Health Equity in National Cancer Control Plans: An Analysis of the Ontario Cancer Plan

Document Type: Original Article

Author

1 School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada

2 MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

Abstract

Background
National cancer control plans (NCCPs) are important documents that guide strategic priorities in cancer care and plan for the appropriate allocation of resources based on the social, geographic and economic needs of a population. Despite the emphasis on health equity by the World Health Organization (WHO), few NCCPs have a focus on health equity. The Ontario Cancer Plan (OCP) IV, (2015 to 2019) is an example of an NCCP with clearly defined health equity goals and objectives.

 
Methods
This paper presents a directed-content analysis of the OCP IV health equity goals and objectives, in light of the synergies of oppression analytical framework.

 
Results
The OCP IV confines equity to an issue of access-to-care. As a result, it calls for training, funding, and social support services to increase accessibility for high-risk population groups. However, equity has a broader definition. And as such, it also implies that systematic differences in health outcomes between social groups should be minimal. This is particularly significant given that socially disadvantaged cancer patients in Ontario have distinctly poorer cancer-related health outcomes.

 
Conclusion
Health systems are seeking ways to reduce the health equity gap. However, to reduce health inequities which are socially-based will require a recognition of the living and working conditions of patients which influence risk, mortality and survival. NCCPs represent a way to politically advocate for the determinants of health which profoundly influence cancer risk, outcomes and mortality.

Keywords

Main Subjects


  1. Braveman P, Gruskin S. Defining equity in health. J Epidemiol Community Health. 2003;57(4):254-258.
  2. Commission on the Social Determinants of Health WHO. Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Final Report of the Commission on Social Determinants of Health; 2008.
  3. Braveman P. Health disparities and health equity: concepts and measurement. Annu Rev Public Health. 2006;27:167-194. doi:10.1146/annurev.publhealth.27.021405.102103
  4. Woolf SH, Braveman P. Where health disparities begin: the role of social and economic determinants—and why current policies may make matters worse. Health Aff (Millwood). 2011;30(10):1852-1859. doi:10.1377/hlthaff.2011.0685
  5. Crompton R. Class and Stratification. Polity; 2008.
  6. Cancer Care Ontario. Ontario Cancer Plan IV; 2015.
  7. Romero Y, Trapani D, Johnson S, et al. National cancer control plans: a global analysis. Lancet Oncol. 2018;19(10):e546-e555. doi:10.1016/S1470-2045(18)30681-8
  8. World Health Organization. National Cancer Control Programmes: Policies and Manegerial Guidelines. http://www.who.int/cancer/publications/nccp2002/en/.  Accessed January 24, 2019. Published 2002.
  9. Atun R, Ogawa T, Martin-Moreno J. Analysis of National Cancer Control Programmes in Europe; 2014:97.
  10. Cancer Care Ontario. CCO Annual Reports; 2015. https://www.cancercare.on.ca/toolbox/libraries/corplibrary/.  Accessed December 13, 2016.
  11. Cancer Quality Council of Ontario. End-of-Life Care Measures - CSQI 2015. http://www.csqi.on.ca/by_patient_journey/end_of_life_care/end_of_life_care_measures/.  Accessed November 29, 2015. Published 2015.
  12. Auditor General of Ontario. Annual Report 2017. http://www.auditor.on.ca/en/content/annualreports/arreports/en17/2017AR_v1_en_web.pdf.  Accessed January 23, 2018. Published 2017.
  13. Mackillop WJ, Zhang-Salomons J, Groome PA, Paszat L, Holowaty E. Socioeconomic status and cancer survival in Ontario. J Clin Oncol. 1997;15(4):1680-1689.
  14. Booth CM, Li G, Zhang-Salomons J, Mackillop WJ. The impact of socioeconomic status on stage of cancer at diagnosis and survival. Cancer. 2010;116(17):4160-4167. doi:10.1002/cncr.25427
  15. Sharp L, Carsin A-E, Timmons A. Associations between cancer-related financial stress and strain and psychological well-being among individuals living with cancer. Psychooncology. 2013;22(4):745-755. doi:10.1002/pon.3055
  16. Sayani A. Socially based inequities in breast cancer care: intersections of the social determinants of health and the cancer care continuum. Women’s Health Urban Life Int Interdiscip J. 2017;13(1). http://uoit.scholarsportal.info/ojs/index.php/whul/article/view/2.  Accessed May 29, 2017.
  17. Bryant T, Raphael D, Schrecker T, Labonte R. Canada: a land of missed opportunity for addressing the social determinants of health. Health Policy Amst Neth. 2011;101(1):44-58. doi:10.1016/j.healthpol.2010.08.022
  18. Raphael D. Health inequalities in Canada: Current discourses and implications for public health action. Crit Public Health. 2000;10(2):193-216. doi:10.1080/713658246
  19. Public Health Ontario. Priority Populations; 2015. https://www.publichealthontario.ca/en/BrowseByTopic/HealthPromotion/Pages/Priority-Populations.aspx.  Accessed August 5, 2016.
  20. Maddison A. Inequity in access to cancer care: a review of the Canadian literature. Cancer Causes Control. 2011;22(3):359-366.
  21. Sayani A. Inequities in genetic testing for hereditary breast cancer: implications for public health practice. J Community Genet. 2019;10(1):35-39. doi:10.1007/s12687-018-0370-8
  22. McGibbon E, McPherson C. Applying Intersectionality & Complexity Theory to Address the Social Determinants of Women’s Health. https://tspace.library.utoronto.ca/handle/1807/27217.  Accessed October 5, 2015. Published May 2011.
  23. Hsieh H-F. Three Approaches to Qualitative Content Analysis. Qual Health Res. 2005;15(9):1277-1288.
  24. Taplin SH, Anhang Price R, Edwards HM, et al. Introduction: Understanding and Influencing Multilevel Factors Across the Cancer Care Continuum. J Natl Cancer Inst Monogr. 2012;2012(44):2-10. doi:10.1093/jncimonographs/lgs008
  25. Wakefield MK. The Quality Chasm Series: Implications for Nursing. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Advances in Patient Safety. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008. http://www.ncbi.nlm.nih.gov/books/NBK2677/.  Accessed January 24, 2019.
  26. Whitehead M. The concepts and principles of equity and health. Int J Health Serv Plan Adm Eval. 1992;22(3):429-445.
  27. Canadian Cancer Society’s Advisory, Committee on Cancer Statistics. Canadian Cancer Statistics 2015. Canadian Cancer Society; 2015.
  28. Scott-Samuel A, Smith KE. Fantasy paradigms of health inequalities: Utopian thinking? Soc Theory Health. 2015;13(3):418-436. doi:10.1057/sth.2015.12
  29. Weiderpass E, Meo M, Vainio H. Risk factors for breast cancer, including occupational exposures. Saf Health Work. 2011;2(1):1-8. doi:10.5491/SHAW.2011.2.1.1
  30. Su X, Tamimi RM, Collins LC, et al. Intake of fiber and nuts during adolescence and incidence of proliferative benign breast disease. Cancer Causes Control. 2010;21(7):1033-1046. doi:10.1007/s10552-010-9532-7
  31. Marchildon G. Health Systems in Transition. 2nd ed. Canada: University of Toronto Press; 2013.
  32. Taylor DW. Benefits Outweigh Costs in Universal Healthcare: Business Case for Reimbursement of Take-home Cancer Medicines in Ontario and Atlantic Canada. Am J Med Med Sci. 2014;4(4)126-138. 
  33. Partridge AH. Non-adherence to endocrine therapy for breast cancer. Ann Oncol. 2006;17(2):183-184. doi:10.1093/annonc/mdj141
  34. O’Neill VJ, Twelves CJ. Oral cancer treatment: developments in chemotherapy and beyond. Br J Cancer. 2002;87(9):933-937. doi:10.1038/sj.bjc.6600591
  35. Bradley CJ, Yabroff KR, Dahman B, Feuer EJ, Mariotto A, Brown ML. Productivity costs of cancer mortality in the United States: 2000-2020. J Natl Cancer Inst. 2008;100(24):1763-1770. doi:10.1093/jnci/djn384
  36. Reeder-Hayes KE, Wheeler SB, Mayer DK. Health disparities across the breast cancer continuum. Semin Oncol Nurs. 2015;31(2):170-177. doi:10.1016/j.soncn.2015.02.005
  37. Burge FI, Lawson BJ, Johnston GM, Grunfeld E. A Population-based Study of Age Inequalities in Access to Palliative Care Among Cancer Patients. Med Care. 2008;46(12):1203-1211. doi:10.1097/MLR.0b013e31817d931d
  38. Barbera L, Paszat L, Chartier C. Indicators of poor quality end-of-life cancer care in Ontario. J Palliat Care. 2006;22(1):12-17.
  39. The Quality Hospice Palliative Care Coalition of Ontario. Advancing High Quality, High Value Palliative Care in Ontario; 2011.
  40. Faggiano F, Partanen T, Kogevinas M, Boffetta P. Socioeconomic differences in cancer incidence and mortality. IARC Sci Publ. 1997;(138):65-176.
  41. Groome PA. Demographic Differences between Cancer Survivors and those who Die Quickly of their Disease. Clin Oncol (R Coll Radiol). 2008;20(8):647-656. doi: 10.1016/j.clon.2008.05.006
  42. Ward E, Jemal A, Cokkinides V, et al. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin. 2004;54(2):78-93.
  43. Raphael D, Sayani A. Assuming policy responsibility for health equity: local public health action in Ontario, Canada. Health Promot Int. 2019;34(2):215-226. doi:10.1093/heapro/dax073
  44. Richardson S, Williams T. Why Is Cultural Safety Essential in Health Care Patients’ Rights. Med Law. 2007;26:699-708.
  45. Garvey G, Cunningham J. National cancer control plans. Lancet Oncol. 2018;19(12):e666. doi:10.1016/S1470-2045(18)30834-9
  46. Labonté R. Health Systems Governance for health equity: critical reflections. Rev Salud Publica Bogota Colomb. 2010;12 Suppl 1:62-76.
  47. United Nations. The Millennium Development Goals Report; 2015.
  48. Navarro V. What we mean by social determinants of health. Int J Health Serv Plan Adm Eval. 2009;39(3):423-441. doi:10.2190/HS.39.3.a