This video presentation by Elise Adams delves into the persistent disparities in healthcare outcomes within the United States, even among those with health insurance. Adams highlights particular cases such as higher death rates in Black and African Americans from breast cancer, and the significant challenges faced by rural, Indigenous, and lower-income communities. She explains her motivation for joining Stanford to collaborate on addressing health disparities and her aspiration to contribute to Stanford becoming a leader in health equity science.

Focusing on cancer, Adams underscores the prevalent financial, social, and racial inequities in accessing treatment despite technological advancements and policy changes. She discusses the dramatic changes in cancer treatment over the past 30 years facilitated by political will and innovations but points out the persistent gaps in accessibility and outcomes. Further, the video covers exhibits and discussions around policies like Medicare Part D, prior authorization measures, and the impact of these on health equity and costs.

Main takeaways from the video:

Please remember to turn on the CC button to view the subtitles.

Key Vocabularies and Common Phrases:

1. disparities [dɪˈspɛrɪtiz] - (noun) - A great difference, typically referring to inequality in rank, quality, or degree. - Synonyms: (inequalities, imbalances, discrepancies)

So, over the last 25 or so years, I have been studying why it is that even when people have health insurance in the United States, we still see market disparities in health care outcomes.

2. epidemiologists [ˌɛpɪˌdiːmiˈɒlədʒɪsts] - (noun) - Scientists who study the spread and control of diseases within populations. - Synonyms: (public health experts, disease specialists, health statisticians)

I was excited about coming to a campus where I could feasibly collaborate with epidemiologists in one part of the campus.

3. chronic [ˈkrɒnɪk] - (adjective) - Describing a condition lasting for a long time or constantly recurring. - Synonyms: (persistent, long-lasting, continual)

So, over the last 25 or so years, I have been studying why it is that even when people have health insurance in the United States, we still see market disparities in health care outcomes, particularly for chronic conditions like cancer

4. moonshot [ˈmuːnʃɒt] - (noun) - An ambitious, exploratory, or groundbreaking project. - Synonyms: (initiative, venture, endeavor)

All the way up into the modern day, which is of course, the cancer moonshot under the Biden administration.

5. equitable [ˈɛkwɪtəbl] - (adjective) - Fair and impartial. - Synonyms: (just, fair, unbiased)

I'm excited about, which is the work that we're doing here to move to a more equitable future for everyone.

6. mortality [mɔːrˈtælɪti] - (noun) - The state of being subject to death; also refers to the death rate within a population. - Synonyms: (death rate, fatality, lethality)

The US sadly, is leading in cancer mortality.

7. holistic [həʊˈlɪstɪk] - (adjective) - Characterized by comprehension of the parts of something as intimately interconnected and explicable only by reference to the whole. - Synonyms: (integrated, comprehensive, whole)

And other innovations in care which have allowed us to take better care of our patients in a more holistic way.

8. novel [ˈnɒvəl] - (adjective) - New or unusual in an interesting way. - Synonyms: (innovative, original, new)

Often what we find again is that people who have the highest risk of bad cancer outcomes are least likely to be able to access or afford novel therapies.

9. affordability [əˌfɔːrdəˈbɪləti] - (noun) - The degree to which something is affordable, relating to its cost relative to available resources. - Synonyms: (cost-effectiveness, inexpensiveness, reasonableness)

affordability is critical, particularly with persistence with effective treatments.

10. persistence [pəˈsɪstəns] - (noun) - The fact of continuing in an opinion or course of action in spite of difficulty or opposition. - Synonyms: (endurance, perseverance, tenacity)

affordability is critical, particularly with persistence with effective treatments.

“Healthcare Innovation, Policy, and Equity,” Professor Alyce Adams

Hi, everyone, my name is Elise Adams. I'll tell you a little bit about me before I get started in talking about the talk, so there'll be some consistency. You'll understand where I'm coming from today. So, over the last 25 or so years, I have been studying why it is that even when people have health insurance in the United States, we still see market disparities in health care outcomes, particularly for chronic conditions like cancer. So what does that look like? It looks like black and African Americans, for example, having much higher death rates from breast cancer, far beyond what would be explained by insurance status when they got treated or who's treating them. I'm talking about disparities in rural communities. For example, rural indigenous communities where people have to travel two and three hours to get basic care that we take for granted in urban areas. I'm also talking about lower income and lower education communities who have been disenfranchised for numerous reasons in terms of access and care.

The reason I came to a place like Stanford three and a half years ago, in the middle of the pandemic, like square in the middle of the pandemic, was I was really excited to come to a place where people are excited about research and science and science for the betterment of society. I was excited about coming to a campus where I could feasibly collaborate with epidemiologists in one part of the campus, engineers in another, as well as sociologists in another part of campus to really try to understand some of these disparities and address them. And then finally, I was convinced that the leadership here, both of the healthcare system, but also of the university, are committed to Stanford becoming a leader in health equity science, if you will. So that's why I'm here. I'm so excited to see all of you. I'm really hoping this is going to be more of a discussion than me here yakking at you. So please do ask questions. When we get to the Q and A component, just as a preamble, there's someone who's going to be coming around with a mic. So our request is that you wait till you get the mic before you speak so that everyone in the room can really participate fully in the conversation. Thanks so much. And with that, I think we should go ahead and get going.

So the first thing I want to do is acknowledge the land that we stand on. The Ohlone people were here before us, they continue to be here, and they're our partners in a lot of the research we're going to be talking about. Today, disclosures, I have no conflicts, but I will say a lot of the work is funded by Stanford University, as I am this endowment as the Stanford Medicine Innovation Professor. We have a large grant from NCI for our cancer center, as well as other federally and non federally funded research grants. And this really is really important for me to say, I'm not that kind of doctor. Those of you who grew up with Doctor who and BBC will understand what I'm talking about. I have a PhD, not an MD. So what does that mean? I can't answer medical questions. So if they come up, please talk to your doctor. I cannot help you in that way. I still hope that I am somewhat helpful in other ways, but I'm not that kind of doctor.

Okay, so this is sort of a glimpse into what we're going to talk about today. So I'll talk about the impact of cancer. I'm going to talk about innovations in cancer, historical and up to date. And then I want to talk about the core of our research, which is really trying to understand how is it when we have all this innovation, we still get these outcomes that are suboptimal not only for everyone, but particularly for underserved groups. And then finally, what I'm excited about, which is the work that we're doing here to move to a more equitable future for everyone. So cancer affects all of us. Raise your hand if you know somebody. You have it. Your family member has it. Anyone who has been touched by cancer, raise your hand. It's probably everybody in this room. Right. And the reason I do that is because I believe that to affect differences in how cancer affects us, to improve outcomes, we're all going to have to work together. This affects every single one of us.

So again, I'm not a biologist, but what I will say is cancer is sort of characterized by uncharacteristic growth of cells that then spread to other parts of the body. So it's something that's not supposed to happen. The body is normally supposed to regulate itself and keep that from happening. But cancer is the case where it happens. And there's the usual standards for addressing it have to be addressed. Sorry, my notes just went away. That's all right. So what I want to say about cancer is that it's a growing condition in the United States. It affects so many people globally, it costs billions of dollars. In the U.S. alone, the estimated cancer cost in 2030, I believe, will be 230, $34 billion in a single year. That's one year. And that's direct and indirect costs. That's a 34% increase from 2015. Right? From 2015 to 2030, 34% increase in the cost of cancer. And again, that includes what happens in the clinic and beyond.

And worldwide, generally speaking, more what we call developed nations. Those with higher income, higher educational attainment, tend to be more likely to suffer from cancer primarily because they're not dying from other things. Right. So if you look at the world, in places where we see a lot of poverty and a lot of challenges, they die at a much earlier age. Those of us who've been lucky enough to live in these higher GDP societies tend to be more likely to get cancer. But that's not universal. Some types of cancers, for example, like cervical cancer, you do see more frequently in other types of countries. The US sadly, is leading in cancer mortality. And the ones, the cancers that we worry about most in the US this is not by far by all of them, but it's breast cancer, prostate cancer cancer, and colorectal cancer, however, or lung cancer. Excuse me. There are lots of other cancers that are also on the rise, like colorectal cancer, pancreatic cancer, and other areas. And when you put them all together, and it is like a piece, there's so many different types of cancers out there. But when you pull them all together, they really are a particular challenge facing all nations in terms of not only financially, but also just what's happening to our populations and our workforce as we move forward.

So one of the things that we have seen in the last 30 years are dramatic changes in how cancer is treated, particularly in this country, but all countries. And that's due to a lot of different reasons. But in this country, a lot of it really is the influx of technology and advances in technology that allow us to do things we previously could not and to do things much more faster and more efficiently. But importantly, it's also political will. And what do I mean by that? Well, Nixon passed the first cancer bill back in, I think, 1971. And what that did is it said, let's try to work together to address cancer and break down some of the barriers that had really confined what the National Cancer Institute could do in terms of the science in prior years. It made a huge difference in their ability to push forward on a lot of issues related to the development of treatments of cancer and our understanding of cancer cancer. It also freed up funds to do that.

Fast forward to 1993, Clinton reenacted the same law saying, you know what? We need to keep going, keep our foot on the pedal. We Had a lot of progress, but let's keep going in cancer all the way up into the modern day, which is of course, the cancer moonshot under the Biden administration. All of these things have catalyzed important breakthroughs in cancer that have dramatically affected our understanding of cancer and how to treat it. So what does that mean? It actually means that what we're doing is pushing forward, not only from trying to sort of keep people from dying immediately, but we're thinking now of cancer as a chronic disease. And we're even thinking, particularly here at Stanford, about how can we address people who have really advanced diseases when they're actually diagnosed and start thinking about how do we cure those? So it's a very exciting time to be in the cancer space.

And I just wanted to share a very new video. Dr. Atandi, the director of our cancer center, allowed me to share this with you. But you can also see it on YouTube now. But it tells you a little bit about some of the scientific discoveries that we're really investing heavily in here at Stanford. Dare to imagine a future where advanced cancers aren't just treated, they're cured. For decades, Stanford medicine has pursued this brighter tomorrow, Uncovering new knowledge, providing care to countless patients, and inspiring the next generation of leaders. In 1956, Stanford scientists built the western hemisphere's first linear accelerator to treat cancer. A device that is now foundational to radiation therapy worldwide. Today we build on this legacy, Developing uniquely Stanford innovations that will revolutionize cancer care. A first in the country. FDA approved cell therapy for solid tumors gives hope to patients with advanced melanoma. Our early drug development program increases access to early phase clinical trials, Giving patients new hope in their fight. And work to miniaturize proton therapy systems aims to make this precision cancer killing technology more accessible. As cancer cases continue to rise, our translation of research discoveries becomes only more urgent. Powered by Stanford Cancer institute scientists and our community of dedicated physicians and staff, Stanford pushes forward, finding new ways to improve outcomes and deliver hope to those battling complex cancers.

Health Equity, Chronic Diseases, Disparities In Healthcare, Innovation, Education, Technology, Stanford Graduate School Of Business