Tackling Disparities

Transcript

00:00 --> 00:01Funding for Yale Cancer Answers
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00:03 --> 00:05Hospital and Astra Zeneca.
00:07 --> 00:09Welcome to Yale Cancer Answers with
00:09 --> 00:11your host doctor Anees Chagpar.
00:11 --> 00:13Yale Cancer Answers features the
00:13 --> 00:16latest information on cancer care by
00:16 --> 00:17welcoming oncologists and specialists
00:17 --> 00:19who are on the forefront of the
00:19 --> 00:21battle to fight cancer. This week,
00:21 --> 00:23it's a conversation about
00:23 --> 00:25addressing disparities in oncology
00:25 --> 00:26with Doctor Andrea Silber.
00:26 --> 00:28Dr Silber is a professor of
00:28 --> 00:29clinical medicine and medical
00:29 --> 00:31oncology at the Yale School of
00:31 --> 00:33Medicine where Doctor Chagpar is
00:33 --> 00:35a professor of surgical oncology.
00:36 --> 00:38Andrea, maybe we can start off by
00:38 --> 00:40you telling us a little bit about
00:40 --> 00:42yourself and how you got interested
00:42 --> 00:44in disparities to begin with.
00:44 --> 00:49Well, it's really started at age 16.
00:49 --> 00:51If I could predict what I would do in
00:51 --> 00:53medicine, it would have been disparities.
00:56 --> 00:58When I was in medical school,
00:58 --> 01:01you learned how to practice medicine.
01:01 --> 01:05Generally, from people who may not have
01:05 --> 01:08the best insurance or at that time
01:08 --> 01:11certainly didn't have private doctors,
01:11 --> 01:14and I noticed all sorts of things
01:14 --> 01:17growing up in New York City about.
01:17 --> 01:19People who didn't have access
01:19 --> 01:22to the best medical care when I
01:22 --> 01:24became interested in oncology,
01:24 --> 01:27I said this is what I want to do.
01:27 --> 01:31I want to see if there are ways to
01:31 --> 01:34improve healthcare around Uncle Logic.
01:34 --> 01:39Diseases and with a special attention
01:39 --> 01:42to those who traditionally don't
01:42 --> 01:44receive the best healthcare.
01:45 --> 01:47So you know, Andrea,
01:47 --> 01:49I think this topic is particularly
01:49 --> 01:52poignant now in the social and political
01:52 --> 01:54climate that we're currently in,
01:54 --> 01:58where many of us are becoming even
01:58 --> 02:01more acutely aware of systemic.
02:01 --> 02:03Biases, inequities,
02:03 --> 02:06disparities that exist.
02:06 --> 02:08So how much of this difference in
02:08 --> 02:11access that you talk about these
02:11 --> 02:14disparities that you see in medicine are
02:14 --> 02:18related to socioeconomic differences?
02:18 --> 02:21How much of it is intrinsic
02:21 --> 02:24bias and how much of it is
02:24 --> 02:26actual genetic variability?
02:27 --> 02:30That's a. You know that is the
02:30 --> 02:33question I would like to tackle.
02:33 --> 02:36The last point you made first,
02:36 --> 02:40I think we should stay away from
02:40 --> 02:43talking about genetics unless that is
02:43 --> 02:46a special field of someone's interest.
02:46 --> 02:49So many of the problems that we
02:49 --> 02:53see maybe just due to socioeconomic
02:53 --> 02:57factors and bias and racism in the
02:57 --> 03:00healthcare system that had been.
03:00 --> 03:03Pressing for a long time when
03:03 --> 03:05you start talking about genetics,
03:05 --> 03:07you may get into epigenetics,
03:07 --> 03:14or in specific kind of genomic factors, but.
03:14 --> 03:17I think the idea that certain tumors
03:17 --> 03:20in people of color are inherently
03:20 --> 03:24not able to do well due to genetic
03:24 --> 03:26differences is a very simplistic
03:26 --> 03:30way of looking at a very complicated
03:30 --> 03:34health system that has long provided
03:34 --> 03:37perhaps suboptimal care,
03:37 --> 03:40and so you know as you think about
03:40 --> 03:42the kind of wish that you had when
03:42 --> 03:45you got into medical school and
03:45 --> 03:47when you got into oncology too.
03:47 --> 03:49Address some of these disparities
03:49 --> 03:51talk a little bit more about
03:51 --> 03:53how you envision doing that,
03:53 --> 03:56because as you say, it is multifactorial.
03:56 --> 03:58I do, you know,
03:58 --> 04:01when I got interested in this,
04:01 --> 04:04there wasn't even a term health disparities,
04:04 --> 04:07but what can see very obvious things?
04:07 --> 04:09First of all, geographic factors if
04:09 --> 04:12people don't live near a good hospital
04:12 --> 04:15if they don't live in a place with
04:15 --> 04:18good transportation system, they are.
04:18 --> 04:21Going to be subjected to.
04:21 --> 04:24Inadequate care or,
04:24 --> 04:27or less optimal suboptimal care.
04:27 --> 04:30So we start out with geography,
04:30 --> 04:33urban versus rural.
04:33 --> 04:37Both groups have problems where poor
04:37 --> 04:41people and urban areas and poor people in
04:41 --> 04:45rural areas will not get the same care.
04:45 --> 04:48This may be a transportation issue.
04:48 --> 04:52This may be an exposures issue.
04:52 --> 04:56Both those things will affect cancer care.
04:56 --> 05:00Cancer Care has to be delivered in a
05:00 --> 05:03timely fashion with experienced health
05:03 --> 05:07care providers in order to work smoothly.
05:07 --> 05:10And those are the kinds of
05:10 --> 05:12things I thought about now.
05:12 --> 05:15Why can we not have health care
05:15 --> 05:17delivered to the communities
05:17 --> 05:22that are most burdened by cancer?
05:22 --> 05:24For outcomes,
05:24 --> 05:28that's a health systems delivery issue,
05:28 --> 05:30so those are some of the things,
05:30 --> 05:34but it also starts out with the kind of
05:34 --> 05:38care that people receive at very young ages.
05:38 --> 05:39For example,
05:39 --> 05:42if you've poured dental care or you
05:42 --> 05:45have diabetes when your cancer is
05:45 --> 05:48diagnosed and starts start the treatment,
05:48 --> 05:51you're going to perhaps not
05:51 --> 05:53have the same dose.
05:53 --> 05:56Delivery of chemotherapy due
05:56 --> 05:58to increased infections.
05:58 --> 05:58Well,
05:58 --> 06:00these things start out when
06:00 --> 06:01people are children.
06:01 --> 06:04Dental care and obesity,
06:04 --> 06:08which can predispose to cancer,
06:08 --> 06:10also predispose to diabetes.
06:10 --> 06:12These things really start
06:12 --> 06:14out with pediatric care.
06:15 --> 06:18So you know there's a lot to unpack there,
06:18 --> 06:20but let's start with the
06:20 --> 06:20geographic differences.
06:20 --> 06:23One of the things that struck me as
06:23 --> 06:25you were talking about geography
06:25 --> 06:29or urban versus rural is that.
06:29 --> 06:30When people think,
06:30 --> 06:32generally speaking about disparities,
06:32 --> 06:34we often think about racial
06:34 --> 06:35and ethnic disparities.
06:35 --> 06:37But here you're really talking about
06:37 --> 06:42geographic disparities that cut across.
06:42 --> 06:44Racial and ethnic boundaries is that right?
06:45 --> 06:49That's true. I mean, both things exist.
06:49 --> 06:51I would never say there are not
06:51 --> 06:52racial and ethnic disparities.
06:52 --> 06:56But for example, people who have cancer
06:56 --> 06:59in Appalachia have worse outcomes,
06:59 --> 07:01even though we're talking
07:01 --> 07:03about mainly poor whites.
07:03 --> 07:05So it's not only ethnic,
07:05 --> 07:07it's not only racial.
07:07 --> 07:10But when you talk about Hispanics,
07:10 --> 07:12you may have language.
07:12 --> 07:15Difference is you may have poor
07:16 --> 07:19insurance coverage that really explains
07:19 --> 07:23a lot of the disparities that we see.
07:23 --> 07:24For example, in his spirit,
07:24 --> 07:27Hispanics in the United States.
07:27 --> 07:31They may have a lower incidence of some
07:31 --> 07:34cancers than other populations due to.
07:34 --> 07:36Probably better diet,
07:36 --> 07:41but if they don't have insurance
07:41 --> 07:45if they don't have access to.
07:45 --> 07:49Instructions in their native language,
07:49 --> 07:50they're going to have disparities
07:50 --> 07:52on the other end,
07:52 --> 07:56so it really is a multi tiered
07:56 --> 08:00problem and it can cut across
08:00 --> 08:03racial and ethnic groups.
08:04 --> 08:08And so when we think about those geographic
08:08 --> 08:11disparities just to kind of dig into
08:11 --> 08:13that particular bucket to begin with,
08:13 --> 08:16you know one can think about some of the.
08:16 --> 08:17Potential solutions to
08:17 --> 08:20solving some of those issues,
08:20 --> 08:22and I want to get your take on some of them.
08:22 --> 08:26So for example, you know have people
08:26 --> 08:28looked at providing transportation
08:28 --> 08:31as a way of mitigating those
08:31 --> 08:34disparities or building quality
08:34 --> 08:37health resources in rural communities?
08:37 --> 08:40Or did you find that particularly
08:40 --> 08:43during the COVID-19 pandemic when
08:43 --> 08:46many services moved to telemedicine?
08:46 --> 08:48That that really helped with some
08:48 --> 08:50of those geographic disparities.
08:50 --> 08:52Talk to us a little bit about some
08:52 --> 08:54of the the solutions that you see,
08:54 --> 08:57or potentially some of the things
08:57 --> 09:00to be concerned about when thinking
09:00 --> 09:01about solutions.
09:01 --> 09:04I, I think all the things that you
09:04 --> 09:07just discussed are on the table.
09:07 --> 09:09It's not as simple as
09:09 --> 09:10providing transportation.
09:10 --> 09:14For example, if you have radiation delivered.
09:14 --> 09:17Four or five hours away from
09:17 --> 09:20where the patient lives,
09:20 --> 09:23even if you have transportation,
09:23 --> 09:27it's not possible to have someone
09:27 --> 09:29transported for daily treatments,
09:29 --> 09:33so I think there is definitely a
09:33 --> 09:35push towards decentralization of
09:35 --> 09:39cancer care as a way of making sure
09:39 --> 09:42that everyone can get quality care
09:42 --> 09:45and it's not going to be limited
09:45 --> 09:47by transportation difficulties.
09:47 --> 09:52Then I think COVID has provided us with
09:52 --> 09:58so many new avenues to deliver better care.
09:58 --> 10:01Is it really necessary for someone to
10:01 --> 10:05come in once a week to be examined?
10:05 --> 10:06Probably not.
10:06 --> 10:12We now have a Tele visits or video visits.
10:12 --> 10:15I do some video visits as part of
10:15 --> 10:18my regular practice for people that.
10:18 --> 10:23Or perhaps mobility impaired or
10:23 --> 10:25don't have transportation because so
10:25 --> 10:30much of what we do in medicine is
10:30 --> 10:33really by obtaining history and not
10:33 --> 10:35physical examination clinical trials.
10:35 --> 10:38That's a whole nuther area.
10:38 --> 10:40They are so labor intensive.
10:40 --> 10:44One of my real interests is trying to
10:44 --> 10:47increase inclusivity in clinical trials.
10:47 --> 10:47Well,
10:47 --> 10:49if you make a working person.
10:49 --> 10:53Come in once a week to see a physician
10:53 --> 10:57when they need to still have a job.
10:57 --> 11:00You're saying it can't happen,
11:00 --> 11:01but with telemedicine,
11:01 --> 11:04if we incorporate that into
11:04 --> 11:06some clinical trials,
11:06 --> 11:09there's no reason for someone to come in.
11:09 --> 11:12If they've had CAT scans a day before,
11:12 --> 11:14what am I going to find an exam
11:14 --> 11:17that they didn't find on the scans?
11:17 --> 11:20So there's so much redundancy?
11:20 --> 11:23And I would say misappropriation
11:23 --> 11:26of our resources so certain areas
11:26 --> 11:28are under resourced.
11:28 --> 11:30But there are also certain areas
11:30 --> 11:33that are over resourced and we really
11:33 --> 11:36by equitable distribution and by
11:36 --> 11:40using some of our new technology
11:40 --> 11:44we have many avenues to really
11:44 --> 11:46level the playing field.
11:47 --> 11:50Yeah, you know, you can certainly see how
11:50 --> 11:53telemedicine has revolutionized that,
11:53 --> 11:56but I think you know the one potential
11:56 --> 11:59Thorn in the side of telemedicine is lack
11:59 --> 12:03of access to the basics of telemedicine,
12:03 --> 12:06so populations who may not have
12:06 --> 12:09access to a computer or may not
12:09 --> 12:11have access to the Internet.
12:11 --> 12:14Have you found that that has
12:14 --> 12:16exacerbated disparities in in
12:16 --> 12:18the setting of telemedicine?
12:19 --> 12:21You know there's this whole digital divide.
12:21 --> 12:25We're lucky in the state of Connecticut
12:25 --> 12:28that I think at a very high level
12:28 --> 12:31that was looked at early on in
12:31 --> 12:33COVID to try to provide broadband
12:33 --> 12:37access to underserved communities.
12:37 --> 12:39That's not true in every state,
12:39 --> 12:41but that doesn't mean it can't
12:41 --> 12:43be true in every state.
12:43 --> 12:47And I am amazed at how many people,
12:47 --> 12:50even if they don't have a computer.
12:50 --> 12:53They may have a smartphone,
12:53 --> 12:56or they may have a grandchild
12:56 --> 12:58with a smartphone.
12:58 --> 13:01Younger, younger people are a
13:01 --> 13:04great resource in helping their
13:04 --> 13:07elderly relatives get through a
13:07 --> 13:11visit and I am really impressed
13:11 --> 13:14when we first started doing this.
13:14 --> 13:16It was very,
13:16 --> 13:18very difficult for many people and they
13:19 --> 13:22would say can we just do a telephone
13:22 --> 13:25visit instead and people have for you know,
13:25 --> 13:28really upped their game.
13:28 --> 13:31Whether it's with help of family members.
13:31 --> 13:31With smartphones,
13:31 --> 13:34I think our own staff and I'm not
13:34 --> 13:36talking about the medical staff.
13:36 --> 13:38I'm talking about the support staff.
13:38 --> 13:41They are amazing and being
13:41 --> 13:44able to talk people.
13:44 --> 13:46Through getting on a video visit
13:46 --> 13:49and you know the access doesn't
13:49 --> 13:51have to be a Mac computer,
13:51 --> 13:53it really can be a cell phone.
13:54 --> 13:57Yeah, yeah, so lots to talk about in
13:57 --> 13:59terms of disparities in oncology,
13:59 --> 14:01we have to take a short
14:01 --> 14:03break for a medical minute,
14:03 --> 14:04but please stay tuned to learn
14:04 --> 14:06more with my guest Doctor.
14:06 --> 14:07Andrea Silber.
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15:14 --> 15:15Welcome
15:15 --> 15:17back to Yale Cancer answers.
15:17 --> 15:18This is doctor in East Tag Park
15:18 --> 15:20and I'm joined tonight by my
15:20 --> 15:22guest doctor Andrea Silber.
15:22 --> 15:25We're learning more about her work in
15:25 --> 15:27tackling disparities and oncology,
15:27 --> 15:28and right before the break,
15:28 --> 15:31Andrea, we were talking a lot
15:31 --> 15:32about geographic disparities.
15:32 --> 15:35The fact that you know where you live,
15:35 --> 15:38whether in a rural center or an urban center,
15:38 --> 15:42can really impact your care.
15:42 --> 15:44The other thing that I think
15:44 --> 15:45has been well studied, and.
15:45 --> 15:47And maybe you could address this further.
15:47 --> 15:51Is socioeconomics really does play a
15:51 --> 15:54critical role in whether that is add
15:54 --> 15:57mixed in with race and ethnicity,
15:57 --> 16:01whether that is mixed in with geography,
16:01 --> 16:04war insurance status,
16:04 --> 16:08educational status, immigration status,
16:08 --> 16:12let that a lot of health care,
16:12 --> 16:15access and quality has to do with your.
16:15 --> 16:18Pocketbook talk a little bit about that,
16:18 --> 16:22and the effect that socioeconomic
16:22 --> 16:25status has on people's health,
16:25 --> 16:27and perhaps what's been what people
16:27 --> 16:29are thinking about doing about
16:29 --> 16:33that. Well, there are so many
16:33 --> 16:36ways that socioeconomic status
16:36 --> 16:38really determines health.
16:38 --> 16:42We can see that your ZIP code where
16:42 --> 16:46you live is one of the biggest
16:46 --> 16:48prognostic factors for how you're
16:48 --> 16:51going to do with your cancer care,
16:51 --> 16:56and people who live in poor housing.
16:56 --> 16:59If you move them to a different neighborhood,
16:59 --> 17:01they have a better prognosis,
17:01 --> 17:04and that has been looked at. Uhm?
17:04 --> 17:07You can look at other things.
17:07 --> 17:09Correlation between credit score
17:09 --> 17:14and how someone does with cancer.
17:14 --> 17:16So I think it's well known and
17:16 --> 17:18in many ways just obvious.
17:18 --> 17:22Poorer people do not do better who do not
17:22 --> 17:26do as well with their cancer outcomes.
17:26 --> 17:29But let's talk a little bit more
17:29 --> 17:33about what can happen with that if
17:33 --> 17:36you look across the United States.
17:36 --> 17:41The states that do not have good access
17:41 --> 17:47to Medicaid or to what is called Obamacare.
17:47 --> 17:48Statistically,
17:48 --> 17:52they have a worse cancer burden
17:52 --> 17:54and worse outcomes.
17:54 --> 18:00So one fix would be to make sure that every
18:00 --> 18:06state has equal access to Medicaid and.
18:06 --> 18:09Low cost health care.
18:09 --> 18:12I don't know whether that's going to happen,
18:12 --> 18:17but it really is something that
18:17 --> 18:20would change the landscape.
18:20 --> 18:23In terms of immigration status,
18:23 --> 18:27that's a hard one because we know
18:27 --> 18:29people who are undocumented do
18:29 --> 18:33not have the same access to care,
18:33 --> 18:37but the other things in terms of
18:37 --> 18:39socioeconomic status that doesn't
18:39 --> 18:41have to do with insurance,
18:41 --> 18:45it has to do with how people live.
18:45 --> 18:48Poor people do not have the
18:48 --> 18:50same access to good healthy.
18:50 --> 18:52Diets to exercise.
18:52 --> 18:58We know obesity is a strong risk
18:58 --> 19:01factor for many kinds of cancer.
19:01 --> 19:03So if we don't provide good diets
19:03 --> 19:07if we don't provide exercise
19:07 --> 19:11opportunities to poor children,
19:11 --> 19:13poor adults,
19:13 --> 19:15we are going to see it downstream
19:15 --> 19:18in the kinds of cancers we have,
19:18 --> 19:20so these are different kinds of.
19:20 --> 19:23Programs and I know we talked
19:23 --> 19:25in the beginning a little bit
19:25 --> 19:27about race and ethnicity,
19:27 --> 19:30but there is certainly a lot
19:30 --> 19:33of work that shows that we have
19:33 --> 19:36a health care system where the
19:36 --> 19:39providers are mainly white.
19:39 --> 19:42And the poor patients that we see
19:42 --> 19:45are often people of color.
19:45 --> 19:48And we have to change that to
19:48 --> 19:51make health systems to try to
19:51 --> 19:54reduce the bias that is there.
19:54 --> 19:58We can find studies that show that
19:58 --> 20:01white providers are less likely to
20:01 --> 20:04spend the same amount of time with
20:04 --> 20:07black patients or when you get into
20:07 --> 20:12an area like cancer where it's very,
20:12 --> 20:14very complicated.
20:14 --> 20:16Treatments are complicated.
20:16 --> 20:19EXPLANATIONS are complicated.
20:19 --> 20:24We need to have something to allow
20:24 --> 20:27everyone to understand.
20:27 --> 20:30What is happening to their bodies
20:30 --> 20:36when I see someone from a socio
20:36 --> 20:38economically depressed background?
20:38 --> 20:43I try to think how can I explain things
20:43 --> 20:46in a way that everyone understands?
20:46 --> 20:47Well,
20:47 --> 20:51that takes time and our time in
20:51 --> 20:54the healthcare system is money.
20:54 --> 20:56I think that's one way that
20:56 --> 20:58this kind of work is somewhat.
20:58 --> 21:02Disincentivized because.
21:02 --> 21:04Providers are evaluated in
21:04 --> 21:06various healthcare systems by
21:06 --> 21:09how many patients they see.
21:09 --> 21:12Well, if they see a patient who
21:12 --> 21:14maybe isn't medically sophisticated,
21:14 --> 21:17it may take a longer time to
21:17 --> 21:20explain the treatment to explain
21:20 --> 21:22to people what is cancer?
21:22 --> 21:24I I tell people, you know when
21:24 --> 21:27I say I'm a medical oncologist.
21:27 --> 21:30Not everyone knows what that means.
21:30 --> 21:33It takes time because it is important.
21:33 --> 21:35To our health care system that
21:35 --> 21:37we do deliver equitable care,
21:37 --> 21:39but that's not true for every
21:39 --> 21:40health care system.
21:40 --> 21:43I almost think that someone who
21:43 --> 21:45is not health literate they should
21:45 --> 21:48have a qualifier for billing
21:48 --> 21:50purposes to make sure that people
21:50 --> 21:53get the time they need and that
21:53 --> 21:55the providers who do that kind of
21:55 --> 21:57work are not penalized for doing
21:57 --> 22:00the right thing by a patient.
22:00 --> 22:00So
22:00 --> 22:03so, again, lots lots to dig into.
22:03 --> 22:06I think the first issue is
22:06 --> 22:07with regards to insurance.
22:07 --> 22:12You mentioned that the states that
22:12 --> 22:16don't have Medicaid or don't have
22:16 --> 22:19Obamacare tend to have worse outcomes.
22:19 --> 22:22I wonder whether that's because
22:22 --> 22:25those states may have a higher
22:25 --> 22:30proportion of individuals who may be,
22:30 --> 22:34you know, working class.
22:34 --> 22:38Blue collar workers who don't
22:38 --> 22:41support you know expansion of of
22:41 --> 22:44social programs in that way who
22:44 --> 22:47may lean a little bit more towards
22:47 --> 22:50the right of the political aisle.
22:50 --> 22:53So how much of that do you
22:53 --> 22:56think is driven by the fact that
22:56 --> 22:58having universal coverage,
22:58 --> 23:01health care coverage?
23:01 --> 23:03Is provided how much of the outcome
23:03 --> 23:06is due to that versus how much of the
23:06 --> 23:09outcome is due to the fact that these
23:09 --> 23:12people may be just by virtue of being,
23:12 --> 23:14you know, a little bit poorer,
23:14 --> 23:16a little bit less educated.
23:16 --> 23:18How much of it is that and
23:18 --> 23:19not mediated by the insurance
23:19 --> 23:21coverage in and of itself?
23:21 --> 23:24I think the insurance
23:24 --> 23:27coverage is the major issue.
23:27 --> 23:31Yes, there may be political differences
23:31 --> 23:33or educational differences.
23:33 --> 23:38But the insurance. Is so.
23:38 --> 23:42Out of reach for many people,
23:42 --> 23:45even with great insurance,
23:45 --> 23:49cancer can bankrupt anybody.
23:49 --> 23:53It is a really expensive diagnosis.
23:53 --> 23:55The medications are expensive.
23:55 --> 23:58The out of pocket costs are
23:58 --> 24:01expensive legislation that has
24:01 --> 24:04been proposed to try to decrease
24:04 --> 24:07out of pocket costs for everyone.
24:07 --> 24:10It's key that those.
24:10 --> 24:13That kind of legislation is enacted
24:13 --> 24:16because even if you might say,
24:16 --> 24:19well, if someone votes differently,
24:19 --> 24:22they could have better coverage or
24:22 --> 24:25better access to Medicaid in this state.
24:25 --> 24:29But these medications these diagnosis,
24:29 --> 24:32particularly with personalized medicine,
24:32 --> 24:38get into an unbelievable amount of expense,
24:38 --> 24:39and we need.
24:39 --> 24:44To think of a way in this country that
24:44 --> 24:48everyone does have a safety net and
24:48 --> 24:53ability to pay for their medications.
24:53 --> 24:53Yeah,
24:53 --> 24:55I mean because it it's
24:55 --> 24:58quite true that as you say,
24:58 --> 25:01even if you have great insurance,
25:01 --> 25:05the the diagnosis of cancer can
25:05 --> 25:07be medically bankrupting and.
25:07 --> 25:11And so I worry as well about the people
25:11 --> 25:16who may not qualify for Medicaid,
25:16 --> 25:20but who may also not have insurance
25:20 --> 25:22or may not have great insurance.
25:22 --> 25:23Maybe they're working three
25:23 --> 25:26different part time jobs and barely
25:26 --> 25:29scraping together enough to get by.
25:29 --> 25:33They may not qualify for Medicaid.
25:33 --> 25:35And yet they they may find the
25:35 --> 25:38premiums or the deductibles on other
25:38 --> 25:41insurance coverages to be quite high.
25:41 --> 25:43So given all of that,
25:43 --> 25:44do you think that you know
25:44 --> 25:46some of the policies that have
25:46 --> 25:48been talked about in the past?
25:48 --> 25:50UM, universal coverage,
25:50 --> 25:51universal Medicare?
25:51 --> 25:53Do you think that that's the
25:53 --> 25:54answer to solving some of
25:54 --> 25:56the disparities that we see?
25:58 --> 26:02You know, I hope that some of these
26:02 --> 26:05solutions are going to be maybe
26:05 --> 26:08not the answers, but at least.
26:10 --> 26:13Answering part of the major
26:13 --> 26:16problems that are out there.
26:16 --> 26:19Yeah, I do think we need to have
26:19 --> 26:21an universal healthcare coverage,
26:21 --> 26:24but I also think we have to get our
26:24 --> 26:27nation healthier in so many ways.
26:27 --> 26:30And it's not just a question of coverage,
26:30 --> 26:35it's a question of valuing health,
26:35 --> 26:38valuing health for everybody,
26:38 --> 26:40starting early.
26:40 --> 26:44To making sure that when someone is born,
26:44 --> 26:48they are given opportunity to live a
26:48 --> 26:51healthy life and it takes more than
26:51 --> 26:54just insurance coverage to do that.
26:54 --> 26:57Yeah, it has to do with educational policies.
26:57 --> 27:00It has to do with housing policies.
27:00 --> 27:03It has to do with belief systems and,
27:03 --> 27:06you know we are in a time that
27:06 --> 27:09is a time of great turmoil and
27:09 --> 27:12a time of a lot of division.
27:12 --> 27:16But I think all of us agree that
27:16 --> 27:19fundamentally everyone deserves the
27:19 --> 27:25best options with their cancer care and.
27:25 --> 27:29I think we have to be very nimble
27:29 --> 27:32and and maybe again reallocate.
27:32 --> 27:35Some of our resources.
27:35 --> 27:39There are areas that are over resourced.
27:39 --> 27:42Does everyone need a scan every eight weeks?
27:42 --> 27:45Do people with good insurance need a
27:45 --> 27:48scan every eight weeks when it means
27:48 --> 27:50that there's someone out there who can't,
27:50 --> 27:54you know, pay for their insulin?
27:54 --> 27:57You can't treat cancer if someone's
27:57 --> 28:00diabetes can't be controlled because
28:00 --> 28:02they can't pay for their insulin.
28:02 --> 28:03I,
28:03 --> 28:05I think we all agree that the system
28:05 --> 28:08needs a lot of work and that there are many,
28:08 --> 28:12many smart people out there and many
28:12 --> 28:14ideas that are going to be helpful.
28:14 --> 28:17I think the time has come not to
28:17 --> 28:20just point out the disparities.
28:20 --> 28:23There's a lot of literature out there
28:23 --> 28:26that points out the disparities.
28:26 --> 28:28But we really have to talk about
28:28 --> 28:31solutions and we need to try solutions.
28:31 --> 28:34Doctor Andrea Silber is a professor of
28:34 --> 28:36clinical medicine and medical oncology
28:36 --> 28:38at the Yale School of Medicine.
28:38 --> 28:40If you have questions,
28:40 --> 28:42the address is canceranswers@yale.edu
28:42 --> 28:44and past editions of the program
28:44 --> 28:47are available in audio and written
28:47 --> 28:48form at yalecancercenter.org.
28:48 --> 28:50We hope you'll join us next week to
28:50 --> 28:52learn more about the fight against
28:52 --> 28:54cancer here on Connecticut Public radio
28:54 --> 28:56funding for Yale Cancer Answers is
28:56 --> 28:58provided by Smilow Cancer Hospital.
28:58 --> 29:00And AstraZeneca.

Information

Tackling Disparities with guest Dr. Andrea Silber December 26, 2021 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095