A problem of social injustice pg. 2
That’s a very long list of potential reasons for these disparities and we need to understand which items on that list are in play if we’re going to have effective strategies for coping with the problem.
Freeman: I argue that there are three major factors that cause disparities. And they are, first of all, whether or not people have resources, whether it’s poverty of lack or insurance…
Second… is what I put in the category of culture, meaning the culture as a determinant of lifestyle, attitude and behavior, values, belief systems, communication systems… how people behave including the culture of the caregivers themselves…
Then there’s a third element that overlaps both of those circles which I call social injustice… whether or not people have been treated fairly in the system.
You and colleagues across the country are following hundreds patients with lung and colorectal cancer. How will this help reduce disparities?
We’re nearing the end of the study and I expect over the next year there will be a flurry of publications that begin to address some of these questions.
What impact has patient navigation had on cancer disparities?
Freeman: This is a concept that I invented starting in 1990 at the time I was at Harlem Hospital as director of surgery ...
We had published a paper showing that (of breast cancer) patients who came to Harlem Hospital over a 22 year period ending in 1986… only 39 percent of them were alive at the end of five years, compared to about 70 percent in the country as a whole at that time…
This is a problem throughout the nation related to people who are diagnosed and treated too late… I concluded that barriers to getting through the health care system was a fundamental issue for people who were poor and uninsured, and living in communities such as Harlem.
So we set up a program called patient navigation… (to assure that) when people get a test… they will get rapidly treated. We began to see real dramatic results… In the six-year period ending in 2000, the five-year survival of breast cancer patients at Harlem Hospital was 70 percent, compared to the previous 39 percent.
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