The Path Forward 

The solutions to eliminating disparities in cancer mortality are varied and consist of improvements to access, quality of care, and financial feasibility for low-income groups and communities of color. 

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• 🧑‍⚕️ Increase community health workers in low-income areas - Given the barriers to cancer prevention, screening, and care that low-income areas and communities of color face, community health worker (CHWs) and patient navigator (PN) programs can help cancer patients navigate better quality care and improve community access to screening. As experts in the communities they serve, CHWs and PNs help connect community members to health and social services. For cancer patients in particular, CHWs/PNs may connect patients to better care, provide transportation to treatment, educate the community on screening and prevention strategies, and support survivors. Expanding these networks of patient advocates in impoverished and hard-to-reach areas is a proven method to improve treatment adherence and overall disease outcomes.

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• 🏙 Improve quality of care for communities of color - For cancer and various other diseases, Black Americans consistently receive worse quality care than White individuals, due in part to the undertreatment of Black patients’ pain, longer wait times for Black patients, failure of hospitals to hire racially diverse faculty and staff, and worse treatment for Black patients diagnosed with the same diseases at the same institutions as White patients. As established in “An Antiracist Agenda for Medicine”, mitigating racial health inequities demands that colorblind solutions be left in the past and race-explicit interventions be adopted at hospitals and clinics across the country. Brigham and Women’s Hospital in Boston has already developed a pilot for heart failure patients titled “Healing ARC” based on the reparations framework of acknowledgement, redress, and closure that places marginalized patients at the center of institutional change.

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• 🇺🇸 Expand Medicaid access in non-expansion states - Beginning in 2014, under the Affordable Care Act, states were able to expand their Medicaid coverage to all residents under 65 who had incomes below 138% of the Federal Poverty Level (FPL), ultimately filling the major gaps of insurance coverage for low-income Americans. To this day, 12 states have yet to expand Medicaid - Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming. If these states were to expand access, more than 4 million Americans would gain coverage, providing more people with financial security in the case of a future cancer diagnosis. Increasing insurance coverage also improves access to primary care for lower-income populations, ultimately building a more equitable health system from the ground up and working to reduce cancer inequities downstream.