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Addressing disparities

Addressing disparities. Bruce Behringer Co-Chair Tennessee Comprehensive Cancer Control Coalition Assistant Vice President, Division of Health Sciences East Tennessee State University. Defining Disparities.

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Addressing disparities

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  1. Addressing disparities Bruce Behringer Co-Chair Tennessee Comprehensive Cancer Control Coalition Assistant Vice President, Division of Health Sciences East Tennessee State University

  2. Defining Disparities … understanding differences in incidence, prevalence, mortality and burden of disease and other adverse conditions in a population group…

  3. Ranked # 44 in age-adjusted all cancer incidence, 2000-4 Ranked # 20 in age adjusted all cancer incidence, 2005

  4. Ranked # 6 in age-adjusted all cancer mortality, 2000-4 Ranked # 3 in age adjusted all cancer mortality, 2005

  5. Tennessee Males, 2005 # 13 new cases # 5 deaths TN 17.5% higher than US

  6. Tennessee Females, 2005 # 27 new cases # 4 deaths TN 10.5 % higher than US

  7. Tennessee Black Cancer Mortality Disparities are Dramatic and Devastating • 29.1% higher than white Tennessee female mortality, 2005 • 43.3% higher than white Tennessee male mortality, 2005

  8. Tennessee’s national cancer rankings by type of cancer, 2005

  9. Why did incidence rate change so radically from 2000-4 to 2005?

  10. Why is there such a large difference in state ranking between incidence and mortality?

  11. Why did state mortality rankingworsen from 2000-4 to 2005?

  12. The eternal community questions Why is there so much cancer? Is here any worse than other places?

  13. How to define health disparity issues: the product of multiple factors Aday LA. At Risk in America, 2nd ed. San Francisco, CA: Jossey-Bass, 2001.

  14. Is it time to acknowledge Tennessee as a statewide disparities population?

  15. Types of issues raised in disparity research • Is it patient/ population health literacy OR Provider/health system cultural competence? • Is it lack of access to care in health services OR Patient underuse of services, even when barriers are removed?

  16. Types of issues raised in disparity research • Is it low use of cancer screening services OR Lack of a direct provider recommendation for screening? • Is it cultural sense of fatalism about cancer that resists acceptance of aggressive treatment OR Family experience, lack of navigational skills and community history of poor cancer outcomes?

  17. Types of issues raised in disparity research • How do population socio-economic factors INTERACT WITH Environmental factors as causes of cancer? • How do health care policies that guide investments, services reimbursement, research and quality improvement DIFFUSE EQUALLY For the benefit of all providers, populations and communities?

  18. Amazing amount of cancer control activity in Tennessee • Community education and screening programs • High percent of public insurance coverage • State public health activities • 33 cancer centers • Cancer advocacy organizations • Fundraising, events and benefits to help families, friends and neighbors • Support through local prayer calls and donations

  19. Do we have sufficient resources to address cancer disparity? How to target investments? How to use programs that work? How to promote collaboration?

  20. Its not the effort What will help us to be more effective?

  21. What can we learn from ourselves about doing things better? What can we learn from others states that get better rankings?

  22. What can we learn now from our certified cancer registry to help us target our efforts to reduce disparities? Which counties? What cancers? Which genders, ages and races?

  23. Cancer is a health disparity for all of Tennessee We need the framework to work together to target and use effective cancer education, risk reduction, prevention, screening, and treatment strategies

  24. That is the function of the Tennessee Comprehensive Cancer Control Coalition and State Comprehensive Cancer Plan

  25. The TCCCC Challenge • Who has cancer? • Which people? • What places? • What are the reasons? • Which types of cancer? • At what steps in cancer continuum? • How can we make progress in the fight? • What intervention effectively address the issues? • How do gather the resources needed to make a difference?

  26. #44 age adjusted all cancer incidence, 2000-4

  27. #20 age adjusted all cancer incidence, 2005

  28. # 3 age adjusted all cancer mortality, 2005

  29. # 6 age adjusted all cancer mortality, 2000-4

  30. 17.5% higher Tennessee Male Mortality, 2005

  31. 10.5 % higher Tennessee Female Mortality, 2005

  32. 43.3% higher Tennessee Black male mortality, 2005

  33. Rate differences for all genders, ages and races, 2005 Age adjusted mortality rates per 100,000

  34. Rate differences by genders, 2005

  35. Tennessee Rate differences by race, 2005

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