In January of this year, Debarchana (Debs) Ghosh, associate professor in the Department of Geography in the College of Liberal Arts and Sciences (CLAS) and principal investigator at UConn’s Institute for Collaboration on Health, Intervention, and Policy (InCHIP), received a grant through the American Cancer Society to study multi-level drivers of cancer disparities impacting African Americans.
This study will build upon previous studies conducted by Ghosh and her collaborators that have explored the ways social inequality contribute to unequal cancer control outcomes.
The 4-year study will draw upon a nationally representative sample of African American adult individuals and data from other national databases such as the U.S. Decennial Census, American Community Survey (ACS), and the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS). This large quantitative population-level database will be placed in conversation with qualitative data from interviews with community members, leaders, and stakeholders to explore how psychosocial factors such as stress, social support, or neighborhood characteristics influence health and the prevalence of cancer among African Americans. The qualitative phases of the study will be conducted in four focal states, Connecticut, Maryland, Alabama, and Missouri. Conclusions from the study will be used to make recommendations informing public health policy, practice, and interventions to improve the health of African Americans.
“This current collaborative project takes into account the structural determinants of health, which have a strong interplay with social determinants of health at the individual level. There has been a strong call in research communities studying health disparities to show directly how structural policies, like redlining, housing discrimination, and concentrated poverty have impacted health disparities among African American communities,” says Ghosh, who mainly studies health disparities among vulnerable populations, both in terms of health outcomes and in access to health care.
Ghosh is working with Cheryl Knott, professor in the Department of Behavioral and Community Health and Co-Leader of the Population Science Program and Associate Director of Community Outreach and Engagement at the University of Maryland Greenebaum Comprehensive Cancer Center; Eddie Clark, professor of psychology at St. Louis University; Kathleen Hoke, professor at the University of Maryland Carey School of Law; Beverly Williams, professor of sociology at the University of Alabama at Birmingham. Crystal Park, UConn professor of psychological sciences in CLAS and chair of InCHIP’s Cancer Research Interest Group, is also involved in the study.
The study has three phases. In Phase 1, the team will use a community-engaged approach, working with key community stakeholders in the four focal sites, using their input to refine and prioritize the proposed analytic models. In Phase 2, the refined analytical models will be built and interpreted. In Phase 3, the team will again engage community stakeholders to co-create and disseminate recommendations for cancer control activities based on study findings. The study will distribute recommendations for policy, practice, and research to lay and scientific audiences through multiple channels.
“I am excited about the community-engaged phases of the study, where I will listen and learn from the lived experiences of the communities of color in the Greater Hartford Area in Connecticut on how policies, social support, and neighborhood contributes to the health of the residents” says Ghosh. “As our state is witnessing a rise in the number of people of color, this study will be impactful by engaging the communities in need, working together, to mitigate social injustices, discrimination, and reduce the gap of racial health disparities.”
The study is driven in part by disparities highlighted by the novel COVID-19 pandemic which rampaged through under-resourced communities lacking basic health care infrastructure. Black communities in the U.S. were disparately impacted by the COVID-19 pandemic, especially during the early months of the pandemic. According to data from April 2020 to October 2020, Black Americans faced a mortality rate of approximately 83.6 per 100,000. For comparison, Latinos experienced a mortality rate of about 50.7 per 100,00 and White Americans and Asian Americans experienced a mortality rate of about 40 per 100,000.
“The pandemic brought out more of the disparities occurring among African Americans and in other communities. These communities are not more genetically prone to disease, but COVID-19 opened the wound more crudely to show the gap of health disparities,” says Ghosh. “My goal for this project is to use science and show results sharply and directly to develop a policy framework that aims to mitigate and reduce these disparities.”
According to data from the American Cancer Society, African Americans have a higher cancer burden and face greater obstacles to cancer prevention, detection and treatment, and survival. African Americans are less likely to survive a cancer diagnosis compared to other racial and ethnic groups in the United States. Despite having a lower incidence of breast cancer, Black women are 41% more likely to die from the disease than their white counterparts.
While a significant proportion of cancer is preventable, external factors can influence cancer disparities, such as structural racism, which refers to discrimination at the institutional level that facilitated segregation, inhibited the accumulation of wealth, and limited access to quality education, housing, health care, and work.
Although those policies are no longer legal, the effects still manifest today. Areas affected by historical redlining, lending bias, and disinvestment often have a higher population of African Americans and lack amenities including access to public transportation, green spaces, and healthy food. These environments typically increase the prevalence of chronic stress and disease, resulting in poorer health outcomes overall.
“I don’t want to stop at showing the current state of affairs. We know that it’s not good, so I’m focused on showing what we can do to close the gap in these disparities,” said Ghosh.
Ghosh joined UConn in 2011 and began working with InCHIP that same year. Ghosh learned about InCHIP through her mentor, Board of Trustees Distinguished Professor in Statistics and InCHIP PI Dipak Dey.
Through InCHIP, Ghosh began collaborating with Park. They have worked on studies evaluating the nexus of health behaviors and geographical location among African Americans. The researchers found that while social determinants influence health, there are macro-level conditions like policy and location that intertwine with individual behavior to impact health.