Latinos and other people of color face heavy burdens of cancer, diabetes, and more.
These disparities are driven by systemic racism and discrimination that make it harder for people of color than their White peers to get equitable healthcare, education, and more.
That is why Salud America! at UT Health San Antonio is a part of the Collaborative for Anti-Racism and Equity (CARE), a group that provides tools and resources to help people make connections and inform solutions to advance health and racial equity.
As part of this group, we are excited to share a new case study from the Greensboro Health Disparities Collaborative (GHDC).
The GHDC – a group of community leaders, advocates, public health researchers, and healthcare professionals – resolved racial disparities in cancer treatment completion.
“Prior to GHDC’s work, white patients were completing their cancer treatment at a significantly higher rate than Black patients, with a gap of 7 percentage points. To be clear, when it comes to cancer, not completing treatment is fatal,” according to the case study. “This is the little-known story of how this coalition of volunteers, guided by anti-racist principles, community-driven solutions, and authentic partnership, and an unwavering focus on the structural racism at the root of the inequity, got it done.”
Let’s explore the steps GHDC took to make it happen.
1. Build Shared Analysis
The GHDC requires all members to attend anti-racism workshops that offer a historical analysis of the structural and systemic nature of racism, which is present in education, healthcare, the economy, the environment, and other areas.
The case study reports that the training had transformative effects on those who participated.
“[Anti-racism training] really got me to understand that what I had been doing for 20 years was not going to be effective—changing individual knowledge, attitudes, and behaviors was a Band-Aid and not a solution. Instead, what I needed to focus on was systems change,” said Geni Eng, a GHDC member.
GHDC members expressed how building shared analysis through training benefits the collaborative.
“The Collaborative is much more purpose-driven and meaningful about the community it is trying to benefit than what I have seen in professional settings before. Every meeting we were always reminded that African Americans, Black women, were dying,” said Christina Yongue, a GHDC member.
2. Leverage the Expertise of Communities
Community members’ stories and experiences can be valuable.
The GDHC had members participate in a structured storytelling exercise to explore and understand their collective and individual experiences with racism in the healthcare system. They broke into subgroups by racial or ethnic identity.
The exercise found that almost everyone’s lives had been impacted by cancer, specifically breast cancer, either personally, through a family member, or a close friend.
“That means that for GHDC the lived experience of community members is as valuable, and informs the work just as much, as the medical knowledge of the healthcare members or the public health lens of the academic members,” according to the case study. “Therefore, this community expertise was not only at the heart of determining what manifestation of racism would be the focus but also shaped interventions that were developed to solve it.”
3. Bring in the Institution
While the GHDC was able to collaborate with Cone Health Cancer Center, there were difficulties.
“The biggest hurdle was the lack of understanding across the institution that the root cause of the disparities was structural racism,” the case study said.
Focusing on structural racism meant focusing on the systems and policies that lead racism to be baked into an institution.
This doesn’t mean that institutional representatives are bigoted or intentionally provided inequitable care. However, the study reported that GHDC’s focus on the structural racism of the institution left some physicians of that institution feeling as if they were being attacked as individuals.
“Back in 2003, people were not listening to the [entire] phrase ‘systemic racism,’ instead all they heard was the word ‘racism’ and if you used the word ‘racism,’ you were accusing them of being racist,” said Sam Cykert, Collaborative member and professor of Medicine at UNC Chapel Hill.
The GHDC was able to document how structural racism can be so common in day-to-day life that when Black patients were asked if they were treated differently due to their race, most said “No,” unaware that they indeed were receiving worse care than white patients.
Focus groups also showed that there were often delays in hospital communication about care and an insensitivity to the pain for Black patients.
“When thinking about cancer, if the patient didn’t die then for many people it is often seen as a success. But when you dig in, you find out that patients are having drastically different experiences on their cancer journey,” said Kristin Black, assistant professor of health education and promotion at East Carolina University and of the GHDC.
4. Establish Trust
To further trust, the GHDC highlighted the importance of every member being valued regardless of background, race, class, gender, religion, education, and position.
The GHDC achieved this by a “Full Value Contract” that governed its every decision and interaction. Members are required to sign.
The case study emphasized the importance of relationship-building and fellowship.
“We built this family based on conversations,” said Terence “TC” Muhammad, a community activist in Greensboro and co-chair of GHDC.
The study also suggested the concept of sharing a meal, and how that can ultimately bring people together.
“Offering food allows everyone who enters the space to be at the same starting point. As a result, sharing meals together helped build the authentic trusting relationships that are needed for collaborative work to succeed, a strong sense of purpose, and lasting commitment,” according to the case study.
5. Engage with and Learn Through Conflict
Conflict is inevitable.
The GHDC reports that in times of conflict, it should not be ignored. Rather, tension and conflict should be acknowledged, discussed, and examined.
“There needs to be a recognition that conflict is part of the process of coming to an understanding together. You have got to be willing to work through the conflict and having a mechanism to do that is important,” said Jennifer Schaal, GHDC member and member of the board of directors for The Partnership Project.
The GHDC referred to conflict as a “pinch moment” and they practiced it to further establish and normalize transparency.
“GHDC’s longevity despite intermittent conflicts over the years helps illustrate how conflict is often part of transformative work and does not have to be feared by funders. Instead, the ways organizations and collaboratives engage with and learn through conflict can help lay the foundation for more authentic communication and collaboration,” according to the case study.
6. Treat the System
Intervention was designed by the GHDC through partnership with both Cone Health and the University of Pittsburgh Medical Center.
The ACCURE (Accountability for Cancer Care Through Undoing Racism and Equity) project was established to illustrate that an equity-focused intervention could be successful in two significantly different geographical and healthcare settings.
“The intervention was designed to promote the anti-racism principles of transparency and accountability at the community, organizational, and interpersonal levels,” according to the case study.
The intervention had many components at each level including:
- The introduction of health equity training at the institutions.
- Data tracking on care quality disaggregated by patient race in real time.
- Race-specific feedback for providers regarding treatments.
- Nurse navigators who worked to improve communication between the medical center and the patients.
The nurse navigators offered data-informed follow-up to enhance the healthcare system’s accountability to patient needs, served as patient advocates, and took action where needed.
“The ACCURE intervention got results, showing that racial disparities in healthcare could be virtually eliminated,” according to the case study.
The case study reports that prior to ACCURE, white patients were completing their cancer treatments at a significantly higher rate than Black patients, with a gap of approximately 7 percentage points.
“Following the ACCURE intervention, the gap nearly vanished, and completion rates for Black and white patients became similar. Black patients saw a completion rate of 88.4 percent,” according to the case study.
7. Maintain Momentum
The GHDC remains committed to ensuring accountability and sustainability.
The case study found that a successful foundation for future progress requires having a community-based effort, like GHDC, question the status quo, monitor progress, and push the institution to do better.
“Trying to have the system accountable to itself just does not work,” Black said. “Change in Greensboro was enduring because of the relationship the Collaborative established with Cone. That kind of true relationship building that comes first doesn’t happen over weeks or months. Sometimes that takes years while always being clear on why we are together and who the purpose of this work is for. That is how change becomes more sustainable.”
The GHDC hopes to work on “ACCURE 2” and hopes that the ACCURE model could move beyond cancer care to other healthcare disparities and diseases.
The GHDC and its members are also open to expanding their work beyond health disparities and to different minorities, like Latinos.
For additional information and resources, visit the Greensboro Health Disparities Collaborative’s website.
How Can You Take Action?
You can take action in your community!
Racism is a public health crisis. While many people of color face this issue, you can help local leaders declare racism a public health crisis and commit to change.
Download the free action pack, “Create a Meaningful Resolution for Racism as a Public Health Crisis” from the Salud America! Latino health equity national program at UT Health San Antonio.
With this action pack, you can bring awareness to this issue while building support for a resolution to declare racism a public health crisis and take action for more equitable policies and practices. Keep track and draw inspiration from other cities across the country who are adopting resolutions on racism.
Connect with local advocates, draft a resolution, and start a conversation with local leaders!
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