Transcript Addressing disparities - Tennesse Department Of Health

Addressing
disparities
Bruce Behringer
Co-Chair
Tennessee Comprehensive Cancer Control Coalition
Assistant Vice President, Division of Health Sciences
East Tennessee State University
Defining Disparities
… understanding differences in
incidence, prevalence, mortality and
burden of disease and other adverse
conditions in a population group…
Ranked # 44 in ageadjusted
all cancer incidence,
2000-4
Ranked # 20 in age adjusted
all cancer incidence, 2005
Ranked # 6 in ageadjusted
all cancer mortality,
2000-4
Ranked # 3 in age
adjusted
all cancer mortality, 2005
Tennessee Males, 2005
# 13 new cases
# 5 deaths
TN 17.5% higher than US
Tennessee Females, 2005
# 27 new cases
# 4 deaths
TN 10.5 % higher than US
Tennessee Black Cancer
Mortality Disparities are
Dramatic and Devastating
29.1%
higher than white
43.3%
higher than white
Tennessee female mortality, 2005
Tennessee male mortality, 2005
Tennessee’s national cancer
rankings by type of cancer,
2005
All cancers
New cases
# 20
Deaths
#3
Lung
#4
#3
Breast
# 17
#8
Colorectal
# 12
# 10
Prostate
# 36
# 15
Cervix
#6
#6
Melanoma
# 14
# 14
Why did incidence
rate change so
radically from
2000-4 to 2005?
Why is there such
a large difference
in state ranking
between incidence
and mortality?
Why did state
mortality ranking
worsen from
2000-4 to 2005?
The eternal community
questions
Why is there so much
cancer?
Is here any worse than
other places?
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.
Is it time to
acknowledge
Tennessee as a
statewide disparities
population?
Types of issues raised
in disparity research
Is it patient/ population health literacy
OR
Provider/health system cultural
competence?
 Is it lack of access to care in health services
OR
Patient underuse of services, even when
barriers are removed?

Types of issues raised
in disparity research
Is it low use of cancer screening services
OR
Lack of a direct provider recommendation for
screening?
 Is it cultural sense of fatalism about cancer that
resists acceptance of aggressive treatment
OR
Family experience, lack of navigational skills and
community history of poor cancer outcomes?

Types of issues raised
in disparity research
How do population socio-economic factors
INTERACT WITH
Environmental factors as causes of cancer?
 How do health care policies that guide
investments, services reimbursement,
research and quality improvement
DIFFUSE EQUALLY
For the benefit of all providers, populations
and communities?

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
Do we have sufficient
resources to address
cancer disparity?
How to target investments?
How to use programs that work?
How to promote collaboration?
Its not the effort
What will help us to be
more effective?
What can we learn from
ourselves about
doing things better?
What can we learn
from others states that
get better rankings?
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?
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
That is the function of
the Tennessee
Comprehensive Cancer
Control Coalition
and State Comprehensive
Cancer Plan
The TCCCC Challenge

Who has cancer?
– Which people?
– What places?

What are the reasons?
– Which types of cancer?
– At what steps in cancer continuum?

How can we make progress in the fight?
– What intervention effectively address the issues?
– How do gather the resources needed to make a
difference?
age adjusted
all cancer incidence, 2000-4
age adjusted
all cancer incidence, 2005
age adjusted
all cancer mortality, 2005
age adjusted
all cancer mortality, 2000-4
Tennessee Male Mortality, 2005
Tennessee Female Mortality, 2005
43.3%
higher
Tennessee Black male mortality, 2005
Rate differences for all genders,
ages and races, 2005
United States
Tennessee
458.4
Incidence
468.9
2.2% higher
184.1
Mortality
209.6
13.9% higher
Age adjusted mortality rates per 100,000
Rate differences
by genders, 2005
United States
533.8
405.9
226.2
155.4
Tennessee
Incidence
Males
Incidence,
Females
Mortality
Males
Mortality
Females
560.8
5.0% higher
406.5
Not higher
265.9
17.5% higher
171.8
10.5% higher
Tennessee Rate differences
by race, 2005
Whites
543.9
401.1
260.2
165.2
Blacks
Incidence
Males
Incidence
Females
Mortality
Males
Mortality
Females
653.0
20.1% higher
365.7
8.8% lower
373.0
43.3% higher
213.4
29.1% higher