1. Reducing Cancer Disparities in Maryland: from Observations to Solutions Jean G. Ford, M.D. Director, Community-based Research Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

2. Eighteen years ago there was a pressing need to focus attention on the particular health problems of the Negro and to concentrate efforts in a national Negro health movement. Today, we know that this movement has been successful…so successful that there is not the same urgency to emphasize separate needs. Rather the trend now is for all groups to work together for mutual welfare. The National Negro Health Week movement has helped materially to gain general acceptance of the idea that “health is everybody's business.” (National Negro Health News, 1950).

3. Overview  Cancer disparities in Maryland  Pathways to disparities  Reducing cancer disparities through community partnership

4. Maryland Cancer Incidence and Mortality, All Sites Combined Race /EthnicityDatesOverall Incidence Overall Mortality African American 1995-1999527.6276.9 White1995-1999492.9210.3 Hispanic/Latino1999284.138.3 Asian/Pacific Islander 1998-1999203.1101.6 American Indian / Alaska Native 1998-1999144.0134.5 Rates are per 100,000 and are adjusted to the 2000 US population Source: Maryland Cancer Registry

5. RaceSTAGE AT DIAGNOSIS Localized (%)Regional (%)Distant (%) MD White 43.320.916.1 MD Black 34.822.719.4 Distribution of New Cancer Cases by Stage at Diagnosis and Race In Maryland Source: Maryland Cancer Registry, 1999

6. Pathways to Cancer Disparities Cancer Physiologic: Altered Susceptibility Behavioral: Health care seeking Genetics Environmental Exposures: Smoking, alcohol, diet, exercise, occupation Cultural Factors Psychologic State Lack of Social Support Ineffective Coping Strategies Medical Care

7. Pathways to Cancer Disparities Cancer Physiologic: Altered Susceptibility Behavioral: Health care seeking Genetics Environmental Exposures: Smoking, alcohol, diet, exercise, occupation Cultural Factors Psychologic State Lack of Social Support/ SES Ineffective Coping Strategies Medical Care Fundamental Social Causes (e.g., discrimination)

8. Age-adjusted Prostate Cancer Rates in Baltimore City, 1999 Per 100,000 population Source: Maryland Cancer Registry, 2002 237 169 77 37

9. Baltimore City: Significant Facts  25% of residents have no health insurance.  African-Americans twice as likely uninsured.  57% of uninsured men age >40 report having no health coverage in over 5 years. Source: City of Baltimore, 2000 Source: Maryland BRFSS, 2001

10. Baltimore City Cancer Plan at Johns Hopkins

11. Plan Overview  Partnership with established local organizations  Identification of community resources – Community-Linked Asset Mapping (CLAM) – Additional partners  Increase community capacity for cancer education and screening (PSA and DRE)

12. Public Health Grant Progress  Total educated20071  Total screened 1101 – FY04 Screening Goal by June 30, 2004 500 – Total screened since July, 2003 (FY04) 200

13. Achieving Sustainability  CLAM (Community-Linked Asset Mapping)  Avon Breast Research and Care Program ($10.1 million)  Development of research agenda

14. Perspective on the Baltimore City Cancer Plan at Johns Hopkins  A model for delivery of health services to a truly hard-to-reach population  Entry point into health care system  Enormous potential for community capacity-building  Further impact through new collaborations

15. How Do We Reduce Cancer Disparities? Cancer Physiologic: Altered Susceptibility Behavioral: Health care seeking Genetics Environmental Exposures: Smoking, alcohol, diet, exercise, occupation Cultural Factors Psychologic State Lack of Social Support/ SES Ineffective Coping Strategies Medical Care Fundamental Social Causes (e.g., discrimination)

16. Necessary Components of a Pathway to Reduce Disparities  Benefit to the community  Mobilization of community resources  Ongoing critical evaluation  Sustained community partnerships are essential