We Were All Created Equal – Man Made Us Different.

by Christopher Cornue

There are many programs and initiatives nationally that are working toward addressing these disparity issues in healthcare. To illustrate some of these efforts, two innovative large-scale projects, working to address the call to confront this disparity in healthcare issue, will be reviewed. The first (discussed in this posting) is a city-wide effort in America’s 3rd largest metropolitan area, Chicago, to address the disparities that exist in Breast Cancer mortality. The 2nd, which will be the focus of the next & final post in the series, is a national collaborative addressing cardiovascular disease disparities and quality outcomes.

In October 2006, the Sinai Urban Health Institute, the research arm of Chicago’s Sinai Health System, released Breast Cancer in Chicago: Eliminating Disparities and Improving Mammography Quality, which summarized their research and findings. They analyzed the Chicago portions of data from the Illinois State Cancer Registry, Illinois Vital Records files, the Illinois Behavioral Risk Factor Surveillance System and the United States Census. Through this analysis, they found a very disturbing trend in Chicago – that although progress has been made in reducing Breast Cancer mortality rate in whites, the rate for blacks is essentially unchanged since 1980. This gap, where the breast cancer mortality rate among African-American women was 68 percent higher than that of whites, is higher than the national average (37%) and New York City, as a comparison city, (17%). Several reasons have been suggested – including the fact that some studies suggest that African-Americans are predisposed genetically to aggressive forms of breast cancer; however, there is significant evidence to suggest there are socioeconomic causes, too. Some of these include the following:

o patients refusing biopsies or treatment because they cannot afford it;
o unwillingness to seek treatment because they live too far away and transportation is a real issue for them;
o continued “distrust” of the medical system.

One estimate from their studies suggests that each year 80 black women in Chicago die from breast cancer because their rates are not the same as the White rates. The publication is available at www.sinai.org/urban/publications.asp. This report provided a powerful impetus for the creation of a task force to address this issue. Late in 2006, a Chicago Breast Cancer Task Force was created and is chaired by three of Chicago’s most prominent health leaders: Sr. Sheila Lyne (CEO of Mercy Medical Center and past Commissioner of the Chicago Department of Public Health), Ruth Rothstein (former Chief of the Cook County Bureau of Health Services), and Donna Thompson (CEO of Access Community Health Network). This task force will charge healthcare leaders in Chicago, and the City of Chicago to address this healthcare disparity. This first step of this effort was the convening of the “Breast Cancer Quality Summit: A Call for Action,” which took place on Friday, 23 March 2007. Held at Rush University Medical Center, more than 100 leaders throughout the metropolitan Chicago area, including Northwestern Memorial Hospital, University of Chicago, Stroger Hospital of Cook County, University of Illinois at Chicago, American Cancer Society, Mercy Hospital & Medical Center, Mount Sinai Hospital Medical Center, Rush University Medical Center, Avon Foundation, Access Community Health Network, Sinai Urban Health Institute, Centers for Medicaid and Medicare Services (CMS), Y-ME, Harvard Medical School, Cook County Bureau of Health Services, among others, met to begin the process. Research presentations, national speakers about disparities, panel discussions and defined focus on three areas of the problem (1. Access to mammography, 2. Quality of mammography, and 3. Quality of treatment for breast cancer) highlighted the day. In the afternoon, three Action Groups, based upon the aforementioned focus areas, met to plan their course of action over the next six months with a report-out to occur in October. All of these activities, including the individual Action Groups will culminate in another Summit in Fall 2007 where recommendations will be presented to the City of Chicago, with actionable items soon to follow. More information about this Summit and these activities can be found at www.sinai.org/urban/summit/.

Next, a look at the Expecting Success: Excellence in Cardiac Care national collaborative, focusing on disparities in cardiovascular disease in African-Americans and Hispanics.

This post is part of a 5-part series on healthcare disparities:
- Part 1: Introduction to Healthcare Disparities
- Part 2: A few healthcare organization role models to follow
- Part 3: Measuring disparities meaningfully
- Part 4: Two big disparities projects in the works
- Part 5: Cardio in African-Americans and Hispanics