Online Program

Breast Cancer among Socioeconomically Vulnerable Women in Vulnerable Places: Historical Evidence of Better Care in Canada than in the USA

Tuesday, November 3, 2015 : 12:50 p.m. - 1:10 p.m.

Kevin M. Gorey, PhD, MSW, School of Social Work, University of Windsor
Caroline Hamm, MD, Schulich School of Medicine and Dentistry, Western University and Windsor Regional Cancer Center, London, ON, Canada
Isaac N. Luginaah, PhD, Department of Geography, Western University, London, ON, Canada
Guangyong Zou, PhD, Department of Epidemiology and Biostatistics and Robarts Research Institute, Western University
Eric J. Holowaty, MD, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
Better health care outcomes among Canada’s most socioeconomically vulnerable versus America’s have not been fully explained. We examined the pre-Affordable Care Act (ACA) effects of poverty, health insurance and physician supplies on breast cancer care among 7,250 women in Ontario or California between 1995 and 2010. Cancer registry data were joined to census tract-level income data via Statistics Canada and the US Census Bureau, and to county-level data on primary care and specialist physician supplies via Canadian Institute for Health Information and American Medical Association databases. Canadian women were particularly advantaged in the most disadvantaged places: high poverty neighborhoods (standardized rate ratio [RR] = 1.65) and communities that lacked specialist physicians [RR = 1.33). Canadian advantages were completely explained by better health insurance coverage and greater access to primary care. These protective effects of Canadian health care suggested ways to maximize the ACA's protections. Ensure that the newly insured, public and private, are indeed, adequately insured, without having to bare exorbitant out-of-pocket costs for medically necessary care. Expand Medicaid across all 50 states in ways that are consistent with the ACA’s legislative intentions. Bolster the supply of primary care physicians and allied primary health care professionals.

Learning Areas:

Advocacy for health and health education
Chronic disease management and prevention
Provision of health care to the public
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Describe the strong association of poverty with breast cancer treatment inaccessibility in the USA. Describe the large protective effect of primary care in Canada. Discuss the much more equitable breast cancer care observed in Canada, especially in the most vulnerable places: high poverty neighborhoods and communities with low health care service endowments. Discuss implications for contemporary and future reforms of health care in the USA.

Keyword(s): Health Care Access, Affordable Care Act

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a federally funded epidemiologist with more than 20 years of research experience in social epidemiology and international comparative health services research the results of which have been published in over 100 peer-reviewed articles.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.