Moffitt Experts Discuss How to Overcome Disparities
For World Cancer Day, Moffitt Cancer Center experts Dr. Brandon Blue from the Malignant Hematology Program and Dr. Tiffany Carson from the Health Outcomes and Behavior Program discussed how to close the care gap. They highlighted how to identify health care disparities and what we can do to overcome them.
Here’s what they had to say:
What are disparities and who do they affect?
Carson: The word disparity in and of itself simply means a noticeable or significant difference. And when we talk about disparities in health care, we usually are referring to a disproportionate burden of sickness, illness, or death experienced by a particular group compared to another group. So we often see disparities based on race or ethnicity, sex or gender, and socioeconomic status. For example, we know that there are a lot of disparities observed when we compare African American or Black Americans to white Americans in the incidence and mortalities associated with cancer, and there’s just a higher cancer burden there. So our goal is really to eliminate, or reduce those disparities by improving health for everyone. It’s not just about necessarily closing the gap because if people who are doing well start doing worse, there wouldn’t be a disparity there, but that’s not our goal. Our goal is really to improve the health of everyone.
Dr. Brandon Blue, Malignant Hematology Program
Health equity is a word that’s used a lot to try to balance that. Can you explain culturally how you brought up things at home?
Blue: I think that’s always the big question, right? Is this a nature versus nurture issue? Is there something inherent about certain communities that’s passed down in their DNA that makes them unfortunately more at risk for certain cancers? That’s one thing we’re trying to understand and figure out that’s actually a big field of research, something that we do here at Moffitt Cancer Center. There are other things that are patterns or what they call cultural things that happen within certain groups that are just like DNA that are also passed down through various traditions and cultural norms. And so we’re trying to figure out, is it nature versus nurture? I’ll give you an example. In some communities it’s very frowned upon to actually even say the word cancer. And so they may have cancer and we as the doctors may be treating them, but no one in their family will ever find out just because that’s a frowned upon thing in that culture. And so some of these cancers are actually passed down through families. And if you find out about it at an earlier age, sometimes it can actually be preventable. And so at that point it just becomes a very critical question that we’re still trying to figure out and there’s much more research that needs to be done.
Which cancers seem to disproportionately affect the Black community?
Blue: So unfortunately that list is very long. For most cancers, African Americans seem to be doing worse. If you take the big cancers that are always talked about such as breast, for example, African Americans seem to have a worse prognosis. If you take prostate, for example, not only do we also have a worse prognosis, we typically get diagnosed at a younger age. You take colon cancer. They actually recently updated the colon cancer guidelines because a lot of African Americans were actually getting colon cancer younger than the age of 50, which was the whole start of screening. So if you take some of the big cancers that people have heard about, unfortunately African Americans do worse in my field. I take care of a lot of cancer. So unfortunately even in these blood cancers, things such as multiple myeloma, lymphoma and leukemia, we see that same pattern that African Americans seem to have a worse prognosis. They live a shorter lifespan compared to someone from a different ethnic background. We’re really trying to erase that and make things better for that group of people.
Dr. Tiffany Carson, Health Outcomes and Behavior Program
Can you share more about the research Moffitt is doing to examine how different cultural practices and environmental factors have an impact on health disparities?
Carson: A lot of the work that I’ve done is focused on this concept of cultural norms that Dr. Blue mentioned, and we can have the best thoughts about prevention or intervention or treatment, but if they don’t align within an individual’s beliefs or their cultural norms or what’s acceptable to them, then it’s really difficult to get people to adopt those practices. A lot of the work that I’ve done has been to try to understand those cultural norms, environmental contributors, social contributors to individual behavior that’s linked to risk for cancer or decisions about how to engage in cancer care treatment after diagnosis. Some of the things that we look at are some of our daily sort of lifestyle behaviors: diet, physical activity, smoking, things of that nature that unfortunately have patterns that are different across racial and ethnic groups. The reasons for that are numerous. Some of it is cultural. Some of it is socioeconomic, some of it is just access to healthy foods and spaces to be physically active. So it really is sort of a multifactorial sort of model that we’re trying to understand. It’s complicated, it’s complex. We’ve made some strides, but there’s a lot of research that’s really needed to understand that intersection between what’s behavior and what’s biology.
Blue: One thing that I think is so important for people to understand is that your health care travels beyond what happens in the doctor’s office. It’s what they call social determinants of health. It may be things that you might not even think about such as education level. Did you graduate from high school? Do you have access to clean water? Do you have access to clean air or are you in a place that’s full of pollution? There are things in the city called food deserts, meaning that your ability to get fresh fruits and vegetables is impaired based off of where you live with those things being so intricately intertwined in your day to day routine. They unfortunately also play a factor, not only on your health, but also your cancer health, because we know that a lot of things regarding cancer care unfortunately is related to some of these factors.
A lot of times there is a trust issue between the health care world and the African American and Black community. Have you encountered that trust issue and how do you handle that?
Carson: It’s a really great question and one that should not be negated. I’ve certainly ran into a hesitation with folks who want to engage in research and in the health care community, and that’s based on mistrust of the system. A lot of work is required to build trust among those communities. As a researcher that looks like people in those communities, I do have the opportunity to try to go engage and do a lot of work to build trust and capacity in those communities. But we do know that there are some things that were done historically that were atrocious. One of the things that we hear about very often in communities is the Tuskegee syphilis study. As horrible as the study itself was, there are also misinformation and misconceptions about what actually happened in the Tuskegee study. So it was already bad enough. And then, there is a lot of misinformation being circulated about it still. Even decades later that still is a huge barrier to engaging African Americans and research.
