Health equity overview

“Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.”1 - The Robert Wood Johnson Foundation. Health equity or inequity reflects social vulnerabilities and inequalities where people live, work, play, and worship.2

Social vulnerabilities and inequities can impact colorectal cancer (CRC) outcomes and mortality, highlighting the importance of understanding risk factors3

Health equity statistics suggest that geographic location is a strong predictor of life expectancy4

CRC screening is greatly impacted by socioeconomic factors, with different groups experiencing diverse challenges5

Excluded or Marginalized Groups

Excluded or marginalized groups commonly face discrimination, are often excluded/marginalized from society and the associated health-promoting resources, and can be more economically and/or socially disadvantaged.1

Historical examples include, but are not limited to1:

  • People of color
  • People living in poverty
  • Religious minorities
  • People with physical and/or mental disabilities
  • LGBTQ
  • Women

Social Determinants of Health

Conditions in the environments in which people are born, live, learn, work, play, worship, and age. These factors have been shown to influence health, functioning, and quality-of-life outcomes.2

There are 5 key areas for social determinants of health2:

Economic Stability

Employment, food insecurity, housing instability, poverty

Education Access and Quality

Early childhood education and development, enrollment into higher education, high school graduation, language and literacy

Social and Community Context

Civic participation, discrimination, incarceration, and social cohesion

Healthcare Access and Quality

Access to healthcare, access to primary care, and health communication

Neighborhood and Built Environment

Access to safe water, crime and violence, environmental conditions, quality of neighborhood infrastructure

Social Vulnerabilities and Health Inequalities Affect Colorectal Cancer (CRC) Screening in a Variety of Ways

CRC Screening Adherence

Rural Geography

Compared to people living in urban areas, a 2014 survey found that those living in rural areas were 60% less likely to undergo any colorectal cancer screening.6

Black and African Americans

In 2021, 61% of Black adults aged ≥45 years were up-to-date on CRC screening.7

Asian Americans

In 2021, 50% of Asian adults aged ≥45 years were up-to-date on CRC screening.7

Hispanic Populations

In 2021, 52% of Hispanic adults aged ≥45 years were up-to-date on CRC screening.7

Refugees

In two different studies that used data between 1980-2019, 62-87% of refugees were not adherent to CRC screening.8,9

Insurance Status

In 2021, 52% of adults aged ≥45 years with Medicaid, public, or dual-eligibility health insurance were up-to-date on CRC screening. For the same age group, only 21% of uninsured individuals were up-to-date.7

CRC Screening Mortality

African Americans

From 2014-2018, African Americans faced a roughly 20% higher risk of developing CRC than White individuals. From 2015-2019, mortality rates were 44% higher in men and 31% higher in women when compared to White counterparts.10

Financially Insecure

Medicaid expansion has been associated with a decreased incidence of late-stage CRC diagnosis. Patients diagnosed at later stages have a greater risk of mortality.13,14

Hispanic Populations

From 2014-2019, Hispanic individuals faced a lower CRC mortality rate than non-Hispanic White individuals. However, some states are exceptions to this rule, such as Texas and California, where US-born Hispanic men have similar or higher CRC mortality rates than non-Hispanic White men due to acculturation.11

Native Populations

From 2016-2020, American Indians and Alaska Natives were more likely to die from CRC than Hispanic individuals, Asian/Pacific Islanders, and White individuals.12,a

Related Topics

Footnotes

  1. Note that the AI/AN population has the highest racial misclassification in health data of any racial or ethnic group in the US, likely contributing to an underestimation of the burden of cancer among members of this group.15

List of definitions

AI/AN: American Indian and Alaska Native; CRC: colorectal cancer; LGBTQ: lesbian, gay, bisexual, transgender, queer or questioning identity; US: United States.


References

  1. Braveman P, Arkins E, Orleans T, et al. What is health equity? Published May 2017. Accessed May 14, 2024. https://www.rwjf.org/en/library/research/2017/05/what-is-health-equity-.html
  2. Office of Disease Prevention and Health Promotion. Social determinants of health. Accessed May 15, 2024. https://health.gov/healthypeople/priority-areas/social-determinants-health
  3. Agency for Toxic Substances and Disease Registry. CDC/ATSDR Social Vulnerability Index (SVI). Updated November 16, 2022. Accessed May 14, 2024. https://www.atsdr.cdc.gov/placeandhealth/svi/index.html
  4. Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW, et al. Inequalities in life expectancy among US counties, 1980 to 2014: temporal trends and key drivers. JAMA Intern Med. 2017;177(7):1003-1011. doi: 10.1001/jamainternmed.2017.0918
  5. Carethers JM, Doubeni CA. Causes of socioeconomic disparities in colorectal cancer and intervention framework and strategies. Gastroenterology. 2020;158(2):354-367.
  6. Hughes AG, Watanabe-Galloway S, Schnell P, et al. Rural-urban differences in colorectal cancer screening barriers in Nebraska. J Community Health. 2015;40(6):1065-1074.
  7. American Cancer Society. Colorectal cancer facts & figures 2023-2025. Accessed May 14, 2024. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2023.pdf
  8. Milenkov A, et al. Uptake of cancer screenings among a multiethnic refugee population in North Texas, 2014-2018. PLoS One. 2020. Published online first on March 30, 2020. doi:10.1371/journal.pone.0230675
  9. Siddiq H, Alemi Q, Mentes J, et al. Preventive cancer screening among resettled refugee women from Muslim-majority countries: a systematic review. J Immigr Minor Health. 2020;22(5):1067-1093.
  10. American Cancer Society. Cancer facts & figures for African American/Black People 2022-2024. Accessed May 14, 2024. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-facts-and-figures-for-african-americans/2022-2024-cff-aa.pdf
  11. American Cancer Society. Cancer facts & figures for Hispanics/Latinos 2021-2023. Accessed May 14, 2024. www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-facts-and-figures-for-hispanics-and-latinos/hispanic-latino-2021-2023-cancer-facts-and-figures.pdf
  12. Siegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023. CA Cancer J Clin. 2023;73(3):233-254.
  13. Diehl TM, Abbott DE. Association of Medicaid expansion with diagnosis and management of colon cancer. J Am Coll Surg. 2021;232(2):156-158.
  14. Qian Z, Chen X, Pucheril D, et al. Long-term impact of Medicaid expansion on colorectal cancer screening in its targeted population. Dig Dis Sci. 2023;68(5):1780-1790.
  15. Jim MA, Arias E, Seneca DS, et al. Racial misclassification of American Indians and Alaska Natives by Indian Health Service Contract Health Service Delivery Area. Am J Public Health. 2014;104 (Suppl 3):S295-S302.