The Costs of Cancer: Part Two

When it comes to cancer, blacks are diagnosed at later stages and bear a greater burden in the rate of cancer deaths than whites, reports the National Cancer Institute (See The Costs of Cancer: Part One.)

Black men were more than two times more likely to die from prostate cancer in 2005, as compared with non-Hispanic white men, and black women were 34% more likely to die from breast cancer, compared with non-Hispanic white women, reports the Office of Minority Health, a division of the U.S. Department of Health and Human Services.

There are several theories that explain why blacks have higher mortality rates from cancer. They range from lack of adequate healthcare to distrust of the medical community.

Lack of insurance is certainly a problem. Almost 20% of African Americans, compared with 10.4% of non-Hispanic whites, were uninsured in 2007, according to Income, Poverty, and Health Insurance Policy in the United States, a U.S. Census report.

Dr. Stephen B. Thomas, director of the University of Pittsburgh’s Center for Minority Health, says insurance is important, but adds that it is not a substitute for education and prevention.

“We’ve missed the focus,” Thomas says. “We focus on getting people insurance, but will they use it? Even if they have the insurance, if they don’t trust the medical care system they’re not going to use it.”

Many older African Americans distrust health professionals because of historic disenfranchisement such as the Tuskegee Experiment, where black men were misled and used as test subjects for syphilis research without consent. Additionally, a study published in the November 2008 issue of the journal Cancer Epidemiology, Biomarkers & Prevention shows that African Americans are less likely to respond to negative messages about cancer screenings.

To combat the fear that many blacks often associate with cancer and other health concerns, Thomas and other doctors at the University of Pittsburgh’s Graduate School of Public Health (GSPH) created The Healthy Black Family Project (HBFP), an initiative that

focuses on disease prevention by urging participants to take control of their health. The project, facilitated in the Kingsley Association Community Center in Pittsburgh’s East Liberty neighborhood, a low-income black community, offers classes such as body toning, African dance, yoga, and nutrition, and releases a monthly newsletter to 6,000 households in the area.

“We learned early on people won’t show up to a cancer prevention class, but they will show up to go to yoga class,” says Thomas, adding that the African American cancer care program is headquartered inside of the HBFP. “We bring the professionals into that setting, and then they have a chance to get the message out. We created an environment where it is okay to talk about how to control and prevent cancer.”

The project, which is a part of the Center for Minority Health at the GSPH, also ran a series of public service announcements in 2005 showing residents from the community–a family and two best friends–engaging in physical activity and nutrition classes.

Thomas believes that the healthcare industry places too much emphasis on treating disease and not enough emphasis on prevention. “It is a system where everybody gets paid only after somebody gets sick,” says Thomas. “Every other industrialized nation in the world has universal healthcare where the incentives are focused on prevention.”

To further break down the wall between blacks and the health community, Thomas started another initiative, Take a Health Professional to the People Day, which has, since 2003, sent medical professionals to barber and beauty shops to conduct prostate and other cancer screenings. Last year, the organization screened 556 people in 10 barber shops and hair salons in one day. “The work that we’re doing to prevent disease is not appropriately covered by insurance,” Thomas says.

Yet, Thomas understands that simply creating more screening sites and hospital facilities will not make the difference. In addition to more funding for screenings and research, Thomas says there is a need to increase training for medical professionals who will target diverse communities.

“[More than 90%] of health professionals are not black. A recent report from the Institute of Medicine says we need to diversify the work force, but it also recommends that there be more culturally competent providers,” Thomas says. “We have a project with the Mayo Clinic called Urban Immersion, a formal course at the Mayo Clinic that allows [medical professionals in training] to work in Pittsburgh barbershops and learn how to engage [the community] in ways that are culturally relevant.”

All of the programs at HBFP are funded by the National Center on Minority Health and Health Disparities, a division of the National Institute of Health (NIH) and charitable organizations. Unfortunately, the overall NIH budget has decreased over the past 10 years, Thomas says. “There is real concern that when things get cut back, black folks will suffer the most because those are the programs that are the most recent.”