Health disparities in cancer care: Exploring Canadian, American and international perspectives.

I t is exciting to see nurses in cancer care increasing their attention to health equity and social justice. Such concerns have not dominated research and practice in relation to cancer; perhaps, in part, because cancer carries less social stigma than health issues where equity concerns are foregrounded such as mental health problems, violence or HIV (with exceptions such as lung cancer in people who smoke). Cancer nurses are amplifying their attention to health inequities (or disparities) at a time when understanding of the foundational concepts is becoming increasingly robust. The purpose of this introduction is to review the concepts foundational to integrating health inequities in health research and practice and to consider their specific relevance to cancer care. The terms 'disparities' and 'inequities' are often used interchangeably and both must be distinguished from inequalities. 'Inequality' is a broad term referring to differences between groups, whether or not they are unfair. Inequities or disparities refers to differences that are a) unfair and, thus, morally concerning, b) caused by social arrangements, and c) potentially remedial (Whitehead & Dahlgren, 2006). This understanding of inequities is founded on a critical conception of social justice, which differs from the idea of dis-tributive justice underpinning much of western thinking in health care ethics, research, and practice. Distributive justice focuses on fair allocation of resources in society (Hoedemaekkers & Dekkers, 2003). Distributive justice begins by considering the available resources in a society, and evaluates how they are distributed among groups. Importantly, in health care, distrib-utive justice draws attention to fairness in health care access. In contrast, social justice begins with understanding differences between subgroups, particularly power, and highlights the structural conditions that shape inequities (Young, 1990, 2001). For example, considering prevention of breast or cervical cancer from a distributive justice perspective draws attention to the number of practitioners, screening, treatment and laboratory facilities, and how they are distributed. A social justice perspective considers how particular sub/groups are positioned differently and how such positioning shapes health care access and health outcomes. Social justice begins with the social rather than the goods to be distributed. As Kirkham and Browne (2006) explain, " …while justice has to do with fairness social draws our attention to the application of justice to social groups, [and] brings into focus how justice and injustices are sustained through social institutions, and social relationships; and highlights the embeddedness of individual experience in a larger realm …