Achieving health equity requires addressing social determinants of health. Promoting health equity as it relates to cancer control is one of six priorities of the National Comprehensive Cancer Control Program (NCCCP). This article describes recent activities implemented by three NCCCP awardees (North-west Portland Area Indian Health Board, Kansas, Michigan) and the CDC-funded National Behavior Health Network (NBHN), whose aim is to reduce health disparities among those with mental health and/or substance disorders. North-west Portland administered tribal surveys to help better understand tribal cancer-related risk factors, health behaviors, provide baseline data to support their cancer plan, and obtain resources for targeted interventions. Kansas established a health equity workgroup with a vision of addressing health equity through implementation and uptake of activities among all Kansans. Michigan provided trainings in health equity and social justice and developed health equity learning labs. As a result of the successful implementation of the NBHN’s Community of Practice, individuals currently living with mental illness and/or substance disorders have had increased access to tobacco cessation and other cancer support services. These efforts and key opportunities for public health practitioners and their partners to increase engagement in cancer health equity are summarized in this article.


Building a Community of Practice: the National Behavioral Health Network (NBHN) for Tobacco and Cancer Control

CDC’s DCPC, in collaboration with the Office on Smoking and Health, funds a Consortium of eight National Net- works in the following target populations: African Americans; American Indians/Alaskan Natives; Asian Americans/ Pacific Islanders/Hawaiian Natives; Latinos/Hispanics; lesbian, gay, bisexual, and transgender (LGBT); persons with low socioeconomic status; persons with mental health and substance abuse disorders; and geographically defined populations with high commercial tobacco use [7].    The networks focus on reducing disparities in cancer health out- comes and tobacco use in populations that struggle with particular health challenges and may not have adequate access to quality health care or health information. Through the Consortium of National Networks, CDC is strengthening the NCCCP’s capacity to increase awareness and support in certain communities for activities that promote healthy behaviors among cancer survivors. The National Networks have been engaged in a variety of activities to enhance the quality and performance of specific public health programs, public health data and information systems, public health practice and services, public health partnerships, and public health resources that focus on tobacco-related and cancer health disparities in specific disparate populations. Examples include the development of training guides, state strategy sessions, specialized learning sessions to further enhance outreach efforts, tailored fact sheets, infographics, and tailored materials. Building a Community of Practice (CoP)  is a successful strategy that has been utilized effectively by the NBHN.

A CoP is defined as “a group of people who share a concern, a set of problems, or a passion about a topic, and who deepen their knowledge and expertise by interacting on an ongoing basis” [22]. The NBHN serves individuals with behavioral health conditions, mental illness and/or sub- stance use disorders (SUDs). NBHN provides a resource, training and technical assistance hub for community behavioral health organizations (CBHOs); healthcare professionals; local, state, territorial and tribal health departments; and other organizations addressing the social determinants of health. NBHN develops innovative ways of reaching and supporting the behavioral health and larger cancer control community, through the use of white papers, policy briefs and a wide array of in-person and virtual activities (e.g., trainings and technical assistance, communities of practice, state strategy sessions coaching calls, e-digests, videos, and roundtables) to help reduce tobacco and cancer- related disparities among individuals with behavioral health conditions.

One of the NBHN’s successful activities has been the implementation of an 8 month long CoP, which has delivered six training sessions since 2013. Over the past 5 years, located all across ten HHS regions, 89 organizations from 23 different states, multiple tribes and one territory have participated in the NBHN’s CoP to address the disproportionately high prevalence of tobacco use and cancer among individuals with behavioral health conditions. The NBHN CoP brought together organizations, including CBHOs, hospitals, health departments, and cancer control departments, that provide a forum for peer learning, training, and coaching from world-renowned subject matter experts to support the organizations through capacity building activities as well as action and sustainability planning. As a result of the CoP, individuals currently living with mental illness and/or SUD have had increased access to tobacco cessation and other cancer support services. For example, the Pitts- burgh Mercy Health System, a member of the 2015 CoP, worked diligently during the CoP implementation to make nearly 60 behavioral health campuses 100% tobacco-free, resulting in decreased on-site smoking and second-hand smoke exposure impacting over 33,000 people annually [23]. Tobacco cessation counseling and building wellness activities in partnership with other local organizations were also provided. Red Rock Behavioral Health Services joined NBHN’s 2017 CCBHC CoP and initiated an education and screening campaign for Pap tests and mammograms for all eligible women. This increased screening by 56% of all women eligible for a Pap test, and 64% of women eligible for mammograms across the organization in ten Oklahoma counties. Evaluation of the CoP has shown a demonstrable increase in attendee knowledge and practice improvement about tobacco and cancer [23]. In 2017, 96% of participants reported increased confidence in explaining the importance of cancer screening with behavioral health populations to colleagues and leadership; 86% of attendees reported being able to draft and propose a policy that incorporated cancer control strategies and 86% reported they were confident in creating and implementing an action plan with cancer control strategies [23]. New activities initiated as a result of the CoP include: implementing tobacco-free policies across organizations and select facilities; implementing and/or enhancing cancer screenings for clients and staff; training employees in wellness screening procedures; launching awareness campaigns; developing additional cancer sup- port services for survivorship groups, education groups, and financial assistance programs. Attendees specifically referred to in the 2017 CoP were CBHO staff that made up each CoP Team including clinicians, administrators, lead- ership, state tobacco and cancer control staff, other public health department staff, primary care organizations, as well as tribal government staff. To ensure continued sustainability, the CoP has developed a master class for organizations that previously participated in the CoP in order to boost, enhance and reinforce tobacco and cancer control activities implemented over the last 4 years.


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