To ‘Commit to Beat Cancer’, the Government must tackle inequalities

Cancer Research UK’s ‘Commit to Beat Cancer’ campaign calls on parliamentary candidates to pledge to keep cancer high on the political agenda. Over the last few weeks we’ve been exploring some of the issues behind these calls, looking at how Government could protect the UK’s research base and provide access to new treatments..

This week, Heather Walker, policy researcher at Cancer Research UK, explains why all parties should commit to tackle cancer inequalities.

“We need not accept the present size of the social gradient in health as fixed. If it can change, and we can understand why, action is possible to reduce it.”

– Professor Sir Michael Marmot

Early this year, the Marmot Report – a Government-sponsored review of how the health system treats different sectors of society – concluded that health inequalities are strongly linked to things like a person’s income and social background.  As the report found, a man living in the wealthiest part of London can expect to live to 88 years, while in one of the poorest parts of the capital, male life expectancy is just 71.

The issue is not a new one – the Black Report in 1980 said the same, and yet, thirty years on, inequalities persist. And tackling inequalities isn’t easy, as successive Governments have found. But that doesn’t mean we shouldn’t try.

There’s plenty of evidence that inequalities are a real problem throughout the cancer journey, from prevention right through to treatment, and ultimately, mortality and survival.

With regard to prevention, we know that smoking is more prevalent among more deprived groups and this means that these people are more likely to develop smoking-related diseases, such as cancer.

We know that there are inequalities in access to cancer treatments too. To take just one example, a 2007 study in the British Journal of Cancer found that older women are less likely to receive standard treatment for breast cancer than their younger counterparts.  Furthermore, this trend increased with age so that the oldest women fared least well.

And looking at survival, a 2004 review by the National Audit Office found that unskilled workers were twice as likely to die from cancer as professionals.

There are many other groups that experience a whole range of inequalities in cancer. And these can be complex. For example, you might be surprised to learn that people from the most affluent areas are more likely to develop skin cancer. Despite this, however, they have better survival rates than those from the more deprived areas.

Cancer Research UK believes that we should work together to end cancer inequalities. We want the next Government to ensure that everyone has the best chance to beat cancer, regardless of where they live, how well-off they are, their ethnicity, gender, language or indeed, any other factor.

Taking action

Talking about tackling inequalities is all very well, but how do we actually go about doing it? A lot of it comes down to shifting social norms and changing behaviour. This is not easy, but nor is it impossible. Take healthy eating, for example. The idea that we should be eating a balanced diet has worked its way into everyday conversations with help from figures such as Jamie Oliver and, even if people aren’t always doing it, at least they’re now aware that they should be.

We believe there are three key ways for the next Government to successfully address inequalities in cancer:

1) Understanding the issues

This might seem obvious, but it’s essential that we understand the issues before we can act to address their root causes. Making assumptions about the nature of inequalities without proper evidence can mean that we take inappropriate actions.

For example, men are not usually considered to be a ‘disadvantaged’ group. However, our research into men and cancer showed that men are 16 per cent more likely than women to be diagnosed with cancer and forty per cent more likely to die from it. This suggests that we should be developing health and treatment plans targeted at men.

Alongside gender, ethnicity also plays a role. Our report, Cancer Incidence and Survival by Major Ethnic Group shows that understanding the cancer inequalities faced by Black and Minority Ethnic (BME) groups isn’t easy. BME groups are, overall, at lower risk of developing cancer than the white population. However, the true picture is more complex – when we look at specific cancer types or ethnic groups, the risk starts to vary, for example with black men and prostate cancer.

Similarly, we know that there are considerable inequalities in access to treatments across the country, for example in the case of lung cancer care, where access to surgery varies across the UK.

But we need more research into the reasons behind such inequalities. Once we’ve got more evidence into why these discrepancies exist, we can try to address them.

That’s why we’re calling on the next Government to:

• Support the current review of data collection and make sure data is used effectively to deepen our understanding of inequalities.
• Commission more high quality research into cancer inequalities. Only with this information can we start to solve the problem.
• Ensure that patients have equal access to the best cancer treatments.

2) Getting the message right

Next, we need to tailor the tools we use to communicate with specific groups. There’s clearly little point giving a leaflet about breast screening written in English to a woman who only speaks Punjabi – but when the differences are more subtle it is easier to forget that one size does not fit all.

For example, these recent anti-smoking  TV ads showed images of how smoking could make you less attractive to the opposite sex. But this message is aimed at a heterosexual audience, and is unlikely to strike as strong a chord with people who are lesbian or gay. This is unfortunate, as smoking levels among these groups are estimated to be higher than in the general population.

It’s not enough to just throw money at a problem and we know the importance of tailoring messages based on the evidence from high quality research. This is why we are calling on the Government to:

• Help local providers to tailor their services; and
• Support the local NHS to deliver high quality awareness campaigns for diverse groups, ensuring patient information is provided according to social and cultural needs.

3) Finding out what works

Finally, it’s vital that we properly measure whether projects are actually effective in changing people’s behaviour. This will teach us what works and what doesn’t, and help make future projects even better.

It’s also important to remember that social norms don’t change overnight – helping people to change their behaviour for the better takes time. So evaluation should be planned over a long time period and projects shouldn’t be abandoned before they’ve had a chance to prove their worth.

Email your candidates today

We can’t act alone to beat cancer. Tackling inequalities requires Government commitment and funding to give everyone the best opportunity to beat cancer and make our cancer outcomes among the best in Europe.

That’s why we’re asking you to help us get parliamentary candidates to Commit to Beat Cancer and ensure that all political parties are dedicated to tackling cancer inequalities.

Heather

More on this blog:

• Emma Greenwood on Protect
• Hilary Tovey on Provide
• Helen Haggart on Prevent