Equity-Oriented Healthcare: What It Is and Why We Need It in Oncology

Abstract

Alarming differences exist in cancer outcomes for people most impacted by persistent and widening health and social inequities. People who are socially disadvantaged often have higher cancer-related mortality and are diagnosed with advanced cancers more often than other people. Such outcomes are linked to the compounding effects of stigma, discrimination, and other barriers, which create persistent inequities in access to care at all points in the cancer trajectory, preventing timely diagnosis and treatment, and further widening the health equity gap. In this commentary, we discuss how growing evidence suggests that people who are considered marginalized are not well-served by the cancer care sector and how the design and structure of services can often impose profound barriers to populations considered socially disadvantaged. We highlight equity-oriented healthcare as one strategy that can begin to address inequities in health outcomes and access to care by taking action to transform organizational cultures and approaches to the design and delivery of cancer services.

Barriers to cancer treatment and care for people experiencing structural vulnerability: a secondary analysis of ethnographic data

“…An upstream approach to addressing material-based inequities and access to cancer treatment through direct action on the SDOH will require commitment and collaboration from cancer organizations and provincial and national governments, and community organizations. Healthcare providers within cancer care organizations also have a role to play in supporting individual patients, but also in advocating for health systems and structural change [33,34].…”

“…[6,7,23] The cancer treatment trajectory is remarkably complex, and because of a growing emphasis on cost efficiency, treatment is primarily delivered through an outpatient model of care [38,39]. This model of care requires patients to interface with diverse healthcare providers (e.g., oncology care providers, surgical specialists, and primary care providers), across multiple locations and healthcare environments (e.g., acute care services, cancer centers, and primary health clinics) [7,38,39], earning the description of a "broken", "fractured" or "siloed" system [12,33]. Cancer treatment itself is often multi-modal, and may involve a combination of surgical treatment, systemic therapy, and/or radiation therapy.…”

“…A predominant focus of biomedical treatment of cancer means that broader structural and social determinants of health that act as barriers to care remain unaddressed [10,33]. Although Canada has been a leader in developing a theoretical foundation related to social determinants of health, it has been less successful in putting these concepts into action [43]- [44].…”

Health and healthcare equity within the Canadian cancer care sector: a rapid scoping review

“…As a result, there are growing calls to prioritize health equity and address cancer-related inequities within and outside of the cancer care sector [ 14 , 15 ]. As an influential intermediate determinant of health, health systems can play an important role in mediating health inequities by taking direct action toward mitigating the impacts of social determinants of health, transforming organizational culture of healthcare, and through intersectoral collaboration [ 3 , 16 – 18 ].…”

“…Yet, despite increasing attention to health equity and growing calls for healthcare equity to be a priority within the cancer care sector in Canada, it is unclear how health equity is being understood and taken up in this context. In particular, conceptualizations of health equity are widely variable, and although cancer organizations are beginning to foreground policies and strategic plans in health equity and social determinants of health rhetoric, it is not clear whether this is translating into meaningful action [ 14 ].…”