In the past, cancer was perceived as a death sentence. Nowadays, it is more and more of a chronic disease or likely to survive. But this is especially true if you are rich.

This is what we need to remember from the last major reports on cancer deaths in the world. WE and overall. On the one hand, screening for the disease at an early stage has become more prevalent and better treatments help people live longer than ever with cancer.

Yet these successes are not evenly distributed among the people. Cancer is increasingly a microcosm of inequality that defines our era. As the gap widens between the haves and have-nots, the income gap in cancer deaths will continue to widen as well.

Cancer death rate in the United States has decreased by 27% since 1991

First, the good news for the United States. In the past decade, the United States has made tremendous progress in reducing the number of cancer deaths, according to the latest cancer statistics from the American Cancer Society. report.

The cancer death rate has decreased by about 1.5% each year for both men and women – as you can see by 2016, which corresponds to about 2.6 million less than cancer deaths as the peak of the cancer mortality rate in the early 1990s:

In other words, the cancer death rate has decreased by 27%, from 215 deaths per 100,000 population in 1991 to 156 deaths per 100,000 in 2016.

Let's stop to consider how remarkable it is. This steady decline in the cancer death rate continued at a time when other major causes of death in that country have faded. So, the cancer story is one of progress.

This raises the question: how did we achieve these gains?

An important part of the story is that tremendous progress has been made in the early detection and treatment of four major cancers – lung, breast, prostate and colorectal cancer – as you can see in the graphs below:

And this has helped to improve the survival of these cancers.

But the other big story is about smoking. The increase in smoking, which remains the leading cause of preventable diseases and deaths in the United States, is largely responsible for the rise in the number of cancer deaths over the century. latest. Thus, when the smoking rate decreased, the cancer death rate decreased.

"Because of lower smoking rates, lung cancer in men is declining rapidly, and the lung cancer mortality rate is decreasing by 45%, which is a significant improvement, and then almost 20% for men. women", Rebecca Siegel, a researcher from the American Cancer Society, told Vox in 2018. (The decline in smoking-related lung cancer in women is lower than in men, since women started smoking later and have been slower to stop smoking.)

"These stories reflect the growing and growing awareness of the dangers of smoking for health," she added, "as well as public health policies against smoking that have reduced smoking in public places." .

Although progress in the fight against the four main cancers is a source of satisfaction, in other cancers, the gains have not been as dramatic or reversed. The incidence rate of liver cancer increases faster than that of any other cancer, trend that the American Cancer Society attributes to the high rate of undiagnosed hepatitis C among baby boomers. So there is clearly a lot of work to be done.

Earnings are not shared equally in the United States and around the world

Progress against cancer is not unique in the United States. The largest study on trends in cancer survival, published in 2018 in Lancet, data from cancer registries in 71 countries covering 67% of the world population from 2000 to 2014. They also found that cancer survival was increasing in many countries, even for some of the most deadly cancers, such as liver and lungs.

But the paper highlights another important story that emerges from the data: there are persistent disparities between the rich and the poor in your chances of overcoming cancer. And this is true in countries like the United States as in high- and low-income countries.

in the Lancet According to the paper, for example, cancer survival rates were the highest among the richest countries in the world, including the United States, Canada, Australia, New Zealand, Finland, Norway, Iceland and Sweden. At the same time, the poorest countries did not experience the same gains. For example, for childhood brain cancer, the 5-year survival rate was below 40% in Brazil and Mexico and about 80% in Sweden and Denmark.

Income-related differences also appear in the United States. In one of the most recent documents on socio-economic and racial disparities in cancer mortality, published in the Journal of the Environment and Public Health In 2017, researchers found that the wealthier regions of the United States, as well as the most educated and income-rich groups, had lower cancer mortality than their poorer and less educated counterparts.

the 2019 Report of the American Cancer Society The most pronounced disparities in survival occur for the most preventable cancers: "For example, compared to the richest counties, mortality rates in the poorest counties were twice as high for cervical cancer. uterus and 40% higher for lung and liver cancers 2012-2016. "

Americans with high levels of education and high incomes also have a lung cancer or colorectal death rate two to three times lower than low-income Americans. Gopal Singh, researcher at the Health Resources and Service Administration. "And we find that these disparities change over time, and they widen," he added.

Stage 1 of the disease at the time of diagnosis is the # 1 factor in determining cancer survival, said Singh, and people of lower socio-economic status generally have more difficult access to health care. This means that their cancers are not detected as early, which decreases their chances of survival.

Some people also face real barriers to accessing treatment. Some of the latest cancer treatments can cost half a million dollars in the United States, and even if your insurance covers them, outside of some American cities could make the treatments almost impossible.

Lifestyle factors are also behind the gap. Singh noted that he had found differences in health behaviors associated with cancer – such as smoking, diet, alcohol consumption, and physical activity – among Americans most rich and poor. As the rich adopt better and better behaviors that reduce their risk of cancer, the poor are lagging behind.

Part of the solution to the growing cancer gap in America may lie in cities

Eliminating these disparities would prevent one-third of all cancer deaths in Canada, according to the American Cancer Society. Yet while the Trump administration and congressional Republicans are working to reduce health care for the poor, the cancer mortality gap can only continue to widen.

But if we think about cancer prevention, instead of just treating it, another study on health inequalities suggests a solution. And this suggests that cities and local governments have an important role to play in bridging the cancer divide.

For a 2016 study, published in JAMA, a group of researchers led by Stanford University economist Raj Chetty, analyzed income data from the US population from 1.4 billion tax filings between 1999 and 2014. They then compared them Mortality data from death records of the Social Security Administration. And they found a gaping gap in longevity between the richest and poorest in America.

Men who were among the top 1% of those who were better paid 15 years more than men in the lowest 1%. For women at the extremes of income distribution, life expectancy ranged from 10 years.

But they also found that people with low incomes lived longer (and had healthier behaviors) in places with an educated and high-income population, as well as generous government spending. And that geographical differences in the life expectancy of the poorest individuals were "significantly correlated" with behaviors such as smoking.

No smoking, cigarette taxes and anti-obesity efforts (such as prohibition of trans fats or calorie labeling) in cities such as New York could have had a net positive effect on the health of the local population – including people with the lowest incomes.

So, if you consider this as a third of cancers can be avoided By adopting healthy behaviors, such as increasing the level of physical activity or reducing smoking, the political creativity of cities and local governments could help bridge the gap between cancer.