Report on Geographic Disparities in U.S. Cancer Screening and Alignment with Sustainable Development Goals

Executive Summary

• A study published in JAMA Network Open reveals persistent geographic and socioeconomic disparities in cancer screening rates across the United States from 1997 to 2019.
• These findings directly impact progress toward key Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities).
• While overall screening uniformity has improved, clusters of low participation linked to socioeconomic disadvantage remain a significant public health challenge, undermining the goal of ensuring healthy lives for all.

Geographic Patterns in Health Service Access

• Analysis of data from 3,142 U.S. counties identified consistent geographic clustering in screening for breast, cervical, and colorectal cancers.
• High screening prevalence was consistently observed in the Northeastern U.S. (Maine, New Hampshire, Vermont, and Massachusetts).
• Conversely, clusters of consistently low screening prevalence were identified in the Southwest (Texas, New Mexico, and Arizona).
• Spatial autocorrelation analysis confirmed that while disparities have decreased over time—with mammography screening distribution becoming 83% more uniform—significant regional clusters of low access persist.

Socioeconomic Disparities and SDG 10: Reduced Inequalities

• The report establishes a direct correlation between low screening rates and socioeconomic disadvantage, highlighting a critical challenge to achieving SDG 10, which aims to reduce inequality within and among countries.
• Counties with consistently low screening rates were characterized by significant disadvantages relative to high-screening counties.
• Key indicators of this inequality include:
  1. Lower county-level median home values (mean of $74,370.45 in low/high clusters versus $111,820.41 in consistently high clusters).
  2. Greater prevalence of lower educational attainment, lower incomes, and lower insurance coverage.
• These findings underscore how socioeconomic inequality creates significant barriers to accessing essential health services, preventing equitable health outcomes.

Implications for SDG 3: Good Health and Well-being

• The observed disparities in cancer screening directly impede progress on SDG Target 3.4, which aims to reduce premature mortality from non-communicable diseases through prevention, detection, and treatment.
• Unequal access to early detection services like mammography leads to poorer health outcomes and threatens the universal health coverage targets embedded within SDG 3.
• Addressing these screening gaps is essential for ensuring healthy lives and promoting well-being for all at all ages.

Contributing Factors and Policy Recommendations

• The study identifies several structural barriers that contribute to these health inequalities, connecting to challenges addressed by other SDGs.
  1. Infrastructure and Access (SDG 11): Transportation barriers and a relative lack of health facilities in rural areas limit access for vulnerable populations.
  2. Poverty and Economic Stability (SDG 1): Lower incomes and insufficient insurance coverage are cited as primary factors that exacerbate barriers to cancer screening.
• The authors call for future studies to incorporate county-level healthcare access characteristics to better inform targeted policies and interventions aimed at eliminating these disparities and advancing public health goals.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

• The article’s central theme is cancer screening (mammography, cervical, and colorectal), which is a critical component of preventative healthcare and early detection of non-communicable diseases, directly aligning with the goal of ensuring healthy lives.

SDG 10: Reduced Inequalities

• The study explicitly links low cancer screening rates to “socioeconomic disadvantages” and geographic location. It highlights disparities between high-prevalence areas (Northeast) and low-prevalence areas (Southwest), and between counties with higher and lower median home values, pointing directly to inequalities in health outcomes and access.

SDG 11: Sustainable Cities and Communities

• The article mentions “transportation barriers” and a “lack of health facilities in rural areas” as contributing factors to low screening rates. This connects to the goal of providing access to essential services and sustainable transport for all, particularly for residents in rural and underserved communities.

2. What specific targets under those SDGs can be identified based on the article’s content?

SDG 3: Good Health and Well-being

• Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment. The article focuses on improving cancer screening, which is a key strategy for the prevention and early treatment of cancer, a major non-communicable disease.
• Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services. The article points to barriers such as “lower insurance coverage” and a “lack of health facilities,” which are central challenges to achieving universal health coverage and equitable access to essential services like cancer screening.

SDG 10: Reduced Inequalities

• Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of… economic or other status. The research shows that counties with “lower socioeconomic status,” “lower educational attainment,” and “lower incomes” have consistently low screening rates, indicating a lack of inclusion in essential health services.
• Target 10.3: Ensure equal opportunity and reduce inequalities of outcome. The “persisting disparities” in cancer screening rates between different geographic and sociodemographic groups represent a clear inequality of health outcomes that this target aims to address.

SDG 11: Sustainable Cities and Communities

• Target 11.2: By 2030, provide access to safe, affordable, accessible and sustainable transport systems for all. The article identifies “transportation barriers” as a specific reason for low screening adherence, directly relating to this target.
• Target 11.a: Support positive economic, social and environmental links between urban, peri-urban and rural areas. The disparity noted between rural areas (lacking health facilities) and urban communities highlights a disconnect in regional development and service provision, which this target seeks to improve.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Indicators for SDG 3

• Cancer screening prevalence: The article explicitly measures and analyzes the prevalence of mammography, Papanicolaou testing, and colorectal cancer screening at the county level. This serves as a direct indicator for preventative health services (Target 3.4).
• Geographic distribution of screening services: The use of “Global Moran I analysis” to measure spatial autocorrelation of screening rates is a specific metric used to track whether geographic disparities in access are increasing or decreasing over time (Target 3.8).

Indicators for SDG 10

• Screening rates disaggregated by socioeconomic status: The article implies this indicator by comparing screening clusters with county-level data on “median home value,” “lower incomes,” and “lower educational attainment.” Measuring these differences is key to tracking progress on reducing health inequalities (Target 10.2).
• Disparity in screening rates between geographic regions: The study’s comparison of “consistently high screening prevalence” in the Northeast versus “consistently low clusters” in the Southwest provides a clear indicator of geographic inequality in health outcomes (Target 10.3).

Indicators for SDG 11

• Proximity/access to health facilities: The article implies the need for this indicator by citing the “relative lack of health facilities in rural areas” as a barrier. Measuring the density of clinics or travel time to the nearest screening center would be a relevant metric (Target 11.a).
• Impact of transportation on healthcare access: While not quantified, the mention of “transportation barriers” suggests that indicators measuring access to transport for healthcare appointments could be used to track progress (Target 11.2).

4. Table of SDGs, Targets, and Indicators

Source: auntminnie.com