So maybe before we start to discuss this topic, you have to do huge efforts to reach the hard-to-reach population, to reach these communities, to find representatives, to find emissaries that will deal with education and so on and so on. But whatever we do, we can't approach to the equity. We can't have any equity without systemic changes, I think. So we need the support of government and such actions. And I want to ask all of you, if I would ask you, what systemic changes could help in your work? Sue? I think that systemic changes that fundamentally alter the social determinants of health would be very helpful, and addressing income, education, racism, discrimination, all of those social determinants. Beyond that, I think the health system itself needs to put into practice a voiced commitment to achieving equal Maori health outcomes. We've had a change in government recently, and the previous government talked a lot about equity, wasn't quite so good as putting things into action, and then the current government is just walking back a lot of that. But could you say what exactly, which systemic changes could help you in your work with Maori population? One. More Maori doctors. health professionals. Yeah so if you're looking for one thing that we can change I would say the United States National Cancer Registry surveillance system should be collecting sexual orientation and gender identity data so that we know what exactly the health disparities and cancer incidence rates are across the United States for LGBTQI plus communities. Anyone who works or lives in the U.S. and you want to know how to get involved in these advocacy efforts come see me. Is it working? I don't know if this one is working. I don't think I'll probably say just to add up into that it may be creating a bridge between health care and public health. That's part that I think that we're missing because we can do as much as we can within the health care system but we don't have a clear connection or a bridge for to helping our patients so we can address those factors outside of the health care walls and then really make an impact not only with their medical condition in this case lung cancer but also impact and help them live healthier lives focusing on their health and assisting them along their care journey so we can achieve that goal together. That part I would probably say. Focusing on the health is in my opinion just to provide the people reasonable free health care services. Do you think that this is achievable in the United States in New Zealand? Free health care system? I would say that even if you have what is interesting about the different talks today not only at this session but throughout with that lung cancer disparity in this case lung screening is a worldwide problem and it regardless of health care coverage so we don't have universal health care system other countries do. That addresses part of the problem but it doesn't address everything so we talk about optimizing health care we can even if we provide care accessible free and no additional cost for any other part that would address one part but not all the other things like food and housing insecurity, work instability, all other things that may be more pressing for patients to truly focus on their health. In New Zealand we do have universal health care but there are user part charges for primary care and five dollars per prescription item up to a maximum of a hundred dollars a year. First a little bit of a comment. I want to thank the organizers of this meeting as well as this panel because it's the first time I've been at a meeting at ISLC where where the meeting hasn't been dominated by all the harms and what's wrong with screening but this time we're really hearing none of that we're hearing about how do we get it out how we serve communities that are not being served that are not getting the benefit of being involved in screening and I think it's just really pretty fantastic to hear each of the speakers talking about you know making sure there's equity and the understanding that this is really important and that we need to get it out to everybody so I think just as a starting point that's a pretty amazing accomplishment and so I'm just delighted to see that at this meeting. The other comment I guess I'd make also is I think when we start talking about underserved and you know that we should also start thinking about not just screening but lung cancer in general and you know and and there's there's a lot to this you know it screening is a part of it but once we start getting into these low and middle income or groups that have been marginalized it's not just the screening that's been marginalized it's the whole spectrum of lung cancer and early lung cancer that's been marginalized and so you know I have to thank also the organizations of Bristol Myers Foundation that have really started to look into these areas and are pushing it because I think early lung cancer as a topic even beyond just the screening is major and I think we're going to hear more about this so if anybody wants to embellish what I just said I'd be delighted. Thank you. I think you can probably start from from a global perspective at the Lung Cancer Policy Network we are very cognizant of the sort of disparities globally in where and to what extent screening LDCT screening programs are being implemented and sort of expanding the conversation I suppose as Dr. Jankielewicz is I suppose challenging us to to think more in the round about earlier detection and we do work as a network and I think it's good to bring this topic to the fore of recognizing that screening implementation in terms of organized programs is not currently feasible in many low and income lower middle income settings and that there are many other early detection strategies that can sit together in a suite of tools and strategies to to detect lung cancer earlier and the LDCT is a big part of that and can be a big part of that but we should be thinking in the round about earlier detection and how to achieve that globally. Yeah I was just gonna make a general comment thank you so much for what you said and when when we look at language there's a lot of communities when they hear social determinants of health they feel like they're stuck where they are and they don't have choices or opportunities to change so when we go talk to and present to community groups we now call them social drivers of health because it really means that we can come together and we can address these social drivers of health and we can make change that can change the direction that those drivers are taking health in the entire globe. I'll just make a quick comment it's something I've noticed a lot we're talking about language and we always talk about the vulnerable population or the underserved population I like to think of it as they're my priority population I think changing it from kind of a slightly negative tone to something more positive and so they're our priority for screening like the Maori people in New Zealand like the Aboriginal people in Australia like the so rather than saying all these people are poor things you know they're just so vulnerable so hey they're the ones we need to go for they're out there are number one group our priority I think changing that language is really important. Next question please. Hi everyone I'm Coral Osagasti medical oncologist from the University of Miami I want to congratulate all the speakers and the organizers for such an amazing session my question is directed to Dr. Flores I do lung cancer screening and focus on racial and ethnic disparities I love community outreach but my when I'm trying to design a concept and a protocol for community outreach I want to make sure that I develop something that's long-standing right I don't want to create something just to publish it and just forget about the community do you have any tips or any advice or thoughts as how to how you can really create those like both with the community and create something that's gonna be long-standing and not just something for publication. Thank you for your question and for the work that you're doing well I admire the work that you're doing in Miami one of the things that I would say encourage people is to start those relationship in a non-transactional way I think that the key piece because they in order for them to the community to see that you're connecting just to do something for the in service of the community so even meeting them where they are like that physically going to the community it's just a more than just symbolic you just show the willingness that you have to get out of the health care system and then connect with them in the first when I start these conversations I just say I'm interested in doing this but beyond the project even if we don't do it together to me is more important developing a relationship for you I think to me that's a part that we miss in science that because we're so focused on on the outcomes and getting the project done and meeting timeline but actually more important to build that relationship and then once you build that relationship you may get a question so how do you get back to the community and you say well how the result go back to the community and you have a plan for them but also just say like the beyond the results I'm here for the community hence the reason why I show that this next weekend I'm going with some of the team and the American lung cancer quitting initiative dr. Yang with some of their teams and other foreign years are talking to their health care to talk about that because it's not about the project it more about the long-standing relationship with the community and then things flourish and not only you get recharged personally but then you get a lot of new information that you get to inside look up pressing issue in the community and and the new research idea come from that and and all the other price become easier because it just part you start thinking about them part of your work rather than part of our checklist Bruce Pines and I'm an actuary from New York and congratulations to the panel this has really been a special presentation my question is why lung cancer for equity in health I've had the privilege of being in similar settings for other forms of cancer screening heart disease and so forth and is there any are there any lessons from those other cancer screenings or other broad health issues I just see the community leaders so this week it's the lung cancer people next week it's going to be the mammogram people and I'm surprised nobody on the panel had talked about a more holistic approach to health which is probably everybody's goal I mean I agree what you're saying it reminded me some of the early conversation I'm having with Dr. Kim sounds I was in the audience here Vanderbilt in terms of integrating both lung and breast cancer screening and it to me is about we can't expect patient so we talk about barrier outside the health care system and to your point we can expect patient to overcome those barriers every single time to go to get lung screening colorectal screen in the next month and breast prostate any of them we have to provide a more comprehensive approach to empower our patients and their community to leave healthier lives so the ideal situation is that all those services get integrated so I want to say one stop shop but more so maximizing when a patient has a touch point with the health care system and truly become more of a team based approach to screening so that we can achieve that goal together so also for example like cancer creating a primary responsibility of currently a primary care but there's an opportunity for other services to assist patient in their journey particularly if they are seen with the primary care shortage any patients are seeing other services more frequently so I would love for us to rethink of as a model how do we provide a more comprehensive care so you don't have to come overcome all the outside barriers to engage in cancer screening but more so as a system take advantage of when you connect that we can offer everything to that you need that you're eligible for. Can I just make a follow-up comment on that just about it's not so easy in Australia the breast the mobile breast screening program in Western Australia has been highly successful building long-term relationships with Aboriginal women where they have a mobile truck come into a town there's a schedule you can go online and book in Aboriginal health care workers book in a whole community day and the women are bused in from remote communities to the town and it's a woman's day a woman's cultural day where they celebrate and it's women's business so to then just lump that in the lung cancer screening truck will just park next to the breast screening truck and it will all be hunky-dory just doesn't work so you have to be very aware of the cultural differences and then you know you've got to screen men how do you make it they can't be screened at the same time as women because it's a women's day it's a women's cultural day so it becomes quite complex so understanding your community as has been raised is really important because it's not always so simple to make you know a one-stop shop to do everything for the whole community that is a priority I think we've got time for one more question yeah we have time for one more question well you know I'm a recorder I'm from Brazil I live in the US for many years and when I have to fill out the forms they say you are black you were Spanish you are white I didn't know what I am because there is no Latino or maybe Brazilian in Brazil I'm white when they are in America I'm Latino or maybe I'm brown so I don't know right so and for many years in the West you know the history you have to deny what you are to be accepted by by the community somehow I think I think this table is about that and when I see this discussion and I think a lot of people here is thinking why are you having this discussion right it's because if you're on the other side if you are the minority you need to be understood that's why when I spoke here saying to be understood sometimes we have patients that bring the report of the CAT scan because they cannot read and and then or or here in the u.s. that you need translation for the Portuguese and sometimes they don't have a person to speak Portuguese in the whole hospital so I went there and I did many translations there are because there were no Portuguese speakers so that's why I think we have this table because needed people need to be understood and new people need to be need to understand and that's my point and say I was having a discussion with their detection committee and David was there and and someone was saying oh you know what you need no we don't know what people need we need to ask them what they need and in sometimes it's not exactly what you think they need and that's what the table is about and then I my comment is what is your you know experience Flores in your experience because of it what use a form the template that you you use to ask the questions I think the world has changed and now you need to ask to offer but but but if you remain white Caucasian and you reach and you see the offer for people that has nothing but they start having something that will affect your life because then you raise the bar right you see access for biomarkers access for robotic surgery access for many things in Brazil doesn't mean nothing okay because people they don't have access to a single CAT scan so you need to promote and that's what I mean I came here to talk promote some kind of some free CAT scan to everyone because this is too basic it's like to provide water right so if you will raise the bar then you can talk about biomarkers you can talk about robotics you think you can talk about things that don't many people to have access that's what that's my thought and what's your template to ask the the right questions in your experience of this one my point thank you thank you Ricardo for this now I want to ask Raymond Osorio Gagbion

health inequities

systemic changes

Maori health professionals

social determinants

holistic healthcare