November 2021 Remarks at Florida Association of Health Plans Annual Conference

Ambassador Nancy G Brinker

FAHP Remarks as prepared for delivery

November 14, 2021 — Orlando, FL


Thank you all for inviting me and thank you Audrey for your friendship and for the incredible leadership you bring to these issues.

I can’t tell you how great it is to be here in person with all of you today. I last visited with you two years ago at the end of 2019. I had just completed knee replacement surgery, and I was so happy to finally be out in public. Little did I know that I would only have a few months to enjoy being out in public … before COVID shut everything down. So once again, it is great to be back. And this time hopefully no chaos will follow- I am superstitious!

This year – 2021 – is an important milestone. It represents the fifty-year anniversary of President Nixon declaring a War on Cancer.  In 1971, he said, “The time has come in America when the same kind of concentrated effort that split the atom and took man to the moon should be turned toward conquering this dreaded disease.”

So, as part of this effort, the government and private sectors put unprecedented amounts of money into cancer research, created cancer centers, and provided leadership and coordination to better focus our efforts.

My own role in this War began shortly thereafter. My sister Suzy was my best friend. We talked nearly every day on the phone. I was living in Dallas, and she was living in Peoria, Illinois.  But one day I took a call from her that would change both of our lives. She had breast cancer.

Suzy fought bravely, but just three years later she was gone… at just 36 years old. Leaving behind a heartbroken family, including two young children.

Before she died, Suzy grabbed my hand and made me promise to do everything in my power to make sure no one else would suffer from this disease. I promised her, and that promise became the foundation for my life’s work.

So there I was… alone. Having made a promise to end the threat of breast cancer and also to make sure that anyone who could not afford treatment would have access to it. It’s an old joke that when you get obsessed about something unimportant, people remind you that you’re not “curing cancer.” And here I had promised to do just that.

But to think big, you sometimes have to think small.

The organization I founded in Suzy’s name did not begin as a national organization. It began as a small group of women sitting in my living room. We took an old fashioned and yet very modern approach. We began mobilizing in our own communities. We talked to our neighbors and coworkers. We went town-by-town, street-by-street, and door-by-door. We raised money, and kept vast amounts of it where it was raised. And in the decades that followed, we made a difference.

We raised and invested $3.2 billion dollars — $1 billion dollars for research, and the rest for education, screening and treatment programs. And we raised awareness. Taking a disease that had only been talked about in whispers and bringing it out of the shadows.

Today, cancer is still part of our lives, leading many to wonder if the War on Cancer has been a success. Our research has given us unprecedented knowledge about the nature of cancer, its causes, and its most effective new treatments. From 1989 to 2016, we helped lead a 40 percent decline in breast cancer mortality. The incidence of cancer in this country started dropping in 1990 but now breast cancer is still the largest disease in this country.

After Suzy’s cancer diagnosis, I frequently joined her when she underwent treatment at the MD Anderson Cancer Center in Houston. There, we watched dozens of under resourced women –huddled in small waiting areas for hours and days hoping to see a doctor. It wasn’t right. And Suzy told me, “Where a woman lives, shouldn’t determine whether she lives.”

So, while I’m grateful for the progress we’ve made in treating cancer, I’m still haunted by Suzy’s words – and the millions of people who have not benefitted from that progress. And this is why I am dedicating the last quarter of my life to addressing the health care disparities that continue to plague our system.

You all know the reasons for health care disparities are numerous. Some of it is the high cost of health care, particularly surrounding chronic diseases. People are scared of five- and six-digit medical bills, and thus do nothing.

But access to affordable care is only one part of the challenge. Equally – if not far more – important are the social determinants of health.

For people struggling with rent, poverty, hunger, or safety, taking ownership of their health seems like a luxury they can’t afford. We keep having the same discussion in the United States.

So, while cancer incidence and mortality rates overall are on the decline in the United States, there is a large and growing gap related to these social determinants. Between 2012 and 2016, the overall cancer death rate was roughly 20 percent higher for those living in the poorest counties, compared to those living in more affluent counties.

This disparity is especially large for cancers that are preventable. Having been involved in the cancer community for over five decades, some of the most tragic scenes I’ve witnessed are women who may have had a preventable disease, only to die because they didn’t seek screening or care soon enough.  And isn’t it odd that once again, like every other year, the US Preventative Services Task Force will meet to discuss increasing the age recommended for cervical cancer screenings.

The real problem in South Florida, where I live, is that we have over 80,000 women who have no medical home and no access to care. The root of this problem is that we have largely for-profit hospitals. In fact, in tragic situations people are forced to go to the emergency room. There are few hospitals that have charity care.

It doesn’t have to be this way. And that is why I, along with a small group of like-minded women and men, have now created The Promise Fund.

The Promise Fund is a new initiative separate and distinct from Susan G. Komen. The Promise Fund is unique in that it focuses its efforts on assisting individuals gain access to life-saving screening, early detection, and potential treatment – regardless of their ability to pay. It is a granular approach – that once again has me moving from town to town, street to street, and door to door in our county.

The Promise Fund provides one-on-one assistance, pairing individuals with patient navigators who help guide them through the health care system, and address the social determinants that might leave them without care.

These navigators are incredible – and incredibly important. We focus on hiring individuals who have diverse backgrounds in areas such as social work. And we also prioritize having navigators who can speak multiple languages, to better connect with the communities we are trying to reach.

As part of this effort, we also partner with a number of groups and organizations like FAHP. These organizations help us help these individuals with a wide range of issues, including transportation, enrollment in health plans, financial assistance, child care and other obstacles that keep people from seeking care.

We are also relying on partnerships with Hologic, a medical technology company, and FoundCare, a federally qualified health center that provides subsidized women’s health care services in West Palm Beach.

We have paired these 2 entities together and we have launched the Promise Fund Mammography Screening Center. This enables access to primary care checkups and – for the first time in our county – breast and cervical cancer screening all in one location for under-resourced women.

I’m often asked, why are we starting this effort in Palm Beach County?

One, it’s a population center. Palm Beach County is the third largest county in the third largest state. And prior to COVID-19, about 2,000 new residents were arriving every day.

Two, because our state is a microcosm of the country. In Palm Beach, some of the most affluent neighborhoods are located right next some of the most impoverished. And you can guess what the health outcomes are like in those two distinct pockets.

Three, because this is an area in need. Florida ranks last in the United States for the number of women under 65 who have health insurance. These gaps in coverage are even worse for under-resourced populations.

Finally, we’re doing this in Florida because our state has some of the worst health outcomes of any state in the country. In Palm Beach County, almost 45 percent of cervical cancers and almost 30 percent of breast cancers are at an advanced stage when diagnosed.

But while our focus is currently on Palm Beach County, our goal is much larger. Over the long term, our goal is to create a gold standard model for a continuum of care. Our hope is that this will then be replicated elsewhere, helping people gain access to health education, navigation for breast and cervical health, early detection screenings, and support services through an established network of providers. We are aggregators of care.

We are doing this to save lives, but I would be remiss if I did not mention that this approach also saves money. We know that early detection and treatment of chronic disease is significantly less expensive than late-stage interventions.

In 2017, roughly 17,000 Florida women were diagnosed with breast cancer. The average cost of treating a woman with Stage 4 breast cancer is $134,000 dollars. At that price, the costs of treating those 17,000 women would come to $2.3 billion dollars. But the cost of mammograms for 17,000 women is $1.7 million dollars.

One year ago, I stood outside our Promise Fund Mammography Screening Center –as a group of us watched and waited, a truck arrived to deliver our first state-of-the-art 3D mammography machine. As the machine was being unloaded from the truck, it passed a group of women  who were already waiting in line to make appointments. They began crying. One woman told me, “No one has ever done anything like this for us.”

… and then I began crying.

This is what happens when we create health care systems that view people as people – instead of viewing people as profits. Last year alone, our 10 patient navigators helped to educate, navigate, screen, and treat more than 12,000 women in Palm Beach County. And that was in the midst of the pandemic. In the year ahead, I would like to see that number doubled to over 24,000 women.

Today, you may have noticed something unusual about my outfit. It may be hard to see, but I’m proudly wearing my pink boots.

You all know how important the color pink has been in the fight against breast cancer. It was my sister Suzy’s favorite color. The Promise Fund is slipping on its pink boots! We have launched a new campaign in which we want you to be a part of, Pink Boots on the Ground,  to encourage communities to take action in the fight against breast cancer.

We would like every company here today to figure out a way to help us. It could be change from a sale, rounding up, spreading the word…anything you can think of.

I hope you all will join us in bringing these boots to the ground – even metaphorically. So that one day soon, all women – regardless of where they live, how much money they have, or what language they speak – will have access to health care, cancer screening, and treatment.

Thank you!