NEWS

Freeman Sets Goals for Center to Reduce Cancer Health Disparities

Jemarion Jones

In December, the National Cancer Institute established the Center to Reduce Cancer Health Disparities, and Harold P. Freeman, M.D., was named as its director. Freeman is the chairman of the President’s Cancer Panel and the president and chief executive officer and director of surgery at North General Hospital, New York.



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Dr. Harold P. Freeman

 
The center was created as part of NCI’s strategic plan to reduce health disparities. Journal News correspondent Jemarion Jones recently spoke with Freeman about the history and future plans for the center.

What events led to the elevation of the health disparity issue and the creation of the NCI Center to Reduce Cancer Health Disparities?

There has been awareness about the problem of disparities in health care and cancer for a long time. We have known for a while that blacks, in particular, do not do as well as whites. That was underscored by an article written by Henschke in 1973. [Henschke UK, et al. Cancer 1973;31:763–8.] The article showed that there was an alarming increase in the cancer mortality among black Americans in the previous 25 years. That article touched a nerve, although it was not the first time a statement like that had been made in the literature. It really hit the whole country and affected the way the SEER data was subsequently collected according to race.

Now, Congress has paid attention, and in 1998, President Clinton decided to put more resources into the disparity problem across six different diseases, with cancer being one of them. The NCI leadership also began to contemplate how it could best approach this problem.

How will the center go beyond what’s previously been done?

The intention is to give disparity research a higher profile and support it with greater resources. What we want to do is take what the NCI is already doing on this issue and enlarge the concepts and the direction of disparity research.

What will be the mission and focus for the new center?

The mission is to try to better understand the real variables that cause disparities in various populations in America and to find ways to influence change through culturally targeted education and by providing credible, accurate information to policy makers. Also, we want to support the development of scientists from all racial, cultural, and ethnic groups.

So what exactly will the center do?

The center will have both research and policy divisions. We want to raise appropriate research questions and try to discover the reasons for disparities, going deeper than we have now through current research.

For example, we would like to raise a particular question, such as why there is such a high death rate from cervical cancer in certain parts of America. This is actually an issue that’s been brought out by NCI mortality maps and one that the center will address. There are certain geographic areas along the Appalachian Trail where there is a much higher death rate from cervical cancer. What are the factors that cause this to be so? Who are these people? What are the reasons that people are dying at a higher rate from a curable disease? We think no one should die from cervical cancer. Diagnostic tests such as the Pap smear and treatments are available, but yet women are still dying from the disease.

We’d like to bring out all the information on that particular issue. Then, we would like to bring that information to a body of critical thinkers, like a think tank, and have a dialogue about those issues and come up with some findings that could assist policy makers in understanding the issues.

How does the center fit in with the recently appointed HHS Advisory Committee on Minority Health and the NIH National Center on Minority Health and Health Disparities? Will efforts be coordinated with these agencies?

I think we will be on the same track and I am sure we will be working toward the same end. I’m looking forward to coordinating our efforts. We are one-disease oriented so the Center to Reduce Cancer Health Disparities hopefully would contribute to the broader movement to reduce disparities across all diseases. There may be some special things we would have to do, but I think we will all be moving in the same direction. It’s better to have more than one strategy as we move toward a common solution.

What kind of resources are available to the center?

We have incorporated the previous Office of Special Populations Research into the new center. That office has existed since 1995. The office has 18 research grants under way that we will continue to oversee and hopefully expand. Currently, $60 million has been dedicated over the next 5 years. We believe that the research this center should oversee will go beyond the current Special Populations Network research as we begin to bring more people into the center and begin to think of questions that need to explored from a broader perspective than what we are currently doing.

How will the new administration affect the efforts of the center?

I see no reason to believe that we would not get the full support of this new administration related to disparity issues, and I am looking forward to working with it.

Ultimately, what would you like to see the center accomplish?

I would like to see the center be a focal point within the NCI and NIH to explore new ideas and to create a better understanding of the issues that are causing disparities. The center should be one that pays attention to all the factors that cause disparities, including social injustice as a factor. As a result, hopefully we’ll elucidate for the scientific community the nature of these problems.

However, we won’t stop there. We want to have an influence on changing the lives of the people that are suffering the most. The way to do that (since we are not an organization that can deliver care) is to promote the delivery of information to the public so people can change lifestyles, attitudes, and behaviors. We can also clarify key issues for policy makers. So hopefully, we’re not simply a center that does studies and puts them on the shelf. We want to take the information to see how we can educate the public as well as the policy makers. Ultimately, my goal is find out what we can do to improve the lives of people who may and do develop cancer.

How did your involvement with the center begin?

I have spent a career studying these issues during my 33 years as a surgeon in Harlem, which is a poor, primarily African-American community, and my work here has led me to delve deeply into some of the issues. For example, there is a question of why certain populations don’t do as well as others. Race is one thing I have looked at very deeply as a contributor to disparities, and I have looked at other issues that I believe drive disparities, such as poverty and culture. My career has been spent looking at the causes of disparities and whether they can be delineated by race, by socioeconomic status, or by lifestyle and attitude, which are cultural. Specifically, I have spent a great deal of time thinking and writing about the interface between these issues. I have gained a certain amount of respect over the years as an authority on these issues, and I suspect that is why I was asked to take on this responsibility.

You wear many hats as chairman of the President’s Cancer Panel and as president, CEO, and director of surgery at North General Hospital. How will your current commitments affect your position as NCI’s associate director for reducing health disparities?

My work in New York will be modified to fit the needs of the center. I am making transitions here to spend the right amount of time and energy to effectively direct the center.



             
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