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Critical Analysis Of The Extent To Which Social Determinants Of Health Explain Health Inequalities In Relation To Lung Cancer Among Males In India
Lung cancer in males has been globally reported that increase the number of new cases by millions. As opined by Basu et al. (2019), the prevalence of lung cancer has contributed to 18% of cancer-related deaths. Different factors have been associated with the increase in cases of lung cancer that is linked with the co-morbidities. The epidemiological trend has been gradually changing in India. This causes an alarming threat to the Indian population. It is evident that several factors which include, including lifestyle, economic factor, health inequality within the clinical settings and occupational exposure has increased lung cancer incidence. According to the "World Health Organisation" report, it is forecasted that cancer-related mortality has resulted by 1.38 million per year which overall increases the overall "burden of lung cancer" towards morbidity and mortality (Who.int, 2023). Association of the lung cancer in males due to health inequalities has estimated the incidence at 70275 considering all ages along with both sexes. Incidence rates of lung cancer have ranked fourth on overall cancer excluding “non-melanoma skin cancer”. It comes after “breast”, “cervical”, and “oral cavity cancer” on the ground of males. However, in the case of female, lung cancer have positioned sixth-ranked in regard to cancer incidence.
Industrialisation and smoking trend are the primary factors that increase the trend in the cancer community. According to Sahoo et al. (2021), health inequality in socioeconomic status has drafted an “initial erroneous impression” of lung rarity cancer that likely results from lung cancer paucity, this made an observation in increasing the “burden of lung cancer” in different centres of the country. Statically report demonstrated that Indian males have 53,728 new cases of lung cancer with a “crude incidence rate” - 8.3, “ASR (W) – 11”, and “cumulative risk - 1.36”, whereas, Indian females have 16,547 new cases of lung cancer with “crude incidence rate” - 2.7, “ASR (W) - 3.1”, and “cumulative risk - 0.37”. It is determined that the mortality in India due to lung cancer has made up 63,759, therefore, withholding the third position of “cancer-related mortality” in India. It is evident that the mortality rate of lung cancer is high among Indian males with 48,697 and the mortality rate of lung cancer is high among Indian females and is estimated to be 15,062 (Who.int, 2023). India comprises of "large elderly population" that contributes to becoming the second-largest country worldwide. Older people have developed an enormous diversity that pertains to economic, social, health status and education. The demographic transitions have been accelerating in India which comes with an increase in "disease burden" and "growing demand for healthcare". However, population-wide mechanisms have been found to develop due to a lack of social security. On the other hand, as suggested by DiMarco and Milli (2022), the infrastructure of public health is inadequate to “burgeoning the health burden”. Moreover, India has experienced a “Triple burden of diseases” due to health vast disparity in the context of economic and social determinants. It includes which includes “emerging non-communicable diseases”, communicable diseases, and infectious diseases.
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Determinants of Lung Cancer in Males in India
Tobacco and smoking
It has been estimated that almost 90% of lung cancer occurred in men. As, this could have other epigenetic and genetic abnormalities, in most cases Males in India are affected by tobacco and smoking. As tobacco smoking can cause vital lung carcinogenic as well as other disease processes. As said by Schabath and Cote, (2019), it has been seen that in the last 50 years, tobacco and smoking have caused emerged and a strong prognostic that can affect lung carcinogens which have an involvement of lung cancers. Smoking tobacco can cause a risk factor of lung cancer as this causes death. These pipe smoking and cigar smoking can cause lung cancer and this also increases the risk of lung cancer. It has been seen that tobacco is a mixture of more than 7000 mostly poisonous chemicals, as they create lung cancers in males. People who are more likely to smoke cigarettes are more tend to get affected by lung cancer compared to the person who doesn't smoke or smoke occasionally. Smoking tobacco can cause cancer in the mouth and throat as well as in the colon and stomach but they mostly affect the lung, as this occurs due to the breaths of the smoke. This smoke can damage the cells of the lungs (Corrales et al. 2020). When inhalation of cigarette has been done this cause lung cancer as, they consisted of plenty of substances which can cause cancer such as carcinogens. These cause the damaging to the tissues in the lungs.
Occupation hazards
There are such 12 occupational exposures which can be carcinogenic and that can cause lung cancer in males in India. Such products are arsenic, aluminium production, asbestos, cadmium, radon, bis-chloromethyl ether and “coke and coal gasification fumes”. As men are most likely to be associated with this type of job so they got most exposed to these chemicals. Such male workers who use these certain chemicals and metals can be a risk for them. In India, most males are associated with such occupations as mining, construction, manufacturing and sandblasting. As suggested by Thandra et al. (2021), as a result, occupational lung cancer can occur among them as they always breathe in these chemicals, fibres as clouds of dust which can cause a problem in their lungs. Though this disease could a long time to develop and also shows a long-lasting effect on the lung, as they are mostly breathing in this polluted air. Such products like Asbestos can cause lung disease that can cause lung cancer in men who are working in a profession like steamfitters, plumbers, construction workers and pipe fitters, these workers can be at risk. Also in such professions, workers who have been using certain metals and these chemicals can be at risk. Silicosis also can cause lung cancer in males who are working in these industries such as mining and construction.
Over the past two decades, the factors affecting medical care that are influenced by various factors. In this study, we use the word “medical care” rather than the word “health care”. The commission of “The World Health Organization” has explained the conditions of males who are suffering from lung cancer (Korn, 2023). Lung cancers are one of the most common diseases nowadays. Medical care is truly required for the care of males who are suffering from lung cancer. There are some relations between the medical and social factors (Dwyer, et al., 2023). However, the factors are not as simple as other diseases. For the past few years, cancer is the financial burden of every country. Among the entire countries lung cancer is the most common and frequent. In India 97 per 100000 persons are suffering from lung cancer (Saini, et al., 2020).
Social economic status
Lung cancer is one of the leading causes of mortality among men. As this can occur among the people who belong to the “lower socio-economic status” as these generally have some worse outcomes. As stated by Ebner et al. (2020), males who are in a lower income group and lower in education can have a risk of higher mortality that create the most risk of cancer. Socio determinants such as race, level of income, and insurance can cause lung cancer and they are unable to get a better education and awareness about this topic as well as they don't even get the proper medication or treatment. It has been visible that lower education can cause a higher rate of mortality due to the higher risk. Education can help to aware of the disadvantages of these types of cancer. So in India, males are not getting proper education as a result occurs lung cancer among males. Socioeconomic status can be determined by the economic and social factors which can affect a particular part of society. This income, job and education can create a lot of differences as this can lower the economic status and affect the economic status as a result they have a higher risk of cancer. This socioeconomic status has a bad effect on the males in India.
The treatment of lung cancer is sometimes not successful at all. Only 40 percent of the people are recovered from lung cancer. Most of cases it is observed that the people suffering from lung cancer are males (Barr, 2019). As males, they are more addicted to nicotine and related addictions. It is also studied that persons from below poverty are severely affected by this cancer (Iott, 2020). There is gender inequality in cancer treatment. Sometimes the male patients are not well treated by the social workers. There are very small areas or hospitals studied in this research (Melkonian, 2019). This situation is called the macro-perspective. There are some national policies undertaken by the government to ensure the proper treatment of cancer-suffering patients.
Selection theories in health inequalities refer to the health of the individual that influences social mobility which produces the difference in the context of social class in health. As stated by Pérez (2021), social selection theory in health inequalities drafts the engagement of the social aspects that develop differently on the ground at which the dominance overrules. The data extracted from the articles reflect that lung cancer in males has been evidently high which imposes a promising difference among the Indian population due to social class. Health inequalities are the improper delivery of treatment and cases based on several factors. Similarly, As opined by Maurya et al.(2021), social inequalities within India's health settings have been predominantly imparted differently on the basis of income and high-low classes. The facilities with healthcare are a major social global issue.
Behaviour and culture theories in health inequalities result in compressing the health behaviour among the “lower socioeconomic group”. According to Verma et al. (2021), behavioural theories emphasise imposing restrictions and imparting delivery care that is the right of the individual. As discussed above, lung cancer in males is primarily increasing due to the increased health inequalities that are largely influenced by the social environment. Providing facilities on the ground at which effective treatment and intervention have been expected to mitigate chronic disease. The relation between the Behavioral and cultural theory and cancer is that both lung cancer could be affected by a lack of proper behavior or lifestyle culture. Regular smoking of tobacco, exposure to being a passive smoker, which is second hand smoking, and further exposure to asbestos and radon effects in the workplace or nearby factories could be causes of lung cancer (Chambers et al. 2022). Intake of certain unhealthy steroids or diet supplements, drinking water filled with arsenic, and other radiation exposure could be the main cause of lung cancer. The cultural barriers or factors mainly "knowledge", "beliefs", "attitudes", and another screening process, and having mistrust of the systems which are there for the healthcare facilities, or other fake or fatalistic beliefs could discourage a person from participating in the screening of cancer, this could be majorly noticed among the minority culture people.
“Social Determinants of Health” refer to “non-medical factors” that are promptly influenced by health outcomes. It is a condition in which individuals grow, live, and work. The wider “set of forces” that shapes systems in daily life includes economic, “policies and systems”, social norms, development agendas, and social policies within the political systems. As mentioned by Mohanty et al. (2021), "Social Determinants of Health" play a crucial role in influencing health inequities due to avoidable and unfair differences in health status, it is seen within countries. Health, income and illness are predominated by the social gradient which worsens the health status of the population. In India, it is evident that increased lung cancer in males has been due to "lower socioeconomic position", it drafts effective and worse health outcomesSeveral social determinants affect lung cancer in any individual - among which is water and sanitation, also Education could be two main factors affecting the lung cancer
It is very important to intake water, which is properly either filtered or chemical and contaminants free, to lead a healthy lifestyle. Water contaminants like arsenic, agricultural chemicals, radon rays, and hazardous wastes are often the cause of lung cancer in individuals. Strong evidence of arsenic ion water has been found for the cause of cancer in different individuals, which could certainly damage not only the lungs but also other organs (Taeger et al. 2022). Another factor is water pollution which could also adversely affect lung cancer in people. High levels of arsenic and its compounds could also cause skin cancer and bladder cancer. According to different studies, also in the "journal" of "The National Cancer Institute" it has been found that drinking water from private wells could have high evidence of arsenic causing cancer in the lungs.
“Social determinants of health” (SDoH) are notably linked with cancer risk along with its treatment outcomes. Exploring “Social determinants of health” with increasing interest helps in capturing “electronic health records” (EHRs). It helps in assessing cancer “risk and outcomes”; to examine the “Social determinants of health”, and “natural language processing” has been identifying SDoH 15 categories of which 10,855 lung cancer patients ahs have been diagnosed using cohort studies in “real-world lung cancer patient” cohort. Most cancer diseases or cancer-related to the lungs or other organs are caused by long-term exposure to severe hazardous like smoking habits. Although occupational "lung diseases" are preventable. Individual lifestyles like having no proper diet, lack of nutrition, and more intake of fatty foods could also affect the organs of the body causing cancer (Mueller, et al. 2019). Socio-economic status like having stress and anxiety related to anything could also be a major symptom of lung cancer. As discussed earlier the lack of proper education and unemployment could cause financial surges among the people causing a lack of medication and proper treatment for the prevention of the disease. People working in factories where there is high exposure to heat, carbon, or other such materials which are deadly and fatal for inhaling, could be a major cause of lung cancer.
Economic stability in health inequalities is the scientific term that helps in summarising the population health that is linked with the group-specific attribute. It includes education, economics, and ethnicity. As stated by Basu et al. (2019), economic stability is one of the social determinants which provide economic security to meet the individual the basic needs that different factor has been associated with health disparities which include environmental factor, healthcare accessibility, income, educational inequality and behavioural factors. Socioeconomic status is the leading issue that contributes to lung cancer in males in India. Having no proper education about the cause, consequences and happenings of cancer could affect people and would let them suffer heavily. Mainly the people who belong to the rural areas are uneducated and have less scientific and logical knowledge, (Rankin et al. 2020) which makes them aware of the do and don't to avoid being affected by such fatal diseases. Providing proper education or creating cancer prevention events could help in their prevention and early medication (Williamson et al. 2020). It has been often seen that people living on rural sides focus more on the arts group rather than educating themselves and their kids about the scientific knowledge which is applicable on the day to day life. Thus they remain backward about the knowledge of cancer and its happenings, avoiding any early symptoms and its proper medication.
On the other hand, according to Mazzone et al., (2020) in an idea, most male patients do not want to go to the hospital due to economical instability. The males who live in the jungle do not have proper money to take admitted to a private hospital and also do not get proper health care service. Similarly, Haddad et al., (2020), state that in India, most people are unable to afford quality type of healthcare services. It has been also observed that a male who cannot afford a quality type of healthcare server, go to a government hospital having no proper infrastructure. The native people who have experienced different types of cancer have died due to inadequate financial resources. A patient who is suffering from lung cancer needs huge financial resources to fight against lung cancer. However for male is it, not easy to take admitted to a private hospital, which has proper infrastructure and has proper ventilation support. that is facing different respiration issues need proper ventilation service and need proper medication. However not having an adequate amount of money most of the native people cannot adopt a quality type of health care service and face different issues in lung cancer condition. Most of the male people of the are not aware of lung cancer also and they do not take proper treatment. According to Goodwin et al. (2019), most male patients in India do not take proper treatment for lung cancer situation for not have proper education about the lungs. Those people always try to take medicine from a regional medical store and avoid meeting professional doctors.
All the citizens of India need to be aware of the effect of lung cancer and need to know about the methods to cure lung cancer. Similarly, Kratzer et al., (2023) say that a male patient is the head of a family and the patient thinks that if they spent money for their treatment their family will be affected extremely badly. Most of the male patients do not accept proper treatment to provide proper financial support to their families. In India, it has been seen that most people do not have adequate knowledge about lung cancer and they do not know how serious this is. The government of India need to organize a proper event to provide proper knowledge to every citizen. However, Islam et al., (2022) have said that many people have some kind of knowledge about the seriousness of lung cancer but they act like uneducated people. Most citizens do not take lung cancer seriously. They thought lung cancer is as the same as other diseases. The government of India should establish proper infrastructure and need to adopt proper technology to promote proper knowledge to the citizen about the effectiveness of lung cancer. The citizen of India needs to be aware of the negative effect of cancer. The facilities with healthcare are a major social global issue. Therefore, this theory has enabled to draft the of health inequalities in the context of delivering health treatment through health selection. This leads to a significant deterioration of health status due to social hierarchy. Therefore, from this critical evaluation, it is summarised that the social selection theory in health inequality imposes a barrier to the delivery of quality care for the patient's health outcome.
There are different factors, which restrict a male patient to get proper health care service. The government of India need to provide proper quality type education to the Indian citizen. Most Indian people are not aware of the seriousness of lung cancer. Due to lack of money, a male patient cannot take admitted to a private hospital and does not get proper quality type health care service. A patient who is suffering from lung needs proper ventilation support and needs proper medication. In a private hospital, the infrastructure and the technology are extremely advanced than in a government hospital. Many native types of millet cannot afford proper health care services for not having proper financial stability. The reach people who have proper financial resources go to the private hospital and get proper ventilation and medication at the time of lung cancer. Most of the males also does not have well-established financial resources and does not have the proper regional infrastructure. Due to not having proper money support and the regional health care institute most of the male not get proper treatment at the time of lung cancer. A proper quality type of education is extremely important to increase awareness about lung cancer and to get proper quality type health care service. The people who do not have proper financial resources always take admitted to a government hospital and do not get proper health care service.
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