Understanding Global Cancer Disparities: The Role of Social Determinants from System Dynamics Perspective.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.