Social Determinants Affect Cancer Health Equity

A new paper published in CA: A Cancer Journal for Clinicians provides recommendations to address population-based cancer disparities caused by social determinants.

“Although cancer mortality rates declined in the United States in recent decades, some populations experienced little benefit from advances in cancer prevention, early detection, treatment, and survivorship care. In fact, some cancer disparities between populations of low and high socioeconomic status widened during this period. Many potentially preventable cancer deaths continue to occur, and disadvantaged populations bear a disproportionate burden,” according to the authors.

The paper, titled “Understanding and addressing social determinants to advance cancer health equity in the United States: A blueprint for practice, research, and policy,” is part of the American Cancer Society’s Cancer Control Blueprint series.

The World Health Organization’s definition of social determinants is used, which defines the term as “the circumstances in which people are born, grow up, live, work, and age and the systems put in place to deal with illness,” which are impacted by the “distribution of money, power, and resources at global, national, and local levels.”

The blueprint establishes a framework of social determinants for cancer health equity, addressing:

  • Structural inequities and social injustice
  • Institutional environments
  • Living environments (physical, economic, service, and social environments)
  • Downstream consequences of upstream conditions

Priority recommendations within each of the social determinants are provided.

Recommendations to address structural inequities and social injustice

  • Address income and wealth inequality
  • Support targeted provisions
  • Support models of care that consider social risk
  • Enhance multilevel research
  • Implement focused training for health care providers

Recommendations to address institutional environments

  • Improve access to high-quality care
  • Enhance standards relevant to patients’ social circumstances
  • Enhance navigation and service integration

Recommendations to address living environments

  • Enhance surveillance data and data integration
  • Increase cross-sectoral collaboration

Cross-cutting recommendations

  • At the leadership level, commit to eliminating disparities
  • Proactively partner with disadvantaged communities/patients
  • Consistently monitor progress and provide feedback

“The cancer control continuum comprises a range of intervention targets, from prevention and screening to survivorship and end‐of‐life care,” the authors concluded. “Just as current cancer control efforts must target this entire continuum of influence, so must future cancer control efforts target the entire social determinants continuum of influence, including social‐structural factors. Failure to embrace this perspective will inevitably contribute to the perpetuation, and potentially widening, of cancer disparities.”