For decades, the rate of cancer incidence and deaths from the disease among African-Americans in the United States far outpaced that of whites. But the most recent analysis of national data by the American Cancer Society suggests that “cancer gap” is shrinking: In recent years, death rates from four major cancers have declined more among blacks than among whites.

The report was published online Thursday in CA: A Cancer Journal for Clinicians, a peer-reviewed journal of the American Cancer Society.

African-Americans still bear a disproportionate share of the cancer burden in the U.S., having the highest death rate and the lowest survival rate of any racial or ethnic group for most cancers.

“In 2019, approximately 202,260 new cases of cancer and 73,030 cancer deaths are expected to occur among blacks in the United States,” the analysis by ACS investigators notes.

But their report also shows that the gap between blacks and whites has closed considerably over the past few decades when it comes to lung, prostate and colorectal cancers. In fact, during the period from 2006 to 2015, overall death rates from cancer declined 2.6 percent per year among black men, compared to 1.6 percent per year among white men. Among women, for that same time period, death rates from cancer declined 1.5 percent per year among blacks compared to 1.3 percent per year among whites.

“Twenty?five years of continuous declines in the cancer death rate among black individuals translates to more than 462,000 fewer cancer deaths,” according to the report’s authors.

The improvement among African-Americans is largely due to dramatic decreases in incidence and death from lung cancer, says Dr. J. Leonard Lichtenfeld, acting chief medical officer for the American Cancer Society, and that likely reflects the steep declines in the prevalence of smoking.

“I can’t say why smoking has decreased so dramatically in the black community but the fact that it has is very good news,” he says. “It has significantly narrowed the gap between blacks and whites and we are very grateful.”

Still, racial disparities in cancer continue. The reasons are likely multiple, Lichtenfeld notes, and include disparities in education, socioeconomic status and access to health care.

When the U.S. ensures that everyone has equal access to good health care, screening and treatment, Lichtenfield says, “we’ll see even greater success. We have to make a commitment to make that happen.”

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Distrust of vaccines may be almost as contagious as measles, according to medical anthropologist Elisa Sobo.

More than 100 people have been infected with measles this year, according to the Centers for Disease Control. Over 50 of those cases have occurred in southwest Washington state and northwest Oregon in an outbreak that led Washington Gov. Jay Inslee to declare a state of emergency on Jan. 25.

Some public health officials blame the surge of cases on low vaccination rates for this highly infectious disease.

Clark County, Wash. — the center of the current spate of cases — has an overall vaccination rate of 78 percent, but some schools in the county have rates lower than 40 percent.

Washington is one of 17 states that allows a parent to send his or her child to public school not completely vaccinated because of a “philosophical or personal objection to the immunization of the child.”

What makes some families reluctant to vaccinate their children? Sobo, a professor at San Diego State University, says it may be driven in part by the desire to conform in a community where many parents are skeptical of vaccines.

To better understand how parents decide not to vaccinate, Sobo interviewed families at a school with low vaccination rates in California. She found that skepticism of vaccines was “socially cultivated.”

Parents who believe that vaccines are dangerous persuaded other parents to believe the same thing by citing fears of “mainstream medicine” harming their children. Enrolling in the school even seemed to change the beliefs of some parents who had previously followed the state-mandated vaccine schedule: They started to refuse vaccines.

NPR’s Audie Cornish spoke with Sobo on All Things Considered. These interview highlights have been edited for clarity and length.

What are the common ideas that we have about families that don’t believe in vaccination?

One common idea would be that they’re all absolutely looney-tunes, crazy people wearing tinfoil hats and reading all these conspiracy theories on crazy blogs on the Internet. And that is absolutely not the case. What I found was that most of the people who are hesitating to vaccinate … They’re really smart people, and they’re highly, highly educated.

Back in 2012, you actually spoke to some parents in California, in a community where parents had their kids at a fairly progressive school. Half of kindergarteners had gotten exemptions from vaccines. What was going on in this community?

Often, the parents, the family didn’t arrive at the school having any hesitancy about vaccinations … As they acculturated or became part of the community, that’s when these kinds of beliefs and practices would take hold.

The longer the family had been in the community, … this practice of being hesitant about vaccinations evolved and it became part of that family’s medical practice.

[In areas where there are low vaccination rates], there tends to be a more open norm, where not vaccinating is accepted or sometimes even encouraged. When you have people surrounding you that move in that direction, to go in a different direction has social costs.

It’s not just the facts and the information that you’re going by. It’s: “What are the norms? What are people around me doing? And they seem to be OK, and everything’s working out for them.”

Think about yourself and the clothes that you wear to work. I’m guessing that you probably don’t have a formal dress code, but you kind of look around, and you see: “Oh, OK, this is what we’re expected to wear to work.” And you just do it.

Are you talking about a formal kind of peer pressure?

The peer pressure is not formal.

Informally, there becomes a sort of feeling in the community. It becomes known for not vaccinating.

There are parts of the country where there’s the opposite expectation, where someone who didn’t want to vaccinate their kids might be socially isolated for that decision.

And then their behaviors would be pushed underground. They might not feel comfortable telling other people.

When you see what’s going on in Washington State, what came to mind for you?

What is the media coverage going to do? Are they going to vilify these parents?

That witch hunt aspect is not helpful to have a good discussion about vaccination. It needs to be much more open and much less polarizing.

Are people ready to listen? Can there be convincing?

I think people are very ready to listen — if they’re heard. If you listen to them, and you allow them to say what they think without feeling judged, without pushing them into a corner, they’re absolutely ready.

Mara Gordon is a family physician in Washington, D.C., and a health and media fellow at NPR and Georgetown University School of Medicine.

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On a bitter cold afternoon in front of the central bus stop in Bangor, Maine, about a half-dozen people recently surrounded a folding table covered with handmade signs offering free clean syringes, coffee and naloxone, the drug also known as Narcan that can reverse an opioid overdose.

They’re with a group called the Church of Safe Injection that is handing out clean drug-using supplies in cities around the U.S.

Even though they could be arrested for doing so, volunteers say they have to step up because of the staggering number of opioid overdose deaths and because the public health system has failed.

“There are all these barriers to people getting well — like insurance and treatment rules,” said one of the Bangor volunteers who goes by the name Dave Carvagio, though it’s not his real name. “It’s to the point where, for some people, the only treatment options are in institutions like prison.”

Carvagio doesn’t want to be identified because it’s illegal in Maine to have more than 10 hypodermic syringes unless you’re a certified needle exchange. Police cars sometimes circle the park, but no one has been arrested — yet.

“I believe that there is not just like a moral duty to violate unjust laws, but in this circumstance a spiritual duty,” Carvagio said. On this day, they gave out 100 syringes, 10 naloxone kits and made one referral to treatment.

Bangor police Sgt. Wade Betters knows about the group. He says he’d like to sit down and meet with the volunteers, but he believes their focus should be on getting people into treatment.

“You know, if you’re committing a crime in the state of Maine, you could be subject to arrest or ticketed,” Betters said. “But in these cases, we use a lot of discretion because the goal is the same — to save lives.”

In Lewiston, Maine, police have taken a different position. They’ve warned the group not to give out clean syringes in a local park because it’s against state law. So the group members have arranged to meet with people and bring the supplies to different meeting spots.

Driving through Lewiston one night, in a car packed full of boxes of syringes and other drug-using equipment, Kandice Child met up with two young men standing near a convenience store.

“I’m going to give you 100 [syringes],” Child told one of the men. “What about alcohol wipes, you need any of those?”

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A drug user in Lewiston, Maine, puts used needles into a sharps container to be exchanged for clean needles.

Jesse Costa/WBUR

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Child gave them naloxone and test strips for the powerful opioid fentanyl. She says she only gives clean needles when someone returns their used ones so as to help keep syringes off the streets. Child says she does this because she has a family member who is struggling. She also says there are only six certified needle exchange programs in Maine, none in Lewiston.

“Why wait?” Child asked. “Should we all sit around and talk and point fingers or should we get off our a– and do something about it? This helps, it works, it saves lives, it reduces HIV, it reduces hepatitis, and it keeps syringes off the streets.”

Next stop was an apartment where three people were waiting to trade containers filled with used syringes for clean ones. Another volunteer demonstrated how to use naloxone as Child filled out paperwork keeping track of what she’s handed out.

A 36-year-old man — who didn’t want his name used because he’s using drugs — was uneasy. He says he’s glad to get the clean equipment but that he’s conflicted about whether getting these supplies makes it easier for him to use drugs.

“The only reason I struggle is the inner conflict, you know? It’s preventative maintenance yet at the same time it’s enabling, you know?” he said.

A woman in the apartment, who also didn’t want to be identified, chimed in: “I understand, but what are you supposed to do? If someone isn’t able or ready to go to treatment — should they die?”

Even the founder of the Church of Safe Injection, Jesse Harvey, 26, acknowledges that he’s struggled with the same questions. But he says working in addiction recovery has made him frustrated by the deaths and barriers to treatment. He says there are criteria to becoming a legitimate syringe exchange program that he’s not likely to meet, so he started this church.

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Jesse Harvey, founder of the Church of Safe Injection, stands in a Denny’s parking lot in Auburn, Maine, alongside four sharps containers filled with used needles collected from drug users around the neighboring city of Lewiston.

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Harvey says there are now 18 chapters of the Church of Safe Injection in eight states — all of them funded by private, anonymous donations. Each one is independent but must abide by three rules: to welcome all people of all faiths, to serve all marginalized people and to support harm reduction.

But he says the group is not supporting legalizing drugs.

“We’re not saying it’s our religious belief to use heroin. No, not at all,” Harvey said. “We’re saying that it’s our sincerely held religious belief that people who use drugs don’t deserve to die when there are decades of solutions.”

Harvey plans to register the church as a nonprofit and then argue for a religious exemption from drug laws. He says the U.S. Supreme Court has already ruled that a religious group is allowed to use the illegal psychedelic ayahuasca in its rituals.

“I don’t think it’s illegal, and if it is, I think we have a religious exemption here,” Harvey said. “With the high rate of fatal opioid poisoning in Maine, why criminalize a group of people with lived experience who are trying to save lives? If the state is not going to do something about this, well guess what? We’re going to.”

Harvey says eventually he hopes to have a location for the church that will include a site where people could inject drugs under supervision. Such supervised injection sites are legal in some other countries, but Justice Department officials have warned that they will prosecute anyone operating one in the U.S. Nevertheless, at least a dozen U.S. cities are considering whether to open a site.

For now, Harvey says his congregants will continue to risk arrest to hand out supplies.

This story was produced in partnership with WBUR.

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