Reduce Dutch cancer care inequalities with a ‘Health in All Policies’ approach, say cancer advocates

The Netherlands has been confronted with a new report showing inequalities in cancer screening between people with high and low incomes. Advocates are calling for public health to be embedded in all types of policies to reduce treatment disparities.

Income-related Treatment Inequality

The Netherlands’ Comprehensive Cancer Organisation (IKNL) told Euractiv that income-related treatment inequality relates to preventing, screening, and caring for cancer patients, they argue for a formal ‘Health in All Policies’ approach.

Earlier this year, a Swedish Institute for Health Economics (IHE) report commissioned by the European Federation of Pharmaceutical Industries and Associations (EFPIA) found that the risk of developing and surviving cancer is shaped by where a person lives. Identifying and reducing inequalities a European patient faces when compared to one of their neighbours in a different EU state has therefore become crucial.

Participation Gap in Cancer Screening

While the Netherlands is among the leading countries in some metrics, it has identified areas of improvement. For example, the participation gap in cancer screening between people with a high and low income was found to be large compared to other EU member states. Consequently, such disadvantaged patients often present more advanced stages of cancer.

“Our health is not just determined by our lifestyle, genes or access to care, but also by such factors as our living environment, residential environment, and income. Policymakers can reduce health differences by taking these factors into account,” a spokesperson for the IKNL told Euractiv.

Misinformation, or Lack of Insurance

Administrative aspects, such as providing correct and understandable information, complemented with targeted and audience-focused prevention programmes should be taken into consideration.

Possible reasons for the socio-economic screening gap include a lack of knowledge or misinformation about cancer screening, a person’s migration background, being un-insured, or under-insured, and having a low health literacy, the spokesperson said.

They added that it’s also important for health to be considered alongside other policy areas too.

“The resulting policy is referred to as Health in All Policies (HiAP). Health care providers can reduce inequalities by ensuring patient-centred care, taking health literacy and potential barriers into account,” the spokesperson said, highlighting that a person’s health is not only determined by their lifestyle, genes, or access to care.

Ongoing Initiatives

According to the IKNL’s spokesperson, there are a number of ongoing initiatives being taken to continue reducing inequalities in cancer care. As a knowledge institute and manager of the Netherlands Cancer Registry, the IKNL is one of the initiators of the Netherlands Cancer Agenda in which inequalities are considered in all themes and actions.

The spokesperson highlighted that a few years ago, the Health Ministry started funding municipalities to stimulate a local integrated approach to reduce health inequalities as part of the National Prevention Program. The programme, GezondIn, provided tailored advice and support on local approaches to health disparities to 164 municipalities.

“Despite all these initiatives, lots of work has to be done on reducing disparities, and that is what we, as IKNL, with our data-driven insights, try to illuminate,” the spokesperson said.

However, the IKNL also frequently spotlights areas the Netherlands excels at. For instance, the Netherlands places a Nutri score on the packaging of products to try to make it clearer for people to differentiate between healthy and unhealthy food.

The Dutch have also used HPV vaccination buses and pop-up vaccination stops during the HPV immunisation campaign to reach the target group of young adults.

Using NGS in More Than Half of Biopsies

The IHE report mentioned several areas the Netherlands, along with other countries, is considered to be a leader in. Denmark and the Netherlands were the only countries to report the use of next-generation sequencing (NGS), a technique that offers oncologists more comprehensive diagnostic information that can be used to offer patients more targeted treatments in more than half of all biopsies.

In contrast, no biopsy samples are analysed with NGS in Czechia and Slovakia. The report also found that while there are over 2,000 cancer survivors per 100,000 inhabitants in the Netherlands, this figure drops to fewer than 1,300 survivors in Cyprus.

Political commitment at the EU level to tackle cancer has received a significant boost with the publication of Europe’s Beating Cancer Plan (EBCP) in 2021, the IHE report said. One of the key elements of this plan entails improving access to innovative and evidence-based treatment.

Pharma Companies as Partners

Euractiv asked Roche Netherlands General Manager Andrew Plank whether pharmaceutical companies have a role to play in reducing cancer care inequalities. Plank said that Roche made a voluntary commitment to file its medicines, including its oncology medicines, for pricing and reimbursement (P&R) within two years of EU approval in all EU member states.

“That’s the first step we can take to make sure that any innovation we bring to market, we’re as quick as possible to give every health system the opportunity to adopt that medicine to benefit patients,” said Plank.

However, Plank highlighted the importance of working in synergy with governments since they know where their patients live and work and how to properly deliver their care.

“We can provide a solution, but we’re not a care delivery arm. So we want to partner. We want to collaborate. We want to remove barriers,” said Plank who described the overall mission as something that needs to be done together with governments.

“It’s not something the sector or a single company like Roche can accomplish on its own,” he said.

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