On June 26, 2023, the Biden-Harris Administration awarded $50 million in the launch of the Persistent Poverty Initiative—a program designed to alleviate the cumulative effects of persistent poverty on cancer outcomes by increasing research capacity, fostering cancer prevention research, and promoting the implementation of community-based programs.
Background
Persistent poverty areas are defined as those where 20% or more of the population has lived below the federal poverty line within the last 30 years. Individuals who live in these areas have been found to have a higher incidence of cancer, experience delays in cancer diagnosis and treatment, and be more likely to die from cancer than those who do not live in poverty. However, there has been limited research on how to improve cancer outcomes in persistent poverty areas.
“Persistent poverty is a place-based and community phenomenon that reflects a failure of the structures and institutions in society, including health care,” emphasized Shobha Srinivasan, PhD, Senior Advisor for Health Disparities in the Office of the Director in the Division of Cancer Control and Population Sciences at the NCI. “Conducting research to understand the connections between institutions—such as social, economic, and health systems—and persistent poverty is the only way to inform changes to social conditions and determinants of health that will ultimately improve overall health, cancer control, and cancer outcomes,” she added.
Overview of the New Persistent Poverty Initiative
Coordinated by the National Cancer Institute (NCI), the Persistent Poverty Initiative is the first major program to address the structural and institutional factors of persistent poverty in the context of cancer.
These awards will create five new Centers for Cancer Control Research in Persistent Poverty Areas to advance the key priorities of the Biden-Harris Administration’s Cancer Moonshot initiative—including reducing inequities in the structural drivers of cancer and preventing more cancers from developing by reducing tobacco use and ensuring equitable access to healthy foods.
Further, the launch of the Persistent Poverty Initiative complements several other Administration priorities such as ending hunger and reducing diet-related disease. It may also play an essential role in helping President Joseph R. Biden and First Lady Jill Biden, EdD, achieve the clear goals they set when they reignited the Cancer Moonshot initiative in 2022: prevent more than 4 million cancer deaths by 2047 and improve the experience of patients affected by cancer.
Goals of the New Cancer Centers
Each of the five centers will work with targeted low-income communities to implement and measure the effectiveness of structural interventions for cancer control and prevention, follow-up care, and survivorship. These centers will conduct research in areas such as reducing obesity, improving nutrition, increasing physical activity, helping individuals quit smoking, and improving living conditions through supplemental income. In addition, the centers will train a pipeline of early-career investigators to work with underserved communities in conducting multilevel intervention research.
The awards will be spread over the next 5 years across all centers, pending the availability of funds. Among the new centers are:
- Acres Homes Cancer Prevention Collaboration: Led by The University of Texas MD Anderson Cancer Center, this center will work with primarily Black and Hispanic communities in northwest Houston to evaluate interventions in nutrition and physical activity to help prevent obesity and obesity-related cancer.
- The Center for Cancer Control in Persistent Poverty Areas: Led by the University of Alabama at Birmingham, this center will work with Black communities in Jefferson County, Alabama, to test diet and exercise interventions for cancer survivors and evaluate interventions aimed at reducing cancer disparities by improving living environments and promoting healthy activities.
- The Upstream Center: Led by Stanford University, this center will work with Hispanic and Asian American communities in Santa Clara and Yolo Counties in Northern California to assess how state programs for guaranteed basic income might affect cancer outcomes. It will also test whether the earned income tax credit promotes the adoption of healthy behaviors related to reducing the risk of colorectal cancer.
- The Center for Social Capital: Led by Weill Cornell Medicine and Columbia University, this center will work with Black, Caribbean American, and Hispanic communities in the South Bronx, north-central Brooklyn, Washington Heights, and Western Queens in New York City to test the efficacy of cancer education and tobacco cessation programs in promoting multigenerational health.
- HOPE & CAIRHE 2gether: Led by the University of Utah, this center will work with primarily Hispanic communities in Utah and American Indian communities in rural areas of Montana, Oregon, South Dakota, and Wisconsin to test interventions for commercial tobacco cessation and obesity prevention.
Conclusions
“By involving the community and making [it] an essential part of this effort, we are building a sustainable model. The idea of structural change then becomes much more built into the system,” Dr. Srinivasan concluded.
For more information about NCI’s investments in underserved areas, visit cancercontrol.cancer.gov.
