Each year, the President’s Cancer Panel assembles a group of experts to provide official testimony about the nation’s cancer agenda. The theme changes annually – for 2009-2010 the panel focused on “America’s Demographic and Cultural Transformation: Implications for Cancer.” A full report was released this spring.
The report concludes that cancer incidence among minority populations is projected to nearly double between 2010 and 2030 while increasing 31 percent among the non-Hispanic white population. At the same time, our understanding of cancer risk, progression and outcomes is primarily based on studies that do not include the diverse racial, ethnic and cultural variables that are present in today’s United States.
UNC’s Wizdom Powell Hammond, PhD, MPH, was honored to have been selected as a member of this expert panel – but the theme is a natural fit for her work. The assistant professor of health behavior and health education at UNC’s Gillings School of Global Public Health and member of UNC Lineberger Comprehensive Cancer Center does research that spans the individual, psychological factors that affect health behavior in minority populations all the way through the sociological, environmental and healthcare system factors that impact health status, health behavior and healthcare utilization.
“The panel looked at a really broad range of issues around health disparities including physician quality and cultural facility, healthcare access, sociohistorial issues around mistrust of the health care system and minority representation in clinical trials,” Hammond noted. These issues were reflected in the panel’s recommendations.
“There are lots of things happening at once – it’s a perfect storm to create cancer disparities,” she said, “What often happens under this level of complexity is that we trade off the structural issues – in an attempt to remove the visible or economic barriers – but don’t address longstanding cultural and relationship barriers that have an equal or greater influence on disparities. This panel addressed all of these issues and didn’t shy away from the complexity this approach creates.”
Hammond said she brought to the process an understanding of the key issues plaguing minority communities in terms of both health care use and clinical trial participation – things that happen in the processes of care that contribute to cancer disparities. “It was an honor and a privilege to give a voice to those communities and speak on their behalf.”
Her testimony centered around a few key issues, including medical mistrust – both the historical influences and experiences in today’s health care system that contribute to expectations of disparate treatment on the basis of race. While access to care is important – continuity of care may be critical to reducing cancer disparities. “To have the kinds of partnerships and trust with their physicians, continuity of care is important. We want folks to come in sooner if they notice something going on with their health – and the only way to have that happen is a patient-centered medical home,” she notes.
While praising efforts at inculcating broader cultural competency in physician training, she says, “We are all human beings and we are not yet living in a post-racial society. Issues of cultural competence need to be integrated throughout the curriculum – this could have a huge impact on the way patients are treated in care.” These issues also apply to minority recruitment for clinical trials. “We know that there are no differences in willingness when there are equal opportunities to participate. If we remember that people are bringing their lived experience to the interaction with physician and researchers, we can put in the effort to dissolve mistrust, fear and worries.”
Hammond stressed in her testimony that these changes aren’t something that ‘the system’ can do without input from all of those served. “Minority communities are eager to join us in our effort to end cancer disparities, but not as silent partners,” reads her quote in the report, “They want us to hear their voices, to include them as equal partners, and to do nothing about them without them.”