Health and healthcare equity in the cancer care sector in Canada: Results of a rapid scoping review.

Abstract

e18536 Background: Despite advances in research and treatment, and a publicly funded healthcare system in Canada, alarming inequities exist across the cancer continuum. Although attention to these inequities is increasing, it is unclear how organizations are acting upon calls to address health equity. Our objective was to identify how health and healthcare equity are being discussed as a goal or aim within the Canadian cancer care sector. Methods: A rapid scoping review was conducted for published and unpublished literature on health equity in the Canadian cancer care sector. As this review was part of a larger initiative aimed at informing policy recommendations and research priorities with specific time constraints, we also drew on the WHO’s guidance for conduct of rapid reviews to strengthen health policy and systems. Five biomedical databases, 30 public health and multidisciplinary websites and databases, and Google were searched. Documents available in English, published between 2008 and 2021, and that discussed health or healthcare equity in the Canadian cancer context were included. Results: Of 3,678 documents screened, 83 were included for full text analysis. The focus on health equity within the Canadian cancer care sector increased 3-fold between 2015-2021 when compared with the period 2008-2014. Only 25% of documents included a definition of health equity. Concepts such as inequity, inequality, and disparity were frequently used interchangeably or in a tokenistic way, resulting in conceptual muddling. Less than half of documents included an explicit health equity goal. Stated health equity goals ranged from broad to specific, with examples from across the cancer continuum. A range of actions were described to address equity goals, including health system improvements and policy and planning considerations. Most actions were framed as recommendations rather than actions taken or underway, and few documents described measurement of progress toward health equity goals. Conclusions: Health equity is a growing priority in the cancer care sector, however conceptual clarity is needed to guide the development of robust equity goals, specific objectives, and meaningful action. Moreover, evaluation mechanisms to understand the impacts of actions on equity goals are urgently needed. If we are to advance health equity in the cancer care sector, a coordinated and integrated approach will be required to enact transformative and meaningful change.