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

Problem: Europe is characterized by disparities in access to cancer prevention and care services and by significant social inequalities between and within European countries, which deeply impact cancer incidence, survival and mortality.

Objective: It aims to promote equity-oriented policy making related to cancer prevention and control by highlighting practical actions to tackle social inequalities in cancer at the European and national levels.

Implementation status: Fully implemented and terminated

Key Contextual Factors

  • This policy paper is a product of Work Package 5 of the Cancer Control Joint Action (CanCon) Initiative of the EU (https://cancercontrol.eu/).
  • Coordinator: Fisabio Research Foundation (Valencia, Spain). Colaborators: European Cancer Patient Coalition; Epidemiology Unit ASL TO3, Belgian Cancer Centre; European Cancer Concord; London School of Hygiene and Tropical Medicine.
  • Social inequalities in cancer have common roots, both across the continent of Europe and among different social groups within the population. A significant proportion of European citizens have inadequate access to surgery, radiotherapy and systemic therapies. Social inequalities in cancer outcomes also have important financial consequences for individuals and major economic consequences for Member States and European Union.

Key Components/Steps

  • A “Call for Experts” was launched in July, 2015, by the European Commission, and 23 experts were selected in order to review the policy paper drafts.
  • A literature review was performed between September and October of 2015 to identify evidence of cancer inequalities and any regional, national and European-wide strategies designed to tackle them.
  • In 2016 Member States were surveyed on their experiences in tackling social inequalities in cancer. We received 7 complete surveys, and the information was incorporated into this policy paper.
  • This policy paper has 13 general recommendations that focus on 3 main areas: capacity-building; primary and secondary prevention; and cancer treatment, survivorship and rehabilitation.
  • Each general recommendation includes a background bases on evidence, specific recommendations, and examples to identify through the Member States Survey, expert’s knowledge, and the literature review. The 13 recommendations are:
  • Embed equity within the cancer prevention and control policies in all European Union Member States.
  • Align cancer prevention and control policies with a Health in all Policies approach.
  • Adopt a Health Equity Impact Assessment framework.
  • Engage and empower communities and patients in cancer prevention and control activities.
  • Promote the exchange of good practice and support development of professional expertise in social inequalities in cancer in all European Union Member States.
  • Support the development of European research programmes that help deliver equity in cancer prevention and control in all European Union Member States.
  • Implement proportionate universalism policies to develop and maintain living environments favouring compliance with the European Code Against Cancer.
  • Improve equitable access and compliance with cancer screening programmes.
  • Ensure equitable access to timely, high-quality and multi-disciplinary cancer care.
  • Ensure equitable access to high-quality surgical care in all European Union Member States.
  • Ensure availability of sufficient radiotherapy capacity with appropriate technology innovation in all European Union Member States.
  • Ensure that all patients have timely access to appropriate systemic therapy.
  • Develop national cancer rehabilitation and survivorship policies, underpinned by an equity perspective.

Main Impacts / Added Value

  • This policy paper provides practical recommendations on which European Commission and Member States can base concrete actions designed to reduce social inequalities in cancer. It provides evidence-based recommendations to address those factors related inequalities in cancer prevention and care for which strong pan-European collaboration is required.
  • The recommendations can serve as a guide for action for national and European policy makers to tackle social inequalities in cancer prevention and control in Europe.
  • In terms of supporting patients facing the challenges of survivorship, some Member States have taken important steps to help them overcome some of life’s financial burdens.

Lessons Learned

  • Introducing the perspective of equity in cancer control is essential to reduce the inequalities that occur in its prevention, treatment, survivorship and rehabilitation.
  • Shared knowledge is crucial to advance in the fight against cancer.
  • Implementation of the recommendations will require appropriate resources to adapt the recommendations to each country, thus respecting the profile of the population and the social and economic context of each country.
  • For the recommendations to be successful, it is necessary that social inequalities in cancer are placed at the top of the European public health agenda, therefore maximizing the impact of future EU initiatives on cancer.

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