Emily Medhurst

Why addressing the social determinants of health is essential in cancer policy

3 February 2023

The number of people living with and dying from cancer is increasing globally. Social determinants of health are responsible for a large proportion of cancer cases, so addressing them is key to improving health equity.

Cancer is the second leading cause of death globally. There were 19.3 million new cancer diagnoses in 2020 and almost 10 million deaths. These numbers reflect increases of 26% and 21%, respectively, since 2010. Global cancer rates are predicted to keep rising as people are living longer. According to the World Health Organization (WHO), the most commonly diagnosed cancers are breast, lung, colorectal and prostate, while the cancers with the highest mortality rates are lung, colorectal, liver, stomach and breast.

What are social determinants of health?

Social determinants of health (sometimes abbreviated to SDoH) are non-medical factors that affect health outcomes. The WHO defines them as ‘the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life’. Social determinants include income, education, job security, food insecurity, housing, early childhood development, social inclusion, environmental factors, structural conflict and access to affordable healthcare.

Social determinants were previously considered distant or secondary influences on health, but research suggests that they account for 30–55% of the global burden of disease. They have a direct link to the spread of communicable diseases – for example, close and unsanitary living quarters allow the spread of diseases such as Ebola and hepatitis. Social determinants of health also have an effect on the rates of non-communicable chronic diseases such as cardiovascular disease, type 2 diabetes, stroke, cancer, heart disease and kidney disease.

Social determinants of health have an effect on the rates of non-communicable chronic diseases such as cardiovascular disease, type 2 diabetes, stroke, cancer, heart disease and kidney disease.

How do social determinants of health affect rates of cancer?

Multiple studies show a clear causal link between social determinants of health and cancer. Social determinants may contribute to up to 70% of cancer cases and significantly increase the risk of death. Research has also demonstrated that certain social determinants are directly related to reduced cancer survival rates. For example:

Education. The incidence of cancer is higher among people with a lower level of education than it is among more highly educated people. This may be because education promotes adherence to healthier lifestyle choices and/or because occupational exposure is more likely to affect people who have received less education.
Housing insecurity. Having unstable or inadequate housing arrangements increases the likelihood of poor health and reduced access to healthcare, which can result in delayed diagnosis and treatment of cancer.
Social inclusion. A lack of social connections has been linked to a lower quality of life among people with cancer, and an increased risk of tumour recurrence and mortality.

In addition, smoking, alcohol misuse and obesity – all of which disproportionally affect lower socioeconomic groups – are risk factors that contribute to higher rates of cancer. Cultural and social factors and a lack of access to healthy food can exacerbate these risk factors, many of which can be classified as social determinants because people cannot control them.

Overall, social determinants of health mean that people with a lower socioeconomic position have worse health outcomes and higher mortality rates from cancer than other groups. Addressing the many non-clinical factors that affect health outcomes is key to lessening the global burden of cancer.

Why addressing the social determinants of health is essential in cancer policy

Men in more deprived areas and certain other regions are more likely than men in more affluent areas to be diagnosed with prostate cancer at a late stage. In fact, the latest figures show that more than one in three men with prostate cancer is diagnosed at stage IV in Scotland, compared with just one in eight in London. Meanwhile, Black men face double the risk of prostate cancer compared with other men, and develop it at a younger age.

Marion Thorpe, Senior Policy Officer at Prostate Cancer UK

What can be done to improve outcomes?

Although the effects of social determinants of health can seem quite bleak, interventions can help mitigate them and improve disparities in cancer prognosis.

For example, improving access to nationwide population-based cancer screening programmes can reduce the impact of social determinants of health. This involves making the tests free, eliminating geographical barriers (e.g. covering the cost of travel for a participant), involving primary care physicians to a greater extent and tailoring communication to the individual. Across all cancer types, ‘innovative and bespoke’ approaches are needed to reach the most vulnerable and deprived people.

One initiative from the charity Prostate Cancer UK, which aims to raise awareness of the disease, uses accessible technology to encourage men to check their risk factors.

Our recent campaign saw 1 million men use our 30‑second online risk-checker, which resulted in 2,300 more men receiving a diagnosis in just a few months. We also offer support and education to clinicians and healthcare bodies across the country to help promote best practice. This sort of work is essential to make sure men can receive the care they need wherever they are in the UK.

Marion Thorpe, Senior Policy Officer at Prostate Cancer UK

Other interventions that can help mitigate social determinants of health include the direct provision of subsidised healthy food to alleviate food insecurity, the creation of affordable housing to reduce housing insecurity, the implementation of community-based healthcare to improve care access, and the provision of free transport for all medical services.

The WHO’s Commission on Social Determinants of Health has generated broad recommendations to tackle social determinants and their effects on health outcomes. These include the following:

Improve the conditions of daily life, bettering the circumstances in which people are born, grow, live, work and age.
Tackle the inequitable distribution of power, money and resources by strengthening government, having an accountable private sector and recognising the value of collective action.
Take steps to measure and understand the problem and assess the impact of action – for example, expanding the knowledge base, educating the workforce about social determinants of health and raising public awareness.

While individual interventions can help mitigate the impact of social determinants of health, these recommendations demonstrate that larger-scale systemic reform is needed to fully address the issue. The widening gap between the highest and lowest economic quartiles will only continue to exacerbate low cancer survivorship rates unless widespread action is taken to create more equitable societies.

Why addressing the social determinants of health is essential in cancer policy

The number of people living with and dying from cancer is increasing globally. Social determinants of health are responsible for a large proportion of cancer cases, so addressing them is key to improving health equity.

What are social determinants of health?

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How do social determinants of health affect rates of cancer?

What can be done to improve outcomes?

The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.