I had the privilege this week to serve as the keynote speaker for the 4th Summit sponsored by Latinas Contra Cancer-an organization founded and led by Ysabel Duron, a formidable cancer survivor and news media presence in San Francisco.
Bringing together members of the Latino community, researchers, community health workers, promotores (more on that later) and advocates, the summit focused on the issues facing the Latino community in increasing awareness, access to care, improved treatment and research opportunities among other topics. But what was most impressive was the spirit, engagement and commitment that permeated the room for the two days of the meeting.
I would like to share with you some of what I learned during the preparation for that lecture, as well as some observations that tie together the impact and calls to action that are relevant to the Latino community and many other ethnic and socioeconomic groups in the United States. (You may wish to refer to the American Cancer Society’s “Cancer Facts and Figures for Hispanics/Latinos 2012-2014” which contains a wealth of information relative to cancer for this community.) [more]
When one takes a closer look at the Latino community, one finds there are a number of what we euphemistically call “social determinants” that make such a difference in understanding the community itself and the challenges that many face. A recent report from the Pew Charitable Trust Hispanic Trends Project highlights some of the changing demographics and their impact on Latinos in the United States. Take that information and apply it to what we understand about health disparities and one begins to get a better understanding of the challenges faced by the Latino community, especially regarding prevention and early detection of cancer as well as access to adequate cancer care.
First among several is the fact that the Latino community in this country is far from uniform. Yes, the majority of Latinos are either from or link their heritage to Mexico. But the list of countries is long, and each has a bit of a different cultural tilt. This is not an insignificant observation, as one of the researchers pointed out during the meeting: even outcomes from cancers such as stomach cancer can differ for unexplained reasons depending on where someone or their family came from.
The Latino community has other distinguishing characteristics: those that tend to be foreign born are older, while the native born community skews much younger. English is not a primary language for many foreign born Latinos, and for a good percentage of native born as well. Poverty is a factor, and as noted by Sam Broder MD when he was director of the National Cancer Institute a number of years ago, “Poverty is a carcinogen.” Different populations pursue screening in different numbers, implying a different view-or different access-for those from different countries of origin. It is a population that is growing, and in fact will contribute much of the growth in this country for the foreseeable future-both in absolute numbers as well as at the ballot box.
From a health view, one of the glaring issues when it comes to social determinants is the high rate of obesity among Latinos, especially among the Mexican population. And, to make matters more serious, the problem extends to the youth as well. We know that obesity increases the risk of many diseases, including cancer, diabetes, hypertension and heart disease. A looming crisis can be averted if we pay increased attention to this problem in the Latino (and other) communities. And given the preponderance of children and young people among Latinos, focusing on this issue and others-such as smoking and alcohol consumption-are real opportunities to make a difference in health decades from now.
Finally, on this incomplete list, is the fact that some cancers are less prominent in the Latino community while others are seen with greater frequency. Prostate, lung and breast are on the “lower” list, while liver, thyroid, stomach and cervical cancer are higher than the general population. Some of these cancers are related to infectious causes, and for others we don’t know why Latinos suffer them to a greater degree.
What really stood out for me during this meeting was my education on the role of the “promotores” in the Latino community. These are people-generally women-who have a long history of success within the community, wherever it may be. They serve as health coaches, they navigate the system, they make certain people can get where they have to be, and they help with the treatments. They even at times can make certain people have food to eat and a clean house to live in. They may be volunteers, they may be paid, they may come from a family tradition of service. They are an informal, community based resource that is viewed with respect.
I came away with an understanding of how important the promotore is within the Latino community and their engagement of the health care system. But I was “called out “so to speak when I likened them to community health workers and made the suggestion that we establish training programs in technical/community colleges that might lead to certification. In reality-I was clearly told-the bureaucratization of the promotore could lead to an intrusion into their success (although others shared with me that there is uncertainty about this). No matter: what we need to do is capture the essence of what the promotores do, and figure out how to increase their influence and their opportunity to improve the
The background work I did leading up to the talk reminded me of the reasons we need to pay attention to access to cancer care not only in the Latino community, but in many diverse communities in this country as well. No one is alone on this issue: insurance is a major driver of access to care, but it is not the only driver. When you look at communities you are reminded that education and income-proxies for socioeconomic status in our culture-mean better access to care no matter who you are or where you live.
Research done by the American Cancer Society a decade ago and highlighted in our publication Cancer Facts and Figures 2008 showed the importance of those “drivers” in leading to better health, culminating with the realization that if everyone had the health outcomes of those among us who are best educated we could avert about half of premature deaths in the United States from all causes (I do not believe by the way that everyone needs a college education. But they do need an education that offers them opportunity and decent health, and builds a self-awareness of how important healthy behaviors are in our lives).
So it doesn’t matter the color of your skin, or where you are from: if you have success in your personal life, the years of your life are likely to benefit. I will say that the American Cancer Society takes pride that our research then and now led us to understand the importance of access to care if we are to achieve our goals of reducing cancer risk and improving cancer outcomes in the United States.
All of which points us in a direction that we need to go: we need to understand communities, we need to understand their particular issues that govern their daily lives, we need to address the barriers they face. And that is not a message restricted to the Latino community: we should be able to offer this to any community in this country, whether based on ethnicity, race, educational, socioeconomic or geographic location. We need to meet people where they are. We need to encourage communities to take charge of their health, and develop their solutions. We need to strengthen the opportunities to get better access to better care (one example: an attendee mentioned that when she was in Mexico she could get her mammogram during hours and days that were convenient and worked with her employment schedule. Here, not so much). Fundamentally, we need to listen, to learn, to enable and to act.
I could continue this discussion, but have already shared a good amount of information. Clearly, Latinas Contra Cancer made an impression on me. But I also firmly believe that although the determinants and the problems may be different community to community, the opportunity is universal. How we understand and support that opportunity-our very diversity as a nation, both in the past, today and undoubtedly tomorrow-can make the difference not only in our success in reducing the tragedy of cancer but can also reflect on the very humanity of who we are as a nation.