Unfortunately, some issues or diseases are more prone to affect people in certain communities—case in point, colorectal cancer has been known to disproportionately affect the Black community as compared with white communities. In fact, according to the American Cancer Society, Black people are up to 20% more likely to get colorectal cancer and are also about 40% more likely to die from it.
We interviewed Phyllis Morgan, PhD, FNP-BC, CNE, FAANP, academic coordinator for Walden University’s MSN-FNP program, as she has conducted research on colorectal cancer in men as well as Black men and women’s health issues, including disparity in health and health care.
Phyllis Morgan, PhD, FNP-BC, CNE, FAANP
Why does colorectal cancer disproportionately affect the Black community?
There are several reasons why colorectal cancer disproportionately affects the Black community. First, there is a general lack of knowledge about screening for colorectal cancer, which contributes to inadequate prevention and screening behaviors. There are also various fears that come into play, such as fear of cancer and of a cancer diagnosis, and fatalistic views about cancer.
A recent study showed that in Black Americans, the right side of the colon ages much faster than the left side, which could contribute to this population’s increased risk for colorectal cancer, particularly on the right side of the colon, and at a younger age.
Other factors may include delayed treatment and the fact that Black individuals have a higher incidence of obesity and more often consume a high fat, low fiber diet, which increases risk.
Why are Black people who get colorectal cancer about 40% more likely to die of it than other groups?
In addition to factors such as inadequate prevention and screening behaviors as well as delayed treatment, racial inequities in care also contribute to the fact that Black people who get colorectal cancer are more likely to die of it than other groups. There is a widespread lack of access to care for many people in this population, and some have no health insurance or inadequate health insurance for treatment.
Additionally, lifestyle factors such as diet and exercise can contribute to this.
What are the challenges facing the Black community regarding colorectal cancer?
Some challenges facing the Black community regarding colorectal cancer include inequities in health care, lack of access to quality care, and a lack of adequate resources to educate about the importance of colorectal cancer screening. It is crucial that we increase screening by providing better education for the Black community regarding screening and the importance of polyps being removed from the colon.
Additionally, we need more diverse health care providers, so patients can have providers who look like them and with whom they can connect and relate. Black health care providers can play an important role in helping patients to understand the seriousness of colorectal cancer in their community.
What can nurses do in order to get people in minority communities to go for tests, pay attention to symptoms, etc.?
First, nurses can help by providing more colorectal cancer resources for their communities. In addition, culturally appropriate educational programs and community or faith-based educational programs can be helpful in encouraging people in minority communities to undergo screening.
As an African American woman and advanced practice nurse, I have participated in many projects and studies to identify ways to increase awareness, prevention, and treatment of health issues that impact the Black community. Specifically, I worked on a community and faith-based education program to increase awareness of prostate cancer among Black men, which resulted in an increase in participants’ general knowledge of prostate cancer and treatment by over 40%. I have also implemented successful community and faith-based education programs in North Carolina and Virginia to help educate Black people about colorectal cancer and increase screening behaviors. These types of programs are proven to make a difference.
Nurses can play a vital role in helping community and faith-based organizations develop and execute programs to address health disparities. It’s critically important for research to be conducted, especially in developing culturally appropriate models for diverse communities, so more contributions toward reducing health disparities can be made available to effect positive social change.
Last but not least, Walden University and the National League for Nursing are excited to launch the Institute for Social Determinants of Health and Social Change, where nurse educators and inter-professional colleagues will play an instrumental role in achieving health equity across various demographics. The institute is designed to cultivate these health care professionals into leaders who address the impact of structural racism, socioeconomic status, environment, education, adequate housing, and food insecurity on health and well-being.
In minority communities, there have been a number of challenges with people not wanting to receive a vaccine for COVID. While we’ve already talked with someone about what is going on in the Black community, we also wanted to check in with the Hispanic community as well.
Norma Cuellar, PhD, RN, FAAN, is President of the National Association of Hispanic Nurses as well as the editor-in-chief of the Journal of Transcultural Nursing. She took the time to answer our questions about this.
Why are Hispanic communities not being vaccinated as the same rate as white people?
There are many reasons. One is the social determinants of health, like a lack of access to health care providers or lack of culturally congruent health care. The second is trust. Underrepresented or underserved communities often look skeptically on the health care system because of historic inequities. This leads to fears of adverse health outcomes, including side effects of the vaccine.
Regarding the vaccine, what are the challenges facing the Hispanic community?
A major issue is confidentiality, particularly as it relates to immigration status. Also, language barriers can be a significant roadblock, so there needs to be more communication in Spanish to help reach people that are otherwise left behind.
Are people in the Hispanic community hesitant to receive the vaccine to prevent COVID-19? Why or why not?
There is a spectrum of receiving a vaccine: from yes to no, and then the middle. Vaccine hesitation is in the middle. It does not mean that the vaccine will not be taken but that the vaccine is not going to be taken for today. How can we move the “hesitation” into “action” or vaccination?
There are a variety of reasons that Latinos have vaccine hesitation. The lack of trust of the federal government plays a major role in their decision. They fear having information about them will put a red flag and immigration may be notified. They are concerned about increased deportations.
They get their information from their peers and doubt the messages that have been sent out about COVID-19 that have not been consistent. They do not know who to trust, and do not have anyone they trust to go to. They need a PSA that is culturally congruent to the Latino community.
In addition, for the past four years, they have been intimidated through propaganda. They fear the stigma of being Latino, referred to as “rapists” and “drug dealers” in the last four years. They stay away from dealing with authorities, avoiding confrontations, and conflict. They are concerned about being visible, aware of the increase of hate crimes in our country.
Like the Tuskegee study, Latinos know about the abuse of minorities who have been treated unethically in research studies and believe it could be repeated with the new vaccination that has not been fully tested. With few Latinos participating in NIH research funding, they are unaware of the benefits of learning more about improving health outcomes through legitimate research engagement. They want to see Latino role models who take the injection before they do.
If they are hesitant about receiving it, what information can nurses give to them to help alleviate their fears?
We need to forge new community partnerships and work with people that are trusted by their peers. We need to communicate directly with people who are hesitant and educate them on this. For the Latino community, we also need to relay information in Spanish.
How can nurses who work in Hispanic communities working to build trust in the communities that they serve? How are you building that trust?
Though not specifically vaccine-related, the All of Us Research Program is working actively with partner organizations to build trust in communities and help educate people about the importance of research. The National Association of Hispanic Nurses is just one of those proud partners. We go wherever we can reach the community, as many times as it takes, and partner with other Latino organizations to build trust with the community. Compassion is essential, and we believe that one-on-one engagement will help close the gap on these inequities.
How can more research like the NIH All of Us Research Program help to prevent health disparities like this in the future?
The All of Us Research program allows Latinos not to be subjects in a research study but to be participants in the program. Through community-based partnerships, we are educating our Latino communities about research and the program. We want them to see that they can trust us and see that the community partners are in this with them. Through All of Us, we encourage all minorities to participate in our program because it impacts generations to come. Increasing self-awareness by Latino leaders in our organization will show that we lead by example and that we have faith in these programs. We must develop trust and protect Latinos from everything they fear (deportation, notification of immigration status, lack of safety in research studies). Consistent messaging of health prevention measures in Spanish must be available.
As we head into the second year of the pandemic, it’s undeniable that the mental health of a lot of people has been affected; and because mental health and addiction are often co-occurring, the rates of substance use and overdoses have increased as well. Research has also shown that the segment of the population that is being disproportionately affected is the Black community.
Let’s be honest: mental health and/or addiction in the Black community are not welcomed diagnoses. As a Black woman working in behavioral health care, I see first-hand the aversions that many people have towards the words “mental health” and “addiction.” In addition to the stigma that exists with those two conditions in society, people with mental health issues in the Black community can also be seen by some as “crazy,” which is something no one wants attached to them, and also a significant deterrent for a lot of people to reach out for help.
There are other deterrents, though, that exist within the community: namely the systemic racism in health care and all that it entails. Historically, we’ve been subjected to treatment that is highly unethical at best, such as the Tuskegee Experiment in which African American men diagnosed with syphilis were not told nor treated. Then there’s the case of Henrietta Lacks whose cancer cells, taken and utilized without her knowledge or consent, were identified as the first immortalized human cell line. These are just a couple of examples from the past, but inequalities in treatment still exist today. For example, in a 2016 study, 50% of the medical students and residents who participated thought black people couldn’t feel pain in the same way as others because our skin is thicker and our nerve endings are less sensitive than those of other races or ethnicities. The Black maternal death rate is still the highest in the country with researchers suspecting institutional racism to be a contributing factor. And take COVID-19 – a survey found that 35% of Black adults would not take the vaccine with one respondent saying, “… I don’t trust the medical community because of mistakes in the past.” I know that the apprehension to seeking medical care and distrust of the health care system is not something born of paranoia and delusions, and it’s something I’d like to see change.
Right now, a lot of people are struggling with addiction and/or mental health issues that can be treated, but they don’t want to reach out. As we enter the second year of the pandemic, among other stressors, and with signs of deteriorating mental health and substance use becoming ever-apparent, it’s incumbent on us medical professionals to meet this community where they are. Here is how we do that:
Educate. Educate the Black community with subject matter experts who look like them. Us Black nurses, doctors, and other medical providers have a unique understanding of other Black people’s concerns. With our medical expertise and lived experiences as Black people, we can help chip away at the distrust our people have in the medical community.
Access. Provide accountability through accessibility. Once they have the information and are ready to take the steps to receive the type of care they need, we need to make sure that barriers no longer exist. Extremely long wait times, a lack of accessibility, and a lack of practicality is enough to cause people who are actually attempting to get help to stop trying entirely. If we don’t have the tools and resources to get them to an appointment, such as internet access for telehealth and scheduling, then the education we’ve provided becomes null and void.
Break the stigma. At the rate the country is going, it’s very likely that things won’t be changing too much anytime soon. COVID-19 will continue to disproportionately impact the Black community and will continue to lead to substance misuse.
Please ask for help.
I cannot stress the importance of reaching out for help for a medical condition that will progressively get worse. This is where we can use what is typically the cornerstone of our community: the church.
For many, one of the first people our problems are brought to is our Pastor. We ask for guidance and support from the church and everyone does what they can, but we need the church to further that support by pointing those struggling to the medical professionals who can provide appropriate treatment and care.
The doors to treatment centers are still open. Mental health conditions and addiction do not, and will not, cease because of a pandemic. If anything, they’ve both gotten worse. I implore everyone in the Black community to not be afraid to ask for help, there is absolutely nothing wrong in doing so; addiction and mental health conditions are health issues just as real as a broken leg – they both require the help of a professional.
I ask you to please overcome the hesitation to reach out; as a Black woman, I understand, but as a medical provider, I care and want to help.
The role of the health care professional has seen its fair share of evolution throughout history. Shamans and healers in ancient societies paved the way for modern medical professionals, who have a duty to society as a whole that spans well beyond diagnosis and healing. Medical doctors today are expected to exhibit professionalism as well as effectively communicate with patients and colleagues, and conduct plenty of research.
And for optimal patient care, that research isn’t confined to information directly related to the health care industry. Health care professionals must also remain on top of current events, and be aware of the various societal issues that can shape both medicine and public policy, such as immigration. In this regard, health care workers often double as agents of societal change.
As the Hippocratic oath remains a crucial part of modern medicine, ethical considerations are of paramount importance in the health care arena. Whether you’re a primary care provider, registered nurse, anesthesiologist, or another type of health care worker, you’re in a prime position to advocate for immigrant families. You may be unequipped to help immigrant families in a legal or political capacity, but your direct health care efforts may ultimately catalyze societal change.
Medical Care for Immigrant Families
It’s important to note that the needs of immigrant families may differ drastically based on the citizenship status of family members. And the terminology itself doesn’t necessarily tell the entire story: Children who were born in the U.S. but have at least one foreign-born parent are typically identified as children in immigrant families (CIF). As of 2019, an estimated 1 in 4 children in the U.S. can thus be considered CIF, but their social determinants can vary considerably.
For instance, immigrant family members who are legal U.S. citizens can access the same health care benefits afforded to all Americans, including Medicaid and Medicare. Undocumented immigrants, however, are much less likely to have any type of health coverage. These individuals are subsequently more vulnerable to chronic health issues and contagious viruses including COVID-19.
According to the American Medical Association (AMA), approximately 11 million undocumented immigrants are living in the United States. What’s more, “physicians and other health professionals should be aware of how to advocate for these patients, including through self-education, education of trainees, in the exam room, and on Capitol Hill.” A large number of undocumented immigrants tend to avoid seeking medical care, even if it’s urgent, due to fear of deportation or the intervention of government agencies.
Politically speaking, the subject of illegal immigration is a contentious one. Yet it’s crucial to remember that, for many families and individuals, immigrating isn’t exactly a choice. Many immigrants to the U.S. are refugees seeking asylum, or humanitarian protection, from persecution or war in their home countries. Asylum seekers are subject to a lengthy immigration process, and there is a governmental cap on the number of refugees admitted on an annual basis.
The Importance of Immigrant Health Care Workers
As a health care worker, it may behoove you to learn a little bit about the immigrant families that you serve to better address their needs. But you should also look to your colleagues for guidance and inspiration: Plenty of immigrants are gainfully employed in the health care industry. According to the Migration Policy Institute (MPI), about 2.6 million immigrants are employed in various health care fields, including approximately 1.5 million doctors, registered nurses, and pharmacists.
Unfortunately, immigrant health care workers tend to be underappreciated, yet this segment of the workforce is invaluable in the realm of disaster response. In 2021, disaster response is heavily focused on curbing the spread of COVID-19, but the discipline encompasses much more, notably natural disasters like earthquakes, hurricanes, and wildfires. Within disaster response, the humanitarian side of health care is heavily emphasized, as disaster survivors often require social services — to access food and emergency housing, for example — in addition to medical care.
Similarly, immigrant families may have similar psychological and humanitarian needs, even far removed from disaster response scenarios. Health care professionals from immigrant families are well-equipped to address these sorts of needs among their patients, especially if they have personal experience in seeking legal asylum, or securing stable housing and job opportunities.
Looking to the Future: From Telemedicine to Health Care for All
No matter your background, as a health care professional, you’re likely well-versed in the various social determinants that can influence one’s health and well-being. The conditions and places that one is born and raised in, widely known as social determinants of health, overwhelmingly correlate to individual health, as well as that of entire communities.
Even those social determinants that are directly related to economics and education can have a significant impact on individual health, and the COVID-19 pandemic has only exacerbated the situation. In regards to social determinants, the Centers for Disease Control and Prevention (CDC) reports that “for many people in racial and ethnic minority groups, living conditions may contribute to underlying health conditions and make it difficult to follow steps to prevent getting sick with COVID-19 or to seek treatment if they do get sick.”
The good news is that, as a health care provider, you can help bridge the gaps among your minority and immigrant patients, and telemedicine is an ideal starting point. In a world under the threat of a deadly pandemic, telemedicine has become a crucial component of health care. While you can’t treat serious conditions solely via telehealth, the platform is extremely versatile. Telemedicine can streamline patient monitoring as well as the appointment setting process, reducing the need for multiple visits or a lengthy commute to a hospital or clinic. Further, simple tests such as vision exams can be conducted safely and easily using telehealth.
And signs indicate that telemedicine is likely here to stay, post-pandemic, as it can help generate revenue in health care facilities ranging from major research hospitals to local clinics and private practices.
Although revenue is certainly relevant in every corner of the health care industry, caring for patients is still the ultimate goal. As a health care professional, you may find that advocating for your patients is just as important as administering quality health care. Determining the individual needs of your patients, whether immigrants or natural-born citizens, can ultimately serve to improve public health overall, and give you greater satisfaction that you’re truly making a difference in the world.
“It is fake news.” … that is the loud, common cry of the many. In a society where the majority rules and the ones with the loudest roar make waves to suspend the truth. Where facts seem to cease to exist because the multitudes ignore it. Where wrong rebuffs its own pretense to be congruent to the cognitive dissonance of the masses. Where wanting to be liked has become the prevailing social norm. Where lying has been normalized by the media and has become the new world order. Where the powerful and the privileged lie too often enough it becomes the truth to many who believes – not because it is so but solely because the bulk of the populace believes it to be true. Where, in a time of deceit telling the truth is a revolutionary act. Where speaking the truth becomes blasphemous to those who righteously claim to be Christians. Christians who rerouted the way of speaking the truth in love by disseminating fear in a cacophony of subversive fibs. Where wadded up falsities, hypocrisy, and irony are stitched together to create an artistic quilt of flattery, illusion, manipulation, and control of the senses – stripping the many of their power of self-determination. Brainwashed – a paralysis of reason and logic sets in.
When a preponderance of men gets bedazzled by the cock and bull story of somebody so lightweight, then society resigns to live in mendacity – a world connected without truth. Danger and impending peril to the pillars of institutional and constitutional norms loom in the horizon as the viral twisted social construct of truth remains unimpeded. So, with collected bated breath we await with great apprehension the destruction of everything we behold – but often minimalized and trivialized in its value – our FREEDOM.
With a conflated false sense of valor and a screwed command of reality, the many amongst us relegated their power of sensible self-governance to be commandeered by their bold disobedience to TRUTH – to do the unthinkable. A bewildered nation stood still in disbelief as the sacred cradle of our very existence as a nation of men dedicated to the ideals of equality, justice, and freedom got desecrated by no less our own. Yet. Yet, our Constitution survived the grave assault on its legitimacy. And yes, our societal and democratic institutions came through the perils injured but still in one piece. Freedom and democracy prevailed. Its endurance, a testament to the certitude that truth matters and its glaring significance can never be diminished.
As Leo Tolstoy said, “Wrong does not cease to be wrong because the majority share in it.” Nor a lie becomes truth simply because the plurality of men believes in it. It will not, nor will it ever be. No societal class, party, or individual can claim the exclusive rights to truth. Truth is apolitical. Truth is unbiased. Truth is without prejudice. “Truth will always be truth, regardless of lack of understanding, disbelief or ignorance,” said W. Clement Stone. No amount of opposition, spin and disruption, sneering and jeering will obscure the truth because the light of truth will always find a tunnel to let its light shine through. TRUTH is TRUTH. Only TRUTH can claim the right to TRUTH. As Winston Churchill aptly said, “The truth is incontrovertible. Malice may attack it, ignorance may deride it, but in the end, there it is.” And when everything is said and done, TRUTH remained steadfast – unperturbed by common dissonance and unencumbered by the frailties of man.
In a span of just one week, there have already been two mass shootings that have gained national attention. The killings in Georgia and Colorado are the latest in what seems like a never-ending stream of stories about innocent people getting killed senselessly and violently. Now, in what has become a national routine, political lines are already being drawn. And they are being drawn on the same old line: gun control.
It is hard to not take a breath of exasperation whenever we see the same cycle play out repeatedly in the aftermath of a mass shooting. It starts when the seemingly dormant, yet perpetually antagonistic factions of gun policy resurface in mass media and re-ignite their unending war against each other. As the public’s attention on gun violence once again reaches a critical mass, public officials then proceed one by one to take up gun policy as their new priority. Depending on their persuasion, some leaders may say that there are not enough guns to protect the innocent, while others may say that gun ownership is out of control. The debate intensifies and captivates the nation for weeks or months on end until finally, it reaches a crescendo that ends in nothing but the same, inevitable stalemate that has become the hallmark of almost every mass shooting. The problem never gets solved, national discourse moves on to other news, while innocent people never get the justice they truly deserve.
It does not have to be this way. We, as a society, need to re-evaluate how we approach mass shootings. Gun policy is certainly an issue worth looking into, but it is not THE main issue in these cases. Perhaps we need to start looking at something else. Talking about guns just because guns factored into a news story addresses only the symptom of a major problem, but do not address the true causes of mass shootings.
Public discourse is important. But what is equally important is the content of such discourse. Mass shootings are not and should not be mainly about gun control. Instead, mass shootings must be seen as opportunities to discuss ways on how to address the country’s mental health crisis. Rather than worsening the fault lines of national political dialogue, our leaders can instead find more common ground in improving our nation’s mental health infrastructure. Clearly, these mass shootings are psychotic acts of violence. Guns are the tools that these people use to cause destruction, but it is the mind controlling these guns that we must really be focusing on.
In the medical field, a typical psychiatric assessment involves asking people if they are thinking of harming themselves or others. An affirmative response triggers a cascade of interventions that most likely will lead to a ‘5150’ or an involuntary hold until a person is no longer deemed a danger to self or others. The desire to harm others is so serious that health professionals are trained to carry out a set standard of procedures to protect people from imminent danger. In these situations, there is no debate. There is no time to waste. The person deemed to be a danger is promptly treated and given the attention they deserve. In doing this, the medical community sees thoughts of self-harm or harm to others as an acute crisis, just like any ailment or disease that warrant a visit to the hospital.
If society can give mental health issues the same sense of urgency and level of seriousness that it gets from the medical community, we may be able to find meaningful solutions and prevent these atrocious mass shootings in the future. Our leaders can work together towards allocating more resources towards identifying and assisting at-risk individuals and groups. For instance, hiring more school counselors and other types of mentors who are trained in psychiatric disorders may be able to curtail the possibility of school shootings if early intervention is provided for students that are showing signs of antisocial behavior. Companies and organizations can also be incentivized to provide robust training programs that promote understanding and tolerance of cultural differences. And instead of relying completely on police to deter criminal behavior, communities can invest some resources towards social workers who are trained to diffuse aggressive behavior peacefully and potentially help would-be deviants towards a better path in life.
Mental health issues are not just a medical issue. They are a vital social issue that warrant our utmost attention. Mental health issues permeate the fabric of our collective soul as a nation whether we recognize it or not. The problem is, if we continue to ignore them, they can and will fester like an untreated, open wound.