Place Is Power: Investing in Communities as a Systemic Leverage Point to Reduce Breast Cancer Disparities by Race

Abstract

Racial disparities in breast cancer present a vexing and complex challenge for public health. A diverse array of factors contributes to disparities in breast cancer incidence and outcomes, and, thus far, efforts to improve racial equity have yielded mixed results. Systems theory offers a model that is well-suited to addressing complex issues. In particular, the concept of a systemic leverage point offers a clue that may assist researchers, policymakers, and interventionists in formulating innovative and comprehensive approaches to eliminating racial disparities in breast cancer. Naming systemic racism as a fundamental cause of disparities, we use systems theory to identify residential segregation as a key leverage point and a driver of racial inequities across the social, economic, and environmental determinants of health. We call on researchers, policymakers, and interventionists to use a systems-informed, community-based participatory approach, aimed at harnessing the power of place, to engage directly with community stakeholders in coordinating efforts to prevent breast cancer, and work toward eliminating disparities in communities of color.

Association of Race and Area Deprivation With Breast Cancer Survival Among Black and White Women in the State of Georgia

“…14,15 Examining the association of neighborhood deprivation with breast cancer mortality may help to elucidate factors contributing to racial disparities and inform community-level approaches to mitigate these well-known disparities. 16 In this study, we used the area deprivation index (ADI), which is computed for each census block using 17 measures from US Census data, as a measure of neighborhood deprivation. [17][18][19] We analyzed associations among ADI, race, and mortality for Black and White women diagnosed with breast cancer in Georgia using data from 3 large health care systems.…”

Effect of Neighborhood Deprivation Index on Breast Cancer Survival in the United States

“…This could improve the socioeconomic conditions which could eventually improve clinical outcomes. [19] Several factors in the neighborhood in uence the health of an individual directly, as well as indirectly: poverty, access to the health care system, transportation system, housing quality, unemployment, environmental pollution including air and water pollution, neighborhood hygiene, waste management system, crime rates, racial composition, educational system, tobacco availability and marketing, access to healthy food [20][21][22][23]. These along with the factors that affect the individual such as marital status, family/social support, co-morbidities, mental health, nutritional status, healthy lifestyle, insurance status, and educational status play an inevitable role in the survival outcomes of malignancies.…”

Development of Systemic Interventions to Decrease Breast Cancer Risk: A Group Concept Mapping Study

“…The complexity of the disease is also reflected in the strong evidence that there are a range of risk factors for breast cancer, many of which interact with one another in affecting the risk of developing the disease for individual women. These risk factors are diverse, including factors associated with the social and built environment; exposures to environmental toxicants; diet, nutrition, and physical activity; tobacco and alcohol use; age and reproductive history; genetics and family history; and several other factors [ 4 , 5 , 6 , 7 , 8 ].…”