The National Institutes of Health has defined cancer disparities as differences in cancer measures, including screening rates, incidence, and mortality, among certain groups [1]. With regard to describing the gap between the health status of African Americans and Whites, the term health disparity is not new. Health disparities have been studied and documented for decades. In 1899, W. E. B. DuBois documented the “remarkable phenomenon” of disparities among the death rates of African Americans and Whites in his book the Philadelphia Negro: A Social Study [2].
A question that someone may ask is how close have we come in 123 years to eliminating health disparities and establishing health equity? Although many public health and medical professionals have attempted to determine solutions for eliminating cancer disparities, a final review of Healthy People 2020 revealed that the gap in cancer measures between African Americans and Whites remains wide [3]. The health status of African American women, in particular, has not seen drastic improvements, and the significant gap in cancer mortality remains.
The burden of cancer disparities tends to be heavier for African American women who experience a triple threat to their health based on their racial identity, their gender identity, and their limited access to economic resources [4]. As a whole, African American women experience major health issues due to their social status. As Bell Hooks [5] describes, African American women are “not only at the bottom of the occupational ladder, but our overall social status is lower than that of any other group.” Gender, class, race, and sexuality oppression are primary causes of the lack of access to quality health care, in addition to the lack of culturally competent health care providers. Patricia Hill Collins [6] suggests that the three dimensions of oppression that affect African American women’s social status, and in turn their health, are.
-
the exploitation of Black women’s labor that is essential to US capitalism;
-
the denial of African American women the rights and privileges routinely extended to white male citizens;
-
controlling, stereotypical images of Black women that originated during slavery.
The social status of African American women has been impacted by the horrendous wrongs that occurred during slavery [7]. Although chattel slavery was abolished in 1865, African American women still presently feel its impact. Many of the stereotypes of African American women developed from “negative anti-woman mythology” during slavery [8]. These stereotypes still exist in 2022 and have continuously been prevalent throughout mainstream media. As a result of the exposure to these stereotypical images, people have been conditioned to perceive these stereotypes to be true representations of African American womanhood.
These stereotypes are the primary reason that African American women continue to be objectified. The objectification of African American women has affected their ability to improve their social status as a group. While some African American women have been able to maneuver through the system to achieve well-paying jobs and higher-class levels, many African American women continue to be economically exploited. African American women who are economically exploited tend to work labor-intensive jobs that pay menial wages and provide no benefits, such as health insurance. Prolonged economic exploitation leads to chronic stress and significant declines in health.
As stated in the landmark report Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, health care providers’ bias and beliefs in stereotypes play major roles in racial and ethnic disparities in care [9]. The Communication Predicament Model of Aging was developed to illustrate the challenges and dilemmas that older adults have when they attempt to communicate with their younger health care providers [10]. I propose that the Communication Predicament Model can be adapted to illustrate how health care providers’ stereotypes and beliefs impact the health of African American women. Starting with the provider’s encounter with an African American woman, the provider is able to recognize race and gender cues that cause them to develop stereotyped expectations of the patient. Holding stereotyped expectations, without regard to the patient’s actual educational level or economic status, will lead the health care provider to modify their speech and behavior toward the African American woman. In turn, this will lead to constrained opportunities for patient-provider interaction, a loss of personal control and self-esteem of the patient, and overall poorer quality health care. Furthermore, African American women may become reluctant to return to a health care provider that they perceive does not provide them with quality care.
Evidence suggests that racial and gender prejudice that impacts cancer outcomes is still quite prevalent throughout the medical system in the USA [11]. For example, Jacobs et al. [12] found that perceived discrimination was associated with lower rates of Pap testing and mammography among African American women. The difference in provider recommendations for cancer screenings has also been documented in the results of the National Health Interview Study that indicated that a greater proportion of African American women relative to White women reported that their doctor had never suggested mammography (41% versus 28%, respectively). Additionally, several studies have found that there were significant, systematic differences in treatment for breast cancer, cervical cancer, endometrial cancer [13,14,15], and colon cancer between African American patients and White patients [14, 16,17,18,19,20].
Solutions for Narrowing the Gap
Currently, white males dominate the US health care system. However, all hope for improving the cancer disparities among African American women should be not lost because of that fact. Persons of any race can provide culturally competent care. Cultural competence means that a person is aware of their culture and is accepting of other cultures. Cultural competence is not a cultural invasion, by which the provider only sees health care through the lenses of their culture. Culturally competent health care providers understand the needs of all of their patients regardless of race, gender, class, or sexuality. Although many federal and state government agencies and hospitals mandate cultural competency training, such training programs have not proven to be extremely successful at improving cultural sensitivity. A longer-lasting means of creating a culturally competent health care workforce would be to infuse cultural competency in the education curriculum for all people who provide health services.
Furthermore, because health disparities are the result of an interaction between structural factors (social, neighborhood, and environment), institutional factors (access, policies, racial bias), and individual factors (personal, behavior), there need to be interdisciplinary collaborations [21]. Interdisciplinary collaborations will allow for the improvement of all factors that impact the cancer outcomes of African American women.
Due to the lack of African American women in positions of power within the US health care system, systemwide actions need to be taken to ensure that provider prejudice is eliminated. Cancer health equity is possible. However, cancer health equity can only be achieved when culturally competent health care is provided consistently, and all the factors that lead to cancer disparities are adequately addressed.
References
National Cancer Institute: Cancer disparities. https://www.cancer.gov/about-cancer/understanding/disparities (2020). Accessed 8 Feb 2022
Dubois WEB (1899) The Philadelphia Negro: a social study. University of Philadelphia, Philadelphia
National Center for Health Statistics. Healthy People 2020 Progress by Population Group. Healthy People 2020 Final Review 2021
Johnson KA (2000) Uplifting the women and the race: the educational philosophies, and social activism of Anna Julia Cooper and Nannie Helen Burroughs. Garland Pub, New York
Hooks B (1984) Feminist theory from margin to center. South End Press, Boston
Collins PH (2000) Black feminist thought. Routledge Classics, New York
Giddings P (1996) When and where I enter: the impact of Black women on race and sex in America. W. Morrow, New York
hooks b (1981) Ain’t I a woman: Black women and feminism. South End Press, Boston
Smedley BD, Stith AY, Nelson AR, Care. IoMUSCoUaERaEDiH (2003) Unequal treatment: confronting racial and ethnic disparities in health care. National Academy Press, Washington, D.C.
Williams A, Nussbaum JF (2001) Intergenerational communication across the life span. L. Erlbaum, Mahwah
Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT (2017) Structural racism and health inequities in the USA: evidence and interventions. The Lancet 389(10077):1453–1463. https://doi.org/10.1016/S0140-6736(17)30569-X
Jacobs EA, Rathouz PJ, Karavolos K, Everson-Rose SA, Janssen I, Kravitz HM et al (2014) Perceived discrimination is associated with reduced breast and cervical cancer screening: the Study of Women’s Health Across the Nation (SWAN). J Womens Health (Larchmt) 23(2):138–145. https://doi.org/10.1089/jwh.2013.4328
Freedman RA, Virgo KS, He Y, Pavluck AL, Winer EP, Ward EM et al (2011) The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care. Cancer 117(1):180–189. https://doi.org/10.1002/cncr.25542
Hao S, Snyder RA, Irish W, Parikh AA (2021) Association of race and health insurance in treatment disparities of colon cancer: a retrospective analysis utilizing a national population database in the United States. PLoS Med 18(10):e1003842. https://doi.org/10.1371/journal.pmed.1003842
Murphy CC, Harlan LC, Warren JL, Geiger AM (2015) Race and insurance differences in the receipt of adjuvant chemotherapy among patients with stage III colon cancer. J Clin Oncol 33(23):2530–2536. https://doi.org/10.1200/jco.2015.61.3026
Hicks ML, Yap OW, Matthews R, Parham G (2006) Disparities in cervical cancer screening, treatment and outcomes. Ethn Dis 16:S3–63–6
Shavers VL, Brown ML (2002) Racial and ethnic disparities in the receipt of cancer treatment. J Natl Cancer Inst 94(5):334–357. https://doi.org/10.1093/jnci/94.5.334
Singal V, Singal AK, Kuo YF (2012) Racial disparities in treatment for pancreatic cancer and impact on survival: a population-based analysis. J Cancer Res Clin Oncol 138(4):715–722. https://doi.org/10.1007/s00432-012-1156-8
Smedley BD, Stith AY, Nelson AR, Institute of Medicine. Committee on U, Eliminating R, Ethnic Disparities in Health C (2003) Unequal treatment: confronting racial and ethnic disparities in health care. National Academy Press, Washington, D.C.
Yu XQ (2009) Socioeconomic disparities in breast cancer survival: relation to stage at diagnosis, treatment and race. BMC Cancer 9:364. https://doi.org/10.1186/1471-2407-9-364
Wallace BC (ed) (2008) Toward equity in health: a new global approach to health disparities. Springer, New York
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Williams, M.S. Advancing Cancer Health Equity for African American Women. J Canc Educ 37, 241–243 (2022). https://doi.org/10.1007/s13187-022-02152-0
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13187-022-02152-0