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Addressing disparities Bruce Behringer Co-Chair Tennessee Comprehensive Cancer Control Coalition Assistant Vice President, Division of Health Sciences.

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Presentation on theme: "Addressing disparities Bruce Behringer Co-Chair Tennessee Comprehensive Cancer Control Coalition Assistant Vice President, Division of Health Sciences."— Presentation transcript:

1 Addressing disparities Bruce Behringer Co-Chair Tennessee Comprehensive Cancer Control Coalition Assistant Vice President, Division of Health Sciences East Tennessee State University

2 Defining Disparities … understanding differences in incidence, prevalence, mortality and burden of disease and other adverse conditions in a population group…

3 Ranked # 44 in age- adjusted all cancer incidence, Ranked # 20 in age adjusted all cancer incidence, 2005

4 Ranked # 6 in age- adjusted all cancer mortality, Ranked # 3 in age adjusted all cancer mortality, 2005

5 Tennessee Males, 2005 # 13 new cases # 5 deaths TN 17.5% higher than US

6 # 27 new cases # 4 deaths TN 10.5 % higher than US Tennessee Females, 2005

7 Tennessee Black Cancer Mortality Disparities are Dramatic and Devastating 29.1% higher than white Tennessee female mortality, % higher than white Tennessee female mortality, % higher than white Tennessee male mortality, % higher than white Tennessee male mortality, 2005

8 Tennessees national cancer rankings by type of cancer, 2005 New cases Deaths All cancers # 20 # 3 Lung # 4 # 3 Breast # 17 # 8 Colorectal # 12 # 10 Prostate # 36 # 15 Cervix # 6 Melanoma # 14

9 Why did incidence rate change so radically from to 2005?

10 Why is there such a large difference in state ranking between incidence and mortality?

11 Why did state mortality ranking worsen from to 2005?

12 The eternal community questions Why is there so much cancer? Is here any worse than other places?

13 How to define health disparity issues: the product of multiple factors Population Health Outcomes Characteristics of health delivery system Characteristics of population at risk Aday LA. At Risk in America, 2nd ed. San Francisco, CA: Jossey-Bass, 2001.

14 Is it time to acknowledge Tennessee as a statewide disparities population?

15 Types of issues raised in disparity research Is it patient/ population health literacy Is it patient/ population health literacy OR OR Provider/health system cultural competence? Provider/health system cultural competence? Is it lack of access to care in health services Is it lack of access to care in health services OR OR Patient underuse of services, even when barriers are removed? Patient underuse of services, even when barriers are removed?

16 Types of issues raised in disparity research Is it low use of cancer screening services Is it low use of cancer screening services OR OR Lack of a direct provider recommendation for screening? Lack of a direct provider recommendation for screening? Is it cultural sense of fatalism about cancer that resists acceptance of aggressive treatment Is it cultural sense of fatalism about cancer that resists acceptance of aggressive treatment OR OR Family experience, lack of navigational skills and community history of poor cancer outcomes? Family experience, lack of navigational skills and community history of poor cancer outcomes?

17 Types of issues raised in disparity research How do population socio-economic factors How do population socio-economic factors INTERACT WITH INTERACT WITH Environmental factors as causes of cancer? Environmental factors as causes of cancer? How do health care policies that guide investments, services reimbursement, research and quality improvement How do health care policies that guide investments, services reimbursement, research and quality improvement DIFFUSE EQUALLY DIFFUSE EQUALLY For the benefit of all providers, populations and communities? For the benefit of all providers, populations and communities?

18 Amazing amount of cancer control activity in Tennessee - Community education and screening programs - High percent of public insurance coverage - State public health activities - 33 cancer centers - Cancer advocacy organizations - Fundraising, events and benefits to help families, friends and neighbors - Support through local prayer calls and donations

19 Do we have sufficient resources to address cancer disparity? How to target investments? How to use programs that work? How to promote collaboration?

20 Its not the effort What will help us to be more effective?

21 What can we learn from ourselves about doing things better? What can we learn from others states that get better rankings?

22 What can we learn now from our certified cancer registry to help us target our efforts to reduce disparities? Which counties? What cancers? Which genders, ages and races?

23 Cancer is a health disparity for all of Tennessee We need the framework to work together to target and use effective cancer education, risk reduction, prevention, screening, and treatment strategies

24 That is the function of the Tennessee Comprehensive Cancer Control Coalition and State Comprehensive Cancer Plan

25

26 The TCCCC Challenge Who has cancer? Who has cancer? –Which people? –What places? What are the reasons? What are the reasons? –Which types of cancer? –At what steps in cancer continuum? How can we make progress in the fight? How can we make progress in the fight? –What intervention effectively address the issues? –How do gather the resources needed to make a difference?

27 #44 age adjusted all cancer incidence,

28 # 20 age adjusted all cancer incidence, 2005

29 # 3 age adjusted all cancer mortality, 2005

30 # 6 age adjusted all cancer mortality,

31 17.5 % high er Tennessee Male Mortality, 2005

32 10.5 % high er Tennessee Female Mortality, 2005

33 43.3% higher Tennessee Black male mortality, 2005

34 Rate differences for all genders, ages and races, 2005 United States Tennessee 458.4Incidence % higher 184.1Mortality % higher Age adjusted mortality rates per 100,000

35 Rate differences by genders, 2005 United States Tennessee 533.8IncidenceMales % higher Incidence, Females Not higher 226.2MortalityMales % higher 155.4MortalityFemales % higher

36 Tennessee Rate differences by race, 2005 WhitesBlacks 543.9IncidenceMales % higher Incidence Females % lower 260.2MortalityMales % higher 165.2MortalityFemales % higher


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