title: The socioeconomic determinants of cancer.
abstract: This paper provides a synthesis on socioeconomic inequalities in cancer incidence, mortality and survival across countries and within countries, with particular focus on the Italian context; the paper also describes the underlying mechanisms documented for cancer incidence, and reports some remarks on policies to tackle inequalities.From a worldwide perspective, the burden of cancer appears to be particularly increasing in developing countries, where many cancers with a poor prognosis (liver, stomach and oesophagus) are much more common than in richer countries. As in the case of incidence and mortality, also in cancer survival we observe a great variability across countries. Different studies have suggested a possible impact of health care on the social gradients in cancer survival, even in countries with a National Health System providing equitable access to care.In developed countries, there is increasing awareness of social inequalities as an important public health issue; as a consequence, there is a variety of strategies and policies being implemented throughout Europe. However, recent reviews emphasize that present knowledge on effectiveness of policies and interventions on health inequalities is not sufficient to offer a robust and evidence-based guide to the choice and design of interventions, and that more evaluation studies are needed.The large disparities in health that we can measure within and between countries represent a challenge to the world; social health inequalities are avoidable, and their reduction therefore represents an achievable goal and an ethical imperative.
authors.affiliation: Center for Cancer Prevention, University of Turin, San Giovanni Battista University Hospital, Italy. franco.merletti@unito.it
authors.forename: Franco
authors.initials: F
authors.lastname: Merletti
authors.forename: Claudia
authors.initials: C
authors.lastname: Galassi
authors.forename: Teresa
authors.initials: T
authors.lastname: Spadea
mesh_terms: D019049:Developed Countries; D003906:Developing Countries; D005060:Europe / Q000453:epidemiology; D005260:Female; D006291:Health Policy; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality; D012959:Socioeconomic Factors