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Information about ongoing health services research and public health projects
| Clinical research professor | |
|---|---|
| Investigator (PI): | Krieger, Nancy |
| Performing Organization (PO): |
(Current): Harvard University, Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences / (617) 432-1135 |
| Supporting Agency (SA): | American Cancer Society |
| Initial Year: | 2015 |
| Final Year: | 2020 |
| Record Source/Award ID: | ACS/CRP-15-094-01 |
| Funding: | Total Award Amount: $400,000 |
| Award Type: | Grant |
| Abstract: | How scientists, policy makers, people affected by cancer (their own or of family members), and the broader public view the existence and causes of social inequalities in cancer determines how we as a society do, or do not, support work to eliminate them. A widespread awareness of the societal determinants of cancer and cancer inequities has yet to be achieved, in part because of limited frameworks and inadequate evidence. In alignment with the American Cancer Society's "priority focus on health equity in cancer prevention and control," I seek to conduct empirical and theoretical work that constructively challenges mainstream epidemiologic and clinical approaches to analyzing US social inequalities in cancer. Ultimately, the proposed projects are oriented around a single, critical goal: establishing a sound scientific basis for the elimination of these inequalities. Many challenges exist, chief among them: the persistence of scientific analyses and cancer surveillance programs that present data on "race" with scant or no data on socioeconomic position, discrimination, or historical context, or trends in cancer inequities. The net result is to limit the evidence base for both scientific understanding and effective interventions. Specific components of the proposed project are as follows: empirical study #1: Social inequalities in breast cancer estrogen receptor status: over time, across countries; empirical study #2: Methods to improve measuring and monitoring of cancer inequities; empirical study #3: Methods to improve measures of adverse discrimination, relevant for cancer research; and conceptual project: Cancer inequities and emergent embodied phenotypes: theory for causal analysis. The short-term contributions of the proposed empirical work to cancer control are thus three-fold: (1) new knowledge about the potential modifiability of social inequalities in two key biomarkers for breast cancer (estrogen and progesterone receptors, highly relevant to treatment and survival), as revealed by novel analysis of long-term trends jointly in relation to race/ethnicity and socioeconomic position; (2) improved methods for measuring and monitoring of cancer inequities, using novel measures that take into account the troubling rise of spatial social inequality, with neighborhoods increasingly characterized by extreme concentrations of privilege or deprivation; and (3) new methods for rigorously measuring exposure to discrimination that can readily be used by researchers concerned about causes of cancer inequities across the cancer continuum, from prevention to incidence to treatment to survival to mortality. This new empirical knowledge, combined with theoretical advances arising from the proposed conceptual project, underlie the long-term contribution to the control of cancer: advancing a cogent critical framework, informed by evidence, to further thinking and research on the causes of cancer inequities, so as to advance the action and resources needed to rectify and prevent them. |
| MeSH Terms: |
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| Country: | United States |
| State: | Massachusetts |
| Zip Code: | 02115 |
| UI: | 20163109 |
| Project Status: | Completed |