About

 THE PROBLEM

Causes and social determinants of a health inequality

 

 

In India, cervical cancer is the 2nd leading cause of cancer deaths among women (Bruni et al., 2017). High rates show Ranging from privileged populations, groups of people, and to rural communities. Several factors contribute into the prevalence of this disease such as, resource limitations, unestablished cervical cancer screening programs, and lack of awareness. Approximately 71.6% of urban parents and 75.5% of rural parents had never heard about HPV. Most parents do not know that their daughters could be at risk for HPV infection (58.2%) or cervical cancer (64.1%) in the future (Degarege et al., 2018).

     For an at-risk woman, the social determinants that affect her lay within her environmental construct. Within the district of Mysore, the incidence rate of cervical cancer cases is 13.7% per 1,000,000 females. Early age at marriage, multiple sexual partners, multiple pregnancies, poor genital hygiene, malnutrition, use of oral contraceptives, are all of the many social determinants.

 

 

EFFECTS

Impacting disease rates

 

 

About 122,844 new cervical cancer cases are diagnosed annually and about 67,477 cervical cancer deaths are reported. Women at risk for cervical cancer are those who have contracted HPV (Human Papillomavirus) are commonly of lower class & education, have multiple children, and engage in sexual behavior at an earlier age (Sreedevi et al., 2015). However, unlike in the U.S where cervical cancer screening or pelvic examinations are easily accessible and covered by health insurance, Indian women only have access to one pap smear in their entire life. Fear of being ostracized by family and neighbors due to stigma with a positive diagnosis also discourages these women from attaining proper screening and reaching out for social support. (Nyblade et al., 2017)       

Disease rates impact the quality of life in a community.  Outstandingly enough, more than 75% of sexually active individuals will be affected by HPV in their lifetime. However, due to misinformation and lack of knowledge, most of these individuals are unaware of this. This could be that only up to recently, the HPV vaccine ban was lifted in 2008. Positive HPV diagnosis can lead to cervical and anal cancer. (Degarege et al., 2018)  

 

 

 

WHAT CAN BE DONE

What can be done to alleviate this health disparity?

 

 

During our time in India, we had an opportunity to interview an Asha, whom is a person that is the interface between villages and the public health system counseling women on preparing for birth, immunization, and prevention of common infections etc. Our conversation with the Asha led us to believe that in order to alleviate this disparity, more dialogue needs to be held within the community and villages regarding these health concerns. She believed that more self-groups need to be created to build more dialogue. More dialogue can bring awareness and awareness could reduce stigma. As an individual, commitment to building awareness in the community is fundamental. Investing full support into interventions locally and globally can make a difference overall. If individuals act together and invest time, education, awareness and support, many health disparities can be eliminated and reduced.

       Interventions such as community education on cervical cancer and HPV, social mobilization, vaccinations, screenings and treatment. Education in schools to both girls and boys on the precautions they need to take to have safe sex, using condoms, as well as delaying the age of sexual intercourse. In addition, the use of tobacco, which is an important risk factor for cervical cancer including other cancers.

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PHRII’S INTRODUCTION

CERVICAL CANCER SCREENING – MOBILE CLINIC

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Public Health Research Institute of India (PHRII) is a non-profit organization based in Mysore, India dedicated to providing healthcare services to local rural and urban women. Founded in 2007 by Purnima Madhivanan, an Associate Professor of Epidemiology at Stempel College of Public Health & Social Work, Florida International University.

PHRII noted the health disparity women face in order to access cervical cancer screenings, therefore they decided to offer this service in their clinic and later created the mobile clinics to outreach women in more remote areas. The mobile clinics are held every 15 days in selected communities around the Mysore district that caters to lower income women. Since performing conventional methods of pelvic examinations proves to be costly, the women at PHRII have elected to use a simpler, low cost method called Visual Inspection with Acetic Acid (VIA). Also, being that there is just 1 physician performing the examination for every camp held, only 15-20 women are screened during their visits; this ensure the most accurate results. Nonetheless, they have helped screened over 3000 women and performed 82 cancer prevention treatment procedures within the past 9 years.

 

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