The last few months have shone a stark light on our health in the UK, with the COVID-19 pandemic exposing the deep inequalities running through our society.
But inequalities in the UK affect more than our risk from COVID-19, they’re intricately entwined with all aspects of our health, including cancer. New figures released today reveal that there are around 20,000 extra cancer cases each year in more deprived areas of the UK.
It’s a sobering figure, equating to around 60 cancer cases a day that could be avoided. And what’s worse is that this figure is just one of many.
People from more deprived areas are not only more likely to get cancer, they’re more likely to be diagnosed at a late stage for certain cancer types , and have trouble accessing cancer services . And, sadly, they’re more likely to die from the disease.
It’s an unacceptable reality in 2020. And one that government must urgently address.
When it comes to cancer cases, the starkest differences between the most and least deprived areas of the UK are in smoking-related cancer, like lung and laryngeal cancer.
Smoking rates have been falling across the UK for decades, but there’s a big difference in smoking rates between the most and least deprived communities. In Northern Ireland, around 3 in 10 adults in the most deprived communities will smoke in 2020, compared with 1 in 10 people in the least deprived communities. A picture that’s mirrored in other parts of the UK. It also means that rates of smoking related cancers – such as lung and oesophageal – are 3 times higher for the most deprived populations compared to the least deprived.
Children from the most deprived areas are also twice as likely to be obese in Scotland. Children who are obese are 5 times more likely to be obese as adults, putting them at higher risk of developing 13 different types of cancer.
The number of people who take part in cancer screening also varies depending on where people live. In Scotland, 47% of eligible adults in the most deprived areas take part in bowel screening, much lower than the 69% of people living in the least deprived areas. Screening can detect cancers at an early stage, as well as helping to prevent cancers developing in the case of cervical screening.
By identifying theses cancers early, treatment is more likely to be successful and people are more likely to survive their cancer. Because how and when someone is diagnosed matters.
Cancer diagnosis and treatment
For some cancer types, people from more deprived communities are more likely to be diagnosed at a later stage, giving them fewer treatment options. They’re also 50% more likely to be diagnosed through emergency routes like A&E when looking at all cancers together. Higher proportions of emergency presentations in more deprived groups is particularly clear for bowel, lung, bladder and pancreatic cancers and it’s a bad sign – people diagnosed in this way have worse survival, even when you take into account their cancer stage.
It’s difficult to pinpoint the reasons why more people are diagnosed through emergency routes, but we’re constantly surveying the public to try and understand barriers people face. Data suggests that people from the most deprived communities are less aware of cancer symptoms and report more barriers to seeking help – the most common being difficulties getting an appointment with a particular doctor or at a time that works. Because of these barriers, people may find it difficult to seek help or put off doing so until the disease reaches a crisis point.
And for people from deprived communities, health concerns might not come that high up their list of priorities, with more pressing things like money and family security taking precedence.
The differences don’t just stop at diagnosis. In England, we’re starting to learn that there are differences in treatment between the least and most deprived. We still need to understand the causes of these differences, which are complex and could well be associated with comorbidities caused by poorer general health. And while patient choice is key, it’s vital that everyone has access to the best treatment options, regardless of where they live.
With so many differences in prevention, diagnosis, care and treatment, the sobering reality is that people in more deprived areas have worse cancer survival.
This must change.
Scratching the surface
Most of the data in our latest report isn’t new, for years pockets of this information have been available. But by bringing it together, we hope to start a conversation that will lead to real change.
But we’re just scratching the surface when it comes to health inequalities, which stem from a range of social, environmental and economic factors, known as the wider determinants of health. Understanding how these underlying factors affect cancer risk and outcomes, and taking action to mitigate them, is key to closing the gap between advantaged and disadvantaged groups.
We focused solely on socio-economic deprivation in our latest report. We did so because it’s one of the most influential factors driving differences in the number of people being diagnosed with cancer as well as cancer survival and it’s uniquely intertwined with many other factors. But it’s also one of the most well-researched aspects of cancer inequalities.
But socio-economic deprivation is one of many factors that drive health inequalities in the UK. How long we live, and how long we live in good health, varies depending on a range of factors, including ethnicity, gender, sexual orientation and whether we have any disabilities.
Each of these factors, and the impact they have on health inequalities, must be untangled. And to do that we need better data collection so that we can understand how different groups experience differences in health. This will allow researchers to identify inequalities so that we can then work collectively to reduce or eradicate them.
A catalyst for change
But while it’s important to collect more data, we’ve got enough data to know that governments across the UK must act to reduce inequalities. Fortunately, the UK Government has the perfect opportunity to do so in England in the next few months, with the upcoming comprehensive spending review.
Government must pay close attention to the widening gap between richer and poorer areas, injecting much needed money into public health funding, including stop smoking services, to help reduce this inequality.
– Michelle Mitchell, chief executive, Cancer Research UK
To do this, they need to invest in stop smoking services, creating protected funding for these vital services, ideally through a levy on the tobacco industry. And this money must be used in a way that helps more people quit across the board but, crucially, lessens the gap in smoking rates between the most and least deprived communities.
The other lies in reducing childhood obesity. The UK Government launched a new strategy to tackle obesity in July, which includes a raft of commitments. But the detail has yet to be finalised – the UK Government will be consulting with industry and others on how to introduce the measures, and then the UK Parliament will have to pass legislation. There’s a real risk they’ll be watered down or delayed further.
We need the UK and devolved governments to fully implement their obesity plans, including restricting advertising and price promotion offers on unhealthy food and drink.
Supporting tobacco control measures and introducing measures to help reduce obesity are important steps forward. But they’re just one part of the solution.
“As the NHS and society adapt and recover from the effects of COVID-19, we must use this opportunity as a catalyst for change,” says Mitchell.
Tackling inequalities has been an ambition for the UK’s health services, but we’re still not seeing the level of progress we need. Ensuring that no-one is disadvantaged because of where they live be central when decisions about health are at stake. And it must start now.
One of the UK Government’s priorities for the upcoming comprehensive spending review includes ‘levelling up economic opportunities across all nations and regions of the country’. The wealth of the nation is both linked to and depend on the health of the nation. If the UK is to tackle inequalities and make sure no community is left behind, if we’re to improve cancer survival in every part of the country, then health must be hardwired into the Government’s ‘levelling up’ agenda.
Now is the time for the government to show its commitment to the NHS and its recovery. In the upcoming Comprehensive Spending Review, further investment is urgently required to provide more support for those that need it most and to make sure the NHS has the staff and equipment it needs to clear the mounting backlog of patients, improving and transforming cancer services for everyone.
– Michelle Mitchell, Cancer Research UK’s chief executive.