Intersectional disparities in climate vulnerability and cancer risk

Abstract

Despite significant progress in the early detection, treatment, and survivorship of cancer in recent decades, cancer disparities continue to plague segments of the US population. Many of these cancer disparities, especially those among historically marginalized racial and ethnic groups and those with lower socioeconomic resources, are caused and perpetuated by social and structural barriers to health.These social and structural barriers, which operate beyond the framework of cancer control, also systematically increase vulnerability to and decrease adaptive capacity for the deleterious effects of anthropogenic climate change. The established and emerging overlap between climate vulnerability and cancer risk presents complex challenges to cancer control, specifically among populations who suffer compounding hazards and intersectional vulnerabilities. By embracing these intersections, we may be able to conceptualize promising new research frameworks and programmatic opportunities that decrease vulnerability to a wide range of climate and health threats to advance health equity. K E Y W O R D S cancer, cancer disparities, climate change, environmental indicators, social determinants of health, social vulnerability DISPARITIES IN CLIMATE VULNERABILITY AND CANCER RISKCancer is the second leading cause of death in the United States.Overall, the cancer death rate has fallen 32% from its peak in 1991 to 2019, the most recent year for which data are available. Yet there are well-documented differences in who survives cancer, which are preceded by differences in who gets screened for cancer, receives a timely cancer diagnosis, and receives access to quality cancer care.So, even as we see improvements in cancer survival rates, survival is still less frequent for Black people for almost every cancer type relative to their White counterparts. 1 It has become increasingly evident that these differences, termed cancer disparities, result in part from socially driven inequities that render historically marginalized populations (i.e., ethnic, racial, and sexual minorities, women, and those of lower socioeconomic status) in our society disproportionately vulnerable to chronic disease. [2][3][4][5] The key feature of socially driven inequities is that instead of being intrinsic to individuals or populations, they are extrinsic and driven by structural and systemic systems that dictate and maintain power, privilege, and oppression.

Overlooked and Damaging Impact of Structural Racism and Implicit Bias on US Health Care

“…Structural racism and implicit bias impact people with cancer across the cancer care continuum contributing to disproportionate disparities in cancer incidence and mortality rates among racial and ethnic groups and other marginalized populations 5 . In addition to factors aforementioned, other specific influences on cancer outcomes include work and environmental conditions (related to disproportionate exposure to carcinogens) and how health care is valued and utilized differently by certain groups 6,7 . The unfortunate result is disparities in access to preventive services and programs, leading to delayed screening and later-stage diagnosis 8–12 .…”