In the December 2012 edition of the Journal of Cancer Survivorship, an article titled “Racial and ethnic differences in health status and health behavior among breast cancer survivors—Behavioral Risk Factor Surveillance System, 2009” examined racial/ethnic differences in health status and behaviors among female breast cancer survivors.
What the researchers concluded, yet again, is that surviving breast cancer comes down to what you do as an individual, and that interventions that promote healthy lifestyles are key. These conclusions ignore the social context in which behavior choices are made. Different communities have different social advantages or disadvantages which determine the options we have to make healthy choices. Inequities in breast cancer outcomes among different racial and ethnic communities are based on a complex interplay of numerous social factors of where we live, learn, work and play.
Encouraging woman to eat better, exercise more and drink and smoke less are part of the solution, but continuing to tell people to make better choices without changing policies that increase access to resources, is setting up communities for failure after failure and blaming women for their disease. It also does nothing to change the growing disparities we see in breast cancer and actually might make them worse.
This study’s results, to me, underscore the need for community-based approaches that include policy, systems, environmental, and individual-level changes. The CDC agrees: their Racial and Ethnic Approaches to Community Health Across the U.S. (REACH) program acknowledges that there are numerous societal, policy, environmental, cultural, and individual-level factors that must be changed to eliminate racial and ethnic disparities and that developing appropriate programs that address the complex root causes of racial and ethnic health disparities is critical.
As we look at studies that focus on personal behavior, we should continue to examine how factors outside an individual’s control – such as race, economic status and political power – affect who enjoys good health and who does not, and whether communities are involved in decision-making on policies that affect their access to resources.
Breast Cancer Action continues to challenge our society’s strong emphasis on personal behavior as the silver bullet, and believes that effective strategies to eliminate inequities, to reduce disparities in breast cancer incidence, mortality and survival, require a broader focus on the social and economic contexts in which we all live.