LAUSR

F AT C A M E R A / G E TT Y A 60-year-old, uninsured African American woman from Chicago found a lump in her breast and went to the emergency room. What happened next, researchers say, had much less to do with the woman’s biology than her location. A 2019 case study documented how the local health care system failed the woman at multiple points, from an initial misdiagnosis to a lack of follow-up to a lumpectomy and recommended mastectomy that came without clear communication or a referral to an oncologist.1 African American women are roughly 2-fold more likely to die of breast cancer than white women according to the National Cancer Institute. Other significant racial disparities have been documented for melanoma, stomach cancer, colorectal cancer, prostate cancer, and cervical cancer, among others. Until recently, many researchers viewed race as a biological lens through which the disparities could be explained. Growing partnerships between medical and social scientists are instead strongly suggesting that the predominant risk factors are rooted not in biological differences but rather in deeply ingrained social inequities such as structural racism. “People think of racism as interpersonal, which it can be, or as being unconscious, as it can be,” says David Ansell, MD, MPH, senior vice president for community health equity at Rush University Medical Center in Chicago, Illinois, and a coauthor of the case study. “But what we’re talking about is that it’s structural: It’s actually designed into the way we do our daily work and daily business.” Chicago’s Center for Community Health Equity, a partnership between Rush University Medical Center and DePaul University, is pairing medical researchers with social scientists to take a more holistic approach to identifying and removing barriers to care. A collaborative approach, Dr. Ansell says, can help to zero in on often invisible but important variables such as differences in the quality of care by race. In addition, poverty and isolation can knock out critical social supports that help patients to get through medical treatments. “We think place really makes a difference here, so it’s not just poverty, it’s location,” Dr. Ansell says. For minority communities, one key difference is the way in which poverty is concentrated within specific neighborhoods. In Chicago, he says, women who are poor, are minorities, or are on public insurance are 40% less likely to live near a breast-imaging center of excellence than their white counterparts. Instead, hospitals and clinics that serve minority neighborhoods are often underfunded and unable to keep up with advances or new recommendations. Because the patient population is overwhelmingly black, they tend to bear the burden of the “inequality in quality,” Dr. Ansell says.