I-Team In-Depth

Targeting Disparities In Colorectal Cancer Screening

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Wilfredo Estrada, a 71-year-old New Haven resident and native of Peru, says getting colonoscopies is “muy necesario.” His father died from colon cancer at age 65, and he knows family history plays a role in cancer risk. Estrada described his odyssey fighting polyps detected by preventive colonoscopy screenings, which he has been getting since 2018. During the most recent procedure, Estrada says, the doctor found and extracted 29 polyps, all noncancerous. When asked if he tells people he knows how important it is to get screened, Estrada responded through his interpreter, “No. It’s not something I like to share with others.”

By staying current with colonoscopies, Estrada is doing his part to avoid becoming a cancer statistic.

Disparities

With Demand For Community Health Workers Rising, So Does Need For Sustainable Funding

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New Haven Community Health Worker (CHW) Katia Astudillo helps dozens of her clients navigate the logistics of getting vaccinated and connects them with other health services. She even helps them find rental assistance. In and around New London, CHW Lizbeth Polo-Smith hands out flyers about COVID-19 safety and vaccinations at churches, laundromats, stores, warming centers for the homeless—anywhere she can. As COVID-19 laid bare Connecticut’s health care deserts, it now highlights the efforts of CHWs who labored in forgotten neighborhoods for years. In many ways, they have become a key factor in the state’s public health response for marginalized communities during the pandemic.

I-Team In-Depth

Pandemic Exposes Stark Health Disparities Generations In The Making

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Soon after Minerva Cuapio, a 48-year-old Mexican immigrant who lives in New Haven, was laid off from her job at a dry cleaner in March, she developed a headache, an itchy throat and a dry cough. Then came the shortness of breath that really worried her daughter, Izarelli Mendieta, 29, of New Haven. While trying to get her mother care, she said, they were bounced from a doctor to the state’s COVID-19 hotline to a telemedicine visit back to the hotline and then to a drive-through testing center and an emergency room visit. The family waited nine days for Cuapio’s positive test results. Izarelli’s father, Pedro Mendieta, 55, who lost a foot to diabetes, tested positive, too, but had mild symptoms.

Minerva Cuapio and Pedro Mendieta have recovered, but their daughter, who translates for her parents because they only speak Spanish, said if she could meet Gov. Ned Lamont, she would ask him to make the process easier for families like hers.

Cancer Death Rates Decline, But Income Is A Factor In Survival

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Advances in early detection and cancer treatments have resulted in a 27 percent decline in cancer deaths in the U.S. in the last 25 years, but those benefits are slow to trickle down to those who are lower on the socioeconomic scale, according to a report by the American Cancer Society. In the nation’s poorest counties, the cancer mortality rate is 20 percent higher than in the most affluent counties, and “the difference is much larger for cancers that are the most preventable: cervical, colorectal and lung,” said Rebecca Siegel, strategic director of Surveillance Information Services at the American Cancer Society and an author of the study. Robert Ciemniewski, 57, a longtime smoker from Connecticut, was on the wrong side of the statistical divide when he walked into the emergency room in 2017 with breathing difficulties from what he thought was pneumonia. He did have pneumonia, but he also had advanced lung cancer. Ciemniewski had not had a health checkup since 2013, when he quit his job as a mailman to care for his ailing mother.

Disparities

Care Coordinators Cut Costs, Improve Health Outcomes, But Are Underused

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A few years ago, patient navigators at Project Access-New Haven set out to see if they could change the course of health care treatment for some Medicaid patients who frequently used emergency rooms.

They contacted emergency departments at Yale New Haven Hospital and its Saint Raphael campus and enrolled 100 patients in their study in 2013. Those selected had visited emergency rooms four to 18 times in the past year for chest pain, abdominal pain or chronic migraines, among other ailments. The navigators at Project Access coordinated health care for the patients. They scheduled appointments with primary care physicians, provided reminders, accompanied patients to physician visits and followed up to ensure compliance with the prescribed treatment. The preliminary results were eye-opening: “We saw an average cost reduction of $153 per member per month,” said Dr. Roberta Capp, assistant professor, Department of Emergency Medicine at the University of Colorado Denver, and lead investigator of the study.