Today is National Cancer Survivors Day. The day is proclaimed an annual celebration of life and, though it is called a national day and mainly is celebrated in the United States, today it is observed all over the globe. On National Cancer Survivors Day, all those who survived cancer, as well as family members, friends, and also medical professionals come together to be thankful and celebrate together. The day also aims to be an inspiration for all those recently diagnosed, as it is possible to live an enjoyable life after a cancer diagnosis.
To increase the number of cancer survivors in Meigs County, health equity must continue to be promoted. Health equity is achieved when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.” Health inequities are reflected in differences in length of life; quality of life; rates of disease, disability, and death; severity of disease; and access to treatment.
According to Poverty and Cancer in Ohio, 2010-2014: Cancer Disparities in Ohio’s Poorest and Most Affluent Counties, Meigs County is one of nine Ohio counties with a poverty rate of 20 percent or more. Poverty is defined as the state of being poor and is related to employment, disability status, educational attainment, type of household, age, sex, race, geography and other factors.
The following is 2010-2014 data from the Ohio Dept. of Health on the cancer burden in Meigs County:
• An average of 137 new invasive cancer cases and 65 deaths occurred each year among Meigs County residents.
• The leading sites/types of cancer incidence in Meigs County were lung/bronchus, female breast, prostate, colon/rectum and bladder representing 55 percent of all invasive cancer cases.
• The leading sites/types of cancer mortality were lung/bronchus, colon/rectum, leukemia, female breast and bladder representing 57 percent of all cancer deaths.
The Centers for Disease Control finds that people with lower socioeconomic status (SES) have higher cancer death rates than those with higher SES. Why? A person’s SES affects his or her ability to get health care. A person with more education is more likely to get a job that pays well and provides health insurance and paid sick leave. People who have higher incomes and health insurance are more likely to get tests that can find cancer early and get the right treatment of cancer is found. So, people with a higher SES often have higher cancer survival rates. People with a low SES are less likely to get cancer screening tests. So, their cancer is often found at a later stage, when it causes symptoms. Even if their cancer is treated, patients are less likely to survive cancer that’s found after it has advanced.
In addition, people with a low income are more likely to do things that give them a higher risk of getting cancer, like smoking cigarettes, eating unhealthy food, not getting enough physical activity, and engaging in risky sexual activity.
Meanwhile, the social and built environments in which a person exists affects their chance of developing cancer. The social environment describes the social conditions in which people work and live. A good social environment helps a person make good decisions, like living a healthy lifestyle. The built environment refers to physical objects like buildings, neighborhoods, cities, and roads. A good built environment has a lot of parks, playgrounds, and sidewalks that make it easy to get exercise. A good built environment also provides transportation that makes it easy for people to go to good jobs and schools, doctors, and stores that sell healthy food. Country (rural) areas like Meigs County are usually spread out, making people more likely to drive cars rather than walk. People who live in the country are more likely to be poor than people who live in cities. So, they are more likely to spend time working than going to the doctor. They also are more likely to treat the health problems they know they have, instead of getting screening tests to find other health problems early or making lifestyle changes to prevent future health problems.
Access to health care services is another barrier for those who live in poverty. Racial and ethnic minorities are less likely to have health insurance, so they may not see a doctor regularly. People who see a doctor regularly are more likely to get cancer screening tests. When doctors advise a patient to get a screening test, the patient usually gets the test, especially if he or she is older or doesn’t go to the doctor often. Generally, patients get better cancer treatment at a hospital that sees a lot of cancer patients, or by a doctor who does a lot of cancer surgeries. Patients treated in low-volume hospitals are more likely to be members of racial or ethnic minorities, live in rural areas, have a low SES, and live far away from a high-volume hospital.
Fear of cancer, perceived cost of care, and lack of physician referral also are common barriers to cancer screening and other preventive services. Health care providers play a critical role in recommending and increasing use of preventive services. Research shows that physician recommendation is a major predictor of receipt of screening.
How does the Meigs County Heath Dept. (MCHD) work to reduce health disparities in cancer?
Improve early detection of cancer through routine mammography, Pap tests, and colorectal cancer screening. The MCHD hosts mobile screening units from The Ohio State University (OSU) and the Ohio University (OU) Heritage College of Osteopathic Medicine Community Health Programs, which offer breast and cervical cancer screenings for women regardless of SES status. The MCHD also refers eligible women to the Southeastern Ohio Breast and Cervical Cancer Project and the Gallia County Health Dept.’s Reproductive Health Program for services and to a regional hospital that provides free or low cost colonoscopies.
Implement evidence-based community interventions to increase screening and modify risk behaviors. The MCHD collaborates with the Meigs County Cancer Initiative, Inc. (MCCI) and OSU to conduct community-based participatory research as well as to offer community interventions such as bringing the educational colon and breast inflatables to Meigs County to increase awareness and early detection and promotion of the HPV vaccine for those aged nine-26-year-old as cancer prevention.
Develop research projects that will encourage minority groups to participate in clinical trials for cancer prevention to ensure that significant differences between minority and ethnic groups are identified and undertake research that will inform decisions about interventions to reduce cancer disparities and improve health. There is a growing need for interventions that are available to people regardless of socioeconomic status or lifestyle behaviors that also addresses the social environment The MCHD is represented on the Community Advisory Board for the Appalachian Translational Research Network consisting of the OSU Center for Clinical and Translational Science and several other academic institutions throughout Appalachian including OU.
Use a variety of media and channels to market cancer information to diverse populations in a variety of settings. The MCHD posts culturally competent information about upcoming health screenings, research studies, and its services on its Facebook and Twitter pages as well as via its website (www.meigs-health.com), in local newspapers and radio television. Staff participate in local events and attend meetings [Get Healthy Meigs! (GHM!), MCCI, etc.] with various stakeholders including, but not limited to cancer survivors, health care and social service providers and community members. The MCHD/MCCI partnered with local cable TV station WJOS to air the Someone You Love: The HPV Epidemic and will present the documentary at the Meigs Public Library (Pomeroy Branch) on June 30 at 1 p.m.
Access to quality cancer care and clinical trials needs to be expanded to ensure that minority groups are provided the same care and access to state-of-the-art technology that patients in major care centers receive. The MCHD collaborates with MCCI to coordinate a transportation assistance program that provides gas vouchers and food gift cards on a monthly basis to any Meigs County resident who receive a cancer diagnosis requiring travel to cancer-related appointments. We also make referrals to the American Cancer Society.
Assist with enhancement of social and built environments. MCHD grant-funded programs provide monies and technical assistance to enhance playgrounds and other recreational areas as well as construction of splash parks. We are currently working with ODOT and other stakeholders on the development of an Active Transportation Plan to improve biking and pedestrian infrastructure within Meigs County. We also work with elected officials to change and implement healthy policies.
Conduct community health assessment (CHA) and community health improvement planning (CHIP). Please visit www.meigs-health.com to view the County’s 2015 CHA and 2017-2022 CHIP, which were compiled by OU and the University of Rio Grande, respectively with assistance from the MCHD and GHM!.
Provide health education and tobacco cessation services.
Assess access to care. The Meigs County Health Department is working with OU’s Appalachian Rural Health Institute on an Access to Care project to understand the availability of health care services to the population; identify populations who experience barriers to health care services and identify gaps in access to health care and barriers to the receipt of care. Please log onto https://ohio.qualtrics.com/jfe/form/SV_eRTQfuvOeF7RQUt to complete a survey before the end of June 2018 to assist us with this project to help you, your family, friends and neighbors. More information can be found at https://www.facebook.com/chsparhi/.
Courtney C. Midkiff, BSC, is the Meigs County Health Department Administrator.