Understanding the Social Determinants of Cancer: Challenges, Opportunities, and Pathways to Success
Both conceptually and practically, the construct of social determinants of health is both complex and multidimensional. Social determinants of health exert influence across the cancer continuum from prevention through survivorship. Factors such as housing status and conditions, environmental exposures, educational attainment, employment opportunities, and access to high-quality health care not only increase the likelihood of cancer, but also dictate the quality and length of survival following a cancer diagnosis. Health literacy influences the extent to which patients and caregivers can play an active role in healthcare decisions and the financial burden associated with cancer treatment further exacerbates the influence of certain social determinants.
Several frameworks have been developed to characterize social determinants of health and illustrate their impact on multiple dimensions of health, including the Robert Wood Johnson Foundation’s Culture of Health framework. In addition, an expanding portfolio of evidence-based programs, including patient navigation, offers healthcare professionals effective tools to mitigate the impact of social determinants on both the likelihood of a cancer diagnosis and the outcomes following treatment.
We propose a framework for action to address the impact of social determinants of health on cancer outcomes that includes seven elements: (1) community-level focus; (2) genuine community engagement and leadership; (3) success driven by community leadership; (4) engagement of all key sectors; (5) sustained engagement over a long period of time; (6) strategies to address the built environment and other structural characteristics; and (7) integration of comprehensive performance measurement and evaluation.
KeywordsSocial determinants of health Cancer Cancer screening Health equity Disparities Health literacy Financial toxicity Access to care Housing Transportation Income Education Patient navigation
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