Accessibility to healthy diets is a major factor in cancer inequality


In light of the current cost-of-living crisis, we spoke to Cancer Research UK’s Inequalities Programme Lead, Dr Rachel Orritt, about the impact of a healthy diet and lifestyle on cancer susceptibility

A Healthy diet, exercise, forgoing tobacco, and avoiding excessive amounts of alcohol are often cited as key measures in disease prevention. According to Cancer Research UK, almost 40% of all cancers are preventable, with poor diet and smoking being leading causes of cancer development. Yet, while there is a plethora of information aimed at driving forward the blueprint for healthy living, putting recommendations into practice can be far from simple, especially in the face of rising living costs.

The onset of the COVID-19 pandemic coupled more recently with soaring food and fuel costs has not only made it harder for individuals and families to maintain a healthy diet but has also exacerbated health inequalities. Likewise, delays in government policies aimed at mitigating the consumption of unhealthy foods are painting a worrying picture of the long-term effects poor diet and rising costs could have on cancer. To discuss this, Health Europa Quarterly reached out to Cancer Research UK’s Inequalities Programme Lead, Dr Rachel Orritt.

What are the key goals of Cancer Research UK?

Essentially, we want to create a world where everyone can lead longer, better lives free from the fear of cancer. It is a world where some types of cancer are effectively eliminated, and many more cancers are prevented from developing in the first place. Similarly, those people who do develop cancer are diagnosed at the earliest possible stage. That means that treatments are much more likely to be successful.

Regarding treatments, we want them to be effective, kinder, and more targeted, so people can lead better and more fulfilling lives. In the context of this interview, there is another goal within that, which is that everyone shares in that progress equally, regardless of who they are, where they are from, or what type of cancer they have. We want progress to be felt equally across society.

How has the COVID-19 pandemic impacted the welfare of cancer patients?

We still do not know the full impact of COVID on cancer because it takes time for research to uncover the whole picture. We do know that the pandemic has been hugely disruptive to cancer care. The NHS was put under immense pressure from March 2020, and cancer screening effectively stopped for a few months. The number of people being referred for a test also dropped, and many tests and treatments for people who already knew they had cancer were delayed.

COVID-19 has only exacerbated the long-standing problems that we had pre-pandemic. Despite NHS staff working as hard as they possibly could, cancer waiting time targets have not been met since 2015. We need to deal with the backlog from the pandemic, but we also need to make sure that we put in place processes and resources so that cancer services are fit for the future. That means first and foremost investing in the kits and the extra staff that the NHS really needs. Essentially, it has been years of underinvestment in both staff and diagnostic equipment.

We are seeing the worst staffing crisis in NHS history and that impacts what cancer patients experience; they are feeling the brunt of this. People are waiting too long for the tests and treatments that they need for their cancers. At this point, in particular, whoever becomes the next prime minister needs to face up to these challenges and needs to make cancer services a priority. It is a huge task, but one that we are hopeful that the next government will face up to.

Even though there have been these delays, we would urge people to come forward to their GP if they notice anything unusual in their health, because that is really key. Cancer diagnosed at an early stage is more likely to be treated successfully. So even if it is difficult to get in touch with your GP, keep trying and the chances are that that unusual symptom will not be cancer, but if it is, it is much more likely that it will be treated successfully.

How impactful are a healthy diet and lifestyle in cancer development? Can you highlight some key lifestyle and dietary risk factors?

A healthy diet includes lots of fruits, vegetables, whole grains, high fibre foods, and healthy sources of protein like beans or fresh chicken. It is also low in processed foods and red meat, as well as foods high in sugar, fat, and salt. Cutting down on processed and red meat, and eating a diet high in fibre reduces the risk of cancer.

Obesity is the biggest causes of cancer after smoking and this issue is particularly worrying in the UK. We need to create an environment which supports people in keeping a healthy weight because otherwise, it is going to continue to be a problem and we are going to see the effects on cancer rates in the future.

What are the key challenges when researching and interpreting the effect of nutrition on cancer risk?

Gathering research on food intake can be tricky because it relies on people remembering and accurately recording what they have eaten. The good thing is this research has been going on for several years, so we can look across the body of research and draw conclusions that are more reliable than looking at a single paper.

Often what happens with research is a single paper will come out that says something quite media-worthy and that will get picked up by the press, and perhaps skew people’s opinion of what a healthy diet is. What we do at Cancer Research UK is look across the whole body of evidence, our health information experts do this continually so that we can reassure people that information from us is up to date and based on the best quality evidence.

Like any research, it is important to think about involving enough people and involving a diverse group of people so that the results have a better chance of reflecting what is going on in the real world.

It has taken years of campaigning by the health charity sector and the UK Government was set to take definitive action on
childhood obesity later this year. That came in the form of restrictions on junk food advertising and price promotions, but they have been delayed @iStock/SolStock

What are some of the key barriers to maintaining a healthy diet? How does this vary across demographics?

It is becoming increasingly difficult to eat a healthy diet and it is going to impact cancer in the long term. It will mean that more people are getting cancer through those dietary factors and obesity.

The rising cost of living crisis and other financial pressures that people are under affects how able we are to eat a healthy diet in lots of different ways. On a simple level, this means having enough money to buy food and access to basic resources. But beyond that, it entails access to cooking facilities and maintaining those cooking facilities as well as having the time to prepare food. People may have multiple jobs or caring responsibilities so will likely find it more difficult to choose, shop for and cook healthy meals.

Often when we are talking about barriers to healthy eating, we talk about information on what a healthy balanced diet is. But the more we understand about inequalities and the financial pressures that people are under, the more we see that other barriers are actually bigger and less surmountable than just information. Certainly, providing the information is very important but there are other things that we need to do if we want to open the options up for people to have more healthy balanced diets. When those options are taken away, the alternatives are usually foods that are higher in fat, salt, and sugar. This is because it is much cheaper and easier to get the calories you need for the day from those foods. So, people from more deprived groups, particularly when there are other forces at play, are not left with many options at all. It is a really difficult situation.

The rising cost of living crisis and other financial pressures
that people are under affects how able we are to eat a healthy
balanced diet in lots of different ways © iStock/Marina113

What could be done at a policy level to better address health and cancer inequalities and strengthen preventative measures for cancer?

We need the government to really take this seriously and make policy changes so that people do have more options in the future and are practically able to feed themselves and their families a healthy balanced diet.

It is important to recognise that there is no single solution. It is going to be a multi-pronged approach to tackle health inequalities. First and foremost, we have to recognise that they are the result of wider determinants of health including social, environmental, and economic inequality.

It has taken years of campaigning by the health charity sector and the UK Government was set to take definitive action on childhood obesity later this year. That came in the form of restrictions on junk food advertising and price promotions, but they have been delayed. They were really important measures that would help us create healthier food environments and reduce obesity; the government’s own report agreed with that assessment. It showed that price promotions do lead us to buy 20% more than intended and they cause us to impulse buy those foods that are high in fat, salt, and sugar. The impact of that is biggest among those in more deprived groups so that is a key issue. People are not going to feel the benefit of those policy restrictions for longer and that will have an impact on people’s health, particularly at this time.

We need a cross-government strategy to reduce health inequalities and the health disparities white paper was a good starting point for that. It was an opportunity for the government to commit the funding, and to have that accountability to tackling health disparities that were exacerbated during the pandemic. However, this has also been delayed. We hope that these delays are not a reflection of waning interest from the government to address health inequalities through dietary factors.

As far as research is concerned, there are still gaps in understanding cancer inequalities, so we need to sustain research in this area, and that is something we are working on. Alongside that, we need more consistent and sustained data collection within the health system and that will include demographic information. This is important for enhancing our understanding of cancer inequalities.

Dr Rachel Orritt
Inequalities Programme Lead
Cancer Research UK

This article is from issue 23 of Health Europa Quarterly. Click here to get your free subscription today.


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