Sir, – Further to Paul Cullen's article "Ireland's 'cancer boom': what's gone wrong?", (February 8th), there is an enormous difference in the mortality rates from cancer depending on where you live in this country. The recent Atlas of Health Inequalities from the Centre for Health Geoinformatics, NUI Maynooth, described how people in the most disadvantaged areas have up to three times the mortality rate for cancer of those in the most affluent areas.
Social inequality is the biggest predictor of excess and early deaths from cancer. It is convenient to ascribe these deaths to lifestyle issues and that is undoubtedly an issue (although many are understandable, if unhelpful, coping mechanisms to deal with complex and stressful life and health problems), but even when correcting for these factors income inequality is itself a powerful cause of unequal cancer mortality.
John Crown describes the huge advances in treatment of cancer in this country and that is obvious to those of us at the coalface of the health system. This has not affected the inequality in outcomes unfortunately. Prevention and early detection remain a challenge. This depends on effective primary care and access to diagnostic tests, which are currently much less available in the areas with the worst mortality.
Northwest Dublin has the area with the highest death rate from cancer in the country, yet has one GP for 3,600 people compared with the national average of 1 for 1,800 – exactly half. Medical card patients in this area wait 11 months for an abdominal ultrasound (useful for picking up cancer) as against two months in southeast Dublin. If you have health insurance, the wait is less than a week.
This confluence of high sickness and death rates together with underprovision of care combine to form what is called the inverse care law, where those most in need of healthcare are least likely to get it. This is what results from distributing resources according to numbers without reference to the differing health needs in different areas.
While the ageing population will contribute to some rise in cancer incidence, if all parts of the country could have the same mortality as the most affluent, there would be a huge decrease in overall cancer mortality rates.
Cancer is not one single disease with a single solution, but addressing the profound inequality in access to the health service would be a start. – Yours, etc,
Dr EDEL McGINNITY,
Mulhuddart,
Dublin 15.