Cancer Health Disparities Affecting African Americans
Cancer researchers and public health policy advocates have made tremendous breakthroughs in the past two decades. Yet, cancer disparities in the United States remain a significant problem. According to the National Cancer Institute, African Americans are 25 percent more likely to die from cancer than their Caucasian counterparts. While African American men are more likely to die from prostate and colorectal cancers, breast cancer is the leading cause of death from cancer in African American women. The breast cancer death rate is 41 percent higher for African American women than for white women. Advanced medical interventions are not bridging the gap in treatment and survival rates between African Americans and white Americans diagnosed with cancer.
A variety of economic and environmental factors contribute to these disparities. In addition, a lack of diversity among scientists, researchers and physicians may exacerbate the problem. However, recent efforts have been made to reduce these disparities. Government agencies and health policy research centers are working to find solutions, and certain components of the Affordable Care Act could further drive change.
In a 2011 article titled “Achieving Equity in Health” published in Health Affairs, the primary reasons listed for this continuing disparity are economic determinants, education, geography and neighborhood, the environment, stress and lower quality care. African Americans in the United States have a poverty rate of 25.8 percent (versus 11.6 percent for whites), according to the Census Bureau, and are disproportionately represented in workplaces without employer-sponsored health insurance, which creates an economic barrier to obtaining health care. Low-income African American neighborhoods are also more likely to exist in areas with a higher level of pollutants and hazardous waste that are carcinogenic.
Another important factor is the lack of diversity among physicians. According to a 2009 report, 73 percent of all physicians in the United States were white and only 3.9 percent were African American. Minority physicians are more likely to serve in high-need urban areas and may better understand the cultural norms of their patients. Medical schools with a diverse student body may better prepare medical students to serve diverse populations as well.
Additionally, there has been research suggesting that some ethnic minorities prefer to seek medical treatment from physicians of their own ethnic background. A Journal of Health and Social Behaviorarticle entitled, “Preference for Same-Race Health Care Providers and Perceptions of Interpersonal Discrimination in Health Care” reports that some African American patients prefer African American physicians — and fear lack of empathy by white physicians. This preference may have contributed to reluctance on the part of African American individuals to initiate cancer treatment as quickly as recommended.
The barriers facing African Americans in attending medical schools has made it difficult for African American college graduates to achieve careers in medicine that would foster a greater trust by African Americans in health care providers. Only 12 percent of medical school graduates are African American, according to the American Association of Medical Colleges. Likewise, only 2 percent of oncologists in the United States are African American. Since the training to enter higher-paying specialties is out of reach for many African American physicians, cancer care by African American oncology specialists is largely unavailable to most African American patients.
Efforts to Reduce Disparities
Efforts have been made to address this alarming health disparity. In 2000, a new government agency was established called the National Center on Minority Health and Health Disparities (NCMHD) with an overriding goal of improving minority health through scientific research. The NCHMD recognized a national need for a more diverse body of researchers and scientists and an increased number of minority physicians to help eliminate these entrenched inequalities.
In addition, the Center for Health Policy Research was founded in 1990 at the George Washington University School of Public Health to conduct research to help reduce health disparities. The Center uses rigorous evidence to help inform public discussion and assist policymakers in developing real-world solutions. The Center trains new leaders in public health research and policy with an emphasis on improving health coverage and access for low-income populations.
The Way Forward
To further drive change, certain aspects of the Affordable Care Act are specifically designed to address these disparities. The program will enable nearly four million uninsured African Americans to obtain health coverage by 2016, according to a Department of Health and Human Services ASPE Research Brief. The Affordable Care Act will also make preventative care more affordable and accessible, and preventive cancer screening coverage will be expanded to include mammograms and colonoscopies. Through the National Health Service Corps, scholarships and loan repayments will also be available to medical personnel committed to working in underserved areas, which will also help improve access to health care and promote a more diverse body of health care providers.
While the Affordable Care Act will help address some racial disparities in health care, there are other factors that need continued attention. For example, mentorship of African American high school students interested in the medical profession can enable more African Americans to attend medical schools in the future. In addition, increased awareness of environmental risk factors may also help prevent cancer. African American neighborhoods in commercial zones need health promotion efforts aimed at curbing exposure to known carcinogens.
Success in reducing cancer disparities can be achieved through a multi-faceted approach that includes public health education and policy. By implementing large-scale changes to health policies and continuing research and evaluation efforts, cancer disparities can be reduced over the long term.