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Cancer Control Joint

Cancer Control Joint Action – Policy Papers 5 Conclusions Unacceptable inequalities in cancer prevention, treatment and care, and survivorship still affect millions of cancer patients across Europe. This paper provides evidence-based recommendations to address those factors related to inequalities in cancer care for which strong pan-European collaboration is required. This paper proposes an equity-oriented approach to developing policies for cancer prevention and control, based on universal action, but with a scale and intensity that are proportionate to the level of disadvantage of the population in question. We thus highlight practical actions to tackle social inequalities in cancer at the European and national levels in the form of 13 recommendations that span the areas of capacity building; primary and secondary prevention; and treatment, survivorship and rehabilitation. The recommendations are based on a review of available scientific evidence in addition to experiences identified through our survey of Member States. Our 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. However, implementation of the recommendations will require appropriate resources, first and foremost to adapt the recommendations to each country, thus respecting the profile of the population and the social and economic context of each country. While social inequalities in cancer in Europe are significant and formidable, important experience exists in addressing them, supporting the urgent need for action highlighted by patient organisations consulted during the drafting of this paper. The role of European institutions is also extremely important, particularly cancer institutions. Several Member States have already taken action in this direction, and their efforts can serve to strengthen and expand work on reducing social inequalities in cancer. Despite the principles of subsidiarity, which places healthcare as a shared competence between Member States and the European Union, the European Code Against Cancer and the Equity Joint Action strongly impacted the development and implementation of national cancer plans. 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 maximising the impact of future EU initiatives on cancer. 30

Tackling Social Inequalities in Cancer Prevention and Control 6 References 1 Whitehead M, Dahlgren G. Concepts and principles for tackling social inequalities in health. World Health Organization; 2014 2014-12-02. 2 European Commission. Communication from the commission to the European parliament, the council, the European economic and social committee and the committee of the regions. Solidarity in health: Reducing health inequalities in the EU. Brussels: European Commission; 2009. Contract No.: 567. 3 World Health Organization. Social determinants on health: Key concepts: World Health Organization; [Available from: finalreport/key_concepts/en/. 4 O’Neill J, Tabish H, Welch V, Petticrew M, Pottie K, Clarke M, et al. Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. J Clin Epidemiol. 2014;67(1):56-64. 5 Frohlich KL, Potvin L. Transcending the known in public health practice: the inequality paradox: the population approach and vulnerable populations. Am J Public Health. 2008;98(2):216-21. 6 Krieger N. Defining and investigating social disparities in cancer: critical issues. Cancer Causes Control. 2005;16(1):5-14. 7 Marmot M. Fair Society, Healthy Lives : The Marmot Review. 2010. 8 Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. International Journal of Cancer. 2015;136(5):E359-E86. 9 World Health Organization. The European health report 2012 : charting the way to well-being. Copenhagen (Denmark): World Health Organization; 2012. 10 Allemani C, Weir H, Carreira H, Harewood R, Spika D, Wang X, et al. Global surveillance of cancer survival 1995-2009: analysis of individual data for 25 676 887 patients from 279 populationbased registries in 67 countries (CONCORD-2). Lancet. 2015;385(9972):977-1010. 11 De Angelis R, Sant M, Coleman M, Francisci S, Baili P, Pierannunzio D, et al. Cancer survival in Europe 1999-2007 by country and age: results of EUROCARE-5-a population-based study. Lancet Oncology. 2014;15(1):23-34. 12 International Agency for Research on Cancer; EUCAN. Lung cancer including trachea and bronchus: World Health Organization; 2012 [Available from: aspx?Cancer=18. 13 International Agency for Research on Cancer; EUCAN. Cervical cancer. World Health Organization; 2012. 14 Coleman M, Forman D, Bryant H, Butler J, Rachet B, Maringe C, et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995-2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. Lancet. 2011;377(9760):127-38. 31

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