Health equity and disparities in pediatric and adolescent/young adult oncology

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What are health disparities?

In discussions about cancer-related outcomes, the word “disparity” is often used interchangeably with other words like “difference” or “inequity.” But disparities are not simply “any” differences in health. Rather, disparities, as defined by the World Health Organization (WHO), are avoidable differences in health arising from the social and economic conditions that determine an individual’s risk of illness, and the actions taken to prevent or treat said illness.

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What are cancer health disparities?

The National Cancer Institute (NCI) defines cancer health disparities as adverse differences in cancer incidence, prevalence, cancer-related mortality, survivorship, and burden of cancer or related health conditions that exist among disadvantaged or minority populations in the United States.

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What is a vulnerable population?

The Health and Human Services (HHS) Office of Minority Health defines a health disparity as a particular type of difference in health in which socially disadvantaged groups, including poor patients, racial/ethnic minorities, women, LGBTQIA, and any other people who face persistent disadvantage and discrimination systematically experience worse health or greater risk than more advantaged social groups. These groups who systematically experience worse health outcomes are known collectively as vulnerable populations.

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What factors contribute to cancer health disparities?

Factors contributing to differential outcomes among diverse groups can be biologic or non-biologic in etiology. In general, when speaking about health disparities, the emphasis is on non-biologic factors, specifically, the social determinants of people's lives that impact their ability to achieve good health. Factors contributing to cancer outcome disparities – and health inequities – operate at many levels. These range from policy factors, like insurance coverage and Medicaid/Medicare, to system-levels, like access to transportation and high-quality medical care, to individual level factors at both the patient and provider levels, including bias, discrimination, mistrust, or health beliefs.

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