Black–White disparities across the colorectal cancer care continuum in the USA – Nature

 

Report on Racial Disparities in Colorectal Cancer Outcomes and Alignment with Sustainable Development Goals

This report examines the significant racial disparities in Colorectal Cancer (CRC) outcomes between Black and White individuals in the United States, framing the issue within the context of the United Nations Sustainable Development Goals (SDGs). The analysis highlights the central role of Social Determinants of Health (SDOH) in driving these inequities and proposes a strategic framework for their elimination.

1.0 Introduction: The Public Health Challenge and Its Link to Global Goals

Colorectal cancer represents a major public health burden globally and is the second leading cause of cancer-related mortality in the USA. Despite overall declines in incidence, stark disparities persist. This directly challenges the ambitions of SDG 3 (Good Health and Well-being), which aims to ensure healthy lives and promote well-being for all at all ages, particularly Target 3.4 concerning the reduction of premature mortality from non-communicable diseases.

• Black individuals in the USA experience disproportionately higher CRC incidence and mortality rates.
• Survival rates for Black individuals are notably lower when compared with their White counterparts.
• These persistent inequities undermine national health progress and highlight a failure to achieve SDG 10 (Reduced Inequalities), which calls for the empowerment and inclusion of all, irrespective of race or economic status.

2.0 Primary Drivers: Social Determinants of Health (SDOH) and Systemic Inequities

The evidence strongly indicates that racial disparities in CRC are not primarily driven by biological differences but by Social Determinants of Health (SDOH). These are the structural, economic, and social conditions that fundamentally shape health outcomes.

2.1 The Role of SDOH in Health Inequity

SDOH are the primary mechanism through which systemic inequities manifest as poor health outcomes, creating a clear violation of the principles of SDG 10. These factors directly influence an individual’s ability to maintain health and access care.

1. Access to Health Care: Inequitable access to timely and high-quality medical services, including screening and treatment, is a major contributor.
2. Socioeconomic Conditions: Factors related to poverty (SDG 1) and economic instability (SDG 8) limit opportunities for preventive care and adherence to treatment protocols.
3. Systemic and Structural Inequities: Historical and ongoing systemic factors create barriers that disproportionately affect Black communities, impeding their access to the resources needed for good health.

2.2 Modifiable and Non-Modifiable Risk Factors

The disparities are perpetuated by a combination of risk factors, most of which are modifiable and directly linked to adverse SDOH.

• Modifiable Risk Factors:
  • Low participation in CRC screening programs.
  • Lower rates of receiving guideline-concordant treatment.
  • Higher prevalence of medical comorbidities that increase CRC risk, often stemming from adverse living and working conditions.
• Biological Factors:
  • There is limited evidence to suggest that biological factors are the primary drivers of CRC disparities.
  • Observed biological differences are more likely influenced by the mechanisms through which social and environmental factors (SDOH) impact health over a lifetime.

3.0 A Strategic Framework for Achieving Health Equity and the SDGs

Existing evidence from successful interventions demonstrates that the elimination of Black–White disparities in CRC outcomes is an achievable goal. A dual approach is essential for making meaningful progress towards SDG 3 and SDG 10.

3.1 Near-Term Imperatives

Immediate efforts must focus on removing direct barriers to care to achieve rapid improvements in health outcomes.

1. Improve access to comprehensive CRC screening for Black communities.
2. Ensure equitable access to and receipt of guideline-concordant treatment for all diagnosed individuals.

3.2 Long-Term Systemic Interventions

Sustainable change requires addressing the root causes of inequity, which aligns with the broader mission of the SDGs.

1. Implement policies that dismantle the underlying and historical SDOH that drive health disparities.
2. Invest in community-based programs that address systemic barriers to care within Black communities.

4.0 Conclusion: A Call for Sustained Investment in Health Justice

The review underscores that disparities in CRC outcomes between Black and White individuals in the USA are a solvable problem rooted in social and structural inequities. Addressing this challenge is not only a public health priority but also a matter of social justice. A sustained commitment to a dual-pronged strategy—improving immediate access to care while simultaneously tackling long-term systemic barriers—is crucial. Such efforts will not only eliminate CRC disparities but will also advance the nation’s progress toward achieving key Sustainable Development Goals, particularly SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities), thereby improving the overall health of the nation.

Analysis of Sustainable Development Goals (SDGs) in the Article

SDG 3: Good Health and Well-being

Ensure healthy lives and promote well-being for all at all ages.

• The article directly addresses health outcomes related to Colorectal Cancer (CRC), which it describes as a “substantial public health challenge globally” and the “second leading cause of cancer-related death in the USA.” This aligns with the overall goal of promoting health and reducing mortality from diseases.
• It focuses on specific health issues like cancer incidence, mortality, and survival rates, which are central to SDG 3. The discussion revolves around improving these health outcomes for the entire nation by addressing disparities.

SDG 10: Reduced Inequalities

Reduce inequality within and among countries.

• The core theme of the article is the health disparity between Black and White individuals in the USA regarding CRC. It explicitly states that “disparities in CRC outcomes persist, especially among Black individuals” and that these “inequities are largely attributed to social determinants of health (SDOH).”
• By focusing on eliminating “Black–White disparities” and addressing “systemic inequities,” the article directly connects to the goal of reducing inequalities based on race and socioeconomic status.

Specific SDG Targets Identified

Targets under SDG 3: Good Health and Well-being

1. Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

   The article’s focus on reducing “cancer-related death” from CRC, a non-communicable disease, directly supports this target. It highlights that Black individuals face “higher CRC incidence and mortality,” and proposes interventions like improved screening and treatment to reduce these premature deaths.

2. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

   This target is relevant as the article identifies “access to health care” as a key factor in the observed disparities. It calls for “improving access to screening and guideline-concordant treatment” and addressing barriers that prevent the “receipt of timely, high-quality care.” These actions are fundamental components of achieving universal health coverage.

Targets under SDG 10: Reduced Inequalities

1. Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.

   The article’s central argument for eliminating “Black–White inequities in CRC outcomes” aligns with this target’s principle of promoting inclusion and equality for all, irrespective of race. The health disparities discussed are a clear example of unequal outcomes for a specific racial group, which this target aims to rectify.

2. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices and promoting appropriate legislation, policies and action in this regard.

   The article attributes the health disparities to “social determinants of health (SDOH), such as access to health care, socioeconomic conditions and systemic inequities.” It calls for addressing these “underlying and historical SDOH that drive inequities,” which directly relates to Target 10.3’s goal of reducing inequalities of outcome by tackling systemic and structural barriers.

Implied Indicators for Measuring Progress

The article mentions or implies several quantitative measures that can be used as indicators to track progress towards the identified targets.

• CRC Incidence Rate (disaggregated by race):

  The article explicitly states that Black individuals face “higher CRC incidence.” Tracking this rate, broken down by race, is a direct indicator of progress in reducing the disease burden and the associated inequality.

• CRC Mortality Rate (disaggregated by race):

  Mentioned as a key disparity (“higher…mortality”), this is a primary indicator for Target 3.4. The goal is to reduce this rate, particularly the gap between Black and White populations.

• CRC Survival Rate (disaggregated by race):

  The article notes “lower survival compared with White individuals.” This indicator measures the effectiveness of the entire care continuum, from screening to treatment, and is crucial for assessing health equity.

• CRC Screening Participation Rate (disaggregated by race):

  The article identifies “low participation in CRC screening” as a modifiable risk factor. This rate is a key process indicator for Target 3.8, as it measures access to and uptake of preventive health services.

• Rate of Guideline-Concordant Treatment (disaggregated by race):

  The mention of “low receipt of guideline-concordant treatment” points to this as a critical indicator of whether patients are receiving quality care, which is a core component of Target 3.8.

Summary Table of SDGs, Targets, and Indicators

SDGs	Targets	Indicators
SDG 3: Good Health and Well-being	3.4: Reduce by one-third premature mortality from non-communicable diseases. 3.8: Achieve universal health coverage and access to quality essential health-care services.	CRC mortality rates (disaggregated by race) CRC survival rates (disaggregated by race) CRC screening participation rates (disaggregated by race) Rate of receipt of guideline-concordant treatment (disaggregated by race)
SDG 10: Reduced Inequalities	10.2: Empower and promote the social, economic, and political inclusion of all, irrespective of race. 10.3: Ensure equal opportunity and reduce inequalities of outcome.	Disparities in CRC incidence rates between Black and White individuals Disparities in CRC mortality rates between Black and White individuals Disparities in CRC survival rates between Black and White individuals Disparities in access to screening and quality care based on race and socioeconomic status

Source: nature.com