“Hawaii is a very diverse state. Many are somewhat aware of the challenges the native Hawaiian population faces, but I did not realize how large the healthcare barriers were for all historically marginalized communities in our state, including Chinese, Japanese, and Filipino peoples,” says Elizabeth A. Ignacio, MD, past president and board member for the Hawaii Radiological Society (HRS).

“I’m lucky enough to work with the HRS, our ACR chapter here,” Ignacio says. “I wear different hats. I’m the chair of the legislative committee for the Hawaii Medical Association as well, so there is a convergence there of a lot of advocacy efforts in addressing health equity and access,” she says.

The HRS is also working with the University of Hawaii Cancer Center to address breast cancer rates. “This disease doesn’t just affect women here who are over the age of 50,” she says. “We see cases starting at age 40 and up, particularly for Japanese American women. In Hawaii, the native Hawaiian women are most likely to have increased morbidity and mortality from breast cancer compared to the rest of our population,” Ignacio says.^1,2 “This is one reason we joined the Radiology Health Equity Coalition (RHEC).”

A Community Effort

The RHEC’s goal is to bring together the radiology community to address health disparities and measurably change outcomes. This mobilized network of patient-focused radiologists will collect and disseminate resources and best practices, advocate for and connect with patients and community members, and collaborate on programs and services to empower others to act.

Ten major radiology organizations have collaborated in the formation of the RHEC to positively affect healthcare equity in the radiology arena and beyond. “Disparities and inequities in healthcare have been evident for many years — and the COVID-19 pandemic has magnified the disproportionate numbers of people of color and rural residents in the U.S. affected by barriers to care,” says Carla Brathwaite, MS, RHEC team lead. “We are coming together to do something about it.”
These are among some of the disparities the RHEC is focusing on:

• Life expectancy is three years shorter and heart disease, cancer, and stroke death rates are significantly higher in rural areas (23% of the U.S. population) vs. metropolitan areas.^3,4
• Black women are 42% more likely to die from breast cancer than White women; Black men are 52% more likely to die from colorectal cancer (CRC) than White men. The 19% CRC disparity may be due to fewer screenings.^5,6
• U.S. Latines are more likely to die from CRC than those in many Central and South American nations. The CRC death rate for U.S. Latines has dropped more slowly than for Whites.⁷
• Asian Americans are twice as likely to die from stomach cancers, eight times more likely to die from hepatitis, and have a tuberculosis rate more than 30 times higher than White Americans.⁸
• 39% of U.S. women without health insurance had a mammogram in the past two years versus 75% of those with health insurance.⁹

Awareness/Education, Research And Advocacy

“Stories of healthcare disparities are in the news nearly every day,” says Ian A. Weissman, DO, FACR, president of the Wisconsin Radiological Society and chair of the ACR’s Patient- and Family-Centered Care Outreach Committee. “There are three main things we must address. The first is awareness/education, and we are working on this with the RHEC and through social media,” he says. “The second part is research — making sure that there is research underway to promote health equity.” Included in this research, Weissman points out, is AI and efforts to eliminate unconscious bias.

“The third part is advocacy. That’s what we are trying to do at the local, state, and national levels — through starting the process of joining the RHEC, by holding lectures, and through our work with RAD-AID and the U.S. Women’s Health Access Program,” Weissman says. The COVID-19 pandemic, he notes, has brought health equity issues to the forefront. “We are affecting change, for example,” he says, “by raising awareness through a health equity panel discussion scheduled for the next Wisconsin Radiological Society annual meeting.”

“The pandemic has impacted everything. Another day goes by — and maybe a systemically disadvantaged woman doesn’t get her breast screening exam or her cervical cancer screening,” he says. “This is the kind of critical health issue that we are trying to address, showing how radiology can help. Equity is a concrete issue, and advocacy, particularly grassroots efforts, can improve the situation.”

We were always, and still are, a grassroots organization that has many physicians and laypeople — all working to push legislation that will benefit all patients.

Grassroots Action

“We were always, and still are, a grassroots organization that has many physicians and laypeople — all working to push legislation that will benefit all patients,” says Priscilla J. Slanetz, MD, MPH, FACR, immediate past president of the Massachusetts Radiological Society (MRS). “We were the first state chapter to join the RHEC, back in April of 2022, and did so as we recognize how important it is to promote equitable access, especially to imaging care.”

MRS members have always been committed to finding ways to help the most vulnerable segments of the state’s population, she says. But one of the challenges is that “when we look at where radiology research funding actually goes, it often goes to the very well-off institutions that are not necessarily serving the most vulnerable populations. If we really want to make strides in addressing health equity and minimizing the disparities that exist, research funding must start going to those institutions providing care to these vulnerable patients,” Slanetz says.

In fact, building on work at Boston University Medical Center, the largest safety-net hospital in New England, “we recently received a state chapter grant to develop a radiology waiting- room program that will help identify patients at increased risk for lung and breast cancer and to connect these patients to indicated screening. We are also working with grassroots organizations to push forward legislation that will provide all women free and equal access to screening and diagnostic mammography,” Slanetz says.

STRENGTH IN NUMBERS

Washington State was among the first ACR state chapters to establish a committee on women and diversity, which strives for diversity and health equity — when everyone has access to resources and treatment that is tailored for fair and positive outcomes (learn more about how to create a committee on diversity in your ACR state chapter). “A lot of our emphasis when we started out was to establish activities that might foster camaraderie among women in radiology in Washington State,” says Sammy Chu, MD, FACR, chair of the ACR Contractor Advisory Committee Network and president of the Washington State Radiological Society (WSRS).

“We have to acknowledge, as radiologists, that we are not a very diverse group. People within our specialty need to understand the challenges that historically marginalized communities face within the profession,” he says. As part of its diversity and inclusion efforts, Washington State’s office currently runs two activities — one is a mentoring program and the other is more of a social event.

“The social event was created so that radiologists have a chance to swap stories and experiences,” Chu says. “It’s also an opportunity to talk about how they can better work together and help one another face the many challenges that can plague radiology groups.”

“We hold a Women in Radiology mentoring event every year in conjunction with the University of Washington,” says Rachel F. Gerson, MD, chair of the WSRS Women and Diversity Committee was established in 2015. This is a resident-run event that brings together residency programs throughout the state, a panel of women radiologists in diverse practice settings, and community radiologists to promote mentorship, a frank discussion, and networking.

“Through engagement in broad issues of equity in our community, partnering with community and healthcare organizations, and working with state legislators, we strive to demonstrate the important role radiologists play in health equity,” Gerson says. “Our participation in the White Coats for Black Lives March and our Breast Imaging Task Force’s collaborative event really highlighted the aspect of partnering with and engaging health equity issues in our community.”

“Part of when we go to Olympia — the state capital — is about trying to increase recognition or trying to make state chapter radiologist members aware of what we’re doing in the state,” Chu says. The impetus for any good healthcare-equity movement is motivation — and that means showing our chapter members how our advocacy positively benefits radiologists and patients, he says.
Motivation doesn’t come in the form of dollars, necessarily. “The Hawaii chapter is very motivated — and its officers are very strong advocates (despite being a small group),” Ignacio says. “We are all involved in advocacy, both at the state and local levels. We have provided a good deal of in-person testimony to legislators and knocked on doors.”

The RHEC is calling on all professional radiological societies — diagnostic radiology, IR, nuclear medicine, radiation oncology, nuclear physics, and other subspecialties under the umbrella of radiology. According to Ignacio, “It was an easy decision to join the RHEC — not just because of what is happening in Hawaii, but because we understand the significance of the healthcare equity challenges in communities everywhere.”