Minority health awareness: Change starts with listening

April 27, 2015 | by Abe Rosenberg

Noe Chavez became animated when he recalled the story:

minority health Minority populations face a higher risk of cancer and other diseases than nonminority populations. Ending those disparities starts with listening.

“We were running a health event, screening folks for diabetes,” said the enthusiastic City of Hope population health researcher, “and this man comes over and starts talking to us about the trouble he's having with his eyes. I spoke with him, listened for a while, then I made some calls and found him a doctor. The point is, this guy felt comfortable opening up to us. If we hadn't been there, who knows if he would ever have received the care he needed.”

Although it happened far from California and long before Noe Chavez, Ph.D., arrived at City of Hope to investigate cancer statistics among minority communities, the episode stayed with him, informing much of what he does, not just during April's Minority Health Awareness Month, but 365 days a year.

“Being right there in the community teaches you humility. You learn so much, listening to people's stories, hearing about their needs,” he said.

Chavez and his colleagues at City 0f Hope's Center of Community Alliance for Research & Education (CCARE) are the frontline troops in a broad initiative to understand why minority populations frequently endure higher rates of cancer and other diseases, and to develop programs capable of changing things on the ground.

Poverty, environment and culture play a role

Researchers have known for a long time that poverty, environment, inadequate education and inferior access to nutritious foods or quality medical care all contribute to health disparities in African-American, Latino and other minority communities. “When your number one source for daily food is the liquor store, that's a problem,” said Aria M. Miller, Ph.D., a postdoctoral research fellow at City of Hope. “When your neighborhood abuts a freeway or an industrial complex with all its harmful chemicals and pollutants, that's a problem, too.”

Deep-seated cultural factors also play a role. Many Latino women will put the needs of their family first, delaying treatment of their own symptoms until they become serious. Some, especially the undocumented, hesitate to approach a hospital, fearing that entry into “the system” may expose them and lead to arrest and deportation.

minority health disparities African-Americans often have a deep-seated distrust of the medical establishment. Overcoming this resistance takes time and understanding.

In the African-American community, the concerns are different, but no less compelling.

“Many African-Americans I've met are deeply spiritual and put their faith in God before doctors,” Miller said. “Part of that comes from long-held suspicions. Some folks don't trust doctors and won't confide in them. It goes back to the 1932 Tuskegee study (when blacks with syphilis were denied proper treatment) and earlier, during slavery, when medical people used blacks as guinea pigs.” Miller, who grew up in a middle-class African-American home, remembers sensing that fear in her relatives and friends. “Even today, folks outside the community still don't understand it.”

CCARE works hard to increase awareness and counter deeply-rooted fears that can foster those health inequities. In addition to collecting data in at-risk communities, the program and its researchers publish community-specific educational materials in multiple languages, conduct face-to-face seminars, health fairs, screening services, youth programs and more. To help it all succeed, CCARE taps into the secret weapons already in place: community activists.

“When you access a community's activist network, amazing things happen,” says Kimlin Tam Ashing, Ph.D., CCARE's director. “They know how to get things done, and the community listens to them. They have credibility. Hooking them up with City of Hope enhances that credibility, as well as their prestige in the community, so it's a win-win all around.”

The power within the community

Every community has its movers and shakers. Chavez and others point to the highly successful example of the “promotora” tradition in Latino neighborhoods. Promotoras, generally mothers from the community, have received special health education training and are known and respected as leaders. “They are the change agents,” he says. “They'll organize events. They'll get the healthy food into the school cafeterias. They'll get it done.”

Young people are another group who can help spread messages of health and wellness, Ashing says.

“Whether it's an after-school session, a healthy lifestyle project from our “Eat, Move and Live” program in Duarte, our Teen Nutrition Councils, an alcohol awareness event in Pasadena with Neighbors Acting Together Helping all, whatever it is, we bring the ideas to the teens, and they create their own template, attaching their energy, their tech savvy, their social media creativity to it, and the results are amazing.”

Whatever strategy they employ, CCARE team members usually discover they get far more than they give.

“I wanted to have a bigger impact,” said Miller, who began her career as a bench scientist but switched to community work. “I see every day how this job makes a difference in people's lives.”

Chavez, the first in his family to go to college, took it further:

“Learning about my community,” he said, “activates my identity.”

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