Improving Equity in Cancer Care in the Face of a Public Health Emergency

Abstract

Cancer health disparities have been well documented among different populations in the United States for decades. While the cause of these disparities is multifactorial, the COVID-19 pandemic has highlighted the structural barriers to health and health care and the gaps in public health infrastructure within the United States. The most long-standing inequities are rooted in discriminatory practices, current and historical, which have excluded and disenfranchised many of the most vulnerable populations in the nation. These systemic barriers are themselves a public health crisis, resulting in increased mortality rates in communities of color from both COVID-19 and cancer. While implementing programs to temporarily improve cancer equity locally or regionally is laudable, it is imperative to develop a public health strategy focused on alleviating the root causes of health inequities to improve the health and well-being of every citizen and ensure readiness for the next public health emergency.

Maintaining and Advancing Quality Cancer Care During a Global Pandemic

“…13 Because people of color are often disproportionately disadvantaged financially compared with White, race/ethnicity was also found to be a significant predictor of outcome, with African Americans and Native Americans faring significantly worse with respect to COVID infection rates and outcomes compared with White Americans. 14 …”

Global challenges and initiatives in oncology nursing education

“…Cancer is now the second most common cause of death globally, and as of 2018 accounted for 9.6 million lives lost (1). However, disparities of effective prevention and screening services as well as access to the essential medicines and medical devices and the necessary specialized workforce for effective cancer control are glaring (2), even in highincome countries (HIC) like the US (3). Nevertheless, the cancer burden is expected to rise to 29.4 million in 2040 from 18.1 million in 2018 (4).…”

Creating the Right Team to Ensure Equitable Cancer Care: Whose Job Is It Anyway?

“…Many of the same social determinants of health that engendered the disproportionate burden of COVID-19 morbidity and mortality in communities of color affect cancer incidence and outcomes among those same peoples. 6 Cancer disparities, those preventable differences in the burden of disease experienced by different populations, have been described for decades. 7,8 While some of the gaps are closing, the inequities in cancer care and outcomes are costing the United States millions of dollars and thousands of lives each year.…”

“…For too long we have relied on an outdated health care system built on a scaffold of privilege and disenfranchisement. 6 Now is the time to reshape and rebuild the future of medicine by vigorously embracing what it truly means to be a team, eschewing the performative nod to diversity demonstrated by the hoard of lackluster institutional initiatives cropping up that are little more than a checkbox to assuage guilt or meet an arbitrary guideline. Teamwork requires valuing each member of the team and what they bring to the table.…”

“…If the pandemic has taught us anything, it reminded us how fragile life is and underscored the importance of a public health infrastructure is for the United States. Now is the time to put aside the descriptive disparities research, apply complex systems science, [6][7][8] and create frameworks for identifying and rewarding research that has implications for clinical care and public health. To ensure long-term sustainability, the research and implementation teams must be inclusive of key stakeholders including policy-makers, payors, and pharmaceutical companies, as well as other stakeholders.…”