Leveraging national and global political determinants of health to promote equity in cancer care
Cet article analyse, à l'échelle nationale et mondiale, le pouvoir des forces politiques du secteur de la santé pour promouvoir l'équité dans la lutte contre le cancer et dans l'accès aux soins
Health and politics are deeply intertwined. In the context of national and global cancer care delivery, political forces –the political determinants of health—influence every level of the cancer care continuum. We explore the “three-i” framework—which structures the upstream political forces that impact policy choices in the context of actors’ interests, ideas, and institutions—to examine how political determinants of health underlie cancer disparities.Interests are “the agendas of societal groups, elected officials, civil servants, researchers, and policy entrepreneurs.” Ideas manifest in “knowledge or beliefs about what is (eg, research knowledge), views about what ought to be (eg, values), or combinations of the two.” And institutions are “the rules of the game.”We provide examples from around the world. Political interests have helped to fuel the establishment of cancer centers in India and have galvanized the 2022 Cancer Moonshot in the United States. The politics of ideas underlie global disparities in cancer clinical trials, that is, in the distribution of epistemic power. Ideas also influence which interventions are tested in costly trials. Lastly, historical institutions have helped to perpetuate disparities related to racist and colonialist legacies. Current institutions have also been leveraged to improve access for those in greatest need, as exemplified by the experience in Rwanda.In providing these global examples, we demonstrate how interests, ideas, and institutions influence access to cancer care, across the breadth of the cancer continuum. We argue that these forces can be leveraged to promote cancer care equity nationally and globally.
Journal of the National Cancer Institute , résumé, 2022