Test Cedars-Sinai Takes Multipronged Approach to Reduce Inequities

Jeong Yup Lee, senior pastor of the L.A. Onnuri Church in the heart of Koreatown, knows all too well the roadblocks to good health his congregation faces: a cultural reluctance to talk about illness, a lack of information about health risks and screenings, and poor access to health insurance, among other impediments.

"In the Korean culture, we're hesitant to share personal problems, especially health problems," Lee said. "That’s why my church partnered with Cedars-Sinai, which is sharing information about the health risks we face in my community. We need that information."

The Cedars-Sinai Research Center for Health Equity is front and center in the growing trend of population health studies, which addresses environmental, cultural and genetic factors to understand why certain populations—groups defined by race, ethnicity and socioeconomic status—have higher rates of cancer and other diseases than other groups.

In Los Angeles County and across California, the Health Equity team is focusing on the high cancer mortality rate among Korean-Americans and the growing incidence of liver cancer in the Hispanic population, in addition to other health disparities in a number of communities.

The team's population health approach includes scientific studies and hands-on engagement with local religious and community leaders, who invite Cedars-Sinai experts to lead educational seminars focused on specific cancer risks, screenings, treatments and clinical trial enrollment. Participants fill out written surveys to help the team determine, for example, what roles fear, embarrassment and lack of transportation play in preventing Korean-Americans from getting colonoscopies. Based on the information gathered, the team then arranges convenient, confidential and free cancer screenings in collaboration with local clinics.

"Our approach to tackling health disparities runs from molecular to behavioral," said Robert Haile, DrPH, MPH, associate director for Population Sciences at Cedars-Sinai Cancer. "We bring the power of translational research to affected populations. It's making a big difference."

The Smidt Heart Institute at Cedars-Sinai also is using population health data to advance the understanding of gender differences in heart disease and overall health. Susan Cheng, MD, MPH, MMsc, is leading research programs aimed at uncovering the drivers of cardiovascular aging in women and men. Cheng and her research team are working to pinpoint what sets a person on the track toward ideal health maintenance versus gradual health decline. Cheng's goal is to take laboratory-based discoveries and translate them to each unique patient she treats in the clinic—using therapeutic options backed by rigorous data—whether a personalized medication adjustment or a tailored nutritional or exercise program.

"We have a wealth of data at our fingertips that we can use to decipher key trends about how overall health status changes for people over time," said Cheng, a cardiologist, echocardiographer and clinician-scientist who serves as director of Cardiovascular Population Sciences in the Barbra Streisand Women's Heart Center and director of Public Health Research in the Smidt Heart Institute. "We want to understand what population trends exist, and then drill down to better understand what makes each individual woman or man different from everybody else. This approach will help guide us on how we can best work with our patients—one person at a time—to achieve optimal health over the long term."

Recently, about 50 Korean-American community and church members gathered in the L.A. Onnuri Church auditorium to hear Dong Hee Kim, a Cedars-Sinai community outreach coordinator, give a talk—in Korean—about cancer risks and prevention options. The attendees also got one-on-one advice about health insurance.

Pastor Lee, in his Sunday sermons, emphasizes a holistic approach to medicine, telling congregants that both their physical and spiritual well-being are necessary to maintain good health. Church members are more willing to attend the health seminars because of that philosophy, he said.

"The church looks to restore a person's heart and soul, while the medical center looks to restore the person's physical needs," Lee said. "When we collaborate with Cedars-Sinai, we make something better than what we can do individually."

Zul Surfani, associate director of the research center, said that his team's mission is to share reliable information about cancer so participants "can feel they're in control of their futures and their health."

In December, the research center arranged for Hispanic women to get free breast cancer screenings at the Clinica Oscar Romero in downtown Los Angeles. In January, the group partnered with Susan G. Komen to host an educational event for African-American and Korean women with breast cancer.

In addition to its work with L.A. County's Korean, Filipino, Latino and African-American populations, the research center also plans to partner with the Los Angeles LGBTQ community, "which is deeply underserved," Haile said.

Cedars-Sinai investigators also are working on blood-based, or "liquid" biomarkers, to detect early-stage colorectal and other cancers. The biomarkers may be useful for monitoring cancer recurrence and patient response to therapies. The researchers also are developing technologies to help close the health-disparity gulf. The team wants to expand the availability and affordability of those tools in multiple cultural and racial settings and in a number of languages.

"We're launching 'precision prevention,'" Haile said. The goal is to design a culturally sensitive, personalized prevention program and then compare it to the standard of care to see if it's better. "That is what we’re all about."

Read more on the Cedars-Sinai Blog: What is Precision Medicine?