Derek van Amerongen, MD, MS: If each of you could share 1 or 2 pieces of advice for our listeners in this area of cervical and breast cancer and their role and interaction with racial disparities, what would that be?

Soyini Hawkins, MD, MPH, FACOG: For cervical and breast cancer, I would say that I would encourage our listeners that are going to be, again, diverse, as this panel is, across the board to look at maybe individualizing the way that we’re approaching these population of women. Not specifically that they’re just underserved, or they’re impoverished or they’re uneducated but that they’re unique in their cultural makeup. We know genetically we’re more alike than we are different but there are very important differences that could be accounted for when we build policies or when we think about where we’re putting our research dollars or how we’re building an education pamphlet for patients. When it comes to looking at the disparities and closing that gap in disparities, which we can all agree is extremely important and is going to be where we see a true difference, we need to start to treat these populations as their respective individual populations.

Derek van Amerongen, MD, MS: Excellent advice. Great insight.

Roxie Cannon Wells, MD: I think I would say be intentional and deliberate about looking at disparities, really looking to see what’s there. It’s easy to assume that everything’s going well and there aren’t any issues. But we all know that there are, and the pandemic just shone a glaring light on how [big] the disparities actually are. And when people who are hearing this conversation really think about being deliberate and going out and actually looking for disparities. And then not only looking for disparities, getting data, and then using the data to improve the outcomes for individuals. As I’ve stated before, I just said it, I don’t think the cost of health care will decrease until we start to deal with disparities. Until we start to deal with social determinants of health. We’ve dealt with all sorts of things in trying to decrease the cost of care. But the truth of the matter is, there’s a population of people who are often sicker. They deal with this, what did you call it? Allostatic stress. And it plays a part in their health. We have to really be deliberate and intentional about looking for it. We have to really be deliberate and intentional about thinking about our own biases and actually removing those so that we can move forward and make sure that people have better outcomes.

Sharon Deans, MD, MPH, MBA: I agree 100% with all of the comments. I think cultural competency is essential. Understanding folks’ walk and talk and the everyday American culture and being able to meet them where they are is absolutely essential. And I think again, as I mentioned earlier, should we pull subsets out when we see such profound disease? We make our decisions around screening based on how many people it takes to screen to make 1 diagnosis. In that instance, should we be pulling out some of these separate populations to better understand gastrointestinal cancers in Asian patients, triple-negative breast cancer in African American women? Should we be doing that? I think population health, looking at the numbers, looking at the rural zip codes, looking at the urban zip codes, and understanding who lives there and what their social determinants of health are, is extremely important. At the end of my signatory at work, I have a saying that says, “We are only as rich as our healthiest citizens.” And that’s our commitment on a daily basis, to get to the whole health of each person in their community and make sure folks are safe, that they have access, that they are understood when they get where they’re going. But I think the biggest breakthrough for us that we’ve been pacing through for many years is population health. Being able to… we have amazing data that shows us, that tells us the story, and I’m constantly telling my teams what’s the story the data is telling and how are we going to tell a story differently. With quality, over the course of the years, things have come into play to try to better health care and they have made a difference. Quality is one but it’s just a touch. I want a full program that encircles the entire member. When you get them out of the hospital, you put them back in their community. How do you keep them there? You connect them to a community-based organization that’s culturally competent. When you have diabetes, what can you cook? Because your family will tease you if you eat differently. How do you cook to make it look like what everybody is eating but healthier for you and then healthier for your family? How do you take that message forward? I think cultural competency. I think reversing the subsets, so to speak, and pulling out certain subsets to see if we should be screening them more often, as you said, for colon cancer is extremely important. And then the whole population health snapshot is extremely, extremely important.

Soyini Hawkins, MD, MPH, FACOG: And we have to remember to close the circle. All of these should be measurable outcomes that we are going back and saying these are our ideas and thoughts and what we’d like to implement, and did it work, or do we need to start again?

Sharon Deans, MD, MPH, MBA: Exactly. And I think the other thing is forums like this. Bringing all the different players to the table. The clinicians, the systems, the payer, the community-based organizations, and the state. State code is the federal state code and as you mentioned on policy. And I’m constantly telling my teams this stuff will add up. We’re trying to speak to macro policy. We may not touch it ourselves but the work that we do will speak to that and we’re trying to get to policies that are more equal, that represent more health equity.

Transcript edited for clarity.