Individualized care for specific patient populations Improved outcomes in women’s health
Derek van Amerongen, MD, MS: If each of you could share 1 or 2 pieces of advice for our listeners in this area of cervical and breast cancer and their role and interaction with racial disparities, what would it be?
Soyini Hawkins, MD, MPH, FACOG: For cervical and breast cancer, I would say I would encourage our listeners who will, again, be diverse, as this panel is, across the board to perhaps try to individualize how they approach this female population. Not specifically that they’re just underprivileged, or are impoverished or uneducated, but that they are unique in their cultural makeup. We know that genetically we were more similar than we are different, but there are very important differences that could be explained when we build policies or when we think about where we are putting our research money or how we are building an educational brochure for patients. When it comes to looking at disparities and closing that gap in disparities, which we can all agree on is hugely important and is going to be where we’re going to see a real difference, we need to start treating these populations as their respective individual populations.
Derek van Amerongen, MD, MS: Good advice. Great insight.
Roxie Cannon Wells, MD: I think I would say being intentional and deliberate in looking at disparities, really trying to see what’s there. It’s easy to assume that everything is going well and there are no problems. But we all know there are, and the pandemic has just shed some light on how [big] disparities actually are. And when people hearing this conversation really think they’re being deliberate, go out and actually look for disparity. And then don’t just look for disparities, get data and then use the data to improve outcomes for individuals. As I stated before, I just said it, I don’t think the cost of health care is going to go down until we start addressing inequalities. Until we start dealing with the social determinants of health. We’ve gone through all sorts of things in an effort to reduce the cost of care. But the truth is, there is a population of people who are often sicker. They deal with this, what did you call it? Allostatic stress. And it plays a role in their health. We have to be really deliberate and intentional in looking for it. We have to be really deliberate and intentional about thinking about our biases and actually removing them so we can move forward and make sure people have better outcomes.
Sharon Deans, MD, MPH, MBA: I agree 100% with all comments. I think cultural competence is essential. Understanding the walking and talking people and everyday American culture and being able to meet them where they are is absolutely essential. And I think again, like I said before, should we pull out the subsets when we see such profound disease? We make our screening decisions based on the number of people it takes to screen to make 1 diagnosis. If so, should we extract some of these separate populations to better understand gastrointestinal cancers in Asian patients, triple-negative breast cancer in African American women? Should we do it? I think population health, looking at the numbers, looking at rural postcodes, looking at urban postcodes and understanding who lives there and what their social determinants of health are, is hugely important. At the end of my signer at work, I have a saying that goes: We are only as wealthy as our healthiest citizens. And that’s our day-to-day commitment, to ensure the well-rounded health of every person in your community and to make sure that people are safe, that they have access, that they are understood when they get to where they’re going. But I think the biggest breakthrough for us that we’ve been going through for many years is population health. To be able to have amazing data that shows us, that tells the story to us, and I’m constantly telling my teams what story the data is telling and how we’re going to tell a story differently. With quality, over the years, things have come into play to try and improve healthcare, and they’ve made a difference. Quality is one but it’s just a touch. I want a full program that includes the entire member. When you get them out of the hospital, you put them back into their community. How do you keep them there? You connect them to a culturally competent community-based organization. When you have diabetes, what can you cook? Because your family will make fun of you if you eat differently. How do you cook to make it seem like what everyone eats but healthier for you and therefore healthier for your family? How do you carry that message forward? I am thinking of cultural competence. I think inverting the subsets, so to speak, and pulling out some subsets to see if we should check them more often, as you said, for colon cancer is extremely important. And then the snapshot of the health of the entire population is extremely, extremely important.
Soyini Hawkins, MD, MPH, FACOG: And we have to remember to close the circle. All of these are supposed to be measurable results that we’re going back and saying these are our ideas and thoughts and what we would like to implement, and has that worked or do we have to start over?
Sharon Deans, MD, MPH, MBA: Exactly. And I think the other thing is forums like this. Bringing all the different players to the table. The doctors, the systems, the payer, community based organizations and the state. State code is federal state code and as you mentioned about politics. And I’m constantly telling my teams that these things are going to add up. We’re trying to talk to macro policy. We may not touch it ourselves, but the work we do is going to speak for that and we’re trying to get to more equitable policies, that represent more health equity.
Transcript edited for clarity.
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