Originally posted in April 2018. This post was last updated on 9/2/20.

April is National Minority Health Month - a time to stimulate greater health education efforts and address health concerns that minority populations face. Fight CRC took time to speak with Dr. Darrell Gray about minority health and colorectal cancer. Dr. Darrell Gray is the Director of Endoscopy and Gastroenterology services at the University Hospital East campus of OSU Wexner Medical Center and the Deputy Director of the Center for Cancer Health Equity within OSU Comprehensive Cancer Center.  He engineered and leads the Provider and Community Engagement (PACE) Program, a nationally-recognized initiative with the goal of achieving health equity in colorectal cancer prevention. Dr. Gray has been recognized for this work with the Molina Healthcare Community Champion award, a National Colorectal Cancer Roundtable 80% by 2018 National Achievement Award, and multiple American College of Gastroenterology awards. He was also inducted into the 2015, 2016, and 2017 classes of Who’s Who in Black Columbus, Columbus Business First Forty Under 40 and National Minority Quality Forum 40 Under 40 Leader in Minority Health, respectively. Yet, Dr. Gray is most proud of his roles as husband to wife Brittney and father to daughters Harper and Ella.

Q. What is National Minority Health Month?

A. National Minority Health Month presents an opportunity to enhance local and national dialogues and commitments to identifying and reducing disparities in health and health care among minority populations. It is an inclusive initiative led by the U.S. Department of Health and Human Services Office of Minority Health that received support from the U.S. Congress in 2002, with a concurrent resolution sponsored by Rep. Donna Christensen (H. Con. Res. 388), that “a National Minority Health and Health Disparities Month should be established to promote educational efforts on the health problems currently facing minorities and other health disparity populations” including but not limited to African Americans, Native Americans, Hispanics, Alaskan Natives, and Asians. This year’s theme is Partnering for Health Equity.

Q. What is health equity?

A. There are multiple definitions for health equity, reflecting a lack of a common understanding. I believe the definition provided by the Robert Wood Johnson Foundation (RWJF) to be one of the most comprehensive. They report:

“Health equity means that everyone has a fair and just opportunity to be healthier. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.”

This is very distinct from equality, as the following graphic from RWJF illustrates:

Q. What health disparities arise as it relates to CRC and CRC screening?

A. Colorectal cancer screening saves lives! It has contributed to a tremendous decline in death rates from colorectal cancer over the past three decades. Unfortunately, colorectal cancer screening rates among some minority populations remains low. Research has demonstrated that barriers among minority populations that lead to low utilization of colorectal cancer screening tests include:

• lack of insurance
• low income
• limited education and health literacy
• geographic isolation
• lack of recommendation for screening by a health care provider
• fear

African Americans have the highest incidence (number of new cases) and mortality (death) rates from colorectal cancer in the nation and tend to present with colorectal cancer at a younger age. Both African Americans and Native Americans tend to have more advanced disease at presentation and poorer cancer-free survival at all stages of disease as compared to other racial and ethnic groups. Furthermore, research suggests that it is not only screening patterns that lead to these disparities. Dietary, environmental, and genetic risk factors play a role as well.

Q. What are some challenges that minority patients face when it comes to treatment, survivorship and follow up care?

A. Navigating treatment, survivorship, and follow-up care can be a challenge for anyone. However, among minority groups, there is a great opportunity to increase participation in clinical trials and biobanking, promote support groups and culturally-appropriate patient and caregiver educational resources, and utilize patient navigators to improve the cancer care continuum from prevention to diagnosis and treatment to survivorship.

Additionally, among the health care providers involved in the care of these patients, there is a great need for cultural competence and implicit bias training. Evidence has shown that minority groups face particular challenges of lack of recommendation for and access to clinical trials and experience differences in how their colorectal cancer is managed medically and surgically. It’s not entirely clear why this is and, certainly, there are both patient and health care provider factors that contribute, but implicit bias -- attitudes and/or stereotypes that unconsciously impact understanding, actions and decisions – and lack of cultural competence contribute.

Q. What are some effective campaigns that aim to improve outcomes for minority patients?

A. There are great examples of public health strategies coming in from all across the nation. There are campaigns engaging all stakeholders - from patients to health care providers to city and state leadership. Multimedia campaigns are:

• spreading awareness of colorectal cancer and the importance of screening
• offering patient navigation services to assist individuals beyond challenges they may otherwise experience along the cancer care continuum and/or
• eliminating cost as a barrier to screening and treatment

One of the most comprehensive state-wide initiatives occurred in Delaware. They initiated a statewide screening program in 2002, cancer care consortium in 2003, and cancer treatment program in 2004 with financial resources and human capital from their governor, legislature, health care community, and community at large. These efforts led to the elimination of the screening disparity between blacks and whites, led to an earlier-stage diagnosis among African Americans, eliminated the racial disparity in incidence of colorectal cancer, and significantly reduced the disparity in death rates.

The National Colorectal Cancer Roundtable launched a campaign, 80% by 2018, in which more than 1,675 organizations have committed to working towards a shared goal of having 80% of the age-eligible individuals across the nation screened for colorectal cancer by 2018. It continues to gain momentum as we move beyond 2018.

Update - 9/2/20: 80% by 2018 has evolved into 80% in Every Community. This is an NCCRT initiative that reemphasizes NCCRT's dedication to partnership, collective action, and the pooling of resources to reach 80% colorectal cancer screening rates nationally. According to their mission, "There are still too many communities with lower colorectal cancer screening rates – rural communities, certain racial and ethnic communities, low income communities. We will continue working to bring down barriers to screening, because everyone deserves to live a life free from colorectal cancer. Our mission isn’t achieved until we see 80% screening rates in every community."

Additionally, there are local efforts that aim to eliminate health disparities in colorectal cancer outcomes. One, example is the Provider and Community Engagement (PACE) Program for Health Equity in Colorectal Cancer Prevention at The Ohio State University (OSU) Wexner Medical Center and OSU Comprehensive Cancer Center.

This is a multidisciplinary initiative that provides low-to-no cost colonoscopies to uninsured and underinsured individuals, interactive educational experiences in diverse communities across central Ohio to promote colorectal cancer prevention and screening, an annual Cancer Disparities Conference for health care providers, researchers, public and allied health professionals, and community organization leadership, and a local media campaign.

Fight CRC and Health Equity

Fight Colorectal Cancer is working hard to increase education around colorectal cancer prevention, treatment, and survivorship across all populations. We are committed to the 80% by 2018 campaign, we lobby on the Hill to remove barriers for colorectal cancer screening, and we work in communities to spread awareness and even offer screening.

As advocates and survivors, it’s important to consider the importance of achieving health equity and what we can all do.

For more information: 

Dr. Edith Mitchell, MAB Member, talks about the importance of diversity in clinical trials

LGBTQ CRC Resources

Can We Fix Racial Gaps in Colorectal Cancer Death Rates?

Fight CRC's Milwaukee Screening Event focused on Minority Health

What is 80% by 2018? Webinar with Mary Doroshenk