Social and Economic Factors Have a Bigger Influence on Health Outcomes Than Clinical Care
Between 10%–20% of health outcomes are a direct result of clinical care, whereas 40% are attributed to social and economic factors such as education, employment, income, family and social support, and community safety, speakers said during a session for the 46th Annual ONS Congress™ on April 20, 2021. The remaining 40%–50% correlate with health behaviors, physical environment, and genes and biology, they said.
Disparities Are Not Just a Race Issue
Otis W. Brawley, MD, MACP, FRCP(L), FASCO, FACE, from Johns Hopkins University, said that although overall cancer incidence has declined during the past 30 years, rates for non-Hispanic Black patients are still higher than other non-White populations. But race could be more about coincidence, not cause.
One study showed that a college education was associated with greater adherence to prevention behaviors and higher quality screening than race or ethnicity. He added that preventable deaths also occur in White people. “The issue of disparities in health are not just a racial minority health issue,” Brawley said. Rather, cancer control should be focused on disease prevention (e.g., avoiding tobacco, exercising, eating a healthy diet, avoiding alcohol, getting vaccinated) and providing optimal basic care to all.
“We must be careful not to allow our use of race to propagate institutional racism,” Brawley said. In fact, race is not the only defining factor when it comes to clinical variations. Rather, country or area of origin is more commonly associated with specific genes or mutations. “From the scientific standpoint, there will be less emphasis on racial differences and more emphasis on genomic targets and markers of drug metabolism.”
The Best Interventions Involve the Community
Timiya S. Nolan, PhD, APRN-CNP, ANP-BC, from the Ohio State University, said that key to changing that reality is addressing individuals’ needs at the community level. Community-based participatory research (CBPR) is being used to create interventions which, in turn, become best practices to reduce health disparities. CBPR requires time to build trust, seek engagement and buy-in from the community, address community priorities before personal motivations, and co-design interventions with sustainability in mind.
She cited examples of CPBR, including the MaskUp Campaign in Columbus, OH (https://doi.org/10.1089/pop.2020.0305), which brought together an academic medical center, government, businesses and nonprofits, students and educators to collectively disseminating education and information. Another example was her recently completed Black Impact study, a multilevel, community-based intervention that improved attainment of Life’s Simple 7 metrics (https://www.heart.org/en/professional/workplace-health/lifes-simple-7) among African American men.
Janice Phillips, PhD, RN, CENP, FAAN, from Rush University Medical Center, spoke on social determinants of health: the conditions in which people are born, grow, live, work, and age. Differences such as access to care and increased food insecurity brought on by the pandemic are linked to worse outcomes.
Another factor is the concept of environmental racism, illustrated by a story of an 85-mile-long stretch of the Mississippi River known as “Cancer Alley,” lined with oil refineries and petrochemical plants between New Orleans and Baton Rouge. Residents, who are predominately Black and living near poverty levels, are 50 times more likely to develop cancer than the average American.
The issues go beyond health care and require collaboration with government and every member of the community to work together to make impactful change, Phillips said. Advocacy and policy change can help Americans reach equitable conditions, but nurses need to speak out.