BMS Foundation Working to Improve Minorities’ Access to Healthcare

April is National Minority Health Month in the United States and this year the Department of Health and Human Services has chosen the theme, “Accelerating Health Equity for the Nation.”  The goal is to raise awareness of the health disparities that continue to affect racial and ethnic minorities and to mobilize groups across the nation, like the Bristol-Myers Squibb Foundation, to work with government and other partners to accelerate the realization of health equity – the attainment of the highest level of health for all people (Healthy People 2020).

Ensuring equal access to care and improving health outcomes for racial and ethnic minorities is embedded in the Bristol-Myers Squibb Foundation’s mission and the focus of a broad range of innovative programs receiving Foundation support. The Foundation gives particular attention to groups that have experienced major obstacles to health associated with socio-economic disadvantages and historical and contemporary injustices.

Over the years, Foundation grants have zeroed in on some of the health problems more prevalent among certain populations, such as type 2 diabetes among Native American youth in the American Southwest, lung cancer in African American adults and skin cancer in Latino migrant farmworkers.

Collectively, Foundation-supported programs are finding real solutions to reducing health disparities and improving health outcomes among minorities.

For many programs, part of the solution has been found by tapping into the social and cultural strengths of the community.

Diabetes among Native American youth

Native American youth have the highest and fastest growing prevalence of type 2 diabetes of any racial group in the U.S.; in Arizona and New Mexico, rates are as high as 33.5%. Working with traditional Native American leaders, healers and community health workers from four tribal communities in those two states, the Johns Hopkins Center for American Indian Health (JHCAIH) designed and evaluated a Family Health Coach model to address diabetes among this population.

The program, funded through a grant from the Foundation’s Together on Diabetes® initiative, targeted 250 boys and girls ages 10 to 19 years old at three sites in the Navajo Nation and the White Mountain Apache Nation. All had been diagnosed with diabetes, pre-diabetes or were at high risk of developing the disease.

Trusted members of each tribal community were trained as Family Health Coaches to work with the youth and their families in a year-long project that incorporated certain aspects of Native American culture -- such as eating traditional diets low in fats and processed sugars and high in fruits, vegetables and lean meats and incorporating physical activity into their lives -- to help address the obesity and hypertension frequently associated with the disease.

At the end of one year, HbA1c levels in almost 33% of high-risk participants had decreased and all participants on average had lower body mass index, blood pressure and depression, while overall quality of life had increased.

“The Native American community has a more holistic and less disease-focused view of health than Western society. Consulting traditional members of the communities for insights allowed us to create a strengths-based, culturally relevant program to serve children and their families in the comfort of their homes,” says Alison Barlow, associate director, JHCAIH.

Lung Cancer in African American adults

Community involvement also plays a prominent role in the Georgia Regents University Cancer Center’s cancer-Community Awareness Access Research and Education initiative, known as c-CARE. The pilot program is using community health workers to introduce communities to lung cancer prevention, screening and treatment to reduce the disease burden among African Americans and the medically underserved in the Central Savannah River Area (CSRA) of Georgia.

Although this program focuses on lung cancer, c-CARE educational modules focus on cancers that are either preventable or have the potential to change outcomes if detected early enough, such as lung, breast and colon cancers.

c-CARE works within the unique social and cultural framework of 12 communities in the CSRA with a large minority and poverty-level population. High rates of smoking and industrial exposure have translated into higher than average rates of lung cancer: approximately 500 new cases of lung cancer are diagnosed there every year and about 380 people die from the disease.

The program is primarily a faith-based outreach and education program and uses churches as the pivotal entry point for accessing patients; it is being run at seven African-American churches, four clinics and a large community recreation center.

Through the program, community health workers selected by neighborhood leaders are inviting about 50 of their friends, relatives and neighbors to participate in a four-week program where the health workers present evidence-based, culturally relevant information about lung cancer prevention, screening and diagnosis. This community-based approach reaches a population that might otherwise be unaware of lung cancer screening guidelines and therefore would not seek screening or recognize signs of the disease.

The pilot program, which is still in its early stages, has been conducted at four sites. Although results will not be compiled until the study is complete at the end of the year, many participants have already stopped smoking and been screened for lung cancer. “Our hope is that we will see more people who are at risk of developing lung cancer get screened, and that could lead to earlier diagnoses that will help make treatment more effective,” says Lovoria Williams, PhD, FNP-BC, associate professor, GRU, and principal investigator of the c-CARE lung cancer module.

In Maryland, lung cancer accounts for almost 27% of all cancer deaths. In three counties served by the Anne Arundel Medical Center – Anne Arundel, Calvert and Prince George’s – African Americans make up 18% to 65% of the population and on average, more than 15% are current smokers and more than 18% fall below the poverty line. In addition, Prince George’s has the second largest population of Hispanic and non-English speaking residents in Maryland and an estimated 20% of its residents are uninsured.

The good news is that the lung cancer mortality rate is declining in Maryland, but the bad news is that the incidence of lung cancer has increased, particularly among African Americans.

In 2010 Anne Arundel Medical Center introduced the Rapid Access Chest and Lung Assessment Program (RACLAP), which uses a multidisciplinary rapid assessment team to quickly identify, evaluate and manage patients with abnormal findings on a chest image while keeping in close contact with patients’ primary care providers.

Through Foundation support, Anne Arundel Medical Center is taking a comprehensive approach to provide this continuum of care for low income and minority patients at risk for lung cancer in the three counties.

The program will use community ambassadors to conduct culturally competent education and outreach about smoking cessation and lung cancer screening and will also call on other community partners, including coalitions of physicians and churches, to introduce the program. RACLAP, which has been successful in Anne Arundel County, will expand there and be introduced to a hospital in neighboring Calvert County and later to the community in Prince George’s.

Since RACLAP was implemented five years ago, more than 530 patients have had their lung cancer and other lung conditions expeditiously managed.

“We are taking a multifaceted approach to address this vulnerable and forgotten population that is at risk for developing lung cancer, and bringing it to their community to ensure they will have access to care,” says Cathy Copertino, executive director, Cancer Institute, Anne Arundel Medical Center.

Skin Cancer in Latino Farmworkers

Rates of melanoma have tripled in the U.S. over the past 30 years and migrant farmworkers, exposed to long hours of ultraviolet radiation and pesticides, are at high risk for developing the disease. More than half of U.S. farmworkers are Latino and among those many are migrant workers with poor access to health services and unaware of their risks for skin cancer.

Through funding from the Bristol-Myers Squibb Foundation, Farmworker Justice is developing a culturally competent community mobilization program to raise skin cancer awareness among migrant farmworker populations and provide screening and care in two communities – North San Diego County, California, and Homestead, Florida -- and is bringing together a range of gatekeepers, decision-makers and providers in the effort. The project will reach out to 2,000 farmworkers and their families in the two communities. Nationwide, migrant farmworkers and their families number approximately 4.5 million.

Farmworker Justice has partnered with two community-based organizations. Vista Community Clinic in North San Diego County and Farmworker Association of Florida will help build capacity and develop relationships with a broad array of local collaborators that include comprehensive cancer centers to provide the specialized care that patients may need. Moores Comprehensive Cancer Center, affiliated with the University of California, San Diego, and Sylvester Comprehensive Cancer Center, affiliated with the University of Miami, will serve as clinical treatment partners

Social determinants of health – including income, education and immigration status – are evident in farmworker communities as presenting challenges to accessing and utilizing health care. Farmworker Justice and its partners are training promotores de salud, trusted community health workers, to help address those challenges.

“Promotores lend a level of trust to the project; they have credibility within the community, are accessible and people feel comfortable with them,” says Carlos Ugarte, director, Health Programs, Farmworker Justice. “Migrant farmworkers are a high-risk community that needs support in mobilizing to address skin cancer prevention, and mobilization through community support is a key component of this project.”

In addition to serving the skin cancer prevention needs of farmworkers, the project will inform decision-makers at the local, state and federal levels to advocate for positive changes to better address the challenges that farmworkers face in receiving timely and quality skin cancer prevention services.

To learn more about Bristol-Myers Squibb, go to www.bms.com.