment, and an individual’s responses is an important link to understanding disease,” said Dr. Jones. “It’s probably not that a person is exposed to one specific chemical; it’s the synergistic effect of a variety of chemicals, and possibly the individual’s genetic susceptibility as well. “We need to look at the complex, interrelated factors that affect cancer rates in certain populations,” Dr. Jones said. “Unless you attack the different sources of the problem, you’ll never really resolve it.”For more information on this topic or for questions about M. D. Anderson’s treatments, programs, or services, call askMDAnderson at (877) MDA-6789. Other articles in OncoLog, January 2005 issue:
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