Zoom Series: Comprehensive Cancer Control Coalitions Advancing Health Equity

What is it?

The Comprehensive Cancer Control National Partnership (CCCNP) has launched an effort designed to assist CCC coalitions and programs in addressing health inequities in cancer. The initiative specifically focuses on:

How a coalition can advance health equity through CCC plan update processes and CCC plan implementation and
How a CCC coalition can look at its operations through a social justice and equity lens

As part of this effort, the CCCNP has gathered a set of resources, specifically for CCC coalitions, to help you learn about the issues and to take action (see below).

In addition, the CCCNP is hosting a quarterly zoom series, where experts and CCC coalitions share ways to advance health equity through CCC coalitions and plans.

How do I join the CCCNP Health Equity Zoom Meetings?

To join the next Zoom meeting, use the link below. Email katie.bathje@cancer.org for more information.

Topic: Health Equity Zoom Series: Addressing Disparities with Adapted Evidence-Based Interventions

Moderator: Prajakta Adsul, MBBS, MPH, PhD, Assistant Professor, University of New Mexico

Panelists:

Amber Ahonen, Cancer Control Project Manager, Fond du Lac Reservation
Karel Davis, Program Director, Wichita Falls-Wichita County Public Health District
Sylvia Lopez, MPH, CHES®, Coordinator of Community Outreach and Engagement, UCLA Kaiser Permanente Center for Health Equity and UCLA Jonsson Comprehensive Cancer Center

Time: August 11, 2021 02:00 PM Eastern Time (US and Canada)

Join Zoom Meeting here

Recordings of previous sessions from this series can be found here:

2020 sessions

2021 sessions

What resources can cancer coalitions use to advance health equity?

We encourage CCC coalitions to use these resources to advance health equity in your own state, tribe and territory. The resources are categorized to help you learn more about the issues and to take action.

Resources for Learning

Background Reading on Racism and Health Equity

Annual Review of Public Health. Addressing Health Equity in Public Health Practice: Frameworks, Promising Strategies, and Measurement Considerations. (Liburd et al., 2020; Office of Minority Health and Health Equity, Centers for Disease Control and Prevention [CDC])
Black Lives Matter: A Commentary on Racism and Public Health, American Journal of Public Health editorial (García & Sharif, 2015)
Racism: Science & Tools for the Public Health Professional (e-book from APHA)
RacialEquityTools.org This ‘clearinghouse’ website offers tools, research, tips, curricula and ideas for people who want to increase their own understanding and to help those working toward justice at every level – in systems, organizations, communities and the culture at large. See curated book and film lists for further learning. (Center for Assessment and Policy Development, MP Associates, World Trust Educational Services)
2019 National Healthcare Quality and Disparities Report (Agency for Health Research and Quality [AHRQ])
Blog series: Race and America: How Did We Get Here, and What Can We Do About It? & Race and America: How Medicine Earned the Mistrust of Americans (Pratt-Chapman and Haywood, 2020; Academy of Oncology Nurse and Patient Navigators)
Read about how the 10 Essential Public Health Services framework was revised in 2020 to center health equity

Cancer-specific background reading

Making the Case for Health Equity: Facts, definitions, and statistics about cancer health disparities and why equity matters (American Cancer Society [ACS])
A Time to Dig Deeper and Take Meaningful Action, a Journal of Clinical Oncology editorial (Pierce, 2020; American Society of Clinical Oncology [ASCO])
The Center for Black Health and Equity works to facilitate the implementation and promotion of comprehensive policies, community-led programs and culturally competent public health campaigns that benefit people of African descent.
Cancer Disparities Progress Report 2020: Achieving The Bold Vision Of Health Equity For Racial And Ethnic Minorities And Other Underserved Populations (American Association for Cancer Research)
How structural racism can kill cancer patients (Nelson, 2020) Explores racism and inequality in cancer care. (ACS Journal Cancer Cytopathology)
Understanding and addressing social determinants to advance cancer health equity in the United States: A blueprint for practice, research, and policy (Alcaraz et al., 2019). Introduces a framework for understanding and addressing social determinants of health, such as financial stability, access to healthy foods, and access to cancer-related services. (ACS Journal CA: A Cancer Journal for Clinicians)
Racial/Ethnic Disparities in Lost Earnings from Cancer Deaths in the United States (Zhao et al., 2020) ACS researchers estimate the cost of racial disparities on cancer mortality. (JNCI Cancer Spectrum)
Tobacco is a social justice issue: Racial and ethnic minorities (2017) & Achieving health equity in tobacco control (2015) (Truth Initiative)

Virtual learning & online trainings

Roots of Health Inequity – A web-based course for the public health workforce (National Association of County and City Health Officials [NACCHO])
Unlearning Systemic Racism – Recorded virtual town hall from July 1, 2020. See recordings from each speaker along with links to referenced content (books, films, websites) and additional tools to help you move forward on the path of individual and institutional change, including Advancing Anti-Racism Strategies. (YMCA of the USA)
American Public Health Association’s [APHA] Impact of Racism on the Health and Well-Being of the Nation 2015 webinar series archive with companion PDF summary of each webinar, speaker presentations and resources
APHA's Advancing Racial Equity 2020 webinar series with companion PDF of discussion questions and activities
Video vignettes from Camara Phyllis Jones, MD, MPH, PhD:
Barriers to Health Equity & How Do Health Disparities Arise? (2-min introductory videos)
Gardener's Tale TEDx (20 minutes, Understanding Levels of Racism)
Cliff of Good Health (5 minutes, Understanding Social Determinants of Health)
Prevention Institute's Health Equity and Prevention Primer is a web-based training series for public health practitioners and advocates interested in achieving health, safety, and health equity through policy advocacy, community change, and multi-sector engagement.
Region IV Public Health Training Center has a resource repository of relevant online trainings on unconscious bias, cultural competency, etc.
What is Systemic Racism? – This Race Forward series of videos explain what systemic racism is and how it is embedded in systems to perpetuate oppression of people of color – and what systems hold the power.
Kimberlé Crenshaw's TED Talk on Intersectionality: This 20-minute video looks at the reality of race and gender bias -- and how the two can combine to create even more harm.
Racial Equity Institute’s virtual and in-person workshops
The People’s Institute for Survival and Beyond Undoing Racism® and other programming

Resources for Action

Have conversations about race and health as a coalition

Consider going through the 21-Day Racial Equity Habit Building Challenge©
Resources for talking about race and being anti-racist (National Museum of African American History & Culture)
Resources for sustaining the work (RacialEquityTools.org)
Build a race equity culture in your organization focused on proactive counteraction of racial inequities by following the “Awake to Woke to Work” cycle from Equity in the Center

Take a stand as a coalition or organization

Develop guiding principles
- Health Equity Principles: Example of nine principles that guide ACS and ACS Cancer Action Networks’ work to promote and embrace health equity in all that they do.
- Health Equity: Moving Beyond “Health Disparities” Common principles that can be promoted and strategies to be adopted in framing a health equity agenda. (PolicyLink)
Draft and release a statement on your position on these issues (see examples)
- Comprehensive Cancer Control National Partnership Statement on Health Equity & Racism
- ASCO’s Statement Responding to Racism and Health Inequality as a Cancer Care Community
- Cancer Disparities and Health Equity: A Policy Statement from the American Society of Clinical Oncology
- Cancer Support Community’s Statement of Affirmation in Support of Inclusion and Equality
- Region IV Public Health Training Center at the Rollins School of Public Health, Emory University
- Susan G. Komen of Chicago: Black Lives Matter
- Sample declarations on racism as a public health issue/crisis from around the country (APHA)
Adopt model language on health equity
- Health Equity Model Language for use in official documents (National Association of Chronic Disease Directors [NACDD])
Ensure health equity in your financial operations
- Budget Equity Assessment Tool Template (City of Portland Office of Equity and Human Rights)
- Contracting for Equity: Best Local Government Practices that Advance Racial Equity in Government Contracting and Procurement (Government Alliance on Race and Equity)
- Guidance for Integrating Health Equity Language Into Funding Announcements (Association of State and Territorial Health Officials [ASTHO])
- Organizing for Participatory Budgeting: How to Start Participatory Budgeting in Your Community (video from the Participatory Budgeting Project)
Communicate equitably
- Health Equity Toolbox: Resources to Foster Cultural Sensitivity and Equitable Care for All This toolkit is designed to help stakeholders disseminate and promote health equity resources for patients and providers via social media. (GW Cancer Center)
- Using communication as one strategy to advance racial equity goals (RacialEquityTools.org)
- Communicating for Health Justice: A Curriculum for Developing a Health Equity Communications Strategy (The Praxis Project)
- Communicating About Health Equity: Showing the Bigger Picture to Build Healthier Communities (archived webinar from Berkeley Media Studies Group)

Assess how your coalition and your work are reflecting and advancing racial justice and health equity. Make adjustments to improve as needed.

Organizational assessments
- Coalition make up & human capacity
  - Building Equity into Your Network of Partners (archived webinar from October 20, 2020 and resource list from County Health Rankings)
  - Health Equity at Work skills assessment for staff (NACDD)
  - State Health Department Organizational Self-Assessment for Achieving Health Equity provides public health leaders with tools and guidance to identify skills, organizational practices, and infrastructure necessary to achieve health equity (NACDD)
  - Building Diverse Community Based Coalitions (The Praxis Project)
  - Building Public Health Capacity to Advance Equity: A National Environmental Scan of Tribal, State, and Local Governmental Public Health (2019) – Includes strategies for public health action and recommendations for networking across strategies to build a national movement for public health equity (National Collaborative for Health Equity)
- Coalition policies/procedures
  - 7 Steps to Advance and Embed Race Equity and Inclusion within your Organization (The Annie E. Casey Foundation)
  - Moving to Institutional Equity: A Tool to Address Racial Equity for Public Health Practitioners The Institutional Racial Equity Review Tool will guide the user through a process to identify internal policies and practices that impact public health operations, projects, and decisions—all of these influence how institutional racial equity is expressed in the workplace. The Tool will help in assessing the potential impacts of institutional policies and procedures on equity (NACDD)
  - Foundational Practices for Health Equity: A Learning and Action Tool for Public Health Organizations This learning and action tool was developed to assist state public health organizations to: 1) Introduce a set of foundational practices to advance health equity within an organization and with partners; 2 Identify and document the organization’s current capabilities and practices against seven practices that provide a solid foundation for public health to advance health equity; 3) Track improvements and changes in capabilities and practices (ASTHO)
  - Organizational Assessment Tools and Resources (RacialEquityTools.org)
  - Evaluate your cancer plan’s focus on racial justice and health equity. Use this CCCNP tip sheet to assess your plan.
Encourage use of community, health, and racial equity impact assessments by coalition member organizations
- A Health Impact Assessment Toolkit: A Handbook to Conducting HIA (Human Impact Partners) and Communicating About Equity in Health Impact Assessment: A Guide for Practitioners (Society of Practitioners of Health Impact Assessment)
- Racial Equity Impact Assessment Toolkit, which provides an analysis of how different racial and ethnic groups will likely be affected by a proposed action or decision. Use this to minimize unanticipated adverse consequences and can be a vital tool for preventing institutional racism and for identifying new options to remedy longstanding inequities.
- City of St. Paul, MN racial equity assessment Try this two-hour training with your coalition. Includes PowerPoint slides along with the racial equity assessment tool. The slides follow the toolkit steps. There is time in the training set aside for teams to practice using the assessment tool on a specific policy, procedure, or decision of importance to them.
- Community Assessment Tools and Resources (RacialEquityTools.org)
- The Organizational Self-Assessment for Addressing Health Inequities Toolkit, developed by the Bay Area Regional Health Inequities Initiative, provides public health leaders with tools and guidelines that help identify the skills, organizational practices, and infrastructure needed to address health equity and provide insights into steps health departments can take to ensure their organization can have an impact on this growing problem.
- The Racial Equity Map, developed by the Racial Equity Learning and Action Community, is a tool to guide organizations’ thinking and actions to advance racial equity. It helps organizations assess where they are on their racial equity journey, spark thoughtful and respectful conversations, and identify action steps to advance racial equity together.

Use data to make disparities visible and incorporate analysis into your cancer plan

Data sources where you can look at indicators by different demographic factors to uncover disparities
- Cancer Facts & Figures for African Americans (ACS)
- Cancer Facts & Figures for Hispanics/Latinos (ACS)
- Cancer Disparities: A Chartbook (2018) Illustrates the scope of cancer disparities that exist across our nation (ACS CAN)
- Data Equity Framework from We All Count. When it comes to equity in data science projects, trying to find all the ways that bias, assumptions, unfairness, and prejudice can sneak in may feel overwhelming. Trying to look at a whole project and see all the equity weaknesses and issues is almost impossible. That’s why We All Count has developed: The Data Equity Framework.
- Racial Equity Data Hub from the Tableau Foundation
- State Cancer Profiles Cancer statistics, charts, and maps by data topic across the cancer control continuum (National Cancer Institute [NCI])
- National Equity Atlas One-stop-shop for data and policy ideas to advance racial equity and shared prosperity. Provides equity metrics that are deeply disaggregated by race/ethnicity, gender, nativity, ancestry, and income for the largest 100 cities, 150 regions, all 50 states, and the US as a whole. Includes a brand new racial equity index. (PolicyLink and University of Southern California Equity Research Institute)
- The CDC and the HHS Office of Minority Health developed the Minority Health Social Vulnerability Index (SVI) to enhance existing resources to support the identification of racial and ethnic minority communities at the greatest risk for disproportionate impact and adverse outcomes due to the COVID-19 pandemic but much of the data are relevant for cancer too like SES, language, housing, transportation, health care infrastructure, and medical vulnerability. The Minority Health SVI is an extension of the CDC Social Vulnerability Index, which is a platform that helps emergency response planners and public health officials identify, map, and plan support for communities that will most likely need support before, during, and after a public health emergency.
- New social determinants of health dataset available for download and analysis from the National Cancer Institute. This data set includes, for each US census tract, certain SDOH data elements, including race/ethnicity, education, poverty, urban/rural, socioeconomic status, and racial residential segregation indices defined using 2008-2012 American Community Survey data and 2010 definitions of rural urban commuting areas. The SDOH data set is publicly available, pending an application and data use agreement.
Data Visualization information and tools
- Diversity, Equity, and Inclusion in Data Visualization: General Recommendations
- Do No Harm Guide: Applying Equity Awareness in Data Visualization, published by the Urban Institute, and accompanying resources. Learn how we as data storytellers must have sensitivity for our subject matter, and our audience—guided by the most fundamental principle of all: data points represent real people.
- The Racial Equity in Data Visualization Checklist
- United States Cancer Statistics: Data Visualizations This tool provides incidence and death counts, rates, and trend data; survival and prevalence estimates; and state-, county-, and congressional district data in a user-driven format (CDC)

Implement evidence-based strategies/policies/interventions to address disparities

Community-level strategies and resources

A Practitioner’s Guide for Advancing Health Equity – Community Strategies for Preventing Chronic Disease (CDC)
Community Engagement and Participation Checklist Use this checklist to help assess the extent to which you are integrating community input and involvement into a coalition project. (PolicyLink)
Health Equity Guide – After years of struggling to close health disparities, a new movement has taken root: health departments are using a set of strategic practices to confront the power imbalances and forms of oppression at the root of health inequities, change the conversation about what creates health equity, develop leadership and support innovation, and build a movement for health equity. (Human Impact Partners)
As part of its Culture of Health Program, earlier this year the National Academy of Medicine (NAM) released a model for developing Community-Driven Health Equity Action Plans, as well as Community-Driven Health Equity Action Plans developed by groups from across the country with facilitation from the NAM. See also their Pathways to Health Equity Report and related resources including the public health sector brief.
Promising Practices to Reduce Inequity (NACDD)
17 Strategies for racial equity with resources (RacialEquityTools.org)
Sustainable Communities Series Regional Planning for Health Equity (PolicyLink)

Resources for the clinical community

Advancing Health Equity Leading care, payment, and systems transformation through learning collaboratives, strategy examples, reports and more. (University of Chicago and Robert Wood Johnson Foundation [RWJF])
A Roadmap and Best Practices for Organizations to Reduce Racial and Ethnic Disparities in Health Care (RWJF)
Anti-Racist Cancer Care Recorded panel discussion from August 12, 2020 (Cancer Support Community)
Two National Cancer Leaders Discuss How to Achieve Health Equity in Oncology (ASCO and Stand Up To Cancer recorded Facebook Live conversation from August 23, 2020)
Together, Equitable, Accessible, Meaningful (TEAM) Training -- aims to improve health equity by supporting organizational changes at the systems level with a focus on improved patient-provider communication, cultural sensitivity, shared decision-making and attention to health literacy. To enroll in this course, visit the Online Academy and use enrollment code TEAMcare.
See the messaging toolkit, storybook, videos, policy updates, and more from ACS CAN’s Medicaid Covers US campaign. Use the resources to help elevate the positive impact of Medicaid on reducing health disparities.

National Initiatives and examples from across the country

A major goal of public health is to reduce health disparities. The programs described in the MMWR Supplement, Strategies for Reducing Health Disparities—Selected CDC-Sponsored Interventions, United States, 2016, are examples of CDC-sponsored initiatives that address health disparities with the goal of advancing health equity.
The Center to Reduce Cancer Health Disparities is central to NCI’s efforts to reduce the unequal burden of cancer in our society via basic and community research, as well as networks, and to train the next generation of competitive researchers from diverse populations in cancer and cancer health disparities research.
Racism and Health website (APHA)
Reducing health disparities public policy resources (ACS CAN)
Health Equity Case Studies (ASTHO)
African-American Health Equity Initiative: From Education to Impact (Susan G Komen)
Breast Cancer Disparities Learning Community Lessons Learned and Resources including an online toolkit (ASTHO)
Community Guide of the Community Preventive Services Task Force's findings related to strategies to advance health equity.
The Evidence-Based Cancer Control Programs (formerly RTIPs) website is a searchable database of evidence-based cancer control programs and is designed to provide program planners and public health practitioners easy and immediate access to program materials. Use the search filters to find programs developed and tested with a variety of priority populations.

Stay current with news from national organizations

CDC’s Minority Health website with Health Equity Matters newsletter, Conversations in Equity blog, and other resources
NACDD’s Health Equity Council website with tools & resources, including extensive recommended reading lists, and archived webinars
CDC’s Networking2Save program supports a consortium of national networks to advance commercial tobacco use prevention and cancer prevention in populations experiencing tobacco- and cancer-related health disparities

Evaluate your work with a culturally-responsive equity lens