The Health Divide: New data on cancer disparities, plus the unequal toll of LA's wildfires

Even though cancer mortality rates are dropping nationwide, the disease is increasingly affecting women and younger adults. That’s a key finding from the American Cancer Society’s annual report,released last week.  

On a broad level, the results are promising: Cancer mortality rate declined by 34% from 1991 to 2022 in the United States, saving millions of lives. But it’s not all good news. The cancer rate of women under 50 is 82% higher than men of the same age – that’s up from 51% in 2002. 

While the reasons behind the widening disparity are complicated, it appears that breast and thyroid cancers in women are driving the increase, reported CNN.  

The report also details widespread inequities by race and ethnic groups. For one, cancer mortality rates are two to times higher in Native Americans than white people for kidney, liver, stomach, and cervical cancers. Meanwhile, Black individuals are twice as likely to die from certain cancers compared to white people, such as prostate and stomach cancer.  

Digital therapy’s benefits not shared by all 

A key aim of telehealth has been improving access to underserved groups. When it comes to teletherapy for children, though, the growth in telehealth use has largely come from higher-income earners in cities with private insurance.  

The findings, published this month in the American Journal of Psychiatry, come amid the ongoing youth mental health crisis, made worse by the COVID-19 pandemic. 

In addition, the study found that white children were more likely to receive video visits than Black children. The finding, researchers wrote, “raised concerns over equity in access to internet-delivered telemental health care.” 

“Telehealth did not live up to the hype,” said C. Vaile Wright, senior director of the office of health care innovation at the American Psychological Association in a New York Times article covering the recent study as well as similar usage trends.  

Medical debt ruling could help millions  

A ruling on medical debt could have important implications for millions of Americans, reports NPR. Earlier this month, the Consumer Financial Protection Bureau issued new regulations prohibiting medical debt from appearing on people’s credit reports. About 15 million Americans will have nearly $50 million in medical bills removed from these reports, and lenders won’t be able to use that information against people seeking a loan.  

Adding medical debt to credit reports has made it harder for people with those bills to rent an apartment, get a loan, or find a job.   

Health care debt disproportionately affects marginalized groups and can be a hard cycle to break, according to a report from the Institute for Healthcare Improvement. People facing medical debt might avoid essential health care, skip prescriptions for chronic diseases or forego preventative care, behaviors that can lead to health emergencies and even more debt. “This vicious cycle traps too many patients in the U.S.,” the report found.  

Oregon pilot expands Medicaid to more young adults  

Oregon will offer free Medicaid benefits to thousands of 19- and 20-year-olds with certain physical and mental disabilities who previously made too much money to qualify for the low-income health care. Along with mental health conditions and intellectual disabilities, the new program also includes physical conditions such as asthma and diabetes, reports The Oregonian. The change is part of the state’s goal to widen access to health care and eliminate inequalities, according to the article. Ultimately, the agency plans to expand the program to more young adults up to age 26.  

Altadena’s Black community faces long road to rebuild

Much of the worldwide media attention surrounding the Los Angeles fires has centered on wealthy enclaves such as Pacific Palisades. But the tremendous losses suffered in Altadena, an unincorporated region north of Pasadena, disproportionately impacted middle-class people and communities of color, as Axios reported.  

The Eaton Fire destroyed many Black-owned homes and businesses in Altadena, where about 18% of residents are Black. The community faces a daunting set of challenges in rebuilding, which will be important for journalists to track. Communities of color may “struggle amid the maze of insurance bureaucracies and federal disaster relief programs,” Axios’ Russell Contreras explains.  

During the Civil Rights movement, Altadena became one of the few communities offering housing and loans to Black Americans. Now, eight of 10 Black residents own their own homes, almost double the rate nationally, reports LAist, in an article explaining how the area came to be “a sanctuary for Black residents.” 

Disabled residents left behind in evacuations  

More than two dozen people died in the Los Angeles fires, including individuals whose disabilities and health kept them from evacuating.

Sonja Sharp of the Los Angeles Times shared the story of a great-grandfather, an amputee who used a wheelchair, and his son, who had cerebral palsy and couldn’t get out of bed on his own. The two “huddled together awaiting a rescue that never came, becoming two of the first victims of the unprecedented firestorms still raging across L.A. County,” Sharp reported. 

Disabled Californians are disproportionately likely to die in wildfires, a fact documented in a 2019 California audit. In addition to the practical challenges evacuating without support, disabled people are often fearful of leaving without essential medical and assistance tools.  

Tracking the toll of LA wildfires on underserved communities  

The toll of the ongoing California wildfires isn’t shared equally among Los Angeles County’s residents. People who work outdoors in occupations such as construction, delivery, transportation and agriculture are at greater risk for smoke-related respiratory illness as well as the income hits that arise from work disruptions.  

In Los Angeles County, about 17% of people in Latino neighborhoods are employed in these sectors compared to just 6% in white neighborhoods, reports a recent data brief from the UCLA Latino Policy and Politics Institute and the UCLA Center for Neighborhood Knowledge.  

The fires compound existing health inequities among these populations — Latino neighborhoods, for instance, face almost double the exposure to pollutants like diesel. That has far-reaching health impacts, including a rate of asthma-related emergency department visits two and a half times higher than white neighborhoods. “The addition of wildfire smoke exacerbates these preexisting conditions, compounding the health risks faced by these communities,” the report states. 

What we are reading:

• “Health insurers limit coverage of prosthetic limbs, questioning their medical necessity,” by Michelle Andrews, KFF Health News 
• “‘A very, very small number' of teens receive gender-affirming care, study finds,” by Selena Simmons-Duffin, NPR 
• “Insulin prices dropped. But some poor patients are paying more,” by Katie Thomas, New York Times. 
• “Q&A: Why physicians struggle to care for patients with disability,” by Timmy Broderick, STAT 
• “Soldier’s suicide exposes military’s struggle with mental health stigma,” by Alex Horton, The Washington Post  
• “Americans are ditching traditional health care for something cheaper — and riskier,” by Dylan Scott, Vox