A colleague of mine offered the following ideas about health disparities. They come from an acute care perspective, but in reality they fit the community health view as well. As my colleague reports: While working on an oncology unit I have heard the stories of many patients and their family members concerning the late stages in which their cancer was found. Often, we wonder and question, "Why did they not seek treatment earlier?" There are many reasons why people do not go immediately to a healthcare professional when something seems wrong: fear, embarrassment, denial. But when the reasons are access, education, money, or racism, there is seemingly also a sense of injustice involved.
Our first inclination in healthcare may be to provide more care and more services for those who are underserved. We could add resources to some of the successful public health programs like the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Children's Health Insurance Program (CHIP). However, the bulletin boards in many community centers and churches provide information for many programs and opportunities. There are even mobile mammogram units that will travel to underserved areas. So, if we look around we may see a good amount of outreach, but there are still many citizens falling through the cracks. A question to ask is why and how do people fall through the cracks in areas where services are available and not used to their full extent possible?
Helping the populations who need many preventive health services and programs is a complex goal. However, the story told by my colleague provides some insight into why one woman did not seek the services she needed. My colleague who raised the question above talks about caring for an African American woman who had metastatic breast cancer. This mother of 3 children had been in an abusive relationship with her husband who was at the time of her diagnosis incarcerated. She worked 3 jobs to provide for her family and could just meet basic needs such as food, clothing, and housing. The luxury of caring for her health was not one she thought she could afford. As long as she could provide for her family and function daily, the issues of preventive care or health promotion were not ones she believed she had time to consider. She had to live her life one day at a time and caring for her self seemed almost like a luxury.
Stories such as these are not uncommon. For this reason, the issue editor, John Higginbotham, has written a compelling foreword. His story about the river and the bucket of water resonated with me. He is correct, in that too often we fail to stop what we are doing and focus on the roots of the problem. Focusing on the root causes of health disparities for the future should be our goal, but we must continue our steadfast work to implement and document the programs and efforts we have now to reach as many people in need as possible.
Public health and other community-based professionals have done an excellent job in providing programs, education, and training to reach those who cannot reach us. You will read about a few of these effective examples in this issue. Also, you will read about issues and concerns involving various types of disparities. It is important that we reflect on the good work our colleagues have done and the efforts that we have made while continuing to reach and strive to accomplish more. For as long as there is one story such as the one above, there is more work to do. Above all, the goal must be to solve the root cause, but some days that may seem like climbing a mountain when really all we think we can do is climb a hill.
Jeanette Lancaster