Abstract

This volume summarizes the current scientific evidence and identifies research priorities needed to decrease social inequalities in cancer. The publication, based on the expert knowledge of more than 70 international scientists from multiple disciplines, undertakes a populations-within-populations approach, highlighting the large variations in cancer incidence, survival, and mortality that exist between countries and, within countries, between social groups. Several factors may lead individuals with low social status to adopt unhealthy behaviors, to be exposed to a wider range and a higher intensity of cancer risk factors, and to have reduced access to health-care services, compared with their fellow citizens. A special focus is given to how the phenomenon of inequalities in cancer evolves and is reshaped over time, driven by economic, social, political, legislative, and technological forces; it affects everyone, but the most disadvantaged individuals are particularly hard hit. This IARC Scientific Publication was developed to serve as a reference for policy-makers and public health officials, linking to specific examples of interventions that may reduce future inequalities in cancer.

Contents

• Library Cataloguing Information
• IARC Library Cataloguing in Publication Data
• Foreword
• Preface
• Contributors
• Acknowledgements
• Abbreviations
• Chapter 1. Social inequalities and cancer: the imperative to act
  Christopher P. Wild.
  • Cancer, a disease of difference
  • Cancer differences reflect social inequalities
  • Detailing the nature of social inequalities and cancer
  • The role and commitment of IARC as the cancer agency of the World Health Organization
  • References
• Chapter 2. Social inequalities, global public health, and cancer
  Michael Marmot.
  • Introduction
  • Health inequalities: the gradient
  • Cancer and health inequalities
  • Cancer inequalities: the causes
  • Cancer inequalities: what can be done?
  • References
• Part 1. Evidence of social inequalities in cancer
  • Introduction to Part 1
    Freddie Bray and Ahmedin Jemal.
    • Reference
  • Chapter 3. Why social inequalities matter in the cancer continuum
    Diana Sarfati.
    • What do we mean by social inequality in the cancer continuum?
    • Why should we care about social inequalities in cancer?
    • Conclusions
    • References
  • Focus 1. Changing social inequalities in cancer mortality: the value of linking census and health data
    Andrea Teng, Tony Blakely, and Diana Sarfati.
    • References
  • Chapter 4. Measuring socioeconomic status and inequalities
    David I. Conway, Alex D. McMahon, Denise Brown, and Alastair H. Leyland.
    • Introduction
    • Indicators of SES
    • Sociodemographic factors
    • The future of SES measurement
    • Analysis approaches
    • Metrics of health inequalities
    • Conclusions
    • References
  • Focus 2. Incorporating indicators of socioeconomic status or ethnicity in cancer registries
    Esther de Vries and Freddie Bray.
  • Chapter 5. Social inequalities in cancer between countries
    Miranda M. Fidler, Salvatore Vaccarella, and Freddie Bray.
    • Introduction
    • The Human Development Index
    • Cancer burden and profile by HDI category in 2012
    • Evidence of cancer transitions linked to HDI
    • Inequalities in cancer between countries with different HDI levels
    • Evidence of regional diversity
    • Conclusions
    • References
  • Focus 3. Cancer survival in countries in transition, with a focus on selected Asian countries
    Rajaraman Swaminathan.
    • Introduction
    • Between- and within-country relative survival rates from population-based cancer registries
    • Overall survival rates from hospital-based cancer registries in India
    • Within-state and residence area type comparisons of overall survival rates in India
    • Comparison of cancer survival across different settings, with a focus on Asia and Africa
    • Conclusions
    • References
  • Focus 4. Social inequality in cancer: perspectives from Africa
    Lynette Denny.
    • References
  • Chapter 6. Social inequalities in cancer within countries
    Salvatore Vaccarella, Esther De Vries, Mónica S. Sierra, David I. Conway, and Johan P. Mackenbach.
    • Introduction
    • Cancer mortality data in European populations
    • Evidence of social inequalities in cancer within HICs
    • Evidence of social inequalities in cancer within LMICs
    • Discussion
    • Conclusions
    • References
  • Focus 5. Social inequalities and cancer in Indigenous populations
    Gail Garvey and Joan Cunningham.
    • Conclusions
    • References
  • Focus 6. Inequality and cancer: the conflict ecosystem and refugees
    Richard Sullivan, Omar Shamieh, Tezer Kutluk, Adel Daoud, and Adam P. Coutts.
    • The changing nature of global conflict and its impact on demographically transitioned societies
    • The conflict ecosystem and inequalities
    • Addressing inequalities experienced by refugees or those affected by conflicts
    • References
  • Focus 7. Social inequalities in cancer burden between Black and White populations in the USA
    Ahmedin Jemal and Rebecca Siegel.
    • References
  • Chapter 7. Social inequalities in cancer risk factors and health-care access
    Lynette Denny, Ahmedin Jemal, Mary Schubauer-Berigan, Farhad Islami, Nadia Vilahur, Miranda Fidler, Diana Sarfati, Isabelle Soerjomataram, Catherine de Martel, and Salvatore Vaccarella.
    • Introduction
    • Lifestyle factors
    • Occupational exposures
    • Environmental exposures
    • Infections
    • H. pylori infection
    • Early diagnosis and screening
    • Treatment
    • Palliative care
    • References
• Part 2. Mechanisms and context underlying social inequalities in cancer
  • Introduction to Part 2
    Nancy Krieger.
    • References
  • Chapter 8. Theoretical frameworks and cancer inequities
    Nancy Krieger.
    • Introduction
    • The problematic dominant disregard for explicit theories of disease distribution and conceptualizing the societal causes of health inequities
    • Epidemiological theories of disease distribution for analysing health inequities
    • Cancer inequities: why theories of disease distribution matter
    • Conclusions
    • References
  • Chapter 9. Recent trends in income inequality
    Joe Hasell, Salvatore Morelli, and Max Roser.
    • Introduction
    • Global income inequality
    • Within-country income inequality
    • Using economic inequality data in health inequalities research
    • Conclusions
    • References
  • Chapter 10. The role of health systems in addressing inequalities in access to cancer control
    Filip Meheus, Rifat Atun, and André Ilbawi.
    • Introduction
    • Health systems and cancer control
    • Impact of health system performance on cancer outcomes
    • Which health system strategies promote equality in cancer care? An overview of key policy issues
    • Conclusions
    • References
  • Chapter 11. The economics and control of tobacco, alcohol, food products, and sugar-sweetened beverages
    Evan Blecher and Melanie Bertram.
    • Introduction
    • Between- and within-country variations in use
    • Affordability
    • Price elasticity of demand
    • Tax structure
    • Distributional consequences and use of revenues
    • Different tobacco and non-tobacco products
    • Cost–effectiveness of different interventions
    • Conclusions
    • References
  • Example 1. Tobacco-related cancers and taxation of tobacco in low- and middle-income countries
    Prabhat Jha, Hellen Gelband, Hyacinth Irving, and Sujata Mishra.
    • Introduction
    • Relationship between smoking and social inequalities, and trends over time
    • Effects on social inequalities in LMICs from increases in tobacco taxes
    • Conclusions
    • References
  • Chapter 12. The role of law in reducing global cancer inequalities
    Jonathan Liberman.
    • Introduction
    • Law in cancer prevention and control
    • A matter of human rights
    • Impacts of non-health areas of law and governance
    • The assertion of rights to health care
    • Litigation by corporate actors against public health regulation
    • Collaboration in research and the use of evidence in the development and implementation of laws
    • Conclusions
    • References
  • Chapter 13. Life-course approach: from socioeconomic determinants to biological embodiment
    Michelle Kelly-Irving and Paolo Vineis.
    • Introduction
    • Construction of health inequalities from early life
    • SEP as a risk factor for noncommunicable diseases in adults
    • Social and biological mechanisms: pathways towards health inequalities
    • Translating research findings for policy action
    • Conclusions
    • References
• Part 3. Tackling social inequalities in cancer
  • Introduction to Part 3
    Lynette Denny and Christopher P. Wild.
    • References
  • Chapter 14. Assessing the impact of a public health intervention to reduce social inequalities in cancer
    Gwenn Menvielle, Ivana Kulhánová, and Johan P. Mackenbach.
    • Introduction
    • What inequalities do we aim to reduce?
    • Target of the intervention
    • Conclusions
    • References
  • Chapter 15. Research priorities for social inequalities in cancer in sub-Saharan Africa
    Valerie McCormack and Robert Newton.
    • Introduction
    • Cancer in sub-Saharan Africa
    • Research on social inequalities in the occurrence of cancer
    • Social inequalities and primary prevention research
    • The journey to diagnosis and cancer care
    • References
  • Focus 8. Social inequalities in cancer in Asia
    Rengaswamy Sankaranarayanan.
    • References
  • Chapter 16. Low-cost approaches to reducing social inequalities in cancer in low- and middle-income countries and disadvantaged populations
    Rengaswamy Sankaranarayanan.
    • Introduction
    • Eliminating cervical cancer
    • Reducing breast cancer disparities
    • Reducing oral cancer inequalities and improving outcomes
    • Reducing colorectal cancer inequalities and improving outcomes
    • Other low-cost approaches to reduce cancer disparities
    • Conclusions
    • References
  • Example 2. HPV vaccination and screening for cervical cancer
    Partha Basu.
    • Introduction
    • Social inequality and cervical cancer burden
    • Access to cervical cancer screening
    • Access to HPV vaccination
    • Conclusions
    • References
  • Focus 9. Social inequalities in cancer in Latin America
    Raúl Murillo.
    • Introduction
    • Cancer inequalities
    • The roots of cancer inequalities
    • Avenues to reduce cancer inequalities
    • References
  • Chapter 17. Sharing lessons learned from the AIDS response to address social inequalities in cancer
    Michel Sidibé.
    • Introduction
    • Lesson 1: People as rights-holders
    • Lesson 2: Civil society as a partner
    • Lesson 3: Multisectoral approach
    • Lesson 4: Data-driven accountability
    • Lesson 5: Political leadership
    • Lesson 6: Advocacy and campaigning
    • Lesson 7: Community-driven solutions
    • Lesson 8: Science for people
    • Lesson 9: Integration
    • Lesson 10: Partnerships
    • Conclusions
    • References
  • Chapter 18. Technology and cancer systems: creating better policy to enhance equality
    Richard Sullivan and Ajay Aggarwal.
    • A tsunami of technology
    • Technology: a cure for and a cause of inequality
    • Policy interventions to manage technologies
    • Conclusions
    • References
  • Chapter 19. The inverse care law: overutilization of health services and overdiagnosis
    Salvatore Vaccarella and Louise Davies.
    • Introduction
    • References
• Conclusions.
  • Reducing Social Inequalities in Cancer: Setting Priorities for Research
    Salvatore Vaccarella, Joannie Lortet-Tieulent, Rodolfo Saracci, Miranda M. Fidler, David I. Conway, Nadia Vilahur, Diana Sarfati, Ahmedin Jemal, Johan P. Mackenbach, Michael G. Marmot, Kurt Straif, and Christopher P. Wild.
    • First Priority: Generating Knowledge and Monitoring Progress
    • Second Priority: Expanding Research Focused on Prevention
    • Third Priority: Focus on Equality When Implementing and Assessing Cancer Control Measures
    • A Commitment
    • References
• Disclosures of interests