Black History – Harold P. Freeman, M.D.
This month, CRCHD staff will be blogging about influential black doctors, scientists, and medical innovators, as well as rising stars from our portfolio. If you would like to nominate someone to be honored, please email CUREsupplements (at) NIH (dot) gov
Today’s blog features Dr. Harold P. Freeman, preeminent cancer health disparities researcher, champion of patient navigation, and founding director of our esteemed Center.
Harold Freeman was born on March 2, 1933, in Washington, DC. His great-great-grandfather was a slave who purchased his freedom for $3000 in 1838, and took the name Freeman for himself. His great grandfather was one of the first black dentists in the country, and his grandfather was a doctor and his father was a lawyer. Freeman attended Catholic University and later Howard University Medical School, where he obtained his M.D. “[My mother] wanted me to become a doctor because she said it was something that would elevate me. I thought I might be a school teacher, but she put being a doctor in my mind early in life and it stuck.”
Freeman grew up among highly educated black folks, but segregated. “My only contact with whites for most of my childhood was passing them on the street. It has to create some scars. I don’t feel scarred in an active way, but that kind of forced separation does leave an impression… …people do not intend to do harm to others but still discriminate.”
Freeman completed his residency at Memorial Sloan-Kettering, a renown cancer center, and then took a position at Harlem Hospital Center in 1967. Patient after patient would come into Harlem Hospital Center with advanced stages of cancer – often metastasized and almost certainly lethal. Noting the stark differences between Memorial Sloan-Kettering and Harlem Hospital Center, Freeman asked himself, “Why is this happening,” and began to consider the factors driving these vast inequities.
“This research was totally unintended but a result I uncovered that it was socioeconomical, cultural, and environmental conditions that contributed to these death rates,” Freeman said, and has been fighting to rectify these differences ever since.
Freeman became Director of Surgery at Harlem Hospital in 1974, and served there for 25 years. In 1979, he became Medical Director of the Breast Examination Center of Harlem, which was run by Memorial Sloan-Kettering Cancer Center. This program was designed to improve chances of early detection of breast and cervical cancer in lower income and minority populations.
In 1988, Dr. Freeman authored a report entitled “Cancer in the Economically Disadvantaged,” writing:
“Logically, if we could identify [the group of Americans with higher cancer mortality and lower health status], and determine the underlying reason for the disparity, we could (as a society) bring to bear the appropriate changes to correct the disparity.”
Upon becoming president of the American Cancer Society from 1988-1989, Freeman conducted a listening tour, holding hearings on cancer in the poor throughout the country. The testimonials revealed the depth of the challenge.
“One universal problem that the poor articulated were the barriers they faced simply trying to enter the health-care system. Prior to the national hearings, I was centered on the Harlem experience; the hearings elevated my thinking to a universal level. It was during that exciting time that I coined the term “patient navigation.” Soon after returning to Harlem, I initiated the nation’s first patient navigator program in 1990”
Patient navigation was a radical concept, but it began to take hold. Freeman was elected to the National Academies of Sciences’ Institute of Medicine, where he championed the inclusion of social determinants of health in research and health care. He was appointed to four terms of the President’s Cancer Panel.
In 2000, the National Cancer Institute established the Center to Reduce Cancer Health Disparities (CRCHD) and tapped Freeman to be its first director (while also serving as Associate Director of the NCI). He served in this role for five years, testing the Harlem model of patient navigation during this time, which demonstrated definitively that patient navigation reduces the time from abnormal findings to diagnosis and treatment in poor populations, and can increase the number of people coming to a center for screening.
In 2005, the Patient Navigator Outreach and Chronic Disease Prevention Act (HR 1812) was signed into law by President George W. Bush. This law provided demonstration programs to low-SES, minority, Native American, and rural Americans to help improve healthcare outcomes.
“I hope I can inject more understanding in the world not just for blacks. I’ve tried to look at social injustice in a general sense in order to improve the lives of many.”
“You shouldn’t die because you are poor, from cancer or anything else,” he said. “Patient navigation is one of those elements that, in my view, tends to temper the point that we have great systems, wonderful specialists, powerful cancer centers, and we say we can give the best care in the world—but they don’t say what they should say, which is, ‘If you can pay for it.’”
Freeman has four honorary doctorates, was awarded the Mary Lasker Award for Public Service, the Time ,Inc. International Health and Medical Media Awards’ Lifetime Achievement Award, the American Cancer Society’s Medal of Honor, the First Annual Medical Assembly “Humanitarian Award” at the United Nations “Meeting the Global Challenge of Cancer” meeting in New York. Dr. Freeman continues to run the Harold P. Freeman Patient Navigation Institute.
Freeman, Harold P. "Cancer in the socioeconomically disadvantaged." CA: A Cancer Journal for Clinicians 39, no. 5 (1989): 266-288.
Freeman, Harold P. "Patient navigation as a targeted intervention: For patients at high risk for delays in cancer care." Cancer 121, no. 22 (2015): 3930-3932.