Nogueira Leticia M, Yabroff K Robin
Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA.
J Natl Cancer Inst. 2024 Jan 10;116(1):15-25. doi: 10.1093/jnci/djad185.
Despite advances in cancer control-prevention, screening, diagnosis, treatment, and survivorship-racial disparities in cancer incidence and survival persist and, in some cases, are widening in the United States. Since 2020, there's been growing recognition of the role of structural racism, including structurally racist policies and practices, as the main factor contributing to historical and contemporary disparities. Structurally racist policies and practices have been present since the genesis of the United States and are also at the root of environmental injustices, which result in disproportionately high exposure to environmental hazards among communities targeted for marginalization, increased cancer risk, disruptions in access to care, and worsening health outcomes. In addition to widening cancer disparities, environmental injustices enable the development of polluting infrastructure, which contribute to detrimental health outcomes in the entire population, and to climate change, the most pressing public health challenge of our time. In this commentary, we describe the connections between climate change and cancer through an Environmental Justice perspective (defined as the fair treatment and meaningful involvement of people of all racialized groups, nationalities, or income, in all aspects, including development, implementation, and enforcement, of policies and practices that affect the environment and public health), highlighting how the expertise developed in communities targeted for marginalization is crucial for addressing health disparities, tackling climate change, and advancing cancer control efforts for the entire population.
尽管在癌症控制的各个方面——预防、筛查、诊断、治疗和生存护理——都取得了进展,但在美国,癌症发病率和生存率方面的种族差异依然存在,在某些情况下甚至还在扩大。自2020年以来,人们越来越认识到结构性种族主义的作用,包括结构性种族主义政策和做法,是造成历史和当代差异的主要因素。自美国建国以来,结构性种族主义政策和做法就一直存在,它们也是环境不公正现象的根源,这导致被边缘化社区过度暴露于环境危害之中,增加了患癌风险,破坏了医疗服务的可及性,并使健康状况恶化。除了加剧癌症差异外,环境不公正还助长了污染性基础设施的发展,这对整个人口的健康产生不利影响,并导致气候变化,而气候变化是我们这个时代最紧迫的公共卫生挑战。在这篇评论中,我们从环境正义的角度(定义为所有种族化群体、国籍或收入群体的人在影响环境和公共卫生的政策和做法的各个方面,包括制定、实施和执行方面,都能得到公平对待并切实参与)描述气候变化与癌症之间的联系,强调在被边缘化社区发展起来的专业知识对于解决健康差异、应对气候变化以及推进整个人口的癌症控制工作至关重要。