In 2012, Shelley White-Means, PhD, read a study from the Sinai Urban Health Institute that reported Memphis had the largest disparity in deaths from breast cancer for Black women versus white women of any of the 25 largest cities in the United States. She had recently lost her mother to breast cancer, and she wanted to know why Black women, like her mom, were more likely to die from a breast cancer diagnosis in her hometown.
For Dr. White-Means, a professor of Health Economics in the Department of Interprofessional Education in the College of Graduate Health Sciences at the University of Tennessee Health Science Center, that question has been at the center of her research ever since. She has looked at the perspectives of breast cancer survivors, attitudes and practices of the health care community, cultural and genetic issues, geographic location, and other factors that contribute to this disparity in breast cancer survival of Black women compared to white women in Memphis and elsewhere.
“I want to know why,” she says. “Why is it that we have this higher death rate among Black women compared to white women? What is going on in Memphis? We have a high-quality medical system, we have a high-quality cancer center, we have all this phenomenal care system. Why is it that Black women are dying more than white women?” While the overall incidence of breast cancer is lower in Black women, they are 1.4 times more likely to die of breast cancer than white women.
Dr. White-Means, who is the director of the Consortium for Health Education, Economic Empowerment and Research (CHEER) health disparities research center at UT Health Science Center, recently received a $1.5 million, four-year grant from the National Institute on Minority Health and Health Disparities to explore this question even more deeply.
She and team members will look beyond the social determinants of health to explore what she terms “the intersectionality of race, residential segregation, and poverty as a driver of health disparities in breast cancer.” The goal is to identify effective public policy interventions and strategies to change the picture for Black women diagnosed with breast cancer.
“I want to know why. Why is it that we have this higher death rate among Black women compared to white women?”
Dr. Shelley White-Means
The team includes Sam Li, PhD, assistant professor, Clinical Pharmacy and Translational Science, and Arash Shaban-Nejad, PhD, MPH, associate professor of Pediatrics, both from UT Health Science Center; along with University of Memphis faculty, Jill Dapremont, professor and division director of Family, Community, Health System Science, Daphene McFerrin, executive director of the Benjamin L. Hooks Institute for Social Change, and Elana Delavega, PhD, MSW, professor in the School of Social Work.
Using unique quantitative and qualitative methods the team will identify modifiable pathways to breast health, such as disadvantaged racially segregated neighborhoods, that are the “root causes” of social determinants of health.
“We’re adding a different look. We say that limited social determinants of health are just symptoms of disparities in breast cancer outcomes,” Dr. White-Means explains.
“We’re calling the factors that we want to consider the root causes,” Dr. White-Means continues. “What causes a neighborhood to lack social determinants of health resources? What policies and practices have created neighborhoods that have food insecurity, limited access to health care providers, and limited jobs and economic stability?”
The long-term goal is to identify interventions and policy solutions that transform disparities that are rooted in seemingly unalterable place-related community factors, Dr. White-Means says.