Health disparities exist, and are growing in the United States as the gap between the "have" and the "have-nots" widens. Disparities arise due to inadequate disease awareness, access to screening and treatments, quality of care, and inability to afford treatments.
Health disparities disproportionately affect racial and ethnic populations, the poor, uninsured, and under-insured, as well as rural populations with limited nearby access to specialty care. Described are Dr. Hurlbert’s research into black:white disparities in breast cancer survival, the formation of a city-wide solution the Metropolitan Chicago Breast Cancer Task Force, and recent work addressing challenges diagnosing melanoma in people with darker skin.
A disturbing 2006 report by the Sinai Urban Health Institute in Chicago identified a growing disparity in survival from breast cancer between black and white women of Chicago.
In the 1980s, all women in Chicago experienced similar breast cancer mortality rates. Between the mid 1990’s and 2005, breast cancer mortality rates in white women in Chicago dropped significantly, while mortality rates in black women remained alarmingly high.
Dr. Hurlbert encouraged the medical leaders at public hospitals and universities in Chicago to think big and join together to reduce this city-wide disparity. He also joined together with the leadership of Sinai Urban Health Institute to expand these studies beyond Chicago to the 25- and then 50-largest cities (by population size).
On the interactive map, one can view the breast cancer mortality rates from 2000 to 2014 for both white women and black women in each city.
His work resulted in seminal publications on breast cancer disparities in 2012, 2014, 2016, and 2019. Importantly, the research brought much needed attention to breast cancer disparities in the mainstream media.
Motivated by the alarming data of disparities in breast cancer survival, Dr. Hurlbert was moved to action in trying to help solve the problem. First, at the invitation from the medical leaders at public hospitals and universities in Chicago, he joined them and encouraged them to "think big and join together to reduce this city-wide disparity."
A $1M investment from Avon Foundation and his active participation led to the formation of the Metropolitan Chicago Breast Cancer Task Force.
Learn more: chicagobreastcancer.org/history
The Chicago city-wide effort educated the public, and particularly black women, on the importance of screening and early detection. The Task Force identified mammography screening centers that might not be operating up-to-par and then provided training and education to improve mammography quality.
Next, the Task Force — along with Avon support to each public hospital in the city — trained a network of "patient navigators," a special position dedicated to navigating underserved patients into quality treatment. The multi-hospital network of patient navigators collaborated to improve timeliness and quality of care provided to patients diagnosed with breast cancer, aiming to not let any patient fall through the cracks in the healthcare system.
Dr. Hurlbert inspired and joined in similar city-wide efforts to reduce the black:white breast cancer disparity in Chicago, Boston, Houston, Los Angeles, Memphis, New York, San Francisco, and Washington, D.C. Many of these endeavors continue to this day.
Health disparities exist across many diseases and many types of cancer. In melanoma, disparities in survival exist for people with darker skins of color, particularly black, African American, and Hispanic populations.
In melanoma, the problem is multi-factorial. First, there is lack of sufficient awareness among the general population that "yes, dark skin people can get melanoma." There's also a lack of research into the risk factors and causes of melanoma in people with darker skin of color. Again, a lack of public education and awareness targeting all populations.
Disparities in melanoma detection and treatment also play a significant role. Dermatologists are trained looking for skin abnormalities in white skin. A young medical student in London took it upon himself to develop a new handbook to train doctors in skin of color.
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