Williams Faustine, Zoellner Nancy, Hovmand Peter S
Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, USA,
Social System Design Lab, George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO USA.
Transdiscipl J Eng Sci. 2016;7. doi: 10.22545/2016/00072. Epub 2016 Apr 10.
In 2012, almost 57% of all cancer cases and 65% of cancer deaths occurred in low-and middle-income countries. If the current trend continues, the burden of cancer will increase to 22 million new cases annually by 2030, with 81% of new cases and almost 88% of mortality occurring in less developed countries.
A qualitative review of the literature was conducted. This included a systematic search of eight electronic databases namely, PubMed, Academic Search Premier, CINAHL, Applied Social Sciences Index, EMBASE, SCOPUS, Cochrane and PsycINFO. The reference list of articles retrieved were also thoroughly searched. Inclusion criteria were studies that addressed global health, cancer disparities and global or economic development.
Thirty-one articles were identified that met the eligibility criteria. Results were synthesized in the form of a system dynamics causal loop diagram or map which led to identification of eight major stocks or system variables. These included, children and adult population, overall population health, pollution, quality of healthcare delivery, quality of neighborhood and built environment, social and community cohesiveness, healthy and social norms and attitudes, and literacy level. Based on this, a dynamic hypothesis of global health cancer disparities was developed. The causal loop diagram showed the role of multiple interacting feedback mechanisms as explanations for trends in global health cancer disparities and the underlying consequences.
Addressing these determinants of health requires an effective dynamic approach to improving global cancer health. Application of a systems thinking methodological approach has the potential to provide new understanding to how global development trends in combination with global health efforts to improve population health could shift cancer disparities and burden associated with the disease.
2012年，几乎57%的癌症病例和65%的癌症死亡发生在低收入和中等收入国家。如果当前趋势持续下去，到2030年癌症负担将增加到每年2200万新病例，其中81%的新病例和近88%的死亡将发生在欠发达国家。
对文献进行了定性综述。这包括对八个电子数据库进行系统检索，即PubMed、学术搜索高级版、护理学与健康领域数据库、应用社会科学索引、EMBASE、Scopus、Cochrane和PsycINFO。还对检索到的文章的参考文献列表进行了全面搜索。纳入标准是涉及全球健康、癌症差异以及全球或经济发展的研究。
确定了31篇符合入选标准的文章。结果以系统动力学因果循环图或地图的形式进行综合，从而确定了八个主要存量或系统变量。这些包括儿童和成人人口、总体人口健康、污染、医疗服务质量、社区和建成环境质量、社会和社区凝聚力、健康及社会规范与态度，以及识字水平。基于此，提出了全球健康癌症差异的动态假设。因果循环图显示了多种相互作用的反馈机制在解释全球健康癌症差异趋势及其潜在后果方面的作用。
应对这些健康决定因素需要采取有效的动态方法来改善全球癌症健康。应用系统思维方法有可能为全球发展趋势与改善人口健康的全球健康努力相结合如何改变癌症差异及与该疾病相关的负担提供新的理解。
