Progress Toward Elimination of Health Disparities

The following discussion highlights progress toward the elimination of health disparities. The disparities are illustrated in the Disparities Table (see Figure 3-2), which displays information about disparities among select populations for which data were available for assessment.

Death rate (3-1 through 3-8). Little progress was observed in reducing cancer health disparities. Among racial and ethnic populations, the Asian or Pacific Islander group had the best rates for five of the eight death rate objectives (3-1, 3-3, 3-4, 3-5, and 3-7), and the Hispanic population had the best rates for the other three population-based cancer objectives (3-2, 3-6, and 3-8).

Between 1999 and 2002, disparities in prostate cancer death rates (3-7) increased between 10 to 49 percentage points for the Hispanic and white non-Hispanic populations and 100 percentage points or more for the black non-Hispanic population, compared with the Asian or Pacific Islander population. For lung (3-2), cervical (3-4), and oropharyngeal (3-6) cancer death rates, disparities were 100 percent greater than the best rates for the black non-Hispanic population and persons with a high school education or less. For seven out of the eight cancer sites, death rates for the black non-Hispanic population were more than twice those of the best population group.

The American Indian or Alaska Native population experienced cancer death rates that were 10 percent to 49 percent higher than the best rates for all cancers combined (3-1), lung cancer (3-2), and oropharyngeal cancer (3-6) and 50 percent to 99 percent higher for prostate cancer (3-7).

For cancers occurring in men and women (3-1, 3-2, 3-5, 3-6, and 3-8), females always had better (that is, lower) group death rates. Some progress occurred in reducing gender differences in lung cancer death rates, but an increase in the gender difference in oropharyngeal cancers was noted.

Finally, with respect to disparities in cancer death rates regarding education level, for six of the eight cancer death rates, persons with at least some college had the best rates (that is, lowest death rate). Persons with less than a high school education had the best rates for female breast cancer (3-3) and melanoma (3-8). Disparities in death rates for lung cancer, oropharyngeal cancer, and melanoma grew for high school graduates, compared with persons with at least some college. Disparities in lung cancer also increased for persons with less than a high school education in comparison with persons with at least some college.

Preventive health behaviors and screening (3-9b, 3-11, 3-12, and 3-13). Women, persons with at least some college education, and middle/high-income persons had the best group rates for sun safety behaviors (3-9b). Disparity in sun safety behavior among adults without disabilities compared with adults with disabilities decreased by 10 to 49 percentage points between 2000 and 2003. No other progress occurred in reducing disparities in cancer screening behaviors from the baseline year.

For cancer screening behaviors, persons with at least some college and with middle/high income had the best rates across all five cancer screening objectives and subobjectives. The only observed change was an increase in disparity for persons with less than a high school education who received colorectal cancer endoscopic screening (3-12b). Ever having received a Pap test (3-11a) had the most population groups with large disparities than any other screening behavior. Disparities of 100 percent or more from the best group rate were present for Asian and Hispanic populations, as well as for persons with less than a high school education. The black non-Hispanic population had the best rate for Pap tests received within the past 3 years (3-11b), and persons of two or more racial and ethnic backgrounds had the best rate for sun safety behaviors (3-9b) and FOBT home kit (3-12a).

Reducing or eliminating cancer health disparities remains a critical scientific challenge,³⁰ as well as a moral and an ethical dilemma for the Nation. In January 2003, at the request of the U.S. Department of Health and Human Services (HHS), NCI established a Trans-HHS Cancer Health Disparities Progress Review Group (PRG) consisting of 27 outside experts to assist HHS to define and describe the cancer health disparity issues; identify strengths, gaps, opportunities, and priorities to address cancer health disparities; facilitate the adoption and implementation of research, policy, community-based, and clinical interventions and evaluate their impact on specific cancer health disparities; and ensure unbiased and continuous access to quality preventive and treatment services for every American.³¹

The PRG report identified 14 priority actions that involve planning and coordination across HHS and other Federal agencies with programs that impact cancer health disparities, research discovery, intervention development, and service delivery. The report³¹ acknowledged that the underlying causes of cancer disparities are linked to persistent inequities in health³² and health services, including unequal access to healthy environments, as well as unequal access to evidence-based cancer prevention, screening, diagnostic, treatment, and survivorship support services.

HHS has formed a cancer health disparities subcommittee within the HHS Health Disparities Council. This subcommittee is reviewing the recommendations in the PRG report to identify priorities for action. If reductions in cancer health disparities are to be achieved, new and expanded activities specifically addressing the underlying causes of cancer health disparities need to be undertaken.

<<  Previous—Progress Toward Healthy People 2010 Targets   |   Table of Contents  |  Next—Opportunities and Challenges  >>