Academic journal article Harvard Journal of African American Public Policy

A Community-Driven and Evidence-Based Approach to Health Policy Development: Reducing Cancer Disparities in Arkansas

Academic journal article Harvard Journal of African American Public Policy

A Community-Driven and Evidence-Based Approach to Health Policy Development: Reducing Cancer Disparities in Arkansas

Article excerpt

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Cancer health disparities continue to plague minority and underserved communities despite scientific advances in cancer care (American Cancer Society 2004). At the root of this problem are two persistent factors. First, evidence-based interventions for cancer prevention and treatment are not reaching the communities that need them most. This issue is often referred to as the "critical disconnect" between cancer research and cancer care delivery (President's Cancer Panel 2001). The science of cancer research has advanced with improvements in survival and quality of life through improved screening tests and sophisticated treatment regimens tailored to specific types of cancer. The challenge is how to ensure that those with the greatest need benefit from these advancements. Second, these communities are often not engaged directly in efforts to elucidate barriers and identify solutions that will improve access to evidence-based cancer care. Public health professionals persist in exploring new approaches to address this problem. Health fares, public screening activities, and church-sponsored outreach programs have collectively contributed to the landscape of multiple approaches aimed at reducing cancer health disparities. Despite the momentum and determination of these approaches, death rates from breast cancer, prostate cancer, and colorectal cancer are still on the rise among minority groups, which are the populations that these interventions have been targeting (American Cancer Society 2004).

BACKGROUND: POLICY AS AN INTERVENTION

Policy is an intervention tool used to impact population health. There is growing recognition of the potential role of public policy strategies as vehicles for reducing cancer risks and improving access to beneficial cancer prevention and treatment services. These strategies often utilize policy instruments such as taxation and regulation to facilitate cancer policy development (Gostin 2001). Policy instruments are vehicles that provide a structured pathway for the successful adoption of key political issues (Gostin 2001). Examples of policy regulation instruments used to impact lung cancer include smoking restrictions and the emergence of smoking bans in areas such as the workplace (Radecki and Brunton 1994; Olive and Ballard 1996). Insurance mandates that require health insurers to cover specified cancer screening and treatment services are another form of policy regulation instrument (Rathore et al. 2000; Bellows et al. 2006).

While policy instruments have been historically used to facilitate cancer policy development, it is important to note that public policies do not always reflect the current evidence base regarding effective cancer prevention and treatment strategies such as those outlined by the U.S. Preventive Services Task Force. The reason for this is that policy decisions are shaped by a variety of forces, most notably the competing interests of health care providers, payers, and consumer advocates (Schauffler 2000). The priorities of these interest groups are not always based on the scientific evidence. Additionally, public policies do not always reflect the needs and values of greatest concern to the populations who are the intended beneficiaries, resulting in policies that produce unresponsive and ineffective outcomes (Schauffler 2000).

An example of this would be mandated benefit policies that require coverage for certain types of cancer screenings but that do not address that portion of the population without health insurance coverage (Mays and Norton 2000).

There may be multiple reasons why people don't have access to or utilize scientific advancements in cancer care. These reasons may be unknown or unobserved by policy makers and are sometimes unstudied by researchers. This increases the need for community involvement to identify the barriers to make sure that polices reflect the real needs of the community. Promoting evidence-based and community-driven policy development for cancer prevention and control requires a better understanding of the processes that determine whether and how cancer-related public policies reach the legislative agenda. …

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