Cancer Causes & Control

, Volume 16, Issue 1, pp 5–14 | Cite as

Defining and investigating social disparities in cancer: critical issues

Article

Abstract

Research and action to address social disparities in cancer requires clarity about what constitutes and causes these persistent and onerous inequities in health. Currently, both scientific literature and government documents exhibit important disagreements, confused terminology, and considerable, if not deliberate, vagueness about the meaning of the phrase ‘cancer disparities’ and the related term ‘social disparities in health.’ This article accordingly reviews critical issues relevant to cohering understanding of what is meant by ‘cancer disparities;’ offers a definition premised on the causal contention that social disparities in health, by definition, arise from social inequity; and considers its implications for developing a multidisciplinary research agenda on social inequalities in cancer. Tackling this issue will require rigorous and critical frameworks, questions, and methods derived from multiple disciplines, and will necessarily involve epidemiologic, clinical, and intervention research, both quantitative and qualitative. At issue is making conscious research choices: about which types of disparities we study, in relation to which aspect of cancer, so as to improve the likelihood our research will help inform a society-wide discourse about the extent, origins of, and remedies for social injustices in cancer, thereby aiding efforts to eliminate social inequalities in health.

Keywords

cancer gender health disparity race/ethnicity socioeconomic social inequalities in health 

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References

  1. Kogevinas M, Pearce N, Susser M, Boffetta P (1997) Social inequalities and cancer: a summary by the editors. In: Kogevinas M, Pearce N, Susser M, Boffetta P, eds.Social Inequalities and Cancer. Lyon: International Agency for Research on Cancer (IARC Scientific Publications No. 138), pp. 1–15.Google Scholar
  2. Trans-HHS Cancer Health Disparities Progress Review Group (2004) Making Cancer Health Disparities History. Submitted to the Secretary, U.S. Department of Health and Human Services, March 2004. Washington, DC: US Department of Health and Human Services.Google Scholar
  3. Freeman, HP 2004Poverty, culture, and social injustice: determinants of cancer disparitiesCA Cancer J Clin547277PubMedGoogle Scholar
  4. Ward, E, Jemal, A, Cokkinides, V,  et al. 2004Cancer disparities by race/ethnicity and socioeconomic statusCA Cancer J Clin547893PubMedGoogle Scholar
  5. Sing GK, Miller BA, Hankey BF, Edwards BK (2003) Area Socioeconomic Variations in US Cancer Incidence, Mortality, Stage, Treatment, and Survival, 1975–1999. Bethesda, MD: National Cancer Institute, 2003, NCI Cancer Surveillance Monograph Series, Number 4, NIH Pub. No. 03-5417.Google Scholar
  6. Krieger, N, Chen, JT, Waterman, PD, Soobader, MJ, Subramanian, SV, Carson, R 2002Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matterThe Public Health Disparities Geocoding Project. Am J Epidemiol156471482Google Scholar
  7. Krieger, N 2001Theories for social epidemiology in the 21st century: an ecosocial perspectiveInt J Epidemiol30668677PubMedGoogle Scholar
  8. Porter, D 1999Health, Civilization and the State: A History of Public Health from Ancient to Modern TimesRoutledgeLondonGoogle Scholar
  9. Patterson, JT 1987The Dread Disease: Cancer and Modern American CultureHarvard University PressCambridge, MAGoogle Scholar
  10. Whitehead M (1990) The Concepts and Principles of Equity and Health. Copenhagen, WHO Regional Office for Europe (document EUR/ICP/RDP/414). Accessed on January 4, 2004 at: http://www.who.dk/Document/PAE/conceptsrpd414.pdf.Google Scholar
  11. Evans, T, Whitehead, M, Diderichsen, F, Bhuiya, A, Wirth, M 2001

    ‘Introduction’

    Evans, TWhitehead, MDiderichsen, FBhuiya, AWirth, M eds. Challenging Inequities in Health: From Ethics to Action. Oxford University Press Oxford111
    Google Scholar
  12. Carter-Pokras, O, Bacquet, C 2002What is a ‘Health Disparity’Public Health Rep117426434PubMedGoogle Scholar
  13. Braveman, P, Gruskin, S 2003Poverty, equity, human rights and healthBull World Health Organ81539545PubMedGoogle Scholar
  14. Davey Smith, G 2003Health Inequalities: Lifecourse ApproachesPolicy PressBristol, UKGoogle Scholar
  15. Drever, F, Whitehead, M 1997Health Inequalities: Decennial Supplement Series DS No.15.The Stationary Office LondonGoogle Scholar
  16. World Health Organization. The World Health Report 2000: The World Health Report 2000 Health Systems: Improving Performance Geneva: World Health Organization. Accessed on January 4, 2004 at: http://www.who.int/whr2001/2001/archives/2000/en/index.htm. Google Scholar
  17. Gakidou, EE, Murray, CJL, Frenk, J 2000Defining and measuring health inequalityBull World Health Organ784254PubMedGoogle Scholar
  18. Braveman, P, Krieger, N, Lynch, J 2000Health inequalities and social inequalities in healthBull World Health Organ78232234PubMedGoogle Scholar
  19. Variations Sub-Group of the Chief Medical Officer’s Health of the Nation Working Group (1995) Variations in Health: What Can the Department of Health and the NHS Do? London: The Department of Health. Google Scholar
  20. Agency for Healthcare Research and Quality (2003). National Healthcare Disparities Report. Prepublication Copy. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality, December. Accessed on January 6, 2004 at: http://www.qualitytools.ahrq.gov/disparitiesreport/downloadreport.aspx.Google Scholar
  21. Almeida, C, Braveman, P, Gold, M,  et al. 2001Methodological concerns and recommendations on policy consequences of the World Health Report 2000Lancet35716921697PubMedGoogle Scholar
  22. Braveman, P, Starfield, B, Geiger, HJ 2001World Health Report 2000: how it removes equity from the agenda for public health monitoring and policyBr Med J323678681Google Scholar
  23. Murray, CJL 2001Commentary: comprehensive approaches are needed for full understandingBr Med J323680681Google Scholar
  24. Pear R (2004) Taking spin out of report that made bad into good health. New York Times, February 21.Google Scholar
  25. Bloche, MG 2004Health care disparities–science, politics, and raceN Engl J Med35015681570PubMedGoogle Scholar
  26. Steinbrook, R 2004Disparities in health care–from politics to policyN Engl J Med35014861488PubMedGoogle Scholar
  27. World Health Organization. The World Health Report 2003: Shaping the Future. Geneva: World Health Organization. Accessed January 4, 2004 at: http://www.who.int/whr/2003/en/overviewen.pdf.Google Scholar
  28. Acheson, D, Barker, D, Chambers, J, Graham, H, Marmot, M, Whitehead, M 1998Independent Inquiry into Inequalities in HealthThe Stationary OfficeLondonGoogle Scholar
  29. Agency for Healthcare Research and Quality (2004). National Healthcare Disparities Report. July 2003 (original report, released in February 2004 to replace the edited version released in December 2003). Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality, December. Accessed on March 3, 2004 at: http://www.qualitytools.ahrq.gov/disparitiesreport/.Google Scholar
  30. National Institutes of Health. What are Health Disparities. Accessed on January 5, 2004 at: http://healthdisparities.nih.gov/whatare.html.Google Scholar
  31. National Center on Minority Health and Health Disparities (NCMDH), National Institutes of Health. About NCMHD: Mission, Vision. Accessed on January 5, 2004 at: http://www.ncmhd.nih.gov/aboutncmhd/mission.asp.Google Scholar
  32. U.S. Department of Health and Human Services (2000). Healthy People 2010: Understanding and Improving Health. 2nd edn. Washington, DC: U.S. Government Printing Office, November. Accessed January 5, 2004 at: http://www.healthypeople.gov/Document/html/uih/uih_2.htm#goals.Google Scholar
  33. National Cancer Institute (NCI) Cancer Control and Population Sciences, National Institutes of Health. Overview of Health Disparities Research: Health Disparities Definition. Accessed on January 5, 2004 at: http://cancercontrol.cancer.gov/od/hd-overview.html. Google Scholar
  34. Krieger, N 1994Epidemiology and the web of causation: has anyone see the spiderSoc Sci Med39887903PubMedGoogle Scholar
  35. Krieger, N 2004

    Researching critical questions on social justice and public health: an ecosocial perspective.

    Levy,  BSSidel, VW eds. Social Injustice and Public HealthOxford University PressNew York
    Google Scholar
  36. Kluger R (1996) Ashes To Ashes: America’s Hundred-Year Cigarette War, The Public Health, and The Unabashed Triumph Of Philip Morris. New York: Alfred A. Knopf.Google Scholar
  37. Barbeau, E, Krieger, N, Soobader, M-J 2004Working class matters: socioeconomic deprivation, race/ethnicity, gender and smoking in NHIS 2000Am J Public Health94269278PubMedGoogle Scholar
  38. Washington, HA 2002Burning love: big tobacco takes aim at LGBT youthsAm J Public Health9210861095PubMedGoogle Scholar
  39. Ladrine, H, Klonoff, EA 2000Racial discrimination and cigarette smoking among blacks: findings from two studiesEthnicity & Disease10195202Google Scholar
  40. Krieger, N 2001A glossary for social epidemiologyJ Epidemiol Commun-Health55693700Google Scholar
  41. Krieger, N 2000

    Discrimination and health

    Berkman, LKawachi,  I eds. Social EpidemiologyOxford University PressOxford 3675
    Google Scholar
  42. Krieger, N 2000Counting accountably: public health implications of new approaches to classifying race/ethnicity in the United States 2000 census—US and global perspectivesAm J Public Health9016871689CrossRefPubMedGoogle Scholar
  43. Mays, VM, Ponce, NA, Washington, DL, Cochran, SD 2003Classification of race and ethnicity: implications for public healthAnnu Rev Public Health2483110PubMedGoogle Scholar
  44. Kington, RS, Nickens, HW 2001

    Racial and ethnic differences in health: recent trends current patterns future directions

    Smelser, NJWilson, WJMitchell, F eds. America Becoming: Racial Trends and Their Consequences Vol 2National Research Council, National Academy PressWashington, DC253310
    Google Scholar
  45. Williams, DR 1996Race/ethnicity and socioeconomic status: measurement and methodological issuesInt J Health Serv26483505PubMedGoogle Scholar
  46. Krieger, N, Williams, D, Moss, N 1997Measuring social class in US public health research: concepts, methodologies and guidelinesAnnu Rev Public Health18341378PubMedGoogle Scholar
  47. Lynch, J, Kaplan, G 2000

    Socioeconomic position

    Berkman, LKawachi,  I eds. Social EpidemiologyOxford University PressOxford1335
    Google Scholar
  48. Berkman, LF, Macintyre, S 1997The measurement of social class in health studies: old measures and new formulationsIARC Sci Publ1385164PubMedGoogle Scholar
  49. Krieger, N 2003Genders, sexes, and health: what are the connections—and why does it matterInt J Epidemiol32652657CrossRefPubMedGoogle Scholar
  50. Doyal, L 2001Sex, gender, and health: the need for a new approachBr Med J32310611063Google Scholar
  51. Meyer, IH 2001Why lesbian, gay, bisexual, and transgender public healthAm J Public Health91856859PubMedGoogle Scholar
  52. Parker, RG, Gagnon, JH 1995Conceiving Sexuality: Approaches to Sex Research in a Post-Modern WorldRoutledgeNew YorkGoogle Scholar
  53. Lollar, DJ, Crews, JE 2003Redefining the role of public health in disabilityAnnu Rev Public Health24195208PubMedGoogle Scholar
  54. Zola, IK 1993Self, identity and the naming question: reflections on the language of disabilitySoc Sci Med36167173PubMedGoogle Scholar
  55. Anand, S, Diderichsen, F, Evans, T, Shkolnikov, VM, Wirth, M 2001

    Measuring disparities in health: methods and indicators

    Evans, TWhitehead, MDiderichsen, FBhuyia, A Wirth, M eds. Challenging Inequities in Health: From Ethics to ActionOxford University PressOxford4967
    Google Scholar
  56. Fiscella, K, Franks, P, Gold, M, Clancy, C 2000Inequalities in quality: addressing socioeconomic, racial and ethnic disparities in health careJAMA28325792584PubMedGoogle Scholar
  57. Wagstaff, A, Paci, P, van Doorslaer, E 1993On the measurement of inequalities in healthSoc Sci Med33545557Google Scholar
  58. Krieger, N 2004

    Ecosocial theory

    Anderson, N eds. Encyclopedia of Health and BehaviorSageThousand Oaks, CA292294
    Google Scholar
  59. Friedman DJ, Hunter EL, Parrish RG (2002) Shaping A Vision of Health Statistics for the 21st Century. Washington, DC: Department of Health and Human Services Data Council, Centers for Disease Control and Prevention, National Center for Health Statistics, and National Committee on Vital and Health Statistics.Google Scholar
  60. Regional Network for Equity in Health in Southern Africa (EQUINET), Equinet Steering Committee. Equinet Policy Series 2. Equity in Health in Southern Africa: Overview and Issues from annotated bibliography. 1998. Accessed on January 4, 2004 at: http://www.equinetafrica.org/Resources/downloads/eqser2.pdf.Google Scholar
  61. Group, United States Cancer Statistics Working 2002United States Cancer Statistics: 1999 Incidence. Department of Health and Human ServicesAtlantaGA: Centers for Disease Control and Prevention and National Cancer InstituteGoogle Scholar
  62. Krieger, N, Chen, JT, Waterman, PD, Rehkopf, DH, Subramanian, SV 2003Race/ethnicity, gender, and monitoring socioeconomic gradients in health: a comparison of area-based socioeconomic measures—the Public Health Disparities Geocoding ProjectAm J Public Health9316551671PubMedGoogle Scholar
  63. Krieger, N, Waterman, P, Chen, JT, Soobader, M-J, Subramanian, SV, Carson, R 2002ZIP Code caveat: bias due to spatiotemporal mismatches between ZIP Codes and US census-defined areas —the Public Health Disparities Geocoding ProjectAm J Public Health9211001102PubMedCrossRefGoogle Scholar
  64. Krieger N, Chen JT, Waterman PD, Rehkopf DH, Subramanian SV (in press) Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: the Public Health Disparities Geocoding Project. Am J Public Health.Google Scholar
  65. Bigby J, Holmes M. Disparities across the breast cancer continuum. Cancer Causes Control 16: 35–44.Google Scholar
  66. Gilligan T. Social disparities and prostate cancer: Mapping the gaps in our knowledge. Cancer Causes Control 16: 45–53.Google Scholar
  67. Palmer RC, Schneider ES. Social disparities across the continuum of colorectal cancer: a systematic review. Cancer Causes Control 16: 55–61.Google Scholar
  68. Newmann S, Garner E. Social Inequities along the cervical cancer continuum: A structured review. Cancer Causes Control (submitted).Google Scholar
  69. Kuh, D, Ben-Shlomo, Y 1997A Lifecourse Approach to Chronic Disease Epidemiology: Tracing the Origins of Ill-Health from Early to Adult LifeOxford University PressOxfordGoogle Scholar
  70. Cruickshank, JK, Mbanya, JC, Wilks, R, Balkau, B, McFarlane-Anderson, N, Forrester, T 2001Sick genes, sick individuals or sick populations with chronic disease. The emergence of diabetes and high blood pressure in African-origin populationsInt J Epidemiol30111117PubMedGoogle Scholar
  71. Krieger, N, Davey Smith, G 2004Bodies count & body counts: social epidemiology & embodying inequality.Epidemiol Rev.2692103PubMedGoogle Scholar
  72. Krieger, N, Northridge, M, Gruskin, S,  et al. 2003Assessing health impact assessment: multidisciplinary & international perspectivesJ Epidemiol Community Health57659662PubMedGoogle Scholar
  73. World Health Organization. Health Impact Assessment Glossary. Accessed on January 4, 2004 at: http://www.who.int/hia/about/glos/en/index1.html.Google Scholar
  74. Morgan, RK 2003Health impact assessment: the wider contextBull World Health Organ81390PubMedGoogle Scholar
  75. Krieger, N 2003Does racism harm health? did child abuse exist before 1962?—on explicit questions, critical science, and current controversies: an ecosocial perspective.Am J Public Health 93194199PubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  1. 1.Department of Society, Human Development, and HealthHarvard School of Public HealthBostonUSA

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