Gaps also persist in the availability of quality treatment and the adequacy of pain relief for those who are dying of cancer. Mike in Brazil Poverty, lack of health insurance, and racism all contribute to the chasm in cancer care, the authors explain. It will take the combined effort of many different groups to narrow the gap, they add. "Communities can do a lot by exposing the efforts of tobacco companies to prey on more vulnerable and less educated segments of the population," Thun says. Recognizing the challenge, Aetna Inc. last year became the only national health insurer to begin collecting racial and ethnic data from its members. The company says that is part of a larger initiative it has developed to understand differences in disparities in care and develop strategies to reduce the gaps. 8th street latinas Already, the Hartford, Conn.-based health insurer has rolled out a program to educate and support black women who are at increased risk of preterm labor. Aetna defends its data collection effort, which critics say raises concerns about patient privacy. "Without data, you're kind of shooting yourself in the dark," says Dr. Melissa Welch, medical director for health-care delivery in Aetna's West region. "The good news is we've at least taken a step." Aetna also has developed a cultural competency module that its physicians and nurse employees are required to take. The goal now is to find a way to expand that training to all network providers, she says