With Kilan C. Ashad-Bishop, PhD, of the Sylvester Comprehensive Cancer Center at the University of Miami Health System
By Sarah DiGiulio
In a recent Commentary article in the journal Cancer, Kilan C. Ashad-Bishop, PhD, a postdoctoral fellow at University of Miami's Sylvester Comprehensive Cancer Center in the Cancer Disparities and Equity T32 training program, and coauthors discuss how climate injustice overlaps with cancer inequities and affect similar groups (2023; https://doi.org/10.1002/cncr.34817). The main argument: social and structural barriers to health drive cancer disparities in the U.S., and these social and structural barriers also systematically increase vulnerability and decrease adaptive capacity to cope with climate change ills. Ashad-Bishop told Oncology Times that her learned expertise in molecular cancer biology and personal experience of being involved in environmental justice advocacy led her to get involved in this work.
“When I pitched the idea of this work, it was because in the literature I saw many discussions of populations that experience cancer disparities and environmental injustice separately, but not so much of them being considered together, and I wanted to create a framework through which we could consider those intersections," Ashad-Bishop said. She shared her thoughts on the barriers to addressing these large-scale societal challenges, as well as the opportunities.
1. How would you say cancer disparities overlap with climate vulnerability?
“There are a multitude of ways. We pulled from an Intergovernmental Panel on Climate Change framework that defined vulnerability as a function of exposure, sensitivity, and adaptive capacity to hazards, and also introduced a cancer lens to identify several mechanisms by which climate change can create and/or exacerbate cancer disparities. These include increased risk of exposure to carcinogenic hazards among certain populations, paired with neighborhood-level increases in sensitivity to those hazards and lower adaptive capacity to cope with those hazards at the individual level.
“The same populations, including but not limited to Black people, Latinx people, Indigenous people, and low-income people, that have been historically marginalized and systemically separated from health care are also at the greatest risk to suffer the consequences of anthropogenic climate change. In epidemiology, we call them populations that experience cancer disparities. In climate work, we call them environmental justice or frontline populations. They are largely one and the same: populations that American society has systemically and unapologetically rendered vulnerable to a myriad of risks."
2. What are the biggest opportunities when considering these societal issues and challenges together?
“The opportunity here is to consider and study how, by advancing environmental justice, we also have a crucial opportunity to advance cancer control efforts. For example, as we see an increased number of climate-related disasters, how do we get ahead of disparities in exposure to wildfire smoke or disparities in interrupted access to cancer care in the aftermath of a hurricane? By thinking ahead, we can serve the populations at greatest risk before they are in acute crisis.
“A great example, in light of the [recent] poor air quality in the Northeast, is clearly communicating what we know about the health risks of wildfire smoke inhalation and ensuring that the information is distributed in ways that reach the populations that are at the greatest risk of exposure to that smoke: folks who walk and take public transit, for example.
“There are several scientific collaborations (such as the Thread collaborative) and multisectoral groups (the Urban Heat Research Group) that are working collaboratively to study and address disparities in extreme heat exposure and create equitable awareness campaigns and interventions. I am a part of a new study that aims to investigate how medically vulnerable populations, specifically, are experiencing extreme heat, so that's going to be an exciting addition to the literature."
3. What are the biggest barriers to getting these types of changes enacted in ways to help address the problems?
“Despite consensus in the scientific community, not everyone 'believes' in anthropogenic climate change and climate action. Among those in power, not everyone believes that the legacy of structural racism in this country needs to be rectified. Not everyone believes that access to quality health care should be a fundamental right. The first barrier is to reach the point where those in power reach a consensus that something must be done to address the disparities that we as a society have created in climate vulnerability and disease risk.
“Further, we need more actionable, transdisciplinary work to understand the behavioral and biological mechanisms by which climate-related events operate to affect cancer disparities and open, bidirectional lines of communication between the affected communities, the scientific community, and responsive elected and appointed officials at all levels of government.
“A bottom-line takeaway anyone in oncology should know is [that] context matters. As a result of anthropogenic (human-caused) climate change, we are seeing an increased frequency and severity of climate-related threats, such as hurricanes, wildfires, and periods of extreme heat. For some of us, dealing with these threats is as simple as evacuating an area or blasting our central AC; for others, these are life-threatening events. When we think about barriers to getting screened for cancer, adhering to treatment for cancer, and surviving cancer, we have to consider the context of our changing world (i.e., climate change) if we want to meaningfully advance cancer health equity."
Sarah DiGiulio is a contributing writer.