There has been remarkable progress in reducing cancer death rates in the United States. According to a new report issued by the American Cancer Society, between 1990 and 2007, the most recent years for which data are available, overall cancer death rates fell by about 22 percent in men and 14 percent in women, saving 898,000 Americans from premature deaths from cancer. However, not all segments of the U.S. population have benefited equally from this progress.
Death rates in people with lower socioeconomic status – as defined by the level of education, occupation or residence – showed little if any decrease, and even increased in some instances. As more Americans feel the economic pinch, or fall behind financially, will this translate to more cancer diagnoses and a larger number of cancer deaths particularly among the disadvantaged?
The causes of cancer disparities within different socioeconomic groups are complex to be sure; however, disparities predominantly arise from inequities in employment, the amount of income and wealth a person has, his or her level of education, and where he or she lives. These factors contribute to financial, social, structural and personal barriers that prevent people from seeking high-quality cancer prevention, early detection, and treatment services that saves lives.
That’s one reason why in 1989, Dr. Samuel Broder, then director of the National Cancer Institute, suggested that “poverty is a carcinogen,” or a cancer-causing agent.
A lesson can be gleaned from the African nation of Zimbabwe. Once a vibrant and diversified economy, Zimbabwe was a hope for the continent’s future. Today, it’s in deep crisis and the signs of collapse are tactile with a contracting economy, triple-digit inflation and a staggering devaluation of local currency, which at the latest figures have almost half the country facing food shortages.
There are many ways in which economic crisis can directly cause deaths, including starvation, lack of access to previously available medicines, or economically motivated violence. But beyond these direct and overt avenues, there are also strong relationships between income levels and health indicators that suggest losses of income systematically create additional deaths that would not occur in higher income environments, according to the Center for Global Development, a nonpartisan Washington, DC, think tank. In other words, the economic crisis itself kills people.
In this country, when educational attainment is used as an indicator of socioeconomic status, the disadvantaged have a higher cancer burden (financial and human costs) for all cancers combined compared to those with education levels beyond high school, regardless of race and ethnicity.
This is particularly true for the four major cancers: lung, colorectal, prostate and breast. The disparity is largest for lung cancer, for which death rates are four to five times higher in the least educated than in the most educated individuals, according to the American Cancer Society’s Facts and Figures 2011. The 2007 data compared people from age 25 to 64. Researchers used education as a measuring stick because death certificates include that information.
The report pointed out that people in lower socioeconomic groups have a higher risk of developing cancer and lower survival rates because of a complex set of factors that stacks the deck against them. For starters, they are more likely to engage in risky behavior such as tobacco use and getting too little exercise. They also tend to eat low-cost fatty foods. This is partly because they more easily fall victim to marketing strategies, have fewer personal and community resources and simply lack access to fresh fruits and vegetables.
The lack of resources also prevents lower income people from carrying insurance, or they lack adequate insurance coverage to seek preventative care and treatment services. Studies show people without health insurance are more likely to be diagnosed with advanced cancer and less likely to receive standard treatment and survive the disease.
For all types of cancer among men, the report showed about 56 deaths per 100,000 for those with at least four years of college compared to 148 deaths per 100,000 for those with no more than a high school diploma. For women, the data showed 59 deaths per 100,000 for the most educated, and 119 deaths per 100,000 for the least educated.
The cancer society estimated that more than a third of those premature deaths could have been spared if everyone had a college degree. The data showed people with at least a four-year college degree are seeing a dramatic drop in cancer-related death rates. But the current financial situation means less people now have access to advance degrees, creating a cyclical and far-reaching crisis.
According to the U.S. Census Bureau, the nation's official poverty rate grew in 2009 to 43.6 million people (14.3 percent), up from 39.8 million people (13.2 percent) in 2008 — the second statistically significant annual increase in the poverty rate since 2004 and the third consecutive annual rise. Meanwhile, the number of people without health insurance coverage also rose from 46.3 million in 2008 to 50.7 million in 2009, while the percentage increased from 15.4 percent to 16.7 percent over the same period.
The cancer society report clearly points to health and education equality as essential components of good public policy if the U.S. is going to win its cancer war. It’s clearly a case of what’s good for people, is also good for the country. Consider, in addition to the tragic human cost of cancer, the national economic costs of cancer are staggering.
The National Institutes of Health estimated in 2010 the overall costs of cancer was $263.8 billion: $102.8 billion for all health costs; $20.9 billion for cost of lost productivity due to illness; and $140.1 billion for lost productivity due to premature death.
Lynette Summerill is an award-winning writer who lives in Scottsdale, Arizona. In addition to writing about cancer-related issues for EmpowHER, her work has been seen in newspapers and magazines around the world.
The American Cancer Society’s Report, Cancer Facts
& Figures 2011, is available at http://www.cancer.org/statistics
U.S. Census Bureau. “Income, Poverty and Health Insurance Coverage in the United States:2009.” Dated 9/16/2010. Accessed at http://www.census.gov/hhes/www/poverty/poverty.html
Center for Global Development. Costs and Causes of Zimbabwe’s Crisis. Michael Clemons, Todd Ross. July 2005.
Accessed at www.cgdev.org
Reviewed June 23, 2011
Edited by Alison Stanton