“Where are the unnecessary deaths in Cincinnati?” asked Dr. Harold Freeman, former president of the American Cancer Society, at a recent Cincinnati conference on patient navigation. Freeman was pointing out that the failure to identify and treat cancer in its earliest stages leads to deaths that could have been prevented. Both the Cincinnati and Hamilton Health Departments have identified the neighborhoods where there is a gap of 20 years in life expectancy. Their reports reveal the abundance of death from cancer and other diseases that stains Cincinnati as a city of progress, opportunity, and access to health care. It is hard to believe that people in certain communities average 81.8 to 87 years of age while there are also communities that never get above 69.9 to 73.3 years of age (Hamilton County Public Health. August 2014. Does Place Matter?: Health Equity in Hamilton County, p. 34). Avondale, College Hill, Evanston-East Walnut Hills, Fay Apartments, Northside, South Fairmount, and Walnut Hills were identified as having the highest death rates (N. Maseru and C. Jones. March 2011. Cincinnati Health Department, p.5).
Freeman has come to Cincinnati to tell the story of how he reduced mortality over five years in his community of Harlem, New York City, through a patient navigation process. Early screening and quick follow-up brought the death rate down (H. Freeman. 3/13/2014. Why Black Women Die of Cancer. NY Times.). The key to the success of his program was the training and placement of people called “lay navigators.” Community people, selected and trained for working with cancer patients to overcome their barriers to getting tested, being referred to programs, and receiving top flight care, were the foundation for saving lives and promoting healthy chances for survival. Freeman worked on the philosophy that the “place” that his low income and minority patients lived was not important when the care they received heightened their chances for life. Active, bold, and caring partnerships with the citizens made the critical difference between life and death.
Now, Cincinnati has the opportunity to pioneer a similar program. Community citizens, identified by community leaders, doctors, nurses, and social workers can be trained to work with cancer patients and change the outcome for life. An organization of able patient navigators, deployed in the Cincinnati Health Clinics, or community agencies, or hospitals, or churches, can reach out to citizens with the key information about the signs of cancer in their or their family’s lives. Establishing trust with the community will be important if citizens are to overcome the barriers of fear that rightfully surround the area of cancer. Once a trusting partnership is established, a personal “road map” can be developed that takes the patient to a clinic, and then, where needed, to services in University Hospital or Cincinnati Children’s Hospital. Cincinnati has been a very generous community in providing funds for people with difficulty paying for the cancer treatment. Also, very helpful are the resources of the American Cancer Society when included in the solution to understanding how cancer can affect an individual and a family. In five years in Cincinnati, following Freeman’s program, access and treatment, not place, could be the key factors in survival.
A patient navigation program is the key to dramatically improving health for our low income and minority community members with cancer. Cincinnati can become a “place” where the health of all of its citizens is honored by making sure that everyone, irrespective of their neighborhood, gets access and treatment for cancer. This truly makes us an “ALL STAR CITY.”