Name: ______________________________________ Date: ___________________

Distance from Specialists

A number of studies have found that where people live matters for access to health care. Below are
summaries of two studies about access to primary care providers (doctors people see on a regular basis for
prevention and when they are sick) and access to major cancer centers (where people can get advanced
treatments for cancer).

Study 1:
Residential segregation and the availability of primary care physicians. Health Services Research (Gaskin et
al., 2012)
This team of researchers examined access to primary care physicians in neighborhoods with different
demographic characteristics. They looked at whether neighborhoods made up of a majority of African
American, Asian, or Hispanic people were more or less likely to be neighborhoods identified as a “shortage
area” with fewer providers. The researchers controlled for other kinds of social determinants of health, like
education level and poverty. That way, they could look specifically at the impacts of racial segregation on
physician access.
Overall, 9.6 percent of people who identified as Asian and 13.2 percent of people who identified as White
lived in primary care physician shortage areas. By contrast, 25.8% of people who identified as African
American and 24.3% of people who identified as Hispanic lived in areas with physician shortages. Majority
African American neighborhoods and majority Hispanic zip codes were more likely to be in areas with fewer
primary care physicians. Majority Asian neighborhoods were less likely to be in shortage areas.
African American neighborhoods with a high level of segregation were more likely to be in neighborhoods
with fewer physicians. That was not true for Hispanic and Asian neighborhoods with high levels of
segregation.
The study did not examine segregation and access among the Native American population or other
ethnic/racial groups.

Part A: Reviewing Evidence: Distance from Specialists

1. What evidence, if any, supports the claim that this social determinant matters for who gets cancer
treatment?

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 2. What evidence, if any, suggests this social determinant does not matter for who gets cancer
treatment?

3. What evidence is there that this social determinant is a constraint for health equity or cancer
treatment?

Study 2:
Geographic access to cancer care in the U.S. (Onega et al., 2008)
This team of researchers estimated how long it would take for people to travel to cancer centers across the
country. For every place in the country, they used mapping tools to identify how long it would take to get to a
National Cancer Center driving on major and minor roads. They estimated time based on the speed limit for
those roads.
Analyses of access to NCI Cancer Centers by race/ethnicity show that Asians had the shortest travel times
(median of 28 minutes, with a range of 15–66 minutes), and Native Americans had the longest (median of 155
minutes; interquartile range: 62–308 minutes). Hispanics and White people were similar in their proximity to
the nearest NCI Cancer Center (median of 86 minutes for both; ranges of 23–229 minutes and 33–174
minutes, respectively). African Americans had a shorter median travel time (median of 69 minutes; range,
16–193 minutes) than Hispanics and White people.
People living in rural areas also had longer travel times to the nearest NCI Cancer Center.
The median travel time for suburban areas was nearly 2.5 times longer than for urban areas (57 minutes vs.
146 minutes).

Part A: Reviewing Evidence: Distance from Specialists

1. What evidence, if any, supports the claim that this social determinant matters for who gets cancer
treatment?

2. What evidence, if any, suggests this social determinant does not matter for who gets cancer
treatment?

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 3. What evidence is there that this social determinant is a constraint for health equity or cancer
treatment?

References
Campbell, N. C., Elliott, A. M., Sharp, L., Ritchie, L. D., Cassidy, J. & Little, J. (2001). Rural and urban differences
in stage at diagnosis of colorectal and lung cancers. British Journal of Cancer 84(7), 910–914.
Gaskin, D. J., Dinwiddie, G. Y., Chin, K. S., & McCleary, R. L. (2012). Residential segregation and the availability
of primary care physicians. Health Services Research, 47(6), 2353-2376.
https://doi.org/10.1111/j.1475-6773.2012.01417.x
Monroe, A. C., Ricketts, T. C. & Savitz, L. A. (1992). Cancer in rural versus urban populations: A review. Journal of
Rural Health 8(3), 212–220.
Onega, T., Duell, E. J., Shi, X., Wang, D., & Demidenko, E. (2008). Geographic access to cancer care in the U.S.
Cancer, 112(4), 909-918. https://doi.org/10.1002/cncr.23229
Singh, G. K., & Siahpush, M. (2014). Widening rural-urban disparities in life expectancy, U.S., 1969–2009.
American Journal of Preventive Medicine 46(2), e19–e29.
Williams, D. R., & Collins, C. (2001). Racial residential segregation: A fundamental cause of racial disparities in
health. Public Health Reports 116(5), 404–416.

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