With the move to precision medicine, especially in oncology, the inclusion of diverse populations in research and development can be a matter of life and death. Thought of another way, with ethnic minorities and others considered underrepresented experiencing cancer at greater rates, these population segments generally participate far less in what can be life-saving oncology research. As COVID-19 has clearly demonstrated, from the clinic to research, the embrace of diversity characterizes a fundamental step in progressing the nation’s healthcare outcomes. After all, the United States is more ethnically and racially diverse than most other developed nations. Now the Barbara Ann Karmanos Cancer Institute, already a pathbreaker when it comes to working for health equity, has launched the Diversity and Inclusion Committee to integrate best practices, inclusion, and cultural competence in an ongoing quest to deliver continuously better and more equitable medical care. Perhaps this Midwestern cancer center develops a model for inclusion that others can learn from.
A Major Provider Network
Based in Detroit, a heavily African American populated city, the Barbara Ann Karmanos Cancer Institute is the largest cancer research and provider network in Michigan with 16 treatment locations. Making this move to improve access and care for all, the center has established Justin Klamerus, MD, MMM, president, Karmanos Cancer Hospital & Network as executive sponsor of the local committee with Kay Carolin, chief nursing officer, as the chair.
The Committee Commences
This Diversity and Inclusion Committee consists of members from different organization areas from leadership and administration to clinical staff and researchers. The first meeting was held on October 19, 2020. They anticipate that this committee will collaborate with department leaders in identifying staff members to participate in initiatives to broaden the scope of voices and ideas. Karmanos has a history of embracing diversity while working towards more equitable outcomes. What follows are examples of this work in action.
Karmanos’ Health Equity Book Club
The center has launched the “Health Equity Book Club,” a quarterly program to educate health care providers on the history of systemic racism in medicine and to set the stage for developing strategies and interventions to eliminate the impact of racial inequalities in medical practice and society. More information on this topic can be found via the website: www.karmanos.org/bookclub.
Detroit’s Transformations Ongoing
In the Karmanos Cancer Institute’s recent press release, they note their history of diversity and inclusion. This makes sense given their location in Detroit, which has the highest percentage of African Americans of any major American city. With about 670,000, about 82% of the population is Black, while the metro has over 5 million with approximately 22% of the broader regional population African American.
Detroit’s economy was devastated by outsourcing manufacturing (e.g., auto, etc.) from the Midwest to abroad. Large automobile production moved to more flexible, low-cost production centers with the advent of globalization.
The city, extremely wealthy and with nearly 2 million residents by 1950, experienced the flight of industry starting in the late 1960s; the Anglo/Caucasian population steadily declined (a trend that was coined “White Flight”) while the African American population grew thereafter. A pivotal point triggering a precarious downward slide, the 1967 riots perhaps set the city back decades.
However, since perhaps the early 2000s, there has been somewhat of a renaissance in downtown and midtown Detroit. Despite still high crime rates and significant pockets of urban poverty, the city has started gentrification in certain pockets like many other cities across the country—although reports are that it’s not sufficient investment levels.
Known as the “Motor City,” Detroit’s Black culture has contributed profoundly to broader American popular culture (e.g. “Motown, etc.). Detroit, a traditionally blue-collar, broad-shouldered city, represents an important place in the American story of industrial growth and advancement, opportunity for a diverse workforce, and at one point, the capital of automobile manufacturing. The city is now evolving in many good ways to reimagine and recreate itself yet again, an underlying theme in many American cities.
Karmanos History of Diversity and Inclusion
Perhaps because of its location and the progressive-minded ethos and culture of the institution, the center has, for a long time, now committed to serving diverse populations. Through its Population Studies and Disparities Research (PSDR) Program, Karmanos investigators identify risk factors underlying disease onset and progression to augment and develop intervention strategies to reduce risk and improve diagnosis, treatment, and outcomes. All in a quest to reduce race and ethnic-related disparities and overall disease burden.
Karmanos started the Surveillance, Epidemiology, and End Results Program (SEER) in 1973 as one of nine original registries. The center reports that they contribute about 38% of the national cancer incidence and survival data for African Americans. SEER is used for descriptive studies as well as population-based sources of cases for case-control and case comparisons.
Office of Cancer Health Equity and Community Engagement (OCHECE)
Karmanos house OCHECE is a department that drives toward eliminating health disparities in the State of Michigan by promoting community-engaged research and evidence-based strategies throughout Karmanos’ 46-county catchment area in the state. Programs include HealthLink, an academic-community partnership developed to build community capacity to collaborate in cancer-related research, and the Research and Advocacy Consortium (RAC). This growing network includes 30 faith-based, social service, and public health organizations. The RAC works with OCHECE to support evidence-based interventions to improve cancer outcomes; inform diverse communities about clinical trials, cancer control, prevention, screening, and treatment; aid in disseminating and implementing research discoveries and advancing health policy recommendations.
About the Barbara Ann Karmanos Cancer Institute
Karmanos Cancer Institute is a leader in transformative cancer care, research, and education through courage, commitment, and compassion. Our vision is a world free of cancer. As part of McLaren Health Care, Karmanos is the largest provider of cancer care and research in the state of Michigan. For more than 75 years, our administrative and research headquarters, along with our premier specialty cancer hospital, have been located in downtown Detroit. Throughout the state, our 15 network sites deliver market-leading cancer care and clinical trials conveniently to the communities where many of our patients live. The National Cancer Institute recognizes Karmanos as one of the best cancer centers in the nation. Our academic partnership with the Wayne State University School of Medicine provides the framework for cancer research and education, defining new care standards, and improving survivorship. For more information, call 1-800-KARMANOS (800-527-6266) or visit www.karmanos.org. Follow Karmanos on Facebook, Twitter, LinkedIn, and YouTube