Disparity

The moral arc of the universe bends at the elbow of justice.
- Dr. Martin Luther King

How strange a thing is life when the outrageous seems normal. It is the final morning of a large national meeting and the last few scientific sessions are sparsely attended. I sit near the back of a spacious, nearly-empty conference room and listen to a young resident present her research data. She had carefully reviewed outcomes for a subset of throat cancer patients. She reads from her slides. “Predictors of early death include comorbidities, Medicaid insurance, and race,” she says. She continues going through survival curves and regression analyses. “In conclusion,” she says, “our data demonstrate that African-Americans had significantly worsened outcomes both in disease-free survival and overall survival than whites. Thank you and I would be happy to take any questions.” She shows her final slide and we clap politely.

I have seen similar conclusions for years. The disparity between minority and majority race Americans is pervasive and pernicious. The difference is not due to genetics; rather, the causes are felt to be primarily from the effects of poverty, the social determinates of health, inconsistent access to health care, and inadequate cancer care.

In the US, the poor and African-Americans fare worse in almost every cancer outcomes study. According to a list of studies compiled by the National Cancer Institute, African American women are much more likely than white women to die of breast cancer. African Americans are twice as likely to die of prostate cancer and stomach cancer. Colorectal cancer occurs more commonly in African Americans than in whites. African American women have the highest rates of death from cervical cancer. American Indians/Alaska Natives have the highest rates of liver and intrahepatic bile duct cancer, followed by Asian/Pacific Islanders and Hispanics. American Indians/Alaska Natives have the highest death rates from kidney cancer. The incidence and death rates from lung cancer – our deadliest form of cancer – are highest in African American men. We hear the studies and clap politely.

What is it, I wonder, that allows me to listen to variations of these reports over-and-over and leave the auditorium unaffected? In medicine, we talk about a "hidden curriculum" with which our learners become physicians. If a student or resident hears presentations or interactions that should elicit a sense of outrage but everyone around them reacts with a yawn (or worse), the learner will learn to do the same. I am guilty of this, as well.

My colleagues at Froedtert Hospital, Children’s Hospital, and MCW are actively involved in intervening in health care disparities. Below are just a few examples. Learn more about:

• Diversity and Inclusion initiatives and the Health Equity Pledge
• The Advancing a Healthier Wisconsin Endowment, MCW's statewide health improvement philanthropy to support partners across Wisconsin in reducing health disparities
• The urban Center for Flourishing Lives, which is actively recruiting minority researchers
• The Institute for Health and Equity, which focuses on understanding and building healthy communities
• Disparity research for children and adults
• The Cancer Prevention and Outcomes research program, which conducts research designed to identify and reduce population cancer risks and disparities and to improve cancer outcomes
• How we advocate for changes in health policy

I stop at the podium and congratulate the young resident on her presentation. “Nice work,” I tell her.

She smiles. “I wish we had found that there were no differences.”

“Keep shining the light on this,” I tell her. “We can all have a dream.”