Feature

Every year, millions of people die from cancer simply because they are minorities. While cancer deaths have declined among whites and African-Americans in the United States, blacks, for example, continue to experience the highest rates of every one of the most common types of cancer. Further, according to the National Cancer Institute, the death rate is 25 percent higher for blacks than for whites among the three most deadly types of cancer: lung, prostate and breast.

Research suggests that this disproportionate death rate stems from a complex array of factors, including stress, access to healthy food and good health care, and living in crime-ridden neighborhoods. Complicating matters is the dearth of cancer prevention efforts targeted toward minorities.

Recognizing the need for change, APA is spearheading a $1.7 million initiative funded by the Centers for Disease Control and Prevention that promotes evidence-based cancer prevention programs in socioeconomically disadvantaged populations. Now in its fourth year, the Socioeconomic Status Related Cancer Disparities (SESRCD) program, administered by the Public Interest Directorate's Office on Socioeconomic Status, is helping community-based organizations throughout the United States reach out to underserved populations in targeted and culturally specific ways, in an effort to reduce the disproportionate rate of cancer among these populations.

"The program aims to encourage community-based organizations and stakeholders in the fight against cancer disparities to use evidence-based resources and consider social determinants of health—such as the neighborhood one grows up in and the culture one is born into—when implementing programs and services to socioeconomically disadvantaged populations," says Shalini Parekh, program manager of SESRCD. "These are elements that people have little control over, but can largely predict an individual's access to medical care, healthy food and the amount of physical activity they can take part in."

Through the program's grants and capacity-building efforts, minority cancer patients in Boston are beginning to feel less isolated, and Mennonite women in Ohio are getting screened for breast cancer for the first time.

Improving access to care

Tackling the huge, systemic problem of cancer disparities requires the cooperation of hundreds of community-based organizations. To get them up to speed, APA has awarded nearly 50 grants of up to $5,000 each since the program's inception.

In Boston, for example, the grant provided funding to Facing Cancer Together, a nonprofit that offers free psychosocial support, wellness and education services. Using SESRCD mini-grant funds, the organization teamed with Beth Israel Deaconess Medical Center to launch a 16-week professionally led support group to help minorities navigate their cancer treatment options and develop coping skills to help deal with treatment side effects such as pain, nausea and fatigue as well as all the emotions that come along with a cancer diagnosis, says Nancy Gaulin, PsyD, staff psychologist with Facing Cancer Together.

"These people often have no other community-based options to get the support they may need," Gaulin says. By giving participants a space in the community to come and share with others who are going through a similar experience, the program organizers hope that patients will begin to feel that they have control over their lives and treatment choices. Additionally, through these efforts, Facing Cancer Together hopes individuals will feel less isolated as they meet others who are also struggling with the life-threatening disease.

If you travel 750 miles west, you'll come upon an isolated Amish community where women rarely get mammograms, says Melissa K. Thomas, PhD, founding director of Project Hoffnung, which means "hope" in many Amish and Mennonite communities. The program brings Amish and Mennonite women together at local churches—even offering a hitching post for horses and buggies—where volunteer medical professionals offer information on the importance of regular breast self-exams, free mammograms and cervical cancer screenings and referrals when needed.

Thanks to an APA mini-grant awarded in 2011, Thomas and her colleagues are now helping raise awareness of the needs of these women in the health-care community in Ohio by hosting several seminars throughout 2012 that will educate health-care professionals on the social, structural and transportation-related factors that affect the Amish and Mennonite way of life. There is hope that this will inspire health-care administrators to think of creative ways to reach this underserved population, Thomas says.

"We're working to connect the cultures of the Amish and Mennonite community with the culture of our health-care system," she says.

Project Hoffnung is a good example of how APA is bringing communities together to address health disparities, says Parekh. To that end, as part of its grant agreement, SESRCD has also brought nearly 400 community leaders to interactive, all-day workshops led by APA staff, in collaboration with state health departments and cancer coalitions. Participants leave the trainings more educated about evidence-based resources for interventions in their communities, and concrete plans on how they can reduce cancer disparities in their local communities.

Psychologists are needed

In addition to these activities, SESRCD is training psychologists and other behavioral and social scientists to support community organizations combating health disparities. The Behavior and Social Science Volunteer program is composed of professionals in psychology, public health, anthropology, social work and sociology who help community organizations tackle the behavioral, social, economic, cultural and environmental barriers that underlie poor people's higher cancer rates. For example, psychologist Kathy Canul, PhD, director of Ombuds Services for the University of California, Los Angeles, is advising health-care professionals at Wisconsin's Gundersen Lutheran Medical Foundation about building relationships with the nearby Hispanic community and encouraging community members to take advantage of the foundation's free cancer screenings.

Of Latina descent herself, Canul says her mother's long battle with mental illness and chronic health problems helped her realize early on how deeply health disparities can affect the quality of life among minority populations. "If she had had the opportunity to receive culturally congruent care, she may have been more open to accepting necessary aid, and would perhaps have lived a longer, happier life," Canul says. "Becoming a Behavior and Social Science Volunteer gives me a chance to make a difference."


Amy Novotney is a writer in Chicago.

Additional information on APA's Socioeconomic Status Related Cancer Disparities program is available online.  More information is also available on the SESRCD Facebook page.