Isabella Lopez-Scott
There are many areas in healthcare in which spotting inequalities is obvious, for example, those who can afford private healthcare, dental services, and mental health treatments. However, in specific diseases such as cancer, the lines become more blurred, making it harder for us to identify areas in which socio-economic differences, as well as race and gender, play a part. Whilst these areas are hard to locate, it is crucial they are dealt with, and the system is changed to reduce these differences as rates of cancer diagnosis are only increasing. Policy-makers must implement changes that allow earlier interventions and address imbalances in treatment received and diagnoses.
Why the UK public has been failed:
There are many reasons for which there are increasing rates of cancer, including changes in the environment and an increase in fast food consumption. However, the leading cause is health inequalities, which are responsible for 33,000 cases of avoidable cancers every year. This is a damning figure and should act as a wake-up call for politicians to implement new policies that tackle health inequalities, as well as an in-depth review of leading factors for health inequalities. Unfortunately, these have been side-lined by our current government, with public health grants reduced by a fifth since 2015 and junk food advertising ban delayed until 2025.
The leading cancer in areas of deprivation is lung cancer, with individuals working blue-collar jobs being more likely to smoke than those in white-collar jobs. Obesity is also a leading risk factor for cancers, and those living in deprived areas are more likely to have diabetes and be obese. This is especially prevalent in children, with obesity prevalence being 33% for children living in deprived areas.
The Marmot Review was published in 2010 as an independent review to propose strategies to reduce health inequalities in the UK. It focussed on six policy objectives, including giving children the best start in life, fair employment, and a healthy standard of living for all. However, 14 years later, the results have not been good. There have been consistent failures from the current administration in Westminster to implement any of the recommendations made in the report. Since then, inequalities have only gotten worse, with funding cuts causing many local authorities to have reduced budgets for public health matters, such as anti-smoking campaigns. A starting point for tackling inequalities in the UK would simply be an increased and focussed budget.
How the EU is leading the way:
In February 2021, the European Commission set up the European Cancer Inequalities Registry as a part of their beating cancer plan. It aims to provide accurate and reliable data on cancer prevention and identify trends and inequalities between regions. It has gathered data on all countries within the European Union based on sex, age, income, and disability. This data has shown that cancer causes almost a quarter of all deaths in these countries, with five new cases diagnosed every minute in 2022. Many inequalities have become evident between countries thanks to this initiative. This is due to the difference in funding between countries’ health systems, how they are structured, and whether the healthcare system provides free services. For example, in Malta, Cyprus and Latvia, less than 1/3 of cancer treatments are reimbursed or covered compared to Germany, which includes coverage for all cancer medications.
The differences highlighted between countries are startling, with cancer mortality rates being consistently higher in Central and Eastern European countries. Why is this? It comes down to many factors, from underlying risk factors to variations in cancer detection. Policy recommendations by Boyle focus on adopting healthier lifestyles, with a particular focus on reducing smoking and alcohol consumption as well as more nutritional diets. This is because, particularly in Eastern Europe, the consumption rates of tobacco are concerningly high, with 28.2% of the population of Bulgaria consuming tobacco daily.
This registry also found that screening alone is insufficient to ensure early detection, although cancer screening is associated with better outcomes. In particular, breast cancer screening rates vary hugely between countries and can be concerningly low, as in 11 EU countries, less than half the women between ages 50-69 have had a mammogram in 2 years. The registry proposed many different policy options for the EU to implement to combat this, with its main focus being raising awareness of cancer and possible symptoms to encourage people to attend screenings.
In order for the UK to be able to reduce levels of inequalities in cancer specifically, a new strategy must be taken. One way of doing this could be to adopt a method similar to the European Union’s and start an initiative against cancer inequalities, complete with national surveys and public initiatives. However, whilst cancer inequality is troubling, it is only symptomatic of a broader problem within the UK that health care as a whole is unequal. There are many precursors to cancer, such as diabetes and smoking, that are vital to tackle and get under control before any other action against cancer can be taken. The issue with this is that our current government has shown great reluctance and disinterest in taking measures against healthcare inequality. Whilst policy recommendations have been made and papers campaigning for equality have been written, nothing will change unless our government changes.