By Danika McClure
Although life expectancies have gone up significantly in the United States over the last few centuries, health disparities still exist in a number of communities. For poor ethnic minority populations in particular, life expectancies aren’t improving at the same rate that more affluent white populations are.
In a recent study, University of Washington professor Ali Mokdad conducted a study of 29 cancers and U.S. deaths by county, spanning a nearly 35-year period from 1980-2014. What he uncovered was a sobering reality in today’s healthcare system. Although deaths from all cancers fell by 20 percent as a whole, cancer rates by county can vary exponentially. In 160 counties with predominantly low-income and minority residents, the death rates from cancer are more than 20 times higher than average.
“In a country where we spend more than anyone else on health care and we debate health all the time, it surprised me to see such huge disparities at the county level,” Mokdad told the University of Washington’s alumni magazine, Columns. “We are leaving people behind in some places where the cancer rate is increasing. You see certain counties where life expectancy is as high as anywhere in the world and other places where the life expectancy is like countries in Africa and Asia.”
Medical science can’t always explain why specific ailments occur more often in one part of the country than it does in another. There are certain areas in the United States, for example, where citizens are more susceptible to cancer due to the climate and environmental factors. Occupation can also put people more at risk for developing certain kinds of cancers. Firefighters are more susceptible to contract mesothelioma, and farmers are at risk for developing cancers due to herbicide exposure and direct sunlight, for example.
“It’s hard to speculate on reasons [this is happening],” Mokdad argues. “Something else is going on, but it’s very important to know that it’s a problem.”
What is certain, however, is that these disparities in healthcare access, treatment, and outcome disproportionately affect minority and/or socially marginalized populations.
Breast cancer among African American and Hispanic women is a primary example, as these populations are far more likely to have more aggressive forms of cancer, be diagnosed with more advanced stages of cancer, and are much more likely to have negative treatment outcomes. It also means that their children are far more likely to be negatively affected by a cancer diagnosis.
It’s not just cancer that medical experts are worried about. Research has also proven that vision health disparities impact minorities at far higher rates. Latinos, for example, are far more likely to suffer from cataracts, vision impairment, and blindness than non-Hispanic white populations. In a similar vein, African American and Puerto Rican populations are some of the most likely to suffer from asthma in the United States, but most asthma controller medications are ineffective at treating their symptoms.
The ineffectiveness in treatment is due, in part, to the dearth of low-income minority participation in clinical trials.
“We’ve known for years that certain drugs don’t work on parts of our population,” Sam Oh, an epidemiologist at the University of California, San Francisco Center for Genes, Environment and Health told NPR in 2015. “Only 2 percent of cancer studies and less than 5 percent of pulmonary studies have studied enough minorities to provide useful information.”
The reasons for their lack of inclusion are varied, but as Lupe Salazar, an oncologist and professor at the University of Washington explains, government funding agencies don’t always give researchers adequate resources or funding to pay for translators in order to gain consent from patients.
“It’s also very hard to enroll patients who don’t have a computer or a way to log on to clinicaltrials.gov or a way to find the database of experimental treatments,” Salazar continues.
All in all, the goal moving forward is to focus on a number of factors. First, medical staff will need to reach out to those most marginalized in their community, in order to ensure that those communities are receiving proper diagnosis and treatment.
Next, researchers and government entities need to increase their outreach efforts to reach minority populations, especially in cases where certain populations are more likely to be affected by particular diseases.
Additionally, there must be a continued emphasis on disease prevention and preventative care. As Mokdad argues, “The question is, how can we bring prevention to the forefront of what we are doing? It’s not enough to have excellent treatment.”