World Cancer Day 2022: Recognising and addressing the social inequalities in cancer care

Led by the Union for International Cancer Control (UICC), World Cancer Day is more than a day on the calendar. It is observed every year to raise awareness, improve education, and catalyse personal, collective and government action to save millions of preventable cancer deaths. Furthermore, it seeks to “reimagine a world where access to life-saving cancer treatment and care is equitable for all — regardless of who you are or where you live”.

A multi-year campaign for impact

In keeping with the theme ‘Close the Care Gap,’ UICC launched a three-year campaign this year to create more equitable access to cancer services. In the first year — 2022-23 — the campaign will focus on “understanding and recognising the inequities in cancer care around the globe”.  The second year of the campaign – 2023-24 – is about “uniting and mobilising communities to take actions, build stronger alliances and innovative new collaborations”. The last year of the campaign – 2024-25 – is all about bringing attention to a higher level by raising voices to engage those in power. It is about “calling on leaders to eliminate health inequities by addressing their underlying causes, ensuring that everyone has access to quality health services when, where and how they need them”.

Addressing the social inequalities in the cancer continuum

In the cancer continuum, social inequality refers to systematic differences between social groups that affect people’s risk of developing cancer, the likelihood that they will receive effective and timely (or any) cancer treatment, whether they will survive, and whether they will have access to palliative care. Such inequality can occur along a variety of axes, including, but not limited to, a person’s socioeconomic status, race or ethnicity, gender, disability, sexuality, and geographic location. Persistent social inequalities exist both between and within countries along the cancer continuum. They reflect the significance of social, economic, environmental, historical, and political contexts in determining who develops cancer, what type of cancer they develop, and whether they are able to survive or die from it.

The terminology in this field is somewhat contentious. The term inequity implies a judgement that differences are inherently unjust, such as the unequal distribution of cancer care services. This element of unfairness can be contentious and difficult to determine at times. These barriers — cultural, educational, financial, socio-economic, geographical and gender or age-related discrimination — potentially reduce a person’s chance of surviving cancer – and they must be addressed.

Why should we be concerned about social inequalities in cancer?

Social inequalities are very much evident at every step of the cancer continuum, starting from the individual’s exposure to risk factors, and the likelihood of developing cancer, to whether cancer-related data is collected and counted, through access to screening and cancer diagnostic facilities, and even to fundamental palliative care.

• For decades, social patterns of cancer incidence and mortality have been documented, with many cancers occurring more frequently among groups with lower socioeconomic status and other underserved populations. Cancers associated with chronic infections are significantly more prevalent in countries with a lower Human Development Index. India spends less than 2% of its GDP on healthcare. Out-of-pocket expenses continue to account for more than three-quarters of cancer expenditure in India. In countries where there’s a lack of universal health coverage or other adequate safeguards, a diagnosis of cancer can be financially catastrophic for individuals and their families due to unaffordable out-of-pocket payments.
• The most fundamental requirement for identifying and addressing inequalities in cancer is the ability to generate relevant information from a functional cancer registry. Despite some progress, many low- and middle-income countries still lack the capacity to generate even basic cancer intelligence.
• Indigenous populations, people living in poverty, and ethnic minority groups or other disadvantaged groups tend to experience different patterns of cancer incidence; poorer cancer survival rates are observed among such groups compared to more privileged people in both higher- and lower-income countries.
• Lack of access to healthcare workers and services remains one of the most serious impediments to cancer globally. Given the large number of cancer patients in India, the number of healthcare providers available to treat cancer is insufficient. There are only around 4000 oncologists for an entire 1.3 billion population. Most cancer treatment centres are overcrowded, and patients have to wait for long periods of time to get their treatment done. Approximately 70% of cancer patients live in rural areas with little to no cancer care facilities. Approximately 95% of cancer care centres are located in cities. The main logistical challenges that rural people face are commuting to urban areas, finding housing, and financial difficulties. Furthermore, cancer treatments necessitate a multi-pronged approach making traveling even more challenging.
• Despite its relative affordability, access to palliative care is a neglected aspect of global health, and many people with cancer, including children in low and middle-income countries and underserved people in some high-income countries, die without access to adequate symptomatic relief. Despite its importance in cancer care, India lags far behind in providing patients with palliative care. Many more professionals need to be trained in this area. With an ageing population and an increase in cancer cases, more palliative care centres need to be established. The fact that many of the world’s most vulnerable people do not have access to effective palliative care, can be seen as a “medical, public health, and moral failing, and a travesty of justice.”

What can be done to close the cancer care gap?

Social inequalities in cancer outcomes are not inevitable, but changing them will almost certainly necessitate coordinated action at many levels, both within and outside of the health sector, and at both local, regional, and global levels. Strategies and policies aimed at addressing root causes, such as unequal power and access to resources between groups, are likely to have an impact on population health in general and cancer outcomes in particular. Efforts should be made to improve cancer care access for the entire population in a uniform manner, regardless of geographical or socioeconomic barriers.

In many low-and-middle-income countries, a lack of universal health coverage is a barrier to both development and addressing inequalities in cancer outcomes. Progress toward the United Nations Sustainable Development Goal of universal health coverage will have an impact on cancer inequalities both between and within countries. Advancements made towards meeting the health-related United Nations Sustainable Development Goals of universal health coverage will have an effect on cancer inequalities both between and within countries. Talking about India, the country’s healthcare system needs to be revitalised, with a special emphasis on cancer care. To combat the rising death toll, it is critical to improve healthcare infrastructure at all levels and establish regional cancer centres. Aiming for preventive and early detection services is essential. Advanced treatment equipment and drugs should be made available to all at a reasonable cost. The key is a more cost-effective and efficient health-care network.