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Health Care Disparities and Cancer
Health care disparities occur when a person’s individual characteristics or circumstances—such as race, ethnicity, sexuality, gender identity, age or health insurance status—impact their access to health care or the quality of that care. These disparities can lead to cancer being diagnosed at a later stage, when it is harder to treat.
There has been increased attention on health care disparities, and many health-related organizations are focusing on ways to improve access to care and the quality of care. Medical institutions should abide by non-discriminatory policies, which can be posted on their website or within the care setting. Additionally, the healthcare delivery system is strengthened by the increased creativity and talent of a more diverse workforce. Administrators can promote or hire people with diverse viewpoints into positions of responsibility.
Organizations can also promote the concept of “cultural humility.” Cultural humility is the ability to remain open to another person’s identity. Cultural background, beliefs, values and traditions can impact how people make decisions about their health care. Being culturally humble involves reflection by the organization as a whole (and its health care providers) about their deep-rooted assumptions and being receptive to change.
It also involves recognizing power imbalances. For example, a patient may believe that they must accept health care recommendations without question. Health care providers should encourage patients and their families to discuss and collaborate on decisions regarding their health care.
Cultural humility also values institutional accountability. This means making sure the best options for care are available to everyone. Hospitals, public health administrations, insurance providers and others can take responsibility for differences in care and strive to reach health care equity.
The outcomes of cancer vary considerably according to race and ethnicity. While significant progress has been made to reduce mortality (deaths) due to cancer for all populations, there are still differences. Here are a few examples in the United States:
African Americans experience the highest incidence and mortality rates for common cancers such as lung, colorectal and prostate. Additionally, breast cancer mortality rates are disproportionately higher among African American women than white American women.
Compared to non-Hispanic white people, American Indian and Alaska Native (Native American) people have a much higher incidence of several cancers, including lung, colorectal, liver, stomach and kidney.
Hispanic men and women have a higher incidence of stomach and liver cancer than white men and women.
American Samoan men are eight times more likely to develop liver cancer as compared to non-Hispanic white people.
Genetic factors likely contribute to some of these differences. However, other factors account for these variations to a substantial degree, such as limited access to health care, lack of insurance and reluctance to seek care due to past experiences with interpersonal and/or structural racism.
Your health care team is composed of experts in medical care. However, their focus on medical issues may not account for your beliefs, values and traditions. You should feel comfortable sharing any concerns you have. These may include treatment decisions, potential side effects, financial concerns, family responsibilities and end-of-life issues.
The effects of health care disparities on the LGBTQ+ community include:
Fear of discrimination. LGBTQ+ individuals may worry that disclosing their sexual orientation or gender identity will affect the quality of their health care.
Negative experiences. Fear of non-affirming interactions with health care providers can limit openness, safety and trust.
Lower rates of health insurance. Health insurance policies sometimes do not recognize unmarried partners. Legal protections against discrimination at both the state and federal level are inconsistent.
Denial of care. While acceptance of LGBTQ+ identities is rising, homophobia and transphobia remain a reality. Some people may find themselves having to fight for the care they deserve.
Health care providers may hold biases about the LGBTQ+ community, or simply not be aware of differences in their health care needs. This affects the types of screening that are recommended.
For example:
Lesbians are often screened at a lower rate for cancers associated with reproduction, such as cervical and ovarian cancer.
Doctors may not be aware that the human papilloma virus (HPV) is equally transmitted by anal intercourse as it is by vaginal intercourse. A growing number of health activists believe that routine screening, using an anal pap smear, could reduce the incidence of anal cancer in gay or bisexual men.
A transgender person might retain aspects of their biological sex that require certain forms of care. A trans man may need care from a gynecologist or continued breast exams. A trans woman may require care from a proctologist. However, many health care systems still rely on male-female binaries, reducing the quality of health care for non-binary or gender nonconforming patients.
The following organizations can provide a range of resources and support to members of the LGBTQ+ community who are facing health care disparities.
Gay and Lesbian Medical Association (www.glma.org). Utilizing the expertise of its diverse multidisciplinary membership to drive advocacy, education and research, the GLMA is a source of educational and informative materials. They also maintain a directory of providers dedicated to the support of the LGBTQ+ community.
National LGBT Cancer Network (www.cancer-network.org). The National LGBT Cancer Network works to improve the lives of LGBTQ+ post-treatment cancer survivors and those at risk through education about the importance of early detection and screening. They also train health care professionals on providing more competent, safe and welcoming care. They have an online database to help locate care providers.
National LGBT Cancer Project (www.lgbtcancer.org). The National LGBT Cancer Project seeks to improve the health of LGBTQ+ post-treatment cancer survivors with peer-to-peer support, patient navigation, education and advocacy by way of their online support group community, Out With Cancer.
Human Rights Campaign (www.hrc.org) and Human Rights Campaign Foundation (www.thehrcfoundation.org). The Human Rights Campaign envisions a world where every member of the LGBTQ+ family has the freedom to live their truth without fear, and with equality under the law. Information and advice on a range of topics, including health care issues, is available on their website. Comprehensive programs to support individuals, allies and institutions can be accessed by visiting their related organization, the Human Rights Campaign Foundation.
Due in part to stereotypes and prejudice, older patients sometimes receive inadequate health care. For example, surgery may be recommended less often, even if it is the most appropriate treatment option. Also, screening for certain cancers may be provided less frequently. Older patients may also face physical challenges that limit their mobility (ability to get around) and may also lack reliable transportation options.
The impact of age is often more severe in people from racial minority groups. They often have a lower quality of life, shorter life expectancy and more medical conditions than non-minorities. As such, they may require a higher level of support and attention.
Support from family and friends can make a significant difference. An older person should not hesitate to ask for help, such as:
- Scheduling check-ins
- Being explicit about what help is needed
- Asking for rides to health care appointments
- Reviewing medical concerns and the results of doctor’s appointments
- Asking for assistance with meals, shopping or other personal care tasks
According to the World Health Organization (WHO), social determinants of health are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live and age, and the broader set of forces and systems shaping the conditions of daily life.
Social determinants of health can lead to health care disparities. Examples from the WHO include:
Numerous studies suggest that social determinants of health account for between 30 and 55 percent of health outcomes. Addressing these determinants is fundamental for reducing longstanding disparities in health care. Doing so requires action by multiple segments of society.