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Country/JA: iPAAC logo iPAAC
Action type: Policy recommendations

Problem: Current programmes on health promotion and early detection of cancer yield different results according to social group, having different impact amongst individuals, and thus generating social inequalities in health.

Objective: This initiative aims at identifying and compiling interventions proven effective to reduce health inequalities in European countries, sharing lessons learned, and facilitating replication in other health systems and similar social settings.

Implementation status: Guidance for implementation

Key Contextual Factors

  • This initiative emerges in the framework of Innovative Partnership for Action Against Cancer (iPAAC) Joint Action, in the form of a competition entitled “Contest of best practices tackling social inequalities in cancer prevention”.
  • Fisabio Research Foundation - Cancer and Public Health Unit (Valencia, Spain) led the contest with the support of Cancer Society of Finland.
  • Many cancer risk and protection factors have socially determined conditions. In general, those who pertain to lower socioeconomic groups are more exposed to cancer risk factors and less to protective ones. Consequently, socially disadvantaged groups are at higher risk for most of the common cancers.

Key Components/Steps

  • In February 2019, as a preliminary step, a “Call for Experts” was organized aiming at selecting and involving independent experts in the evaluation of proposals submitted within the contest. Candidates were evaluated according to expertise on epidemiology, public health and social disciplines.
  • The contest was launched in May 2019 through iPAAC Joint Action web page; submitters’ guide and application form were available on line. Submitters’ guide gathered rules for participation and evaluation criteria; application form comprised information on compliance of criteria, intervention description and self-assessment.
  • Proposals assessment was conducted on a peer-review basis in November 2019.
  • Compulsory criteria: relevance, equity and effectiveness; failure to comply them resulted in proposal’s exclusion.
  • Interventions were further assessed according to basic criteria: gender perspective, efficiency, ethics, sustainability, inter-sectors collaboration, transferability, innovation, evidence/theory based, and public engagement.
  • Each basic criterion was assessed on a scale from 0 to 5 according to specific definitions.
  • Proposals achieving an overall score of 27 points or higher were deemed “Best Practice”.
  • A specific section in iPAAC Joint Action web page was created gathering process materials and results. Contest information is available there since February 2020.

Main Impacts / Added Value

  • This contest allowed identification of health and social interventions reducing inequalities in cancer prevention, contributing to provide insight on effective strategies that can be translated to other settings and adapted into more equitable procedures.
  • Among rigorous assessment criteria, equity was considered a key central criterion. This feature makes the initiative different and innovative compared to previous endeavours.
  • Results suggest that a combination of public health universal interventions together with targeted actions might be more effective in preventing cancer in the whole population. Best practices’ summary and contact information are available online so that interested readers can easily get further details.

Lessons Learned

  • Interventions from several countries were submitted, providing a general overview of European initiatives.
  • Actions addressed health promotion and cancer screening; both primary and secondary prevention were represented among submitted proposals.
  • In order to identify practices that effectively reduce health inequalities, equity should be included as a central compulsory criterion in future best practices evaluation, as well as in the future European Code Against Cancer editions and the quality assurance guidelines for cancer screening. 
  • Dissemination of best practices among stakeholders is challenging. This has been approached through different means: website, iPAAC final deliverable road map, technical reports and scientific article preparation.