A later diagnosis, a smaller chance of survival and more pain: if you have a low income and get cancer, you are worse off than if you have a high income. This emerged from research this week Integrated Cancer Center Netherlands (IKNL). For example, people with low incomes are 10 percent less likely to survive cancer after five years than those with high incomes. The quality of life for the first group is also poorer if they do survive the disease, because they suffer more from pain and fatigue and lose their jobs more often.
It is not news that there is a health gap between rich and poor last year the Social and Economic Council stated that 20 percent of the most prosperous people in the Netherlands live an average of 8 years longer, plus 24 years longer in good health, compared to the 20 percent least prosperous people. That is why Frank van Lenthe, professor of social epidemiology and researcher of socio-economic health differences at the Erasmus Medical Center Rotterdam, is “unfortunately not surprised” that their chances of survival and quality of life are lower even after a cancer diagnosis.
“No matter how poignant it is, it would be strange if it were completely the same. People in lower socio-economic groups have a greater risk of various forms of cancer and other chronic conditions. There are certain mechanisms behind this that do not disappear after their diagnosis.”
The solution to socio-economic differences is often sought in medicine, but social policy is more important
What kind of mechanisms are those?
“That is about the direct circumstances from daily life that influence health. For example, material living conditions, such as difficulty making ends meet. But also living or working conditions. Job insecurity, irregular work, quality of life in the neighborhood. These all cause stress, which can lead to unhealthy behavior, which often means that people often arrive at the consultation room in an unhealthier state. As a result, the consequences of illness can also be greater.
You might think you can change behavior, but that is incredibly complicated. And factors that lead to certain behavior are not always within one’s own control. You usually cannot change your living and working conditions immediately after a diagnosis.”
Also read
Lower income and cancer? Then the tumor is treated less often
People with a lower socio-economic status are often diagnosed at a later stage and their tumors are removed less often. Do they receive worse care?
“I wouldn’t want to make that statement. I think several factors come into play. I can imagine that people with a higher income, who often also have a higher education, have the skills to deepen their knowledge. How prepared you go into a conversation with a doctor – how much knowledge you have gathered about treatment options, for example – can influence the course of that conversation and also how solutions are considered.
And what may play a role: people with much better living conditions may have a different attitude. Namely: ‘I want to get the most out of it, try everything.’ People with worse living conditions may have a more fatalistic perspective and think: ‘It is what it is: you just have to deal with it.’ Because they have become used to that attitude, for example regarding work and income.”
Do doctors take the patient’s circumstances into account enough?
“I estimate that a doctor generally treats every patient equally. The question is whether this is necessary if we want to reduce these differences. And whether we should not be much more alert to the patient’s background and realize better that some patients can deal with a disease much better than others due to their living conditions.
I don’t think that’s just the doctor’s fault. The solution to socio-economic differences is often sought in medicine, but social policy is actually more important. Illness can further deteriorate the socio-economic status, for example due to job loss or loss of income due to disability. This perpetuates health differences. Targeted policy can help reduce the consequences. The underlying causes for these differences lie outside the hospital.”
People with worse living conditions may have a more fatalistic perspective and think: ‘It is the way it is’
The research shows that people with a lower socio-economic status receive less aftercare – such as physiotherapy – and are more likely to continue smoking after the diagnosis has been made. Can doctors prevent this?
“Some people find it easier to find the right assistance than others. You could guide the latter group more closely. General advice to quit smoking has a higher chance of success for someone with more resources and less stress than for someone with worries about rent, who trusts public authorities less – that also often plays a role. In addition, the same reasons why lower-income people are more likely to smoke reduce their chances of beating the addictive effect.”
Could this also lead to avoidance of care and thus to a later diagnosis, for example?
“Not so much avoiding care as being there later. Everyone says: my health is my most important asset. But if you have everything in order – work, finances, home – something minor can be a reason to go to the doctor. On the other hand, if you find yourself in more difficult living conditions, you are more likely to say: I’ll wait and see. This applies to health differences in general: it sounds like a matter of choices, but they are actually the result of substantial differences in the lives of people with higher and lower incomes.
In terms of aftercare, one of the factors in the report, for example, was travel time. If you have less time and money, you are more likely to skip a check-up after treatment. Usually that is not a very conscious choice, but something that is dictated by those circumstances.”
Also read
Poor patients die more quickly from cancer, experience more pain and lose their jobs more often. Share Email the editor
Title: Cancer and Class: A Cheeky Look at the Dire Breach of Equity in Healthcare
So, it turns out if you’re middle-class and sporting that designer cancer, you might as well just throw yourself a party – complete with balloons and a reiteration of “you’ve got this!” Meanwhile, the folks down on the socio-economic rung? They’re more likely to throw a full-on tantrum with an existential crisis on the side. The Integrated Cancer Center Netherlands (IKNL) has come out with some rather ‘shocking’ research, showing that a low income can significantly worsen your chances of surviving cancer. Who’d have thought that an empty wallet could be a leading cause of cancer-related malarkey? You’d think we were living in the 21st century!
Take a seat, folks; grab your popcorn because the statistics are simply riveting. It turns out that people with lower incomes have a 10% reduced chance of surviving cancer after five years compared to their wealthier counterparts. But hey, at least they get a taste of life with an extra dollop of pain and fatigue, not to mention the oh-so-charming probability of job loss. This is basically like getting a “get well soon” card that also says, “P.S. You’re poorer now!”
What’s the cause of this shocking disparity, you ask? Well, let’s dive into the perfectly noble world of socio-economic health differences, as dodged by the shouting masses. It’s as simple as pie, really. The disparities are about everything from material living conditions to job security and just bad luck thrown in for good measure. Trust me; telling someone stressed about rent to “just relax and eat some greens” is akin to suggesting a fish switch to water aerobics. Spoiler alert: not happening!
“The solution to socio-economic differences is often sought in medicine, but social policy is more important.”
As Professor Frank van Lenthe so sagely points out, there’s been a bit of a misunderstanding about the whole “treat the patient” notion versus “let’s fix the broken system” idea. It’s a classic case of “let’s fix the car before putting out the fire.” Not quite right, is it? Imagine telling someone with a financial crisis to just drink green juice and everything will miraculously change. *(Cue eye roll)*
Now, let’s tackle a gripping drama – the late diagnosis saga. Lower-income patients tend to show up to the hospital later than you’d find your ex at a party: unfashionably and probably with bad news. And why? They might be too busy thinking, “Well, I’ve got rent to pay, so this cough can wait.” And honestly, it’s like they’re playing a game of let’s-see-how-bad-it-can-get before pulling that ’emergency’ card.
When it comes to silly old “aftercare”, the inequities are downright cringe-worthy. Those with better living conditions can juggle their health like it’s an Olympic sport, while others just clock out and walk away. Just think: telling someone to quit smoking while they’re battling rent and a tumor is like telling a fat man not to eat cake at a buffet. “Have you tried broccoli?” How about you just mind your business, Karen?
“People with worse living conditions may have a more fatalistic perspective and think: ‘It is what it is’.”
And don’t get me started on aftercare – or rather the lack thereof. You need a second mortgage just to go for a check-up. If your week is crammed with the hustle of surviving, those follow-up appointments might as well be applied via carrier pigeon, if the pigeon wasn’t too busy fussing about its own survival!
So when it boils down to it, the disparity in health care isn’t just about doctors being bad at their jobs (which they aren’t, mostly). It’s about much bigger fish in a very polluted pond. While the medical community is hard at work playing catch-up, the root of the problem lies buried deep in socio-economic soil. In this case, social policy is your knight in shining armor on a diet of broccoli.
So, as we chuckle anxiously over our excessive coffee consumption and high-brow social critiques, let’s remember that equity in health care should be the norm, not a pipe dream. Perhaps the real cancer here isn’t just the disease – it’s the system itself, clinging on to its outdated norms like a toddler holding his mother’s leg in a crowded store. Time for a shake-up, wouldn’t you say?
In conclusion, if you’re wealthy, you grab your survival kit and sail through. If you’re not, well… let’s just hope the universe has other plans. Let’s give a round of applause for our socio-economic health system; it’s doing a brilliant job at being just that – a system, but definitely not a healthy one.
Focus on their health when they’re worried about job security is like asking a tightrope walker to simultaneously solve a Rubik’s Cube. The reality is that access to aftercare—like physiotherapy or follow-up appointments—becomes an uphill battle for those with less financial and social capital.
The dire state of equity in healthcare underscores the importance of addressing socio-economic disparities head-on. It’s not enough to offer medical solutions; there must also be a concerted effort to improve the conditions that lead to these health inequities in the first place. Professor Van Lenthe’s perspective highlights a crucial point: while medicine plays a role in treating illnesses, effective social policies are essential for creating a healthier society overall.
In essence, the cancer care narrative is inflected with class struggle. Individuals from lower socio-economic backgrounds face a doubly tough battle—first with the disease itself, and then with the systemic barriers that undermine their survival and quality of life after diagnosis. The statistics don’t lie; they paint a picture of a healthcare system in need of deep reform, where social status should not dictate health outcomes. That’s the real tragedy—because every patient deserves a fighting chance, regardless of their bank balance.
addressing the socio-economic disparities in healthcare requires a multi-faceted approach—one that combines improved medical care with robust social policies aimed at leveling the playing field. Only then can we hope to bridge the gap and ensure that everyone, regardless of their socio-economic status, is afforded the same opportunity for health and longevity. So, let’s ditch the band-aids and tackle the root causes, shall we? After all, a healthier society benefits us all.
