Race, income, education, transportation, and food sources. These are some examples of the social determinants of health. It is surprising to see how numerous studies have found out that 33% to 55% of health problems are caused by social determinants of health. Equity and access are ever-present barriers as they play a significant role in determining who can get screened for disease detection and early intervention. Inevitably those in the most vulnerable communities experience the greatest burdens.
It is time for us to acknowledge the importance of diversity both in clinical trial participation and in establishing more relevant screening guidelines. For example, in the 2011 National Lung Cancer Screening Trial, which studied more than 53,000 current or former heavy smokers to determine the cost and effectiveness of screening, fewer than 5 percent of their participants were Black. Similarly, in the European trial on the same topic, the researchers didn’t include people of African ancestry. Based on these data, the screening guidelines are made and a conclusion is drawn about what tests insurance providers will cover for whom. Since the guidelines are based on clinical trials that exclude certain races, the guideline has to be skewed. Clinical trials examining the benefits of prostate cancer screening also excluded Black men, despite the fact that they are more likely to suffer prostate cancer. The trials which were consistently done on white men showed little or no benefit from the screening. Hence, in 2012 USPSTF publicly recommended against using cancer screening for anyone, essentially making it harder for African American men to suffer through prostate cancer to a severe degree due to the prevention of early intervention.
Another obstacle that prevents health equity is the cost barrier. Communities that face transportation barriers and lack of insurance experience difficulties in having access to cancer screenings. The fortunate news is that “Lung Bus” has been actively serving vulnerable people, providing them with free screening since 2017. According to their data, they found 30 lung cancers, of which 21 were at the potentially curable stage. This shows how we can overcome health disparities when we strive to find solutions to close the gap.
The passage of the Affordable Care Act in 2010 greatly helped people to gain access to health insurance, but there is still a long way to go to solve structural and cultural barriers. Eliminating screening disparities requires tackling structural barriers such as knowing the location of the nearest facility, being able to get there with suitable transportation, and setting up hours to accommodate people with inflexible and difficult work schedules. Another huge factor is education, as it is important for the patients to understand what the risk factors are for illnesses and what screening is needed. Not having a primary care provider to inform you about the diseases can also lead to a lack of care. On top of that, interactions with providers are vital as it is important for the health workers to explain things in layman’s terms that are easy for people to understand. If the patients do not know what they are getting screened for, it's unlikely for them to return for future important screenings.
Despite the discouraging data about health disparities, there are many efforts going on around the world to strive for health equity. For example, Northwestern Medicine’s Project HOPE (Health Outreach Promoting Equity) educates local communities in the Chicago area about health disparities and social determinants of health. Ultimately, patients who have good information and people to help guide them through a confounding process can make better and more effective decisions.
Work Cited: Scientific American Monthly Magazine: December 2021