There are inequalities in cancer incidence, access to services and outcomes, according to deprivation, race, age, gender, disability, religion and sexual orientation. The Cancer Reform Strategy announced that the government will lead a National Cancer Equality Initiative to bring together key stakeholders to focus initially on optimising data collection to enhance our understanding of the inequalities that exist.
The population of Plymouth is younger but faces more severe problems linked to deprivation. Devon and Cornwall have relatively low wages compared to England and wards within the West of Cornwall along with areas of Plymouth and some wards in Torbay suffer marked unemployment and social and economic deprivation. Social and economic deprivation leads to ill health and premature death. There is a social gradient to many cancers, with those in deprived areas having a greater incidence of cancer and likelihood of premature death. Life style factors play a significant part with increased rates of smoking and obesity in deprived populations. However, the effects of social and economic deprivation, poor housing, low educational attainment and un-employment have a greater and more pervasive effect on health than life style factors alone. The diagram represents the diverse factors that affect our health.
Much data related to life style factors and screening is routinely collected on a general practice basis. Established techniques exist to estimate the deprivation of the population served by each general practice and to construct a deprivation score for the practice population which can be related to health measures. The Peninsula Directors of Public Health have agreed a joint approach to health equity audit and the Peninsula Cancer Network hosts a Health Equity Audit Group to examine patterns of health inequality and recommend coordinated action to reduce health inequalities, and monitor the impact of targeted interventions.
Helping and supporting people to make healthy life style choices requires strong partnership working between the NHS, Local Authorities, businesses and work places and most importantly, through providing consistent accurate information to the public with a range of choices and options for practical support. This is a much broader approach to tackling cancer and requires strong strategic partnerships with sophisticated commissioning by both Primary Care Trusts and Practice Based Commissioners to shape effective interventions to improve health and prevent cancer by targeting those most at risk.