Despite progress, colorectal cancer claims thousands of black lives

— Few diseases cause as much pain and suffering as cancer. While survivors, activists, policymakers and healthcare professionals have been successful in raising awareness for some types of cancer, others are not as high profile. Among them: colorectal cancer, the second leading cause of cancer-related deaths among men and women combined in the U.S. Even less widely known is the fact that African-Americans have the highest incidence and mortality rates for colorectal cancer.

The disparities are impossible to ignore. African-Americans are about 25 percent more likely than whites to be diagnosed with this form of cancer, and about 50 percent more likely to die from it. This is particularly troubling when considering that, in many cases, colorectal cancer can be prevented and is highly treatable, if it’s detected early, according to the American Cancer Society.

While we’re still working to understand why African-Americans are more susceptible to this type of cancer, one of the causes of the disparity in mortality is that minorities lag behind in screening for colorectal cancer. Researchers at

the University of Texas have shown that African-Americans are less likely than white patients to receive a colonoscopy— the most common form of colorectal cancer screening— even when controlling for health insurance coverage and access to quality healthcare providers.

Both patients and providers bear some responsibility for the lower rates of colorectal cancer screening among African-Americans. On the patient side, African-Americans may not know that they are at a heightened risk of experiencing colorectal cancer earlier than other groups. In the African-American community, the share of colorectal cancer cases that occur before the generally recommended screening age of 50 is almost twice as high as among whites. That’s why experts advise African-Americans to begin screening at age 45, five years earlier than other demographics.

However, encouraging early and proactive screening is complicated. The invasiveness of the procedure, coupled with fears of pain, often causes African-American patients to rule it out as a preventive measure. What’s more, a lack of access to a physician they trust leads many members of the African-American community to delay this important procedure until it’s too late.

In addition, healthcare providers sometimes contribute to the low colorectal cancer screening rates among African-Americans. A recommendation from a physician has been shown to increase the likelihood that a patient will get a colonoscopy, but according to the American College of Gastroenterology, African-Americans are roughly one-third less likely than whites to get such a recommendation.

These racial and ethnic disparities illustrate the need for a patient-centered, culturally competent approach to healthcare. As with many diseases, a broad range of factors determine a person’s risk of developing colorectal cancer.

Genetics, family history, personal medical history, diet, weight and physical activity all can have an impact.

That’s why healthcare providers must treat each patient in a way that takes into account all of the influences on their health. This includes their race and ethnicity, which in the case of colorectal cancer is a critical factor in determining whether a physician should recommend a colonoscopy, when a patient’s screening should start and concerns a doctor should address about the procedure.

Training healthcare professionals to understand the unique colorectal cancer risks of African-Americans, as well as the unease with which many view colonoscopies, is an important step toward increasing screening rates and catching more cases in their early stages. There is also a need for a broader conversation about increased risk and the need for prompt, diligent colorectal cancer screening in the African-American community.

This disease is expected to claim the lives of over 7,000 African-Americans this year alone. It’s time to make sure the impact of colorectal cancer is just as widely known as that of other forms of cancer. And it’s time to replace misperceptions and fear by embracing a culture of health that puts awareness and prevention first.

Fortunately, incidence and mortality rates for colorectal cancer have been on the decline among both African-Americans and other racial groups across the board, but substantial gaps in health outcomes remain. Healthcare providers and the African-American community must work together to ensure that all patients have and take advantage of the opportunity to access a colonoscopy or other screening procedure that could save their life.

Patricia A. Maryland, Dr.PH, is the President of Healthcare Operations and Chief Operating Officer of Ascension Healthcare, a division of Ascension.

This is why increasing diversity in healthcare is essential for the black community

— Diversity is good for communities, companies and our nation. A plurality of viewpoints, experiences and beliefs has the potential to foster both understanding and innovation. And in the healthcare field, the need for diversity is evident every day. Providers in the U.S. serve people from all walks of life, and each patient’s personal background plays a significant factor in the way care is delivered.

There’s no such thing as a one-size-fits-all approach to keeping people healthy. That’s why it is critical for healthcare organizations to have leaders who reflect the diverse populations they treat, and who understand that different communities can have different health needs – leaders who know, for example, that breast cancer tends to appear in black women at a younger age, and in more advanced forms, than in other racial and ethnic groups; and who are committed to eliminating disparities when it comes to prevention, detection and treatment of this disease.

We need leaders who understand the foundation of person-centered care is trust, and who are acutely aware of the need to broker trust in African-American communities where, historically, the healthcare system has been underutilized for a number of reasons.

Unfortunately, the reality today is both women and minorities are underrepresented in healthcare leadership positions. While almost 80 percent of healthcare workers are women, they accounted for just 43 percent of hospital executives in 2014. Last year, a mere 11 percent of executive leadership positions at U.S. hospitals were held by members of minority groups, and in a 2015 survey of healthcare executives, less than 20 percent of respondents said that minority executives were well represented in management teams.

There are myriad reasons for the shortage of women and minority leaders in healthcare, but one glaring challenge is the lack of a strong talent pipeline. Simply put, women and minorities continue to be significantly underrepresented in the business and clinical areas from which healthcare organizations usually draw their executives. African-Americans, for example, make up just over three percent of practicing physicians nationwide, and a 2014 survey of 5,300 MBA candidates in the United States found that only six percent identified as Black.

Working toward greater representation of women and minorities in healthcare leadership roles is not only the right thing to do, it’s also a care imperative. Consider that 32 percent of hospital patients in the U.S. belong to racial and ethnic minorities, and that each patient experiences the healthcare system differently based on his or her unique history, environment, cultural background and personal beliefs.

If healthcare providers are serious about offering culturally competent, community-based solutions, having leaders who can implement organizational strategies that meet patients where they are and advocate for the needs of diverse populations is mission critical.

Not only is this approach good for patients, it’s good for the continued strength and sustainability of healthcare organizations. In a 2015 survey of healthcare executives, 72 percent reported that diversity enhances care equity, 71 percent believed cultural differences within management teams foster successful decision-making, and two-thirds said diverse leaders can help an organization reach its strategic goals.

To take advantage of these benefits, healthcare providers should consider a number of measures to boost the share of women and minorities in their executive ranks, from making stronger efforts to advance female and minority candidates from within to promoting healthcare management as a career among diverse audiences. And all along the talent pipeline, it’s critically important to communicate an inclusive organizational culture — one that ensures diverse candidates are welcome and successful at the organization.

As an African-American woman, I know the road to the C-suite can be a difficult journey, and even uncertain. But a willingness to take risks and step outside one’s comfort zone is critical for aspiring executives. Embracing one’s role in an unfamiliar or challenging environment is the only way to grow and gain respect from senior leadership.

When it comes to diversity among healthcare leaders, we have much more work to do. But if organizations commit to pulling the best and brightest diverse talent to the top, and if promising minority candidates continue to strive upward, we can create a healthcare system in which our leaders better represent the backgrounds and interests of the patients we serve.

Patricia A. Maryland, Dr.PH, is the President of Healthcare Operations and Chief Operating Officer of Ascension Healthcare, a division of Ascension.

Community Health Centers: Fulfilling promise of ACA, eliminating black health disparities

— One hundred one years ago, Booker T. Washington penned a letter to the editors of America’s leading black newspapers. In it, he contended that health, more than any other measure, was the single most important aspect to achieving progress and parity for African-Americans.

In April, we remember Washington’s call to action, celebrate the gains that have been made, and renew our shared commitment to the work that remains during National Minority Health Month. And as our families, neighborhoods, churches, schools and businesses band together to tackle the many barriers that still impede minority health, there are no nobler warriors to be found than those in our community health centers.

Indeed, community health centers (CHCs) serve some of the nation’s highest-risk, most medically vulnerable populations, with more than 70 percent of patients living below the federal poverty line. And more than two-thirds of the patients who seek care at CHCs are members of racial or ethnic minorities. In 2014, Hispanic patients made up 34 percent of the health center population, and African-Americans accounted for 23 percent.

That’s why when it comes to reducing disparities and truly reclaiming black health, CHCs are our best chance for success and our brightest hope for equity.

Not only do these sites provide vital access points to clinical care, regardless of a patient’s ability to pay, they also address the less visible, but equally important social determinants of health. In a coordinated effort with social service agencies and local nonprofits, CHCs work to alleviate food and housing insecurity, provide education and job training, and connect patients to proactive financial planning services.

In Louisiana, for example, the Daughters of Charity Services of New Orleans DCSNO)— a system of community-based health centers throughout greater New Orleans and part of Ascension, the nation’s largest not-for-profit health system— is working to combat the diabetes epidemic at the local level. Its Diabetes Prevention Program is delivering targeted interventions to at-risk individuals, with the goal of reducing participants’ body weight by seven percent and increasing their physical activity to 150 minutes per week, by providing educational sessions on nutrition, physical activity, managing stress and overcoming barriers to health. DCSNO is also partnering with local organizations to provide vouchers for fresh fruits and vegetables at local farmers’ markets.

This supportive and holistic approach provides a promising model to advance minority health. Studies show that CHCs perform especially well when it comes to providing timely preventive services for vulnerable populations and managing chronic illnesses that disproportionately affect minority communities, such as hypertension and diabetes. They also boast a lower average cost per patient, per day than other physician settings, saving the American healthcare system an estimated $24 billion a year.

CHCs are so effective because they are deeply rooted in a sense of place. We know that where we live, work and learn matters just as much to our health as our family medical history, and health centers are often situated in the heart of minority neighborhoods. The fact that CHCs are so embedded in the areas they serve— they’re even governed by a board of patient-directors— often makes them better positioned to address the unique needs of racial and ethnic minority populations. As providers and public health officials continue to wrestle with the challenge of delivering culturally relevant care, community health centers present accessible and ideal locations.

The Affordable Care Act continues to provide quality coverage to those who need it most, and community health centers remain a key player in carrying out the promise of healthcare reform. As we observe National Minority Health Month, we’re called to celebrate community health centers for their impressive outcomes and commit to their future success. Investing in these innovative models of care means supporting health strategies that work, are safe and leave no one behind.

Patricia A. Maryland, Dr.PH, is the President of Healthcare Operations and Chief Operating Officer of Ascension Health.

Flint water crisis can still bring out best in Americans

— Our nation continues to marshal support for the people of Flint, Michigan, after it was discovered that the water supply was contaminated with extremely dangerous amounts of lead.

The long-term exposure of Flint residents to lead, which even in small amounts can cause grave health problems, has raised the public’s awareness of this health crisis and prompted the call for immediate and enduring action— now and for years to come.

Perhaps the most devastating consequence of the Flint water crisis is the uncertain impact that prolonged lead exposure will have on the city’s children. We know that infants and children under the age of six are exceptionally vulnerable to lead poisoning, which can severely hinder mental and physical development and produce a host of health complications, including learning and behavioral disabilities, slowed growth, poor muscle coordination, hyperactivity and lower IQ.

More than 200 of the city’s children have already shown signs of elevated blood-lead levels and the symptoms of poisoning can set in long after the child is no longer exposed— meaning that a child who appears well now can still face daunting health complications later in life.

We do not yet know the gravity of what has transpired in Flint but we do know this: Flint’s children deserve every opportunity to be healthy, and we must come together to develop a comprehensive strategy that guarantees the compassionate care they need to overcome short- and long-term challenges to health.

Flint has already seen an outpouring of support from community members, nonprofits, social service agencies and healthcare providers, including: the Greater Flint Health Coalition; the United Way of Genesee County; and Genesys Health System, an Ascension hospital serving Flint and its mid-Michigan neighbors; working

together to maximize the benefits of their support services and develop a long-term healthcare strategy for the generation of Flint kids who might be adversely affected.

Underlying the crisis in Flint are the many socioeconomic barriers that low-income children and families faced long before the tragedy, including a lack of access to quality healthcare and affordable housing. In a city of more than 100,000 Americans— where 57 percent of residents are black and more than 40 percent live at or below the federal poverty level— there are virtually no grocery stores to be found. Together, we’re working to change that and ensure that Flint’s children are not left wanting for nutritious food, early education and access to integrated social services ever again.

Even the smallest act of service can help address the short and long-term costs of this crisis. The Flint Child Health and Development Fund, created by a united committee of residents, healthcare providers and community organizations, will be used to provide social services, early childhood education, behavioral health services and more to children in Flint. The Flint Child Health and Development Fund is so important to the local community that Ascension Michigan (Borgess Health – Kalamazoo, Crittenton Hospital Medical Center – Rochester, Genesys Health System – Grand Blanc, St. John Providence – Detroit, St. Mary’s of Michigan – Saginaw, and St. Joseph Hospital – Tawas City) has supported the initiative by donating to this effort.

Giving what you can is the single most effective action you can take to contribute to the ongoing care and interventions in Flint. To contribute, visit: www.flintkids.org.

Even after the water runs clean in Flint once again, its children and our community, may bear the scars for years to come. So we must confront the health ramifications of the crisis and support positive health outcomes for Flint’s children. It will require our foresight and collaboration to guarantee their long-term care.

Patricia A. Maryland, Dr.PH, is the President of Healthcare Operations and Chief Operating Officer for Ascension Health.