Equity as a consideration in National Cancer Control Plans from the American continent: a comparative content analysis
Authors: P Loggetto, J Ritter, C Lam, K Marx, M Metzger
Journal: The Lancet Global Health (2021)

BackgroundSocial determinants of health contribute to disparities in cancer outcomes. At the same time, national cancer control plans (NCCP) are increasingly recognised as an important tool to address cancer burden, organise programmes, and promote equitable care. In this study, we aim to evaluate how cancer-related health plans in American countries promoted equity in cancer care.MethodsWe conducted a comparative content analysis of cancer-related health plans from countries within the American continent. We identified plans for inclusion by systematically screening the St. Jude Global CoreBank, the WHO Non-Communicable Disease (NCD) Document Repository, the International Cancer Control Partnership Portal, and doing online searches. Each plan was coded in accordance with 33 pre-defined indicators across three categories: coherence, or how plans align with priorities set and existing cancer control strategies; equity—which social determinants of health are prioritised and whether the plan prescribes public interventions that promote equity; and governance, measuring transparency, accountability, participation, and integrity.FindingsWe included 46 cancer-related health plans from 34 countries in North, Central, and South America in analysis (26 were written in Spanish, 18 in English, one in French, and one in Portuguese). Twenty-four countries (71%) included cancer control in their NCD strategy, of which 12 (35%) also had a NCCP. Five countries had only an NCCP, and the other five had national health plans with some cancer components. Eight countries (23%) included a situational analysis to support the plan's interventions. Countries were more consistent across governance indicators and less consistent in creating targeted equity interventions. Equity was most often framed as an access problem, and although 25 countries (73%) designed equitable interventions, 17 of them (50%) declared the intended outcomes without defining their measures, and no country dedicated a budget for these interventions. The most prioritised social determinants of health were socioeconomic status (25 countries, 73%), place of residence (22, 64%), race/ethnicity (21, 62%), and gender/sex (21, 62%). Most countries defined their monitoring plan and evaluation variables (33, 97%) as well as the responsible party for supervision (29, 85%). While the authorship process included participants from different backgrounds, 24 countries (71%) recruited stakeholders from the government to the implementation process, signalling a commitment to a Health in All Policies (HiAP) approach to cancer care.InterpretationAmerican NCCPs do not integrate equity sufficiently. When included, equity focused on care access, but did not translate into actionable measures. Lack of budget and proper implementation monitoring may limit plan effectiveness. Future NCCPs should define measurable equity objectives across the cancer continuum, strengthen the HiAP approach, and allocate a budget to all interventions.FundingNone.