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Dublin: 12 °C Monday 20 May, 2013

Column: To end cancer, we must close the health gap between rich and poor

It is only at the local level that we can close the “cancer gap” between the rich and poor, writes consultant medical oncologist Professor John Kennedy.

Image: Minerva Studio via Shutterstock

TODAY, THE IRISH Cancer Society publishes its strategy statement for the next five years entitled ‘Towards a Future Without Cancer’.

This is the first time that we have indicated that not only is this our ultimate goal, but that there is a real possibility that our children may live in a world where people don’t die from cancer. This is our vision and our mission.

For all of us who are part of the Society – our Board, our staff, our volunteers, our donors and our fundraisers – the services we run, the funds we raise, the researchers we support, and the policy decisions for which we lobby – are all aimed at achieving this ambition: a future without cancer.

Rich and poor – and accident of birth

I work as a Consultant Medical Oncologist in St James’ Hospital and St Luke’s Hospital and directly care for many patients with cancer. My personal ambition is that those working on cures for cancer will ultimately make my job redundant.

While highly accomplished researchers, many of whom are funded by the Irish Cancer Society, work on finding a cure for cancer, there are many changes we can make to reduce our risk of developing this disease.

Unfortunately, these changes are far easier for a well-educated, better-off person to make than for those who are not so favoured by accidents of birth. Thus, our battle against cancer is not just about medical research, it is also about closing the health gap between the rich and poor. The causes for such disparities are complex and need urgent intervention at the highest levels.

Local action

For the first time ever, the Irish Cancer Society will create ‘Cancer Action Communities’ in partnership with other organisations located locally. We are doing this because we believe that it is only at the local level that we can really make a difference and effect closure of the “cancer gap” between the rich and poor. It is not acceptable to us that there are communities where the incidence of cancer is far higher than it should be and where lives are being lost to preventable disease.

We want to fully understand why people who live in socially disadvantaged communities are twice as likely to get cancer than their better off neighbours. We will work closely with these communities to design specific programmes aimed at building a new future with them, a future without cancer.

We remain very ambitious for cancer research in Ireland. Breakthroughs in understanding and treating cancer mean that there are people alive now who would otherwise not be, however, there is more, much more, to be done and we are determined to partner the best Irish researchers on delivering on the promise of the molecular revolution in understanding cancer.

Complex social and economic aspects

For as long as cancer exists, there needs to be a concentrated, unshakeable effort to win a battle that we are only beginning to understand. This includes the complex social and economic aspects that determine ones likelihood of being diagnosed with cancer.

Thus, our strategy focuses on four ambitious areas – to empower people to reduce their cancer risk, to support those living with cancer, to advance cancer research and to inform and influence public policy around cancer. By delivering this we believe many more people will have a future without cancer.

In the 50 years since its foundation, the Irish Cancer Society has grown into an organisation that can credibly make bold statements like this. During the last 50 years, advances in cancer treatment and prevention have been extraordinary. We now know that by not smoking, maintaining a healthy weight, eating fresh fruit and vegetables and exercising regularly, that we can reduce our cancer risk by 50 per cent. This is a remarkable fact. For people who do develop cancer, advances in treatment mean that it is now a disease that is routinely survived.

A future without cancer is possible

Truly enormous challenges lie ahead, but we are building on the work already done by cancer specialists, the research and voluntary communities and politicians. It is our collective vision, as people working towards the same goal, that we can say that a future without cancer is possible.

Governments will play a very significant role in creating a future without cancer. Previous governments in Ireland should be acknowledged for their leadership and their ambition. We invite this Government, and future governments, to join us in our strategy, and to take on working towards a future without cancer too.

Patients will continue to be our focus. We want to improve the lives of anyone affected by cancer. We have led the way in supporting them, and we will continue to do so.

It is these patients, as well as our donors and our volunteers, who have spurred us on to create this strategy. Frankly, for them, nothing less will do.

Professor John Kennedy is one of the country’s leading medical oncologists and Chairman of the board of the Irish Cancer Society. He currently holds the position of Consultant Medical Oncologist at St James’s Hospital and St Luke’s Hospital and is Clinical Professor of Medicine in the University of Dublin, Trinity College.

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Comments (26 Comments)

  • I would have thought the disparity a natural extension of three things:

    1. Better diet/excercise regime for the more well off

    2. Lower smoking rates for more well off

    3. Longer waiting lists (e.g colonoscopy) lack of access to quality healthcare in an adequate timeframe for those most in need.

    Resonsibility for 1 and 2 can be argued. But number 3 is a shameful indictment of the last few government’s health policy. Income and cancer mortality rates having a correlation in this way is horrifying for a civilised society.

    Reply
    • I disagree with your point 3. Middle income people have less access to quality healthcare due to not having medical cards.

      Reply
    • Feargal, medical cards don’t give you quicker access to the public system,
      Private health insurance however does, I agree the this insurance is increasingly out of the reach of the middle classes,

      Reply
    • If there were no waiting lists there would be no need for health insurance, makes me wonder if lists are kept deliberately long?

      Reply
    • Feargal,

      Medical cards means back of the queue. Only health insurance offers a chance to jump the queue. I agree that health insurance is a luxury for a growing number of the middle classes.

      Reply
    • feargal don’t be so pathetic. You can still go to a doctor without a medical card and trying to say poor people are better off is a despicable lie. The truth is you obviously begrudge the poor a medical card.

      Reply
    • The new colon cancer screening programme is being rolled out which will hopefully reduce waiting times drastically. It has been delayed a number of years due to HSE ineptitude and inefficiencies Unfortunately again though well-off people are more likely to take part in the screening process than those less well-off. If there was no private health care the waiting times for everybody would be dramatically increased so in a way it helps to ease the burden on the public system. The inequality is unfortunate and it comes down to money.

      The HSE has the money to reduce waiting lists but unfortunately this money goes to administration staff in hospitals who take breaks at 11am because nurses also get a break around then and sure they can’t be giving the nurses a break without giving the admin staff the same break. They also stop working at 4.30pm everyday (they don’t leave til 4.55 though in fairness to them) having had another coffee break at 3.30pm. It also goes to overpaid porters of which there are too many. The HSE make their savings by cutting the wages of nurses, not paying doctors and not investing in the infrastructure that could make our health system world class.

      Reply
    • “Middle income people have less access to quality healthcare due to not having medical cards”

      Did people think Fine Gael gave a shit about the middle class? Same issue with Fianna Fail. My advice: look to the left.

      Reply
    • I think you are more or less correct. Poor diet, lack of exercise and smoking are major factors as is high alcohol consumption and all are more common among the more socially disadvantaged communities. What is puzzling is that everyone and his dog knows that they are significant factors and yet there appears to be a cultural reluctance in such communities to change habits. Why? It’s not a matter of income. Changing one’s diet to a healthier one does not entail significant additional costs while giving up smoking and reducing alcohol consumption of course saves money.

      Reply
  • I just don’t go to the doctors if I’m ill as I can’t afford it. Oh well.

    Reply
    • Stephen, yes the biggest obstacle to healthcare is cost, GP 50-60€, consultant 150-170€, medications 144€ maximum per month, all out of the reach of lower middle classes without medical cards,
      However the article guides use on healthy choices that are within our income range , yet many avoid these choices, personally I smoke, love white bread (batch), and work silly hours which make regular exercise more difficult,
      Education is not the answer alone, not sure what is

      Reply
    • “ll out of the reach of lower middle classes without medical cards”

      I can provide an example analogy: in the USA, the middle class were crushed under the Republicans (the equivalent of Fine Gael and Fianna Fail). The Democrats were elected because Obama would give free healthcare to the struggling middle class while sharing the burden with the top 1 per cent wealthy. In Ireland, the middle class would be given this same affordable medical care if the electorate elected Sinn Finn, or other credible left party (like the USA). But they didn’t. So now they wonder why they are screwed.

      Reply
    • Mark, Sinn Fein , no thanks

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    • So keep voting FF & FG ?!

      …very silly.

      Reply
    • No mark never again ? Fine Gael or Fianna Fáil or labour, but the shinners are not an option for me, will look at the rest with an open mind

      Reply
  • The two cancer deaths I have been exposed to were down to misdiagnosis at the GP stage rather than access to the system. The two successful treatments I know of were picked up as a result of an anomaly noticed in a test run for an unrelated condition. I am not having a go at anyone, but to me there seems to be a a strong element of luck that could ve eliminated by a comprehensive screening program.

    Reply
  • The problem here is not the “health gap”, it’s the wealth gap.

    Reply
  • People with medical cards think differently than others an healthy lifestyle Found it impossible to sell wholemeal bread in a public housing area and responses included “I don’t need health food as I have a medical card”. Such people need help.

    Reply
  • I lost my father to bowel cancer in 1980 and the health system for public patients was a shambles then in relation to cancer and it has not improved since then , We now have a “study” showing that poorer people have higher cancer rates and less access to consultants etc for treatment , How much time and money was wasted by a bunch of college graduates putting that piece of astounding information together for us simple folk.

    Reply
    • Micheal , access to colonoscopy is a major issue, already identified that early detection increases survival rates, there is no good excuse for systems not to place , sorry for your loss

      Reply
    • Belly Up 21/01/13 #

      That’s simply untrue Michael. Just look at cancer survival rates from 1980 and 2012 and you will see just how wrong you are. Unfortunately these studies must be carried out. The answers may seem obvious but the people at the forefront of cancer treatment in Ireland can’t just make these statements without evidence to back them up. They need these studies to lend credence to their claims.

      Reply
  • You can’t just end cancer in the first place?

    Reply

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