Vice President Joe Biden and former New York Mayor Michael R. Bloomberg announced Tuesday a $125 million gift to create a new cancer institute at Johns Hopkins Medicine. (Amy Davis/Baltimore Sun Video)
Recently, as part of the Obama administration's "moonshot" campaign to cure cancer, Vice President Joe Biden and former New York mayor Michael Bloomberg announced $125 million in grant funding to found the Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins. Their commitment to "rid the world of this disease" is commendable, but we cannot stop at biomedical innovation alone. Advanced medical technologies treat, but do not prevent, cancer, and they do so only for those with access to these life-saving resources. If we are to end "cancer as we know it," prevention must be our highest priority. And we cannot prevent cancer unless we address its social and environmental causes.
"Cancer as we know it" is inextricably linked to social determinants of health, conditions such as neighborhood location, air and water quality, wealth and employment, housing, transportation, literacy and educational attainment, and access to healthy food and exercise spaces. These factors shape risk levels for both cancer and other chronic and acute diseases.
For instance, a large body of well-founded scientific evidence links cancer of all types to air, water and land pollution, including industrial and agricultural pollution, as well as toxic chemicals in our building materials, furniture, cosmetics, food and more. Our most socially and economically marginalized population groups are disproportionately exposed to these hazards. One 2009 study found great racial and economic disparity in residential proximity to polluting industrial facilities: Nationally, blacks were 36 percent more likely than whites to live within one mile of such a facility; those with annual income of $15,000 or less were 40 percent more likely than those earning $40,000 or more to live near one; and those without a high school degree were 71 percent more likely to have one in their backyard than those with a college degree.
Here in Baltimore, a coalition of youth-led community activists fiercely opposed the construction of a waste-to-energy incinerator in Curtis Bay due to concerns about environmental toxicity. According to the EPA, the Curtis Bay neighborhood, already home to numerous energy and chemical industries, as well as one of the nation's largest medical waste incinerators, ranked among the nation's most polluted ZIP codes in 2009, with an annual output of over 13.6 million pounds of toxic emissions. Curtis Bay also happens to have a poverty rate of 23.9 percent, higher than the citywide average of 18.8 percent in Baltimore. It's hard to imagine a carcinogenic trash incinerator on a pastoral, tree-lined street in Roland Park.
In addition to shaping environmental risk, social determinants also influence behavioral risk. For instance, according to the CDC, smoking, which causes an estimated 30 percent of United States' cancer deaths, is more prevalent among groups with low income and education levels: 32 percent of adults who did not complete high school smoke, compared to 10 percent of adults with a college degree. Moreover, these groups are less likely to attempt to quit smoking and to have access to smoking cessation resources.
Lastly, social determinants drive disparities in cancer treatment and mortality. The National Cancer Institute cites low socio-economic status, lack of health insurance, barriers to accessing health services, and the absence of primary care providers as factors that contribute to lower screening and treatment rates, and therefore higher mortality, among black men and women.
Exciting advances in immunotherapy, like those proposed by the president's moonshot program and the new Bloomberg-Kimmel Center, offer promising new developments to cure cancer when it occurs. But these treatments and technologies do little, if anything, to change the social and environmental conditions that lead to cancer, nor do they ensure that those most vulnerable — and most impacted — have equitable access to both preventative and curative resources.
Our public health research and intervention efforts must aim to stop people from ever needing cancer treatment in the first place. To this end, we must reduce exposure to known carcinogens through aggressive environmental regulation at the city, state and federal level. Furthermore, we must work collaboratively across all policy sectors to improve economic stability, education, infrastructure and access to affordable, quality health care that largely define who develops cancer, who receives treatment and who survives.
Mr. Biden and Mr. Bloomberg are correct that there is no "silver bullet" that will end cancer, and biomedical advancements are one part of a comprehensive strategy. But unless we commit attention and resources to addressing the underlying social and environmental causes of this insidious disease, we will remain far from this noble goal.