Health equity means that everyone has a fair and just opportunity to be as healthy as possible. Yet, according to a recently released report, Black women in the United States face a perfect storm of issues spanning across every aspect of the health care system and society at-large that are causing them to die about 40% more often from breast cancer than white women. Indeed, in some metropolitan areas, the gap can be as high as 74%.
Why is this happening? As the report, “Closing the Breast Cancer Gap: A Roadmap to Save Lives of Black Women in America,” by breast cancer leader Susan G. Komen highlights, despite advances in science and increased access to early detection nationally, Black women face the combined effects of racial, gender, ethnic and other forms of bias while navigating systems and institutional structures in which entrenched inequities remain the status quo. This experience is felt by Black women nationwide, regardless of their income, education or insurance status.
For example, one Black health care professional who participated in a focus group for the report noted that her own experience is poor when she goes for treatment without her “white coat.” “I was ignored until the doctor came into the room and started asking me very specific questions. The way I answered made the doctor stop and ask my background. I asked, ‘why does it matter?’ She said, ‘Do you work in the health care field?’ I said, ‘More or less.’… She stopped, and she said, ‘Oh, so what’s your title?’ I said, ‘It’s Dr.,’ and within 30 minutes I was upstairs in a room. If I get treated this way, then what do other people go through? I really felt like I was just another Black face, until they understood that this Black face came with a level of influence and authority.”
These issues are exacerbated by the socioeconomic impacts of segregation, unfair employment practices and racist policies like redlining that still divide many metropolitan areas today. For example, many Black women face difficulties finding high-quality cancer care located near them. In the report, one Dallas-area health care provider recounted how a 65-year-old woman walked about 10 miles in the July heat to get to her screening mammogram. By the time she got to the hospital she was dehydrated and had to go to the emergency room to get fluids before her screening. And those who rely on Medicaid or similar insurance are often turned away once they arrive or are forced to wait hours to see someone.
These transportation and insurance issues are just a few of the barriers tragically impacting Black women today. Whether it’s substandard care, the availability and affordability of diagnostics and follow-up care, unfair public policies, insurance practices and implicit bias and racism, the report authors stress that Black women are dying more than white women because our systems are failing them at every step in their breast cancer journey.
Leveraging the insights and solutions recommended in the report, Komen is launching a new initiative called Stand for H.E.R. – a Health Equity Revolution, to take specific action in each of the 10 U.S. metropolitan areas where disparities are the greatest. Made possible by funding from Robert Smith and the Fund II Foundation, this initiative will include several specific interventions to improve the quality of care and to overcome obstacles and bias, including connecting women to care through culturally competent patient navigators.
The hope is that by launching this initiative, other organizations and community stakeholders will join with Komen to address the long-ignored issues that continue to marginalize the Black community.