Serving the Historically Underserved
The Office of Health Equity (OHE), overseen by DCI deputy director Steven Patierno, PhD, is the community facing aspect of Duke Cancer Institute. Its mission is to reduce cancer disparities and improve population health in the region for African American (25 percent of Duke’s cancer patient population), LatinX, Asian American, Native American, Jewish, Muslim, LGBTQ, refugee and rural communities.
“We are constantly finding innovative ways to reach all these populations and establish collaborative relationships,” said Moore.
There are currently five people on staff including Moore, a staff assistant (Aretha Rice), data analyst & evaluation specialist (Kearston Ingraham, MPH), a senior program coordinator (LaSonia Barnett) and a health educator/patient navigator (Nadia Aguilera-Funez) tasked with helping patients access the screening, diagnostic testing and treatments they need, whether at Duke Health, another health system, clinic or a federally qualified health center (FQHC).
The OHE team works closely with a Community Advisory Council comprised of 22 individuals representing diverse perspectives — across race, ethnicity, class, religion, geography, sexuality/identity — who provide insight for OHE initiatives and help OHE’s outreach efforts.
Moore’s an active member of several campus-based groups (the Duke University School of Medicine’s Diversity & Inclusion Council, the Duke Academy for Health Professionals Education and Academic Development, and Duke Health’s Women's Health Community Engagement Task Force) and local, state and national groups including the Men’s Health Council of the Durham County Department of Public Health, Community-Campus Partnerships for Health (ccphealth), National Black Nurses Association (NBNA), ROCKS, Inc. ( ROCKS), and the Minority Advisory Committee for the North Carolina Department of Health and Human Services.
Each year, OHE partners with other Duke groups, Duke providers, the Durham County Health Department, Lincoln Community Health Center, and local community associations to host the annual Men’s Health Screening, and sponsors and participates in the Women’s Health Awareness Day (a National Institute of Environmental Health Sciences and the Delta Sigma Sorority event) — conducting free-of-charge health screenings and sharing educational materials on prevention.
Both events, for the men and for the women, depend on volunteers and were cancelled in 2020 due to COVID-19-related limitations.
“For the Women’s Health Awareness Day in April, we had planned to screen for thyroid cancer and skin cancer, as well as screen for radon, a risk factor for lung cancer,” said Moore. “At our annual Men’s Health Screening, usually held in September, we typically screen for prostate cancer, colon cancer, skin cancer, and we conduct lung cancer risk assessments. We also do blood pressure checks, diabetes testing, hepatitis C and HIV testing. At both events, we also try and guide individuals to the smoking cessation program at DCI or another program outside of Duke if desired. We know that tobacco use leads to cancer.”
Having to cancel these important events, said Moore, was disappointing.
“We know that a lot of people have lost their jobs and subsequently lost their health insurance, if they even had insurance to begin with,” said Moore. “We reached out to all the men who participated in the Men’s Health Screening event in the past and encouraged them to wear a mask, physically distance, wash their hands and continue to get their routine screenings for the chronic diseases that they have, and get other types of screening they may need as well.”
While COVID-19 has impacted some key events and many face to face meetings, this experience hasn’t dampened Moore’s commitment to the execution of OHE’s broader mission., as they develop innovative methods for reaching members of the community.
- The OHE’s efforts at launching a re-imagined Community Health Ambassador program — which will recruit and train trusted individuals from faith-based and other community organizations to educate their communities about cancer prevention, screening and some of the common chronic conditions that increase the risk of cancer — was launched in late July virtually due to the pandemic.
- Moore and OHE senior program coordinator LaSonia Barnett gave a virtual instead of a planned in-person lecture on acute and chronic diseases, including cancer, to students studying to be community health workers at Durham Technical Community College
- Because many churches aren’t meeting in person due to COVID-19, outreach to communities of faith has been virtual — by phone or computer, not the most ideal situation.
In COVID-19, Moore sees something very familiar — under-resourced communities facing barriers to access — both testing (for ex. limited testing sites in close proximity to where they live) and care (due to lack of health insurance and/or their local community healthcare facility is overburdened).
Many community members are “essential workers” and disproportionally suffering the more serious side-effects of the coronavirus.
The switch to telehealth in the first few months of the pandemic, “exposed a digital divide,” Moore said, between urban and rural, the young and the old.
The Black Lives Matter movement shined a light, in the middle of the pandemic, on both the disproportionate injustices suffered and the healthcare disparities experienced by African Americans and other people of color.
“I recently spoke with the Men’s Health Council in Durham about men with chronic diseases not getting the care or screenings they still need. COVID-19 is not stopping people from developing cancer. If people delay, then whenever cancer is found, it may be found in the later stages. People are more afraid, with COVID-19, to go to the clinic,” said Moore. “It’s too early to know what impact COVID-19 will have on cancer rates, but we assume that those rates will go up.”
Some of the scientists conducting COVID-19 clinical trials at Duke are having the same trouble DCI has had accruing African American and Latino participants and have asked Moore for help —studies that, as in cancer, could save lives. The OHE now works closely with the Latinx Advocacy Team & Interdisciplinary Network for COVID-19 (LATIN-19) and the African American/Black Community Response to COVID-19 groups consisting of community members, county and state staff, faculty, staff, students, advocates, faith leaders, etc.
Injustices, like disparities, are systemic. There are many things that need fixing.
“I’m optimistic that things will change; things will get better. You have to be. Or else people will lose the motivation to want to change,” said Moore. “I don’t say much, I’m a doer.”
Moore is hoping that OHE’s extensive relationship building and engagement with the community will result in “greater awareness of how to prevent and screen for cancer, more people in treatment while in the early stages of cancer, fewer cancer disparities, and an increase in the number of minority and historically underserved populations accrued to clinical trials.”
On this Veterans Day, we thank Lieutenant Colonel Moore for his years of military service and thank Dr. Moore for his continuing service to Duke and the community.