Team:SDU-Denmark/Inclusion
Diversity and Inclusion
Inclusion in medical science
The end-user involvement revealed that men across ethnicities feel vulnerable and precautious visiting the doctor. This can be due to the normative role ascribed to men from an early age which also results in gendered inequality in help seeking behavior between men and women (1). This is especially notable for immigrants, who have been found to consult doctors less than ethnic Danes (2). 11.5% of the Danish population consists of international migrants, making this tendency relevant for a large portion of the danish population (2,3). The fact that immigrants use of the healthcare system less frequently has been ascribed to immigrants becoming less sick than nonimmigrant Danes, but recent studies have shown that certain barriers exist between immigrants and the danish health care system (3,4). The existing barriers are linguistic, sociocultural and psychological in nature, and fully overcoming them will likely require improvement in each of these areas, as well as others. For the individual, these barriers can be experienced, as distrust to medical professionals, or difficulties reaching the relevant branch of the health care system (3,4). This speaks to a very real inconsistency in the quality of the danish healthcare services, as errors in communication can lead to the wrong diagnosis or administration of the wrong medication (4,5,6). In order to combat this inconsistency in quality on a systemic level, we need increased focus on cultural differences, non-verbal communication and the challenges associated with non-danish speakers. In order to have a more immediate impact on this inequality, PROSTATUS allows people to test themselves in the privacy and safety of their own homes. The test is designed to help motivate people to use the danish health care system, when it is necessary, to facilitate early detection of prostate cancer.
Existing biases in the healthcare sector also play a role outside of patient interactions. An example of this is the development of novel drugs. Clinical trials, that are conducted to investigate the efficiency and side effects of potential drugs, are carried out at universities and university hospitals. First generation immigrants are less likely to be in these environments as they often have professions or educations from before their migrations. Furthermore, minorities are, by definition, a small fraction of the population, which makes them poorly represented in studies where subjects are chosen at random. As a result, we get a poorer understanding of the effect of novel drugs in this demographic. Ignoring large genetic differences between these population can be harmful to the minority, especially in diseases where genetics is closely linked to the disease phenotype, progression and treatment, as is the case for prostate cancer.
Developing a single drug to treat prostate cancer is an impossible task, as cancer stems from the loss of control of essential cellular processes. Control of these processes can be lost in many combinations of mutations. As such, the disease prostate cancer, can be viewed as many different diseases that arise in the same tissue. Different versions of the disease will develop at different speeds, get a different level of malignancy and should be treated differently. PROSTATUS aims to address this issue by utilizing principles from personalized medicine in prostate cancer diagnosis. In personalized medicine, medical treatment is tailored to the individual patient rather than the disease. By introducing cheap, easy and isolated genotyping (Looking at only a selection of genes) in cancer diagnostics, PROSTATUS hopes to bridge the gap to a future, where your immigration status and the efficacy of diagnostic tools and treatments have nothing to do with each other.
References
[1] Danmarks statistik:”Lægebesøg” (“Visits to the doctor”) from https://www.dst.dk/da/Statistik/emner/levevilkaar/sundhed/laegebesoeg
[2] Sundhedsstyrelsen, 2010: “Etniske minoriteter I det danske sundhedsvæsen- En antalogi” (“Ethnic minorities in the Danish healthcare system- An anthology”)
[3] Nørredam et al. 2006: “Migrants’ access to healthcare”
[4] University of Copenhagen, Faculty of Health Sciences, 2013: “Sundhedsforhold hos nyankomne indvandrere” (“Health of newly arrived immigrants”)
[5] World Health Organization, 2018 “Report on the health of refugees and migrants in the WHO European Region: No public health without refugees and migrant health”
[6] Gabriel et al. 2011: “Refugees and Health Care – The Need for Data: Understanding the Health of Government-assisted Refugees in Canada Through a Prospective Longitudinal Cohort”
