In recent years, more attention is being paid to the impact of disparities and inequities on both the incidence and treatment of cancer. These are issues of importance to oncology social workers who are often involved with patients whose social determinants of health are significant. It is essential that oncology social workers stay abreast of these issues in order to assist their patients as well as to advocate for system level changes that can bring hope to those most vulnerable.

Defining the Terms

Health equity, health disparities, and health inequities have become familiar terms in healthcare, but their entwinement often causes confusion. It is important to understand the distinctions.

The Centers for Medicare and Medicaid Services (CMS) defines health equity as:

“The attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, preferred language, or other factors that affect access to care and health outcomes.” – CMS, 2022

In their work to advance health equity, the Centers for Disease Control and Prevention (CDC) has defined the following:

• Health Equity: State in which everyone has a ‎fair and just opportunity to ‎attain their highest level of ‎health.
• Health Disparities: Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that have been disadvantaged by their social or economic status, geographic location, and environment.
• Health Inequities: Disparities in health that stem from systemic policies and practices that limit opportunities for good health.

Health inequities occur when health outcomes differ across groups due to systemic, avoidable, and unjust social and economic policies and practices that create barriers to opportunity. These inequities have a significant social and economic impact on individuals and societies.

Health disparity is an unavoidable and unfair difference that affects an individual’s ability to reach their optimal health. Examples include race, gender, education, income, disability, geographic location, and sexual orientation. A health disparity is often beyond an individual’s control and caused by health inequities.

Health equity is the attainment of the highest level of health for all people. To achieve health equity, obstacles to positive outcomes must be eliminated. These obstacles include poverty, discrimination, and their consequences, including lack of access to goods, quality education and housing, and safe environments.

Hence, health disparities are the measurable differences in health outcomes between groups, while health inequities are the systemic, unfair, and avoidable root causes behind those differences.

Cancer Health Disparities and Why they Matter

Although cancer incidence and mortality overall are declining in the United States, certain groups continue to be at greater risk for developing or dying from particular cancers.

Cancer affects all populations in the United States, but due to social, environmental, and economic disadvantages, certain groups bear a disproportionate burden of cancer compared with other groups.

Cancer disparities are differences in cancer measures such as:

• Incidence (new cases)
• Prevalence (all existing cases)
• Mortality (deaths)
• Survival (how long people survive after diagnosis)
• Morbidity (cancer-related health complications)
• Survivorship (including quality of life after cancer treatment)
• Financial burden of cancer
• Screening rates
• Stage at diagnosis

Statistics from the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results Program have identified key disparities that certain racial/ethnic groups experience later diagnosis and higher cancer morbidity.

Cancer disparities reflect the interplay among many factors, including social determinants of health, behavior, biology, and genetics, all of which can have profound effects on health including cancer risk and health outcomes. Certain groups in the U.S. experience cancer disparities because they are more likely to encounter obstacles in getting health care.

People with low incomes, low health literacy, or who travel long distances to screening or treatment sites, or who lack health insurance, transportation to a medical facility, or paid medical leave are less likely to have recommended cancer screening tests and to be treated according to guidelines than those who don’t encounter these obstacles.

People who don’t have reliable access to health care are also more likely to be diagnosed with late-stage cancer that might have been treated more effectively if diagnosed earlier.

Some groups are disproportionately affected by cancer due to environmental conditions. People who live in communities that lack clean water or air may be exposed to cancer-causing substances. People who live in neighborhoods that lack affordable healthy foods or safe areas for exercise are more likely to have poor diets and less activity.

Even people with higher socioeconomic status and those with health insurance may reflect the impact of institutional racism and the chronic stress it causes, conscious or unconscious bias from health providers, mistrust of the health care system, or fatalistic attitudes about cancer.

Cancer disparities may also be exacerbated by the lack of diversity in clinical trial participation. Because of this lack of diversity, research results may not be applicable to all populations.

Because many different factors can influence cancer disparities, addressing them is not simple or straightforward. Reducing or eliminating some cancer disparities in pursuit of health equity will require policy changes to overcome systemic, social, racial, and institutional inequalities.

The Role of Oncology Social Workers

On a clinical level, oncology social workers can work to provide culturally appropriate health interventions, improve access to care and to address health literacy issues. On a macro level, oncology social workers can and should stay abreast of the policy issues that affect cancer disparities. In light of the current threats to Medicaid funding, it is imperative that oncology social workers elevate their voices and the stories of our most vulnerable patients to keep policy makers apprised of the impact of these changes on people with cancer.