The National Cancer Institute makes a run at improving results for the poor

Poverty often means less access to good health care, and therefore worse outcomes than those of the wealthy. Now the National Cancer Institute, part of the National Institutes of Health, has awarded $50 million in grants to establish five new organizations devoted to cancer prevention and care. Federal Drive with Tom Temin got details now from the senior advisor for health disparities, Shobha Srinivasan.

Interview Transcript: 

Tom Temin Well, let’s begin with these centers. First of all, what will they do and where will they be located?

Shobha Srinivasan So there are five centers that are going to see NCI funding. And these centers are located in different states. So many of them are working across many other states. There is one in Texas at MD Anderson Cancer Center. One is located at University of Alabama. Another one at Stanford, which is working with University of San Francisco and the University of California, Davis. And there’s one at Utah at Huntsman Cancer Center that’s working with Montana State, and there’s one in New York with Cornell and Columbia working together on another project.

Tom Temin And the problem they’re trying to solve is what exactly?

Shobha Srinivasan They are trying to address the contextual issues of poverty, which cause really dramatic health disparities and could that have outcomes as it relates to cancer and other health issues.

Tom Temin And what is the mechanism you say contextual causes that means as a result of people being impoverished.

Shobha Srinivasan We talk about social determinants of health. These are the places where people live, work, are born into and live their entire life. And these are the institutions of society that can be changed. And there is more emphasis on the social determinants which are from education to housing to income inequality to discrimination, to kind of like, fair wages to health care services which are not easily available to everybody and equitably available. So these will look at some of these institutional factors that are able to look at all of them together at the same time. We look at some of them and see how they affect health.

Tom Temin And what do we know about cancer? For the people that are impoverished or live in areas about the causes of them, because your income necessarily doesn’t cause cancer, but there are other environmental factors, or is the issue more not getting or contracting cancer but getting care for it that you might be getting in wealthy areas?

Shobha Srinivasan Well, that’s a very good question. But in cancer, I would like to talk with prevention. As they say, an ounce of prevention is worth a pound of cure. So in prevention, it’s an active in prevention services. We have to make them much more embedded within the system. It has to start from childhood. You cannot offer only services at certain points in time, but it is a mentality that it has to be educated. You have to have good housing for that and you have to have a family set up and a social network set up that provides that kind of support to give you the best prevention abilities and facilities. So if you are talking about prevention at a later stage, like, say, breast cancer or colorectal cancer for which they’re screening, it is something which we have to build into the system. And then if you do happen to get cancer because of genetic factors and because of environmental deprivation and kind of other phenotypic issues. We do need to ensure that people have access to care as much as good as everybody else.

Tom Temin And there is another part of HHS far removed from the NCI and the NIH, and that’s called the Health Resources and Services Administration, which oversees pretty well-equipped clinics throughout the nation for people that are otherwise underserved by health care. Is there any chance or thought of coordinating with them to help the people they serve?

Shobha Srinivasan Yes, actually, some of these are working with FQHC, which is federally qualified health centers and primary care clinics and community clinics which work in these impoverished areas. But also, we have to understand that these clinics are not easily accessible to people everywhere. Like if you live on reservations, you have to travel a long distance to get the care that you need. If you live in rural areas, then you know your distances that you travel for this kind of care is quite a bit. So transportation issues, child care issues all these issues will come into play. Right. Whether you can even get time off of work to go and get the care that you need and. How much do you have to pay out of pocket for the kind of care that you’re going to get, which becomes a very big issue.

Tom Temin We’re speaking with Dr. Shobha Srinivasan, senior adviser for health disparities in the Division of Cancer Control and Population Sciences at the National Cancer Institute. And getting back to these five centers that will look at all these things. These are primarily research centers? What will their specific tasks be and what are you looking for as outcomes from these $50 million worth of centers?

Shobha Srinivasan So these are primarily research centers. However, they are working with the community in trying to implement intervention programs that will affect their daily lives and also help address some of the contextual issues. For example, there are projects that are looking at nutrition and physical activity and how to change the built environment so as to make it more plausible and easier for people to undertake physical activity and also find the foods that are nutritious and of value for their health. So these kinds of programs will help them in the long run, at least to improve their health and that way improve cancer outcomes. Or in other states, in California, they’re testing out a guaranteed basic income program. So the project is trying to build off of that and see does that really affect health outcomes and does it, for example, affect colorectal cancer outcomes, which is a highly screened, able, avoidable, treatable disease?

Tom Temin And so how will you measure the effectiveness of what the centers are doing?

Shobha Srinivasan That’s a very good question. So poverty and looking at social determinants of health, this has been a very long running issue. These centers are only funded for a very short while for five years. So this is just a drop in the ocean, a starting point for us to understand if, in fact, we change some of these institutional or structural factors, how can we affect the health of people in the long run? So this is just the beginning. So it is just implementing these programs, looking at how they can be implemented with the community and in working with the community, can we make them sustainable. So there is a generational impact on it. After all, persistent poverty is a generational measure, meaning people in these areas have lived in poverty over 30 years. So we are just talking in cancer to look at these factors and implement changes at that level.

Tom Temin And it sounds like maybe in the course of the research, some of the people in these areas affected just might get sensitized to factors that can affect their lives, such as improving diet for the colorectal area or not smoking or giving up smoking, that kind of thing.

Shobha Srinivasan Yeah. What is actually more important than sensitizing even people, which I think is very important, is also trying to influence local policy with the kind of information, the research that they are doing to show how these kinds of changes positively impact health. So that way we can have local programs, community based programs, rather than just individual based programs, which can affect the health of the entire community. So bring everybody along.

Tom Temin And by the way, these centers, will they look at some of the environmental factors that are known to cause increases in cancer incidences, chemicals in the water supplies and that kind of thing, smoke pollution in the air and so on.

Shobha Srinivasan These centers are not specifically focused on it. However, we do have pilot projects within these centers, which the centers can define depending on what the community sees as important. And if water quality is one of the issues, for example, then that could be a project that these centers could take up with the community partners to address those issues. And that is the beauty of these projects to kind of build on what we know, but also add as we go along to areas of research that we don’t know too much about and which need to be addressed.

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