Cancer: double trouble

Cancer is a leading cause of ill health and early death in Scotland. Most of us know that smoking, being overweight, drinking too much alcohol and not doing enough physical activity increase the risk of developing a preventable cancer. Fewer of us know that where you live in Scotland, the environment and circumstances in which you live matters a great deal; smoking 20 cigarettes a day is likely to kill the smoker, but the mortality risk is fourfold greater in some parts of Scotland compared to others, depending where you live. Poverty is the key driver of that difference.

Poverty in Scotland persists, and its effect on health is long lasting and profound. The word ‘poverty’ implies a shortage of money to provide even the basics for yourself and your family. That is only one dimension of the condition that people experience every moment of the day. Poverty is pervasive, eats away at wellbeing, and it forces decisions that are not in the long-term interest, especially for health. Poverty takes over. It puts immediate coping above longer-term interests, whether it is the type and amount of food we eat, the exercise we take, the escape we can achieve through smoking, dependency on drugs, drinking a lot or gambling a lot. We do things that increase our risk of disease, not least illnesses like cancer.  Poverty also means that these things are more likely to kill us if we are struggling than if we are wealthy. And it does this in big numbers – more than a quarter of ill health and early death from cancers could be prevented if everyone had the same life circumstances as the people in our wealthiest areas. Why?

Cancer is more often detected at a later stage among people in our poorest areas than in our wealthiest areas – and the later it’s caught the harder it is to cure. We know this from the data, but that’s not the whole story. The clue to some of the rest of the story lies in what people with cancer tell us. When you ask people with cancer what they need, they say they need help with money – in fact they say this three times more often that they say they need help with pain. Living with cancer is expensive – lost income, care expenses, travel and staying over for treatment – and people in poverty have less reserves (financially and sometimes emotionally) to mitigate that.  

So you see that poverty and cancer is double trouble – the circumstances of life put people at risk and, people in poverty are more likely to develop cancer. What can we do? We have to support people to do all the things we know we should (such as stopping smoking, drinking less alcohol, and moving about more). But we also have to level the playing field so that it’s easier to be healthy, and where you live doesn’t determine your life chances with cancer. The level of poverty that a country experiences is a conscious decision – it’s not an accident. Both poverty and cancer are costly in every respect, a great deal is preventable, and it’s not fair. We need to focus our efforts on the people less able to beat cancer alone – people living in poverty – and we also need to undo the causes of poverty in the first place. Doing that is fairer, and healthier.

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