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This article is part of the supplement: Proceedings of the First Lorenzo Tomatis Conference on Environment and Cancer

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The socioeconomic determinants of cancer

Franco Merletti1*, Claudia Galassi1 and Teresa Spadea2

Author Affiliations

1 Center for Cancer Prevention, University of Turin, San Giovanni Battista University Hospital, Italy

2 Regional Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco, Italy

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Environmental Health 2011, 10(Suppl 1):S7  doi:10.1186/1476-069X-10-S1-S7

Published: 5 April 2011


This paper provides a synthesis on socioeconomic inequalities in cancer incidence, mortality and survival across countries and within countries, with particular focus on the Italian context; the paper also describes the underlying mechanisms documented for cancer incidence, and reports some remarks on policies to tackle inequalities.

From a worldwide perspective, the burden of cancer appears to be particularly increasing in developing countries, where many cancers with a poor prognosis (liver, stomach and oesophagus) are much more common than in richer countries. As in the case of incidence and mortality, also in cancer survival we observe a great variability across countries. Different studies have suggested a possible impact of health care on the social gradients in cancer survival, even in countries with a National Health System providing equitable access to care.

In developed countries, there is increasing awareness of social inequalities as an important public health issue; as a consequence, there is a variety of strategies and policies being implemented throughout Europe. However, recent reviews emphasize that present knowledge on effectiveness of policies and interventions on health inequalities is not sufficient to offer a robust and evidence-based guide to the choice and design of interventions, and that more evaluation studies are needed.

The large disparities in health that we can measure within and between countries represent a challenge to the world; social health inequalities are avoidable, and their reduction therefore represents an achievable goal and an ethical imperative.