Bringing science and better health outcomes to all

The path to health equity is an arduous one, but the public health scientists, community health educators and cancer experts at Fred Hutch/University of Washington Cancer Consortium mapped out their route at the annual Pathways to Equity Symposium.

“Racial disparities in health care exist in the U.S. and we must thus formulate and understand root causes,” said keynote speaker Dr. Edith Mitchell, an oncologist and clinical professor of medicine and medical oncology at Jefferson Medical College in Philadelphia.

The first step is acknowledging the issue, which is an ugly one. Not everybody has equal access to, or is able to achieve equal benefit from, current disease prevention and treatment, particularly when it comes to cancer. As a result, many people suffer and die needlessly, particularly patients of color and other underserved groups.

The yearly symposium was presented virtually on Friday by the Consortium’s Office of Community Outreach and Engagement, housed at Fred Hutchinson Cancer Research Center. It brought together investigators, advocates, health care providers and more to hash out the harsh truths, share progress and ideas and hail the dedicated heroes in the trenches, who this year helped communities across the Puget Sound and beyond navigate cancer and an equally cruel pandemic.

What causes health disparities?

Mitchell spoke on the root causes of health disparities, which are multifactorial.

They stem from the longstanding food and medical deserts created by neighborhood racial redlining which squelched Black home and/or business ownership; the shortened consultation times clinicians spend with Black patients; the incomprehensible cancer prevention pamphlets routinely handed to non-English speakers and the dearth of cancer doctors of color. And they can extend to the way a person’s genes are expressed, or turned on or off, which can be impacted by poverty, social injustice, racism and other adverse circumstances, in a health disparity double-whammy.

All of these factors and more, she said, pave the way to higher cancer mortality rates within BIPOC (Black, Indigenous and People of Color) and other marginalized communities. All of them eat away at health equity, and all need to be addressed.

How can we do that?

“By engaging with the community,” Mitchell said. “By knowing what diseases occur in our communities, not just cancer but also comorbid conditions. By modifying clinical trials to allow for wider participation. By making sure we have community navigators to help us understand and reach the community.”

The retired U.S. Air Force brigadier general also made a strong call for a diverse workforce to better serve a diverse population.

“The percentage of Latino or Hispanic or African American physicians has not changed significantly over the last few years,” she said. “We must direct attention to this area, to enhance and increase workforce diversity so we have more people who understand disparate communities and who dedicate their lifetime clinician work in those communities.”

Expansion on the horizon?

OCOE Director Dr. Jay Mendoza shared data on cancer cases in the “catchment area,” the 13 counties around Puget Sound that the Hutch and its consortium partners currently serve. Population-wise, it’s around 5 million people, about a third of whom identify as a racial/ethnic minority. Within the last year, there were over 31,000 new cases of cancer reported in the catchment area, and OCOE’s research showed Black patients had the highest rate overall for cancer mortality. They also had the highest prostate cancer rates.

Most people died of cancers in these five sites: lung, breast, prostate, hematologic (blood) and colorectal. But liver cancer was one of the top-five cancer mortality sites among Asian and Pacific Islanders while Hispanic people had liver and pancreas cancers among their top five. Also, mortality rates for breast and hematologic cancers were higher in American Indian and Alaska Native patients in the Hutch’s catchment area compared to national rates.

Four counties in the catchment area — Grays Harbor, Thurston, Pierce and Skagit — had high cancer mortality rates, “significantly higher than King County,” home to Seattle, Mendoza said.

The OCOE director went on to highlight some of the OCOE’s prevention efforts including an ambitious push toward higher HPV vaccination rate. “Our goal is an 80% completion rate,” he said. “Statewide, we are only at 29%, and that was prior to the pandemic. County by county, it varies from as low as 9% all the way up to 43%.”

Mendoza also announced OCOE’s plans to expand the Consortium’s catchment area to the entire state.

“We’re the only NCI-designated comprehensive cancer center in Washington or in the WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) region,” he said, referring to the Consortium’s elite status conferred by the National Cancer Institute. Expanding statewide, he said, would mean folding in over 35,000 Indigenous people and over 430,000 Hispanic people into the catchment area.

“It’s a tremendous opportunity,” he said, sharing next steps which include a population health assessment and statewide survey on cancer control. “And really, when have the aspirations of the Consortium and its partner institutions — Fred Hutch, the Seattle Cancer Care Alliance, Seattle Children’s and UW — when have our aspirations ever been limited to 13 counties? We have 13 very important counties in Washington but it leaves the rest of the state out.”

A urologic surgical oncologist and researcher with Fred Hutch and the UW, Dr. Yaw Nyame was awarded the Beti Thompson Cancer Health Equity Research Award for his work to bridge health equity gaps in African American men diagnosed with prostate cancer. 

“Dr. Nyame chooses to work with the community that he serves to address prostate cancer health outcomes and recognizes that to do this, he must consult with the community, as well,” read just one passage from his nomination letter. “He believes that not only is a ‘seat at the table’ needed, but community members should have more input in study design, dissemination of information, and methodology. This makes the process truly immersive and a true community-based research project.”

Physician Dr. Consuelo Rodriguez de Negrete was awarded the Beti Thompson Community Health Trailblazer award for her tireless work to educate others and share resources to mitigate the effects of COVID-19 among the Hispanic and Latino population in the Yakima Valley.

“Through her expertise as a physician in the Mexican health care system and her ability to candidly explain navigating health care in Yakima, she has become a trusted source of information for Spanish speakers here in the Valley,” read a passage from her nomination letter. Rodriguez de Negrete led the training of 20 Spanish-speaking health educators, or “promotoras,” in the Yakima Valley, who went on to educate over 4,000 families about COVID-19 prevention, treatment and vaccination.

Pathways to Equity also featured Fred Hutch Vice President and Chief Diversity and Inclusion Officer Dr. Paul Buckley, who spoke about the Hutch’s efforts to become an anti-racist institution through its policies, hiring practices, culture and research.

“We recognize it’s a long arduous process of intentional engagement,” said Buckley, who also directs the Hutch’s Office of Diversity, Equity and Inclusion. “It’s heavy lifting — physically, psychologically, emotionally — but it’s necessary work.”

There’s still much to do on the path to health equity for all — and some of the necessary work may be uncomfortable as it involves baked-in structural biases even within institutions like the Hutch and its partners.

But as Mitchell stressed at the end of her presentation, “Working together, we can all improve care to our community.”