Running Head: INEQUALITY IN HEALTHCARE AND CANCER

Racial Inequality In Cancer Treatment and Healthcare

Courtney M. Clayton
University of Texas at El Paso
Professor Rodriguez Rhetoric 1302

Inequality In Healthcare and Cancer Treatment

Abstract
Inequality has plagued the United States from the beginning of its time. There has been
racial segregation, gay rights denial, and womens rights denial. The land of the free has been
pushed to its limits a plethora of times. Another issue of inequality that is widely overlooked is
the issue of equal rights in health care and in cancer treatment. Individuals are being treated
unequally based on their race and other factors. Another issue is lack of awareness of health
inequality because most people are unaware of its occurrence, or choose to ignore it. Based on a
personal study survey and intense research, this is a huge problem for the United States and is
highly misunderstood by the common citizen. The purpose of this literary review is to explore
the idea of inequality in health care and cancer treatment in America, assess the understanding by
citizens and by professionals, and also see if there are any solutions purposed to solve the issue.
Key words: Inequality, denial

Inequality In Healthcare and Cancer Treatment

Racial Inequality In Cancer Treatment and Healthcare: A Review of Literature

Inequality in cancer treatment and health care as a whole is a major conflict that has
existed for many years in the United States and worldwide. Inequality in cancer treatment and in
health care is essentially an unequal treatment of individuals based on ethnicity, gender, sexual
orientation, an individuals income or social status, and many other factors. Many professionals
believe that something needs to be done to solve this issue. On the contrary, people in the general
population are unaware of this issue based on a survey conducted on UTEPs campus. It is also
proven by research that most individuals are not aware that inequality in health care is occurring
and that it is affecting many people. Based on many sources, it is a statistically proven issue and
will continue to be an issue until initiative is taken.
It is vital for the community and for the individuals being affected by this horrible
indecency to have questions answered regarding this issue. Due to the many factors that go into
creating the statistics about inequality in health care and in cancer treatment, the many different
views, and the large amount of differing opinions by witnesses, there are four main questions that
need to be reviewed and answered:
1. What are the differences in percentages between whites and minorities in cancer
diagnosis, treatment, and survival rates?
2. What are experts saying about the inequality within health care and cancer treatment?
3. What are others saying about the inequality within health care and cancer treatment?
4. Are there any purposed solutions from professionals or from others?
These questions will show the purpose of this literature review by providing information on the
issue of inequality in health care and cancer treatment, while also answering important questions

Inequality In Healthcare and Cancer Treatment

such as what experts and others are saying about the issue and if there are any purposed
solutions.

What are the differences in percentages between whites and minorities in cancer diagnosis,
treatment, and survival rates?
Sadly, there are many differences in percentages with diagnosis, treatment, and survival
rates between different races. To fully understand this issue, the overall statistics and proof it
exists needs to be examined. According to the Agency for Healthcare Research and Quality, In
all years, Black, Hispanic, and Mexican women were less likely to receive radiation therapy
compared with White women. In 5 of 7 years, Cuban women were less likely to receive radiation
therapy than non-Hispanic White women (AHRQ 2013). Also, according to the same source,
these stats also correlate with the percentage of women who receive mammograms. Women who
are non-White are more likely to not receive mammograms, than those of the White race. This
does not correlate with the next statistic; Black women have a higher risk of passing away from
breast cancer than white women and yet Black women are less likely to get mammograms.
According to this source, it is hard to determine what exactly is causing the miscorrelation in
numbers, but there has to be a reason behind it. Next, the percentage of women who receive
mammograms also differs based on income. Women who have a lower income rate are more
likely to not get mammograms than those with a higher income rate. It is obvious here that an
individual with less money is not able to pay for medical care, but most do not know that
mammograms are offered for free in many areas. The source also connects lack of income with
lack of education, saying that Black women who are uneducated are also from low-income
families, and therefore they are less aware of mammograms, treatment options, and available

Inequality In Healthcare and Cancer Treatment

providers. This is not true in every case though; low-income rates do not always correlate with
lack of education, making it hard for professionals, and this source specifically, to pinpoint an
exact cause of this inequality. Next, survival rates were promising in 2010; the rate of breast
cancer deaths was 22.1 to every 100,000 (AHRQ 2013), but overall breast cancer went down
in every race except Asians. This is a promising statistic, but still does not prove why different
races are receiving unequal cancer treatment. Breast cancer was also analyzed based on the
percentage of a certain race developing breast cancer versus the mortality rate of the race with
breast cancer. According to the Susan G. Komen Foundation, African-American women are less
likely to develop breast cancer than White women, but African-American women are also 44%
more likely to pass away from breast cancer than White women, which can be seen in the image
below. (Susan G. Komen Foundation 2015).

Inequality In Healthcare and Cancer Treatment

Figure 1: SEER Cancer Statistics (2014).Statitics Review. Retrieved from:

http://ww5.komen.org/BreastCancer/DisparitiesInBreastCancerScreening.html

Most individuals claim that White women are the most privileged when it comes to
cancer diagnosis, treatment, and survival, but according to the Susan G. Komen Foundation,
Native American women are 2% more likely to receive a mammogram than White women. Also,
according to a UC San Diego Study, there is a 47 percent relative survival difference in AfricanAmericans and Whites (Murphy 2013). This statistic supports the difference between White
survival and minority survival with cancer. Most believe that the differences in these numbers are
due to lack of awareness, access to healthcare, and the individuals view about the health care
provider. This can also be seen in the figure 2 listed below.

Figure 2: Number of Days From Discovering Breast Abnormality to

Cancer Diagnosis (2010) retrieved from:
https://familyinequality.files.wordpress.com/2010/10/racebreastdela
y.jpg

Inequality In Healthcare and Cancer Treatment

According to researchers and professionals, this is why there is a gap between races and
their percentages of diagnosis, treatment, and mortality. Healthcare and insurance are big factors
in determining the reasoning behind racial inequality in cancer treatment. This purposed idea of
the lack healthcare being a cause of inequality in cancer treatment will be explored further in this
literary review.

What are experts saying about the inequality within health care and cancer treatment?
Many experts have different opinions on what the true causes of this issue are. Some
experts believe that race plays a factor in the mistreatment of African American women who
have breast cancer, but on the contrary, other experts believe that it is more socioeconomic
factors that play a role in this disparity. Some socioeconomic factors include: poverty, inadequate
education, and lack of health insurance. According to Samuel Broder, the Director of the US
National Cancer Institute, and the scholarly article Cancer Disparities by Race/Ethnicity and
Socioeconomic Status, Poverty is a carcinogen. (Broder 2008). These experts are claiming
that not only does poverty affect individuals cancer treatment and diagnosis, but also their
healthcare access; it is all connected. For those who do not have healthcare, they are more likely
to experience health related disparities and mistreatments. Healthcare is extremely important to
Americans and their culture. Americans lives are extremely influenced based on their access and
availability of healthcare. According to another source, almost 5,600 people are missing out on
cancer treatment because of social inequalities (BBC 2012). According to this newspaper, this is
due to the rich-poor cancer gap that continues to exist. This source even found a difference
between men and women, which is an interesting view on social inequality for health care and
cancer treatment that is not recognized often. Another important factor that is not taken into

Inequality In Healthcare and Cancer Treatment

consideration is language barriers. Although this inequality is happening to people whose main
language is English, there are some minorities being affected who simply are not aware because
of their communication barrier between themselves and their provider. This is another important
factor to take into consideration. Also, health specialists believe that socioeconomic factors are
far more relevant than biological differences in determining why inequality occurs. To further the
discussion, the article continues and describes that socioeconomic factors affect minorities in all
aspects of cancer cause, diagnosis, and the disparity in treatment. Factors such as tobacco use,
poor nutrition, physical inactivity, and obesity (Ward 2008) can cause an increase of cancer risk.
This doctor believes that those of the minority and those who live in poverty are more likely to
be exposed to these unhealthy ways of life. Sadly, these professionals also note that there is a
legacy of racial discrimination in the United States that continues to influence interactions
between patients and physicians. A common theme between most sources is the promotion of
change. All of the sources agree that a change needs to be made and there should not be
inequality in health care and cancer treatment. Attempts at change have already been occurring.
According to House.Resource.Org, the US House of Representatives have already been
attempting to solve this issue. According to a YouTube video produced by the House of
Representatives, the United States had a two-hour conference in attempt to solve the issue on
inequality in healthcare and in cancer treatment. This meeting occurred January 4th 2011; they
met to discuss, witness testimonies about disparity in cancer treatment, levels of funding
research, and various efforts already being made to eliminate disparities (House Government
Reform Committee 2011). Therefore, there are specific efforts being made by professionals to
improve our society and make health care and cancer treatment equal. Overall the problem seems
to be a systematic problem related to screening, access, and treatment (Brewster 2015).

Inequality In Healthcare and Cancer Treatment

Brewster believes that if this simple systematic problem is solved, the gaps between Whites,
minorities and other races will diminish, and all people will be provided equal access.

What are others saying about the inequality within health care and cancer
treatment?
Others in this case are referring to the common citizen or individuals who have firsthand experiences with disparity in cancer treatment based on race. According to a womens
health website, When Karen Jackson was diagnosed with Stage II breast cancer in 1993, she
was bewilderednot just by the diagnosis, but by the disparity she saw between AfricanAmerican women and women of other races and ethnicities (Weritch 2015). The writer of this
article does not believe there is a simple answer to why this disparity occurs. But she believes
that this mistreatment can be due to socioeconomic factors and biological factors, agreeing with
other sources. According to another source, differences cannot be explained by screening
behavior or risk factors, the point instead to the need for a broad-based strategies to remedy
racial inequality in cancer survival (Virnig 2009). This is where source to source there are
varying opinions. Most people believe that the reason behind this disparity is due to
socioeconomic factors, but some believe it truly is based on racism and the race of the individual
requesting treatment or diagnosis. Others believe there are group and individual inequalities that
occur in health care. According to a book called Inequalities in Health : Concepts, Measures,
and Ethics, there are univariate and bivariate (Eyal 2013), approaches to describe how
inequality in healthcare and cancer treatment works. The difference is when the individuals being
examined are examined in a group; it is more based on socioeconomic features such as income,
race, and education, instead of being focused on the specific individual. The individual approach

Inequality In Healthcare and Cancer Treatment

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includes different aspects such as their biological make up and other personal traits that may
cause an increase in cancer development. No matter how this inequality is viewed, there is one
thing all of these sources have in common: there is a problem occurring in the United States
today, and change is crucial. When the issue is terminated, the world will be a more equal and
fair place for all.

Are there any purposed solutions from professionals or from others?

There is no questions to professionals or others that inequality in healthcare and cancer
treatment exists. The hardest topic for these professionals and others to figure out is how to solve
it. According to a doctor who specializes in cancer treatment, We need to improve screening
rates and get African-American women in for state-of-the-art treatment for breast cancer
(Brewster 2015). She also continues and states, We know the way we are treating breast cancer
works. The survival rate is at 95 percent. Its just a matter of getting women in for the right
treatment (Brewster 2015). This professional believes that the key to solving the issue is simply
getting women the access to this treatment and raising awareness about breast cancer treatment.
If all women knew that the survival rate was 95 percent, most would be willing to get the
treatment according to Brewster. She hopes that an Affordable Care Act will be passed to aid
those less fortunate to be able to afford health bills. According to a recent study performed by
UC San Diego, after accounting for treatment differences, the race-based survival difference
completely disappeared (Murphy 2013). This study did not find a specific cause of the disparity
but offered six things that could be solved to aide in bridging the gap between minority and white
healthcare and cancer treatment differences. These included: conscious or unconscious provider
biases, patient mistrust, health literacy, patient and provider communication, healthcare access

Inequality In Healthcare and Cancer Treatment

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barriers, and race-based differences in disease biology (Murphy 2013). An overall theme in all
of the sources is a proposal to improve education, healthcare in general, and awareness within
communities. Awareness is crucial in American communities, the more knowledge a community
has, the more powerful the community is.

Primary Research
To see if the common citizen was aware of the inequality happening in America in cancer
treatment; a survey was performed. The purpose of the survey was to not prove why this
inequality is happening, but rather what can be done to solve it. There were six questions asked
to each participant who participated in this study. These questions included: 1. Have you ever
experienced racial inequality when it comes health care or cancer treatment first hand? 2. If not,
have you heard of it in anyway, such as in the media? 3. What does the word inequality mean to
you? 4. What ethnicity are you? 5. How old are you? 6. Do you keep up with the news? The
answers varied from individual to individual, but there was a pattern in the answers. For question
one, most people said they have never experienced racial inequality within their health care first
hand. This can be for many reasons, for example, all of the individuals surveyed live in El Paso
and there is little to no discrimination of race because it is primarily inhabited by Hispanics. El
Paso is known for being extremely diverse, which may limit the opportunities for people to be
discriminated by race. In addition, most of the people surveyed were between the ages of 18-23,
which is not a time span known for having cancer and other needs for medical care. Most people
said that they had not heard of racial inequality on the news or on social media, but a few did say
they had heard of the issue in general. Most of the subjects surveyed said that inequality meant

Inequality In Healthcare and Cancer Treatment

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unequal treatment of the minority in any aspect, or something closely related. Most of the
subjects interviewed were Hispanic race, but there were a few White individuals and an African
American. The last question that was asked was Do you keep up with the news? Most people
said they kept up with the news in some way, whether it is the actual news on TV or through
social media. The generation being surveyed was taken into consideration, because the newer
generations are more likely to keep up with the news through social media rather than the actual
news. The news on social media differs from the news on television. Television news focuses on
things happening in communities and often times have more serious content focus. On the
contrary, the news on social media focuses on more entertaining parts of the news to appeal to
the younger generation. The topic of inequality in healthcare and cancer treatment is not a topic
that would appear on a young persons Twitter or Instagram. This could directly correlate with
the unawareness faced by Americans and specifically teenagers. According to this research, lack
of awareness could be a problem for the United States and prove why this issue is occurring.
Although this research does not exactly prove why the issue of inequality exists, it does give
some insight on what could be done to reduce the gap among all races.

Conclusion/Synthesis
In conclusion, this literary review has analyzed a plethora of data, opinions, and points of
views on the issue of inequality in health care and cancer treatment. The issue of inequality in
health care and cancer treatment is still a problem in the United States and worldwide. Although
there has been possible solutions purposed, there has not been a lot done to completely eliminate
this issue. Professionals have suggested raising awareness in communities, providing more
affordable healthcare, to make the availability of treatment more prominent in low-income areas,

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and educate communities on this issue to aide in closing the gap between all races in cancer
treatment. More intensive research would need to be done to fully understand the full extent of
the issue and what needs to be changed to end this disparity. It is vital to America, and to other
countries worldwide to accept the issue and agree that something needs to be changed in order to
save the lives of thousands and many more to come.

References

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Am. J. Epidemiol. (2002) 156 (5): 471-482.

doi: 10.1093/aje/kwf068
Eyal, N. M. (2013). Inequalities in health: Concepts, measures, and ethics. Oxford: Oxford
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Murphy, J. (2013). Blacks Have Less Access to Cancer Specialists, Treatment. UCSD News
[San Diego].
Virnig, B. A., Baxter, N. N., Habermann, E., Feldman, R. D., & Bradley, C. J. (2009). A Matter
Of Race: Early- Versus Late-Stage Cancer Diagnosis: African Americans receive their
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(Project Hope), 28(1), 160168. doi:10.1377/hlthaff.28.1.160
Ward, E., Jamal, A., Cokkinides, V., Singh, G. K., Cardinez, C., Ghafoor, A. and Thun, M.
(2004), Cancer Disparities by Race/Ethnicity and Socioeconomic Status. CA: A Cancer
Weritch, L. (2015). African-American Women and the Breast Cancer Disparity | A
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Journal for Clinicians, 54: 7893. Doe: 10.3322/canjclin.54.2.78
A Matter Of Race: Early- Versus Late-Stage Cancer Diagnosis. (n.d.). Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766845/
BBC. (2012, November). 'Rich-poor' cancer gap persists. BBC News.
House Resource. org. (2011, January 4). Ethnic Minority Disparities in Cancer Treatment [Video
file]. Retrieved from https://www.youtube.com/watch?v=fauqd81FKbI
Racial Disparities in Breast Cancer Screening | Susan G. Komen. (2014). Retrieved from

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http://ww5.komen.org/BreastCancer/DisparitiesInBreastCancerScreening.html

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