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.
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.
Patricia Cummings, BSN, RN, had an experience that most other nurses don’t get. She gave the COVID-19 vaccine to Vice President Kamala Harris and her husband, Second Gentleman Doug Emhoff. Cummings, a student in Walden University’s Master of Science in Nursing program and clinical nurse manager at United Medical Center says that it was a phenomenal experience, but also acknowledges how the Black community is facing challenges with people receiving the shot.
“My experience of being able to inoculate Vice President Kamala Harris and her husband was truly humbling and exciting. I feel honored that I was given an opportunity to be a part of history, as Vice President Harris is the first woman and the first African American and Asian American person to be appointed to that role. It is certainly one of the greatest highlights of my nursing career thus far,” says Cummings.
But she says that, initially, even she, a nurse, was hesitant about getting vaccinated. “I wanted to conduct my own research on the scientific background of the vaccine as well as speak with colleagues who are experts in the fields of infectious diseases and epidemiology. After reviewing the results of the clinical trials and the vaccine production process, I was convinced about the efficacy and safety of the vaccine, and hence decided to take it,” Cummings explains. “As the mother of two children, we have had to make several adjustments in our socialization, schooling, and other activities. I desire to return to a level of normalcy in my personal life, and I understand that getting vaccinated is presently the only viable solution to avoid contracting and spreading the virus. I am also saddened at the hundreds of thousands of lives lost as a result of the virus and am anxious to seeing the pandemic come to an end.”
Cummings says that one of the biggest challenges facing the Black community is having access to the virus. “Until recently, the vaccine was only accessible at a few hospitals and clinics that are typically far and inaccessible. Additionally, the registration process has been arduous and often requires one to be computer literate, as many sites require registration via the internet,” she says.
However, this isn’t the only reason why BIPOC are hesitant to get vaccinated. History has scared many people. “Hesitancy in the BIPOC population is primarily attributed to their distrust in the U.S. health care system. Historical events such as the Tuskegee Experiment, in which Black men were deceived regarding treatment for syphilis, have had lasting effects on the BIPOC community,” says Cummings. “Additionally, many have expressed skepticism about the short timeframe in which the vaccine was created and the fact that, at first, the only available vaccines required two doses.”
Cummings suggests that nurses can help alleviate patients’ fears because they’ve tended to be seen as people whom the BIPOC can trust as providing information. “Nurses should therefore provide factual information about the efficacy and safety of the vaccine based on their understanding of the clinical trials, as well as the vaccination process thus far,” she says. “Additionally, they should promote vaccination as a part of primary prevention, health, and wellness.”
Building trust in the community she serves is something that Cummings works on regularly. “As a student at Walden pursuing my MSN in the Nurse Executive program, I have learned the importance that the role of a leader as a change agent plays in influencing others to make beneficial choices. I have therefore chosen to put significant effort into sharing information about the vaccine’s efficacy and safety in hopes of building trust in my community,” says Cummings. “I also share my own vaccination experience and am transparent about my initial hesitancy. Additionally, I participate in community events that afford me a voice to safely share information and answer questions in real time.”
Another problem, though, faces certain minority communities—not speaking the same language. “One challenge that I believe exists among Hispanics and other non-English speaking populations is a language barrier. I have not seen adequate advertising and information provided in languages other than English. I believe that it is imperative that vaccine information is presented in a manner that is comprehensible to all people,” says Cummings. “It is important to add that I am passionate about health promotion and wellness. I believe that all people should be able to make informed decisions. My goal is not to strong-arm anyone into accepting the vaccine, but merely to provide them with truthful information and my own experiences in hopes that they make wise choices.”
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