BETHESDAThe National Cancer Institute will rename and
restructure its Office of Special Populations Research as part of its
increased efforts to reduce disparities in the prevention, screening,
diagnosis, and treatment of cancer among various US subpopulations.
The new NCI center will consist of three branches devoted to
research, communications, and health policy, according to Harold P.
Freeman, MD, president and chief executive officer of North General
Hospital, New York. Dr. Freeman, who also serves as chair of the
Presidents Cancer Panel, heads the new NCI organization on a
We will be driven to understand the real variables that are
causing disparity, and to try to understand these things in a
universal way, when there are universals, and to try to understand
the factors that are specific to specific groups, he told the
National Cancer Advisory Board (NCAB). He called the task
daunting but doable.
Health disparities among various racial, ethnic, cultural, and
socioeconomic groups in the United States have drawn increasing
attention, not just in cancer but in health care in general. The
federal governments Health People 2010 program lists
eliminating such gaps as one of its central goals.
Dr. Freeman gave the NCAB members a status report on what is
tentatively being called the Center to Reduce Cancer Health
Disparities and described his views on the issues the center will
address. From his 32 years in surgery, oncology, and cancer policy,
three major issues appear particularly important in informing the
search for the causes of health disparity, he said.
Number one, I believe, poverty is an overwhelming factor
because it is associated with a lack of resources and a lack of
knowledge. This is a universal factor.
A second factor is culture, which is important in determining what
diseases people may develop and how they will respond when they need
to do something about an illness.
The interface and interrelationship between the lack of
resources and culture is something we need to know more about,
Dr. Freeman said.
Third, the effects of social injustice play a significant role.
I believe that when people have been denied the opportunity for
economic and educational advancement because of factors of injustice,
this also plays into the causes of disparities, he said.
Noting the existing efforts within NCI, Dr. Freeman suggested that
the new center might have the opportunity to synergize activities
across the Institutes divisions and elevate cancer disparity to
new areas of concern.
We do not believe this center should reinvent any wheels,
he said. We believe we should look at the wheels that have been
invented, make sure they are all on the same vehicle, and perhaps
move the discussion further forward.
Scientific discoveries have contributed greatly to increased survival
and improved quality of life for Americans, Dr. Freeman said. At the
same time, a heavier burden of disease is borne by the poor and the
medically underserved. One of the things this center must do is
more precisely define who these populations are that are not well
served, he said.
Dr. Freeman expressed his belief that the unequal burden of
disease in our society is a challenge to science, but it is also a
moral and ethical issue for our nation. Sounding a theme from
the 1999 report of the Presidents Cancer Panel, he spoke of the
disconnect between research discoveries and the delivery
of these results to the public.
This disconnect is in and of itself a predeterminant to the
unequal burden of cancer, he said. To know something
through discovery is one thing, but you have to be able to apply
these things to be able to help humanity.
Historically, researchers have framed the issue of health disparities
in terms of race and ethnicity and, indeed, the office of Management
and Budget directs federally funded researchers to use specific
racial/ethnic breakdowns in reporting data. Many researchers now
argue that such categories can obscure both the biological and social
causes of disparities.
There is no biological basis for racial classifications,
Dr. Freeman said. However, the consequences of the racism
inherent in racial classifications have, for some racial and ethnic
groups, been associated with fewer social, education, and economic
opportunities; greater exposure to stress and unsafe environments;
and reduced access to quality health care.
And he added, It is very critical to determine the real
variables that cause disparities. It is simply not enough to go with
the assigned categories as we have in the past.
Structure of the New Center
As now envisioned, the new Center to Reduce Cancer Health Disparities
will be headed by an associate NCI director, who will report directly
to the Institutes director. The center leadership will include
a deputy director and an assistant director for interagency partnerships.
The special populations research branch will focus on epidemiologic,
intervention, and surveillance studies aimed at reducing the risk,
incidence, and mortality of cancer, particularly among groups that
have the greatest burden of cancer.
The communications branch will be concerned with effective ways to
communicate new findings about cancer treatments, diagnosis, and
prevention to these groups.
The health policy branch will play an important role in assisting
policymakers to understand the causes and cures of disparities, Dr.
Freeman added. No matter what we are doing in research, we have
to affect the real people, he said. We need to bring
strong evidence and experts together to provide policymakers all the
information that they need to make decisions.