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Social Determinants of Health

Disparities, Distrust, and the Medical Community

Let’s look at some statistics.

  • During the 1978-79 school year, only 3.1% of medical school enrollees were Black males. When enrollment numbers were gathered for the 2019-20 enrollment period, only 2.9% of those enrolling in medical school were Black males.
  • Black women are three to four times more likely to die from pregnancy-related causes than white women.
  • Black men are 1.8 times more likely to be diagnosed – and 2.2 times more likely to die from – prostate cancer than white men. They are also slightly more likely to be diagnosed with advanced disease.

Did you know? Predominantly Black zip codes are 67% more likely to have a shortage of primary care physicians.

Why do we see these differences? Relying on reasoning that is backed by biology will not help determine the causes of these statistics; a social lens is needed. When looking at health and health outcomes, the social context of a person’s life needs to be taken into great consideration. Health is not just how healthy our cells and organs are; it’s much deeper. Some underlying causes can be linked to the social and community context as well as health care access and quality, two of the five social determinants of health.

What are Social Determinants of Health?

Social determinants of health (SDOH) are the “conditions in the environments where people are born, live, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (Healthy People 2030). Some SDOH include access to nutritious food, racism or discrimination, safe housing/ neighborhoods and language and literacy levels.

Many factors contribute to one’s overall health and many factors lead to health disparities, inequities, and systemic racism, but nearly all of these factors can be traced back through history. These historical and socio-economic issues lead to unequal access to healthcare, disparities in the quality of care, increased negative outcomes, and hesitancy to discuss health issues. In the video below, patient Tony Minter discusses how a lack of conversation about  health has leads to men not knowing about family history, and the need for intentionality discussing prostate cancer.

Distrust and Hesitancy

One of the most well known studies that unethically experimented on Black men is the Tuskegee Syphilis Study which started in 1932. During this experiment about 400 Black men with syphilis were being studied to learn about lasting effects of the disease. Informed consent was never obtained, the purpose of the study was never shared, and the men were not informed that they had syphilis. Instead, they were told they had “bad blood”. The men were falsely told that they were being treated, but no real treatment was actually offered. While the study was taking place, in 1947, penicillin was discovered as a treatment for syphilis. However, the researchers refused to offer this life saving treatment. This experiment lasted until 1972 when it was finally forced to end. This study took advantage of the Black community, inflicted immeasurable harm and led to massive levels of distrust between the Black community and the health and medical community. This distrust is still prevalent today and negatively affects the health and lives of many.

Let’s look at more statistics highlighting distrust. According to recent studies:

  • Only 56% of Black Americans report that they mostly trust their local hospitals and 60% say they trust their doctors most of the time. These are both lower than white Americans who report 70% and 80%, respectively.
  • The race of the medical providers has an effect on levels of trust and likelihood of uptaking services. In one study, Black men elected to receive more preventive services if they met with a Black doctor when compared to those who met with a white doctor. This was more prevalent in services that included blood draws or injections. This is problematic not only because men are choosing to forgo preventative services but also because only 5% of doctors are Black.
  • When seeking care, Black Americans reported that they were refused a test or treatment or a provider didn’t believe them when sharing their symptoms or issues more often than white Americans. In multiple accounts, Blacks have been denied pain medication or had their symptoms linked to drug seeking, no matter the person’s background or past history.

Implicit biases plague all people, influence how people interact with their environment, and are tied to false beliefs. In a study from 2016, 73% of white medical students held at least one false belief about biological differences between races. These beliefs may still be present because in medicine, race is sometimes still taught as being caused by biology or genetics and some tools doctors use to prescribe treatments factor in race. This can lead to Black patients being less likely to get certain drugs, referrals or personalized care. These formulas are used by both doctors and insurance companies.

Another dataset used to guide healthcare is the Surveillance, Epidemiology, and End Results (SEER). This dataset suggests that genetic factors are the main causes for the differences between blacks and whites.

Structural or institutional racism runs deep and providers in healthcare and the medical sector don’t always realize they are participating or part of the problem. Work has been done to bring light to this issue and improvements can be seen, even if they are small and slow moving. In order to save more men from being diagnosed or dying from prostate cancer, the conversations need to continue and providers need to be willing to look inward to ensure they are making the right choices or fueling the inequities.

Lack of Diversity in the Healthcare System

Though the rate of diagnosis of prostate cancer and number of deaths due to the disease are higher among Black men, today’s healthcare system lacks diversity. Diversity in the medical community can allow for a greater level of trust for patients as they may feel as though they have found a provider who understands them and with whom they can identify.

Currently, only 2.1% of practicing urologists self-identify as Black/African American and 2.3% of practicing oncologists self-identify as Black/African American. Increasing diversity in the medical field would enable patients to work with medical professionals who might better understand their cultural and social experiences, resulting in an improved overall patient experience truly meeting the needs of the variety of patients affected by prostate cancer.

Resources

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