Inequity- Key Issues In Cancer Care
What do we mean by “inequity”?
In healthcare, inequality refers to the uneven distribution of resources. By contrast, inequity means unjust, avoidable differences in care or outcomes.
The difference may seem subtle, but closing the cancer care gap isn’t really about simply providing everyone with equal resources. One size doesn’t fit all, and every challenge demands a different solution. Equity is about giving everyone what they need to bring them up to the same level.
What does an equitable world look like?
We will achieve health equity when every person has the opportunity to reach his or her full health potential without barriers or limitations created by social position or other socially determined circumstances.
Inside equity gap: there are 6 barriers that stand in the way of cancer care
Where you live. Who you are. Where you come from. What you do. Who you love. These are called the social determinants of health, and they represent the many factors that can unfairly stand between you and cancer prevention, diagnosis and treatment.
1. Gender norms and discrimination
Around the world, women and girls suffer from discrimination as a result of misogyny, stereotypes and expected gender roles. Certain cultural and religious contexts may further limit access to timely cancer care. Stigma and ostracisation surrounding cervical and breast cancers can make women reluctant to seek cancer screening. In some parts of the world, a woman may need tacit approval or explicit permission from the male head of household to visit a doctor.
Men also face the negative effects of gender discrimination and societal and cultural taboos. Social norms surrounding masculinity may make them less willing to discuss health concerns and consider certain life-saving procedures, such as surgery for early-stage prostate cancer, out of concern for the possible side effects, which can include incontinence or impotence.
2. Barriers for minority populations
Racism has a profound effect on a person’s ability to access cancer care and minority populations often face serious barriers in accessing their countries’ basic health services.
For example, indigenous people living in over 90 countries represent 6% of the world population but account for 15% of the extreme poor. Indigenous people face worse health and poorer outcomes. These factors, combined with systemic discrimination, human rights abuses, language and cultural differences and many other factors, are worsened by a higher exposure to poor nutrition, substance abuse and other behaviours that constitute high-risk factors for cancer.
3. Poverty and socioeconomic status
Poverty seriously limits access to quality cancer care. In high- and lower-income countries alike, lower socioeconomic status means less access. Countless obstacles tied to one’s financial means include transport to hospital from remote locations, inability to take time off work or find childcare to accommodate screening or treatment and a lack of health insurance or other financial means to manage the high monetary cost of care.
Regardless of where you live, if you are diagnosed with advanced cancer and are a low-income patient, have primary education only or lack health insurance, you are more likely to experience financial catastrophe or die within 12 months of a cancer diagnosis.
4. The rural-urban divide
People living in rural areas face many obstacles standing between them and their chances of surviving cancer. A lack of prevention, screening and treatment services likely means travelling long distances to access the necessary resources. The financial burden of this travel, alongside the need to secure childcare and time off work, can be insurmountable.
As a result, where you live too often determines if you live. Rural patients are frequently diagnosed at later stages and are less likely to receive appropriate treatment, receive follow-up or supportive services or be included in clinical trials that may represent their best chance at survival. These challenges can lead to interrupted treatment, and these barriers are compounded by the significant overlap between rural and indigenous, lower-income and older populations.
5. Age discrimination
How old you are shouldn’t decide the quality of cancer care you receive, yet this is the reality for many. Cancer can develop at any age, but the risk of that happening rises dramatically with age. In fact, more than half of people who have cancer are 65 or older. Because early cancer symptoms can be mistaken for everyday pain or minor illnesses associated with old age, many cancers in older patients are diagnosed later. This is exacerbated by a lack of programmes and services designed to respond to the needs of older adults. Also, while more older people are diagnosed with cancer than younger people, older patients are vastly underrepresented in the research that sets the standards for cancer treatments. Ageism that pervades cultures and institutions is one major contributing factor to these imbalances.
Cancer and Ageing
- A high proportion of older women with a particular form of breast cancer receive less chemotherapy than their younger counterparts – despite evidence of the treatment’s efficacy.
- More than 70% of deaths caused by prostate cancer occur in men aged over 75, who usually have more aggressive disease. Few older patients, however, receive treatment for localised prostate cancer, and in most cases they are denied access to chemotherapy for advanced disease.
- Colorectal cancer is another disease disproportionately affecting older people, yet the evidence suggests that optimal treatment is not being provided to older patients.
6. Refugee status and forced displacement
In countries facing political, financial and social instability – from war, social upheaval or natural disaster – cancer organisations must deal with harrowing shortages of resources or even a complete breakdown in basic health services. The majority of people with advanced stage cancer in war-affected areas, for instance, are simply unable to get appropriate care, as regions become inaccessible, hospitals and health centres are damaged or destroyed and health workers are injured, killed or displaced.
Beyond this, cancer patients in conflict and post-conflict areas, as well as refugees fleeing these regions, experience a unique set of obstacles, including emotional or physical trauma, limited financial resources and language or cultural barriers that can dramatically impact access to effective cancer care.
Understanding inequity is the first step
Inequity is everywhere. These seven factors represent just a few of the ways that people all over the world, from all walks of life, are deprived of cancer care. The truth is that no list could be exhaustive – there are countless unjust barriers to accessing quality cancer care, and many of these prejudices are deeply ingrained in our cultures and healthcare systems.
Note that obstacles are made to be overcome and there is hope. The first step is recognising inequity when we see it. Only then can we begin to challenge our own assumptions and biases, listen to the perspectives of people living with cancer and fight to close these gaps once and for all.
Can we create a future without cancer? *The time to act is now*
READ: Why Cancer?