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Cancer is social and political as well as medical

11221511_sCancer is the best death, apparently. As a medical practitioner and former editor of the British Medical Journal, one supposes Dr Richard Smith knows what he’s talking about. His argument is almost philosophical, making the case that a long descent into the grave allows for the wrapping up of one’s personal affairs and prepares friends and family for life after you. Considered in isolation from the traumatic experiences this disease causes millions of people every year, I suppose there’s a certain logic to it. Though I’m not too sure about “wasting” billions on curing cancer. The pharmaceutical industry and its doings are far from unproblematic, but the war against disease is a good war. It should be up to individuals when to call it a day after all.

Published simultaneously was a study claiming that the majority (two thirds) of adult cancers are the results of bad luck. You have wonky genes, or one of your stem cells might slip up somewhere. It is, however, worth noting that we’re talking *types of cancer* here, not cancers in total.

As Owen points out, cancer – like a great deal of disease – has been individuated. The rise of lifestylism and the markets that feed it are constantly reinforcing the message that health is a matter of personal responsibility. If you don’t want cancer, then eat well, do your exercise, and avoid smoking, boozing, and fatty foods. Treat your body like a holy shrine, not a drip tray catching the run off from a revolving hunk of doner meat. That’s the hegemonic set of ideas washing about health policy, public health discourses and the common sense of lifestyle gurus. Contrasting the biologically random chance of cancer puts paid to some of the guilt tripping this industry, for that is what it is, thrives on. That, however, only goes so far.Cancer is social.

Take Stoke-on-Trent, for example. According to the 2012 Public Health Report for the city, it is the 16th most deprived local authority area in England (out of a possible 326). 60.3% of people live in areas among the top 25% most impoverished areas in the country. About half of that (31.3% of total Stokies) lived in the top ten per cent of most deprived communities. In 2008-10, the life expectancy for men in Stoke was 76.2 and women 80.2, whereas for England as a whole it was 78.8 and 82.6 respectively. Of the main causes of death in 2011, 72.9% was made up of respiratory disease, circulatory disease, and the biggest was … cancer. It accounted for 31.7% of total mortality across the city.

The equivalent figure for England is 28.1%. Among the under-75s, the average cancer mortality rate per 100,000 was 141.6. A historic low, but significantly greater than the same statistic for the country as a whole (112.5). There’s considerable variation within the city too. In Meir Park ward the rate was 78.4 whereas Bentilee and Ubberley returned a figure 0f 191.8. The difference? Wealth. If you live in a wealthier area, you’re a third more likely to survive a cancer diagnosis.

As befits the age, the story our culture tells about cancer is one of individuals battling against the disease, as per Stephen Sutton, or folks rallying around to to raise awareness. What it refuses to talk about the bigger picture, how diagnosis and survival is very much linked to one’s material circumstances. The danger is talk of cancer being entirely random disappears the awful truth: that regardless of type it is mediated by social conditions. That makes the war on cancer more than just a medical matter. It’s a political question too.

This article first appeared at All that is Solid

Image Copyright: / 123RF Stock Photo

5 Comments

  1. James Martin says:

    Yes, an illness like cancer can be random, but the article is correct to say that poverty is a significant factor, in that there is less difference than at first appears between a gene based illness like cancer and other diseases.

    As to Dr Smith, if he was talking about the increased cancer risks based on mutation probability that obviously get greater the longer you live there is a point there – we are all mortal and cannot ‘cure’ that. But his comments are crass in the extreme when put in the contest of the cruelty of child cancers, or of young parents dying from cancer and leaving behind children that will never know them. Which makes getting better treatment and the research that goes with it as far from a waste of time as you can imagine.

  2. Roger McCarthy says:

    “There’s considerable variation within the city too. In Meir Park ward the rate was 78.4 whereas Bentilee and Ubberley returned a figure 0f 191.8.”

    Sorry but these wards are too small to draw such sweeping epidemiological conclusions.

    Meir Park has a resident pop of just under 5,000.

    So 78.4 rate per 100,000 amounts to just 4 <75 cancer deaths that year.

    While Bentilee has a pop of nearer 9,000 and a 191.8 rate this still only equates to around 17 75s which is incidentally why these numbers are so low)? Without it any cancer rate could be hugely misleading.

    For example even a poor inner city ward would have a very low cancer mortality rate if its population was almost entirely made up of young families and singles – while the most genteel ward in Bournemouth or Eastbourne would obviously have a much higher rate due to the sheer number of pensioners however affluent they might be.

    1. Roger McCarthy says:

      Somehow message lost a para should be

      “There’s considerable variation within the city too. In Meir Park ward the rate was 78.4 whereas Bentilee and Ubberley returned a figure 0f 191.8.”

      Sorry but these wards are too small to draw such sweeping epidemiological conclusions.

      Meir Park has a resident pop of just under 5,000.

      So 78.4 rate per 100,000 amounts to just 4 75s which has a huge impact and is incidentally why these numbers are so low)? Without it any cancer rate could be hugely misleading.

      For example even a poor inner city ward would have a very low cancer mortality rate if its population was almost entirely made up of young families and singles – while the most genteel ward in Bournemouth or Eastbourne would obviously have a much higher rate due to the sheer number of pensioners however affluent they might be.

  3. Roger McCarthy says:

    OK correctly retyped message but it still eliminates middle paragraph!

    Please delete all comments as they make no sense with sentences randomly excised.

    Basically you can’t draw serious conclusions from such low numbers at ward level.

  4. Syzygy says:

    Salutary reminder of the impact of wealth on health.

    IMF demands for cut-backs in public health and hospitals in Sierra Leone similarly has played a political role in upgrading the spread of Ebola and its death rate.

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