Young Adults with Cancer – How Definitions of Health, Social Determinants, and Multilevel Models of Care Influence Health Care Provision

 Young Adults with Cancer: How Definitions of Health, Social Determinants, and Multilevel Models of Care Influence Health Care Provision 

Over the past 13 weeks, I, Nicole Freer, have explored several topics related to cancer care. Through this process, I discovered that cancer care in Ontario is influenced by various factors that contribute to inequities in care provision. The Canadian healthcare system is guided by definitions of health established in 1948 by the World Health Organization (WHO). Despite these guiding principles, inequities remain within the Canadian system. Multilevel approaches are used to identify and address these inequities, examining how socioecological factors impact access to cancer care and survivorship support. My focus has been on the young adult population in Ontario and the inequities they face in accessing care. 

Defining Health in Canada and its Impact on Cancer Care 

Understanding how Canada defines health is essential for understanding the distribution of cancer care services. The Canadian healthcare system, including provincial standards, is based on the WHO’s 1948 definition of health, which views health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (WHO, 1948). This comprehensive definition was designed to address all aspects of health. However, some critics argue that this definition is problematic. For instance, Card (2017), a health policy researcher, suggests that individuals can experience well-being even with a disability or illness, challenging the idea that health requires perfect psychological and physiological conditions. Others oppose the WHO definition, arguing that it leads to overmedicalization, and political decisions focused solely on health (Bircher & Kuruvilla, 2023; Schramme, 2023; Callaham, 2023). 

Despite these criticisms, Canada’s healthcare system is still based on WHO principles, which shape our standards of care with the goal of ensuring equal access to healthcare, including cancer care, across provinces. However, disparities in access to care still exist. 

The Scope of Cancer and Its Impact 

Before delving into the inequities faced by cancer patients, it is important to understand the scope of cancer in Canada. According to the Canadian Cancer Society (2025), in 2024, 247,100 Canadians are expected to be diagnosed with cancer, an increase from 239,100 new cases in 2023, likely due to Canada’s aging population. The number of cancer-related deaths is also expected to rise from 86,700 in 2023 to 88,100 in 2024. 

Cancer rates in Ontario are significant, with 556.3 cases per 100,000 people in 2022 (Cancer Care Ontario, 2022). In regions like Hamilton, Haldimand, Brant, and Niagara, cancer rates were 551.5 per 100,000 in 2020. These numbers highlight the widespread impact of cancer diagnoses across Canada. Given the diversity of Canada’s population and its vast geography, there are likely barriers to equal access to care, which are often shaped by social determinants of health. 

Social Determinants of Health (DOH) 

Social Determinants of Health (DOH) refer to the broad range of personal, social, economic, and environmental factors that influence individual and population health (Government of Canada, n.d.). This aligns with the WHO’s emphasis on a comprehensive approach to healthcare (Schramme, 2023). In Ontario, social determinants are recognized as key factors in determining health outcomes, and include socioeconomic status, employment, job conditions, education, childhood experiences, physical environments, social support, coping skills, healthy behaviors, access to health services, genetics, gender, culture, and race. 

Cancer Care Ontario identifies certain populations, including adolescent and young adults (AYA), who are at higher risk for poorer health outcomes due to these determinants. AYAs with cancer face numerous challenges, such as difficulty maintaining employment, attending school, and forming relationships. They also experience financial struggles, limited coping skills, increased side effects from treatment, mental health challenges, and difficulty understanding health information. As a result, AYAs are more likely to miss treatment or not access survivorship support, leading to less comprehensive care and worse long-term outcomes (Berkman et al., 2024). Unlike older cancer patients, young adults face lifelong challenges, including the risk of chronic diseases, body image issues, cancer recurrence, and the development of new cancers. This unique experience calls for a targeted response from healthcare organizations. 

Multilevel Frameworks for Addressing Health Disparities 

Given the size and diversity of Canada, disparities in cancer care and survivorship vary by region. An ecological multilevel approach considers how multiple socioecological factors—ranging from individual to policy levels—affect overall health and well-being (Baumgartner, 2024). According to Pearson (2021), an ecological model examines individual, interpersonal, institutional, community, and public policy factors. These frameworks help healthcare providers identify specific actions they can take to improve care within their scope of control. 

Applying the Ecological Model to AYA Cancer Care 

For young adults (AYA), the ecological model is useful in guiding care strategies. AYAs face unique and complex challenges during their cancer treatment, and their struggles continue after treatment. These patients are at risk for chronic disease, mental health issues, body image disturbances, and cancer recurrence. The survivorship quality care model emphasizes the importance of interpersonal, organizational, and community support in addressing these challenges (Berkman et al., 2024). 

As a clinical team member, I can collaborate with colleagues to create tailored care plans for AYA patients. Care plans should address personal concerns, provide clear explanations, assess social support, and consider psychological needs. Additionally, healthcare providers should receive ongoing education on the unique needs of AYAs and adopt pediatric strategies when appropriate. The healthcare system can also improve care by prioritizing resources to support these needs, collaborating with community partners, and offering practical support, such as financial and nurse navigators. 

The Role of Community Partnerships 

Community partnerships are crucial in enhancing cancer care for young adults. These partnerships can provide resources that hospitals may not have, such as transportation and mentorship programs. By connecting with community organizations, oncology units can offer additional layers of support that go beyond active treatment, such as education and emotional support. 

Conclusion 

By using multilevel frameworks to analyze cancer care for young adults, healthcare providers can better understand and address the barriers posed by social determinants of health. This approach can help improve care delivery and outcomes for the AYA population, ultimately leading to better support during their cancer journey. 

 

References 

   

Amy M. Berkman, Andrea C. Betts, Melissa Beauchemin, Susan K. Parsons (2024) Survivorship after adolescent and young adult cancer: models of care, disparities, and opportunities. Journal of the National Cancer Institute. 16(9), 1417-1428.  

https://doi.org/10.1093/jnci/djae119 

Armitage, R. (2022). The WHO’ s definition of health: a baby to be retrieved from the bathwater? BJGP life. https://doi.org/10.3399/bjgp23X731841  

Atoyan S, Muradyan A, Danelyan S, Tamamyan G, Bardakhchyan S and Papyan R (2023) The unique challenges of AYA cancer care in resource-limited settings. Front. Adolesc. Med. 1:1279778. http://doi.org/10.3389/fradm.2023.1279778   

Bircher, J., & Kuruvilla, S. (2014). Defining health by addressing individual, social, and environmental determinants: New opportunities for health care and public health. Journal of Public Health Policy, 25(3), 363-386.https://www.jstor.org/stable/43288035 

Brassolotto, J., Raphael, D., & Baldeo, N. (2014). Epistemological barriers to 
 addressing the social determinants of health among public health professionals 
 in Ontario, Canada: a qualitative inquiry. Critical Public Health, 24(3), 321–336. 
 https://nccdh.ca/images/uploads/CPH_Brassolotto.pdf 

Brook, R, H. (2018) Should the definition of health include a measure of tolerance? JAMA, 317(6), 585-586. https://doi.1001/jama.2016.14372 

Callahan, D. (1973). The WHO definition of ‘Health’. The Hastings Centre Studies 1(3), 77-87. https://www.jstor.org/stable/3527467 

Canadian Nurses Association. (2015, November). Framework for the Practice of Registered Nurses in Canada. - 2nd addition. Framework for the Practice of Registered Nurses in Canada 2015 

Card, A. (2017). Moving beyond the WHO definition of health: A new perspective for an aging world and the emerging era of value-based care. World Medical and Health Policy, 127- 137. 

Cancer Care Ontario (2024). Ontario statistics https://www.cancercareontario.ca/sites/ccocancercare/files/assets/Ontario-Cancer-Statistics-key-findings.pdf 

College of Nurses of Ontario. (2024) https://www.cno.org/ 

Government of Canada (2024, July 18). Social determinants of Health and health inequalities.  

https://www.canada.ca/en/public-health/services/health-promotion/population- health/what-determines-health.html 

Hovsepyan S, Hoveyan J, Sargsyan L, Hakobyan L, Krmoyan L, Kamalyan A, Manukyan N, Karches, K., DeCamp, M., George, M., Prochaska, M., Saunders, M., Thorsteinsdottir, B., & Dzeng, E. (2021). Spheres of influence and strategic advocacy for equity in medicine. Journal of General Internal Medicine, 36(11), 3537- 3540. https://doi.org/10.1007/s11606-021-06893-4 

HPE Public Health. (n.d.). The Social Determinants of Health. 
https://hpepublichealth.ca/wp-content/uploads/2019/08/HPEPH-Social_Determinants_Report_Edited.pdf 

Huber, M. (2011). Health: How should we define it? British Medical Journal, 343(7817), 
 235-237. https://doi.org/10.1136/bmj.d4163 

Olsen, E.R., Olson, A. Driscoll, M. Bliss, D. Z. (2024). Psychosocial factors affecting wellbeing and sources of support of young adult cancer survivors: A scoping review. Nursing Reports 14, 4006-4021. https://doi.org/10.3390/nursrep14040293  

Ontario Health (2024, October). Resource guide to Ontario health’s social determinants of health framework. https://www.ontariohealth.ca/sites/ontariohealth/files/Social-Determinants-of Health%E2%80%93FNIMui-Resource-Guide.pdf 

Saracci, R. (1977). The world health organization needs to reconsider its definition of health. British Medical Journal 314(7091), 1409-1410. https://wwwljstor.org/stable/25174539 

Schramme, T. (2023). Health as complete well-being: The WHO definition and beyond. Public Health Ethic, 16(3) 210-218. https://doi.org/10.1093/phe/phad017 

World Health Organization (1948). Definition of Health https://www.who.int/about/governance/constitution  

 

 

 

Comments

Post a Comment

Popular posts from this blog

Nursing in the 21st Century - Building your online media presence

Being a nurse in the 21st century Currently I belong to the College of Nurses of Ontario.  There is an entrance exam for your license and then you are held accountable to the standards of practice.  In the past I have belonged to the Registered Nurses Association of Ontario (RNAO) for networking and legal protection. I have also belonged to the Interventional Radiology Nurses Association, which is a professional group in the U.S.A, for education opportunities and networking. My profession integrates with many other professions.  We collaborate to develop and provide optimal patient care. This professions may be associated with healthcare, Informatics, business, communications, organizational development,  procurement, and education. These professions work together to develop action plans for the patient journey including direct patient care, financial reimbursement, community engagement, sustainability, future planning and the technology associated to the work. These...
Read more

Young Adults with Cancer - An Outpatient Clinics Role in Supporting Care Equity

Image
Vulnerable Cancer Populations: Who are they?       Close your eyes and consider an image of a cancer patient who experiences inequity in the Canadian health care system. Did you imagine a young adult a s vulnerable to health disparities ? Hovsepyan et a l (2023) s uggest “adolescents and young adults face poorer survival rates than children and adults” ( p. 2). Young adults with cancer face many challenges in their health journey including inability to work, attend school, build relationships, coping skills, understanding of health teaching, mental health challenges, and adopting healthy behaviour ( Berkman et al., 2024). They also have more side effects, financial challenges and a higher likelihood of not following through with care. Further, y oung adult cancer survivors face potential for recurrence, new cancer, physical impairment, psychological strain, and chronic condition (Cancer Care Ontario, 2023). These risks are compounded by economic ine...
Read more

Disparities in Cancer Care for Indigenous Peoples

Disparities in Cancer Care for Indigenous Peoples   Several factors contribute to the inequities in cancer care for Indigenous peoples in Canada. Cancer rates are higher among the Indigenous population, with increased morbidity and mortality observed in Ontario (Jumah et al., 2023; Ahmed & Shahid, 2012). This disparity is shaped by multiple factors, including intergenerational trauma and barriers to accessing care (Jumah et al., 2023; Horrill et al., 2019).   Individual-level factors include lower rates of participation in cancer screening programs (Jumah et al., 2023; Horrill et al., 2019). Many Indigenous communities are located in remote areas, often without the necessary equipment or staffing to provide adequate care (Jumah et al., 2023). Additionally, treatment and screening locations are frequently far from home, creating financial burdens due to the cost of travel, which deters many from seeking care (Jumah et al., 2023; Horrill et al., 2019). The legacy of co...
Read more