Social Determinants of Health Complex and interrelated factors called social determinants of health (SDOH) are main drivers of cancer disparities. The National Cancer Institute defines SDOH as the social, economic, and physical conditions in the places where people are born and where they live, learn, work, play, and grow older that can affect their health, well-being, and quality of life. These include economic policies and systems, development agendas, social norms, social policies, and political systems (27). In the United States, centuries of structural racism and systemic inequities have perpetuated and exacerbated adverse differences in SDOH for racial and ethnic minorities and other groups that are medically underserved. The circle in the figure depicts key SDOH and how they interconnect and intersect, both at societal and community levels and at the individual level. Selected examples of the multilevel factors comprising SDOH are highlighted. Collectively, these factors impact every stage of the cancer continuum, leading to worse health outcomes for people from groups that are racially, structurally, and/or economically disadvantaged. STRUCTURAL INEQUITIES AND SOCIETAL INJUSTICES ADVERSE HEALTH OUTCOMES SOCIAL DETERMINANTS OF HEALTH Socioeconomic Education, Income, Employment Clinical Health care access, Health care quality Environmental Air/water quality, Housing, Transportation, Community safety Cultural Health beliefs, Health-related attitudes Behavioral Diet, Tobacco use, Excess body weight, Physical inactivity Psychosocial Stress, Mental health, Isolation Biological Genetic, Epigenetic, Tumor microenvironment Development Risk Reduction Early Detection Treatment Survivorship CANCER HEALTH DISPARITIES Lack of Diversity in Cancer Research and Care Workforce RACISM • DISCRIMINATION • SEGREGATION FIGURE 2 Cancer in 2023 AACR Cancer Progress Report 2023 19
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