Initiative Spurred by New Report Detailing Systemic Racism and Barriers to Care in the 10 Metro Areas in the U.S. Experiencing Greatest Disparities
Susan G. Komen®, the world’s leading breast cancer organization, today launched a new initiative called Stand for H.E.R. – a Health Equity Revolution, a bold new effort to decrease the gap in breast cancer mortality between Black and white women, beginning in the 10 U.S. metropolitan areas where the gaps are the greatest. In conjunction with the launch of the new initiative, Komen unveiled a series of new reports outlining in alarming detail the underlying causes of inequities Black women face across the breast cancer care continuum in each of these 10 metro areas, where the mortality gap reaches as high as 74 percent.
“For years people have talked about the disparities and suggested we just need to get more Black women screened. Yet in most cases, Black women are getting screened at higher rates than white women, and they are still dying more often,” said Paula Schneider, Komen’s President and CEO. “The disparity is not a simple matter of access to screening – it’s a perfect storm of issues that have been brewing for a long time and span across every aspect of the health care system and society at large. Black women are dying more than white women because all our systems have failed them, and continue to fail them, at every step in their breast cancer journey. Good news is there are solutions to elevate substandard care, the availability and affordability of diagnostics and follow up care, address unfair public policies, insurance practices and implicit bias and racism she encounters daily. It will take all of us working together to create a health equity revolution, delivering the changes needed to save lives, and Stand for H.E.R.”
To help Komen formulate an effective plan of action to address the disparities, the organization sought to truly understand Black women’s lived experiences of racism and bias and the many barriers they face in each of these focus areas. The result of that multiyear analysis is a new series of reports, entitled “Closing the Breast Cancer Gap: A Roadmap to Save the Lives of Black Women in America.” It found that Black women experience higher rates of death from breast cancer due to a combination of factors, including biologic factors such as the aggressive nature of certain breast cancers that are more prevalent in Black women. However, Black women also face barriers to early diagnosis, often receive substandard care, and experience discrimination and the consequences of systemic racism. This experience of racism, bias and barriers in the health care setting is felt by Black women across the country, despite their income, education or insurance status.
While the analysis sought to understand the unique drivers of disparities in each of the 10 metro areas – which include Atlanta, GA, Chicago, IL, Dallas-Fort Worth and Houston, TX, Los Angeles, CA, Memphis, TN, Philadelphia, PA, St. Louis, MO, Tidewater, VA, and Washington, DC – it identified several trends that exist to varying degrees in each area. According to the report:
- Providers, and Black women in focus groups all noted how important the doctor-patient relationship can be to supporting women’s successful management of breast cancer across the continuum of care. Yet Black women often feel ignored or met with disapproval by heath care providers and others in the health care system. Some relayed experiences of harsh, uncompassionate and unnecessarily painful treatment at the hands of their health care providers.
- Health care providers often do not grasp the barriers some Black women face, including lack of access to healthy foods and economic insecurity.
- The quality of health care is segregated, with National Cancer Institute-Designated Cancer Centers and major academic institutions located in predominately white neighborhoods, while Black communities are often supported by community clinics that often do not meet quality standards of care.
- Many health care facilities that provide quality care do not take patients who are on Medicaid, Medicare or other lower-cost health exchange plans. Black women who are on these plans often feel they are discriminated against even when the hospital accepts that insurance.
- The cost of transportation and the time commitment burden of having to travel for care are significant barriers to care for many women, particularly for those who are low-income. Many cannot afford to travel to high-quality care locations and/or are concerned about losing their job if they take time off for appointments.
- There are barriers plaguing access to genetic counseling and testing services in the Black community, which are valuable for those with a family health history of cancers to determine whether or not genetic mutations known to cause increased risk for breast and other cancers (such as mutations in BRCA1/BRCA2 genes) are present.
In addition to detailing the problems, the report recommends strategies that focus on community and systems level change and specific investments, such as culturally competent patient navigators, to overcome the systematic barriers that have been so fundamental in creating the broad disparities that Black women continue to face today.
“Health equity means that everyone has a fair and just opportunity to be as healthy as possible. Achieving health equity in breast cancer is going to take all of us working together to move beyond the status quo, build trust and overcome generations of systemic racism and implicit bias that prevent Black women from getting the care they need to survive,” said Dr. Kim Johnson, Senior Director of Komen’s Stand for H.E.R. initiative. “Komen is committed to doing our part, but we cannot do it alone. It is critical that every sector robustly addresses breast health inequities that plague Black women. Creating large-scale impactful change relies on the commitment of all stakeholders to move beyond the status quo and work collectively to solve this problem. We must align our efforts to achieve results and create measurable improvements.”
Through Stand for H.E.R., Komen is implementing several concrete actions to improve health care quality and overcome barriers. For example, earlier this year Komen announced a partnership with the American Society of Clinical Oncology’s Quality Oncology Practice Initiative to improve the quality of breast cancer treatment at specific health care facilities in the targeted communities. In addition, through existing programs and services that will launch in the target areas in the coming months, Komen will:
- Connect patients to care through Komen-trained, culturally competent patient navigators who understand the barriers, know how to navigate the health care system and know where to get care and support for individuals in their community.
- Provide emotional support through Komen’s Breast Care Helpline.
- Address financial needs through Komen’s Treatment Assistance Program.
- Develop culturally competent education about family health history, its role in breast cancer risk, and the benefits of genetic counseling and testing for Black families in making health care decisions.
Komen will also help lead a national dialogue and engage cross-sector leaders in health care, public policy, research and the public sector in a discussion about these recommendations and actionable strategies to improve health care systems and address social determinants of health and other drivers of breast cancer inequities impacting Black women.
Stand for H.E.R. – a Health Equity Revolution, and the reports on which it is based, are made possible thanks to the funding of Robert Smith and the Fund II Foundation. Learn more about Stand for H.E.R. and to read the Closing the Gap reports, visit https://www.komen.org/about-komen/our-impact/breast-cancer/health-equities-initiative/.