People in
Lower Socioeconomic
Groups

People in Lower Socioeconomic Groups

Socioeconomic position is often described through indicators such as educational attainment, income or level of occupation.[60][61] Based on the latest available data, approximately 10% of the population lived in low-income households in 2017–18; 68% of people aged 25–64 held a non-school qualification at Certificate III level or above in 2021.[60] People in lower socioeconomic groups are at greater risk of poor health, have higher rates of illness, disability and death, and live shorter lives than people from higher socioeconomic groups.[62]

People identifying as belonging to diverse populations may identify across multiple priority population groups. This intersectionality can result in compounding impacts of social, cultural, commercial and environmental determinants of health on cancer experiences and outcomes.

Current state

People in the lowest socioeconomic groups are more likely to be diagnosed with cancer, more likely to die from cancer, and have a lower 5-year relative survival rate compared to those living in the highest socioeconomic group.[1] When compared with adults in the highest socioeconomic group, adults in the lowest socioeconomic group have higher rates of some cancer risk factors, including being 3.6 times as likely to smoke daily, 1.6 times as likely to be obese, 1.3 times as likely to be insufficiently active.[62]

People in the lowest socioeconomic group also are more likely to delay cancer symptom presentation and have lower overall engagement with healthcare services for reasons including costs, limited access to services, lower health literacy, and poorer cancer symptom knowledge.[60][61][63]

Future state

The Australian Cancer Plan aims to improve health equity for people in lower socioeconomic groups. This includes facilitating better access to integrated and holistic care, with tailored information and nutritional, physical, and practical support, and a strengthened policy and regulatory environment to address the social determinants of health. The Plan will also bring attention to the affordability of health services, including costs associated with treatment, diagnostic scans, and palliative care, as well as non-medical expenses such as travel, through innovative approaches such as increasing access to telehealth services.

Key Frameworks, Strategies, and Relevant Plans

Australia's Report on the Implementation of the Sustainable Development Goals

Year: 2018
Author: Department of Foreign Affairs and Trade, Australian Government

Australia’s Report on the Implementation of the Sustainable Development Goals outlines the 17 Sustainable Development Goals which form a roadmap for global development efforts to 2030. Targets within the Sustainable Development Goals include measures relating to addressing inequalities associated with those in lower socioeconomic groups.

https://www.dfat.gov.au/aid/topics/development-issues/2030-agenda/australias-report-implementation-sustainable-development-goals

Implementation considerations

Maximising cancer prevention and early detection
Enhanced consumer experience
World class health systems for optimal care
Strong and dynamic foundations
Workforce to transform the delivery of cancer care
Achieving equity in cancer outcomes for Aboriginal and Torres Strait Islander people

Stakeholder input

People in lower socioeconomic groups were considered to have poorer health outcomes because they may have limited access to physical activity programs or balanced nutrition options.

Additionally, out-of-pocket costs relating to accessing care or travel for cancer prevention and early detection services present additional challenges.

2 Years
5 Years

Actions

1.2.1
Deliver cancer prevention and health promotion activities, including healthy lifestyles, immunisation, and population screening participation, co-designed and tailored to a range of settings.
  • Delivery of programs that enable access to affordable nutritious food, physical activity programs, diagnostic tests (that are not covered by Medicare or have out-of-pocket costs) and travel to preventive care.
  • Additional support through increased access to funded programs and social prescribing[103] where health professionals have the resources and infrastructure to refer patients to non-medical activities such as nutrition or physical activity programs, social services, or activity groups.
  • Outreach activities that focus on people without access to stable housing.
-
1.2.3
Promote translational research on the impact of social, cultural, commercial and environmental determinants of health on cancer outcomes for priority populations to inform policy and practice.
  • Further translational research on the impact of income, community safety, employment status, housing, and food insecurity on cancer outcomes.
  • Investigation of factors contributing to higher rates of smoking and alcohol consumption among people in lower socioeconomic groups.
-
1.2.4
Undertake ongoing assessment of the evidence for risk-based, cost-effective population cancer screening.
  • Risk-based population cancer screening to include the predisposing risks that are associated with people in lower socioeconomic groups.
  • Assessment of cost-effectiveness to include the burden of costs for individual consumers, not just system-wide cost-effectiveness, to enable future accessibility.
-

2 Years

Actions

1.2.1
Deliver cancer prevention and health promotion activities, including healthy lifestyles, immunisation, and population screening participation, co-designed and tailored to a range of settings.
  • Delivery of programs that enable access to affordable nutritious food, physical activity programs, diagnostic tests (that are not covered by Medicare or have out-of-pocket costs) and travel to preventive care.
  • Additional support through increased access to funded programs and social prescribing[103] where health professionals have the resources and infrastructure to refer patients to non-medical activities such as nutrition or physical activity programs, social services, or activity groups.
  • Outreach activities that focus on people without access to stable housing.
-
1.2.3
Promote translational research on the impact of social, cultural, commercial and environmental determinants of health on cancer outcomes for priority populations to inform policy and practice.
  • Further translational research on the impact of income, community safety, employment status, housing, and food insecurity on cancer outcomes.
  • Investigation of factors contributing to higher rates of smoking and alcohol consumption among people in lower socioeconomic groups.
-
1.2.4
Undertake ongoing assessment of the evidence for risk-based, cost-effective population cancer screening.
  • Risk-based population cancer screening to include the predisposing risks that are associated with people in lower socioeconomic groups.
  • Assessment of cost-effectiveness to include the burden of costs for individual consumers, not just system-wide cost-effectiveness, to enable future accessibility.
-

5 Years

Actions

1.5.3
Implement new, and improve existing, evidenced-based, risk-stratified cancer screening programs.
  • Risk-stratified cancer screening programs designed to minimise the financial burden and any out-of-pocket expenses for individual consumers, for example, costs associated with genomic testing.
  • Resources for primary care providers to educate and empower consumers, including their carers and families, on the availability and affordability of risk-stratified screening to enhance uptake and clinical outcomes.
-
1.5.4
Develop a policy framework for genomics in cancer control across the cancer care continuum.
  • Policy framework to include direction on how this technology will be cost-effective and accessible to all Australians irrespective of income or the area in which they live and ensure no or minimal out-of-pocket expenses for consumers including their carers and families.
-

Maximising cancer prevention and early detection

Stakeholder input

People in lower socioeconomic groups were considered to have poorer health outcomes because they may have limited access to physical activity programs or balanced nutrition options.

Additionally, out-of-pocket costs relating to accessing care or travel for cancer prevention and early detection services present additional challenges.

2 Years
5 Years

Actions

1.2.1
Deliver cancer prevention and health promotion activities, including healthy lifestyles, immunisation, and population screening participation, co-designed and tailored to a range of settings.
  • Delivery of programs that enable access to affordable nutritious food, physical activity programs, diagnostic tests (that are not covered by Medicare or have out-of-pocket costs) and travel to preventive care.
  • Additional support through increased access to funded programs and social prescribing[103] where health professionals have the resources and infrastructure to refer patients to non-medical activities such as nutrition or physical activity programs, social services, or activity groups.
  • Outreach activities that focus on people without access to stable housing.
-
1.2.3
Promote translational research on the impact of social, cultural, commercial and environmental determinants of health on cancer outcomes for priority populations to inform policy and practice.
  • Further translational research on the impact of income, community safety, employment status, housing, and food insecurity on cancer outcomes.
  • Investigation of factors contributing to higher rates of smoking and alcohol consumption among people in lower socioeconomic groups.
-
1.2.4
Undertake ongoing assessment of the evidence for risk-based, cost-effective population cancer screening.
  • Risk-based population cancer screening to include the predisposing risks that are associated with people in lower socioeconomic groups.
  • Assessment of cost-effectiveness to include the burden of costs for individual consumers, not just system-wide cost-effectiveness, to enable future accessibility.
-

2 Years

Actions

1.2.1
Deliver cancer prevention and health promotion activities, including healthy lifestyles, immunisation, and population screening participation, co-designed and tailored to a range of settings.
  • Delivery of programs that enable access to affordable nutritious food, physical activity programs, diagnostic tests (that are not covered by Medicare or have out-of-pocket costs) and travel to preventive care.
  • Additional support through increased access to funded programs and social prescribing[103] where health professionals have the resources and infrastructure to refer patients to non-medical activities such as nutrition or physical activity programs, social services, or activity groups.
  • Outreach activities that focus on people without access to stable housing.
-
1.2.3
Promote translational research on the impact of social, cultural, commercial and environmental determinants of health on cancer outcomes for priority populations to inform policy and practice.
  • Further translational research on the impact of income, community safety, employment status, housing, and food insecurity on cancer outcomes.
  • Investigation of factors contributing to higher rates of smoking and alcohol consumption among people in lower socioeconomic groups.
-
1.2.4
Undertake ongoing assessment of the evidence for risk-based, cost-effective population cancer screening.
  • Risk-based population cancer screening to include the predisposing risks that are associated with people in lower socioeconomic groups.
  • Assessment of cost-effectiveness to include the burden of costs for individual consumers, not just system-wide cost-effectiveness, to enable future accessibility.
-

5 Years

Actions

1.5.3
Implement new, and improve existing, evidenced-based, risk-stratified cancer screening programs.
  • Risk-stratified cancer screening programs designed to minimise the financial burden and any out-of-pocket expenses for individual consumers, for example, costs associated with genomic testing.
  • Resources for primary care providers to educate and empower consumers, including their carers and families, on the availability and affordability of risk-stratified screening to enhance uptake and clinical outcomes.
-
1.5.4
Develop a policy framework for genomics in cancer control across the cancer care continuum.
  • Policy framework to include direction on how this technology will be cost-effective and accessible to all Australians irrespective of income or the area in which they live and ensure no or minimal out-of-pocket expenses for consumers including their carers and families.
-

Enhanced consumer experience

Stakeholder input

Stakeholders viewed the costs of receiving cancer care to be a burden, including out-of-pocket payments for clinical services and costs associated with accessing treatment, including travel, accommodation, parking, and time away from work. These costs are not experienced equally by consumers. People in lower socioeconomic groups were seen to experience greater financial burden, reduced access to health care, and less practical support, creating increased hardship.

2 Years

Actions

2.2.1
Develop a national framework for and implement integrated multi-channel, multi-disciplined navigation models that ensure the right support at the right time for every consumer across the cancer continuum.
  • A national framework designed to minimise financial burden and toxicity, and ensure equitable access for all Australians, regardless of income or location.
-
2.2.2
Improve availability of co-designed, tailored information and care for consumers to improve health literacy and reduce cancer-related stigma.
  • Strengthen transparency around costs associated with cancer treatment and offer financial support options and financial counselling for consumers.
  • Expand cost-effective options for accessing information on the cancer care system, including virtual care, telehealth services and online resources.
-

2 Years

Actions

2.2.1
Develop a national framework for and implement integrated multi-channel, multi-disciplined navigation models that ensure the right support at the right time for every consumer across the cancer continuum.
  • A national framework designed to minimise financial burden and toxicity, and ensure equitable access for all Australians, regardless of income or location.
-
2.2.2
Improve availability of co-designed, tailored information and care for consumers to improve health literacy and reduce cancer-related stigma.
  • Strengthen transparency around costs associated with cancer treatment and offer financial support options and financial counselling for consumers.
  • Expand cost-effective options for accessing information on the cancer care system, including virtual care, telehealth services and online resources.
-

World class health systems for optimal care

Stakeholder input

The cost of ongoing cancer treatments can create unnecessary and unmanageable financial burden for those in lower socioeconomic groups. This can be further compounded by the impact of survivorship or caregiving on the ability to fully return to work.

2 Years

Actions

3.2.1
Develop and implement a national framework that standardises the development, update, evaluation and uptake of Optimal Care Pathways (OCPs), including for priority population groups.
  • National framework that provides virtual care and electronic referrals into cancer care services for people in lower socioeconomic groups.
  • Educating and empowering consumers on available financial counselling, financial support systems and broader support services.
-
3.2.2
Develop a national framework for networked, distributed comprehensive cancer care, to facilitate provision of services as close as safely possible to where patients live. This will include the role of Comprehensive Cancer Centres to enhance patient outcomes, strengthen transparency and accountability, and drive continuous improvements for all patients across the network regardless of where the care is provided.
  • National framework for networked comprehensive cancer care designed to provide additional support to reduce the financial burden for people in lower socioeconomic groups.
  • Comprehensive cancer care that provides equitable access for all Australians, regardless of ability to pay or income level.
-
3.2.3
Implement innovative, evidence-based and cost-effective models of care for people living with and beyond cancer.
  • Innovative, evidence-based models of care that expand and/or diversify financial support to reduce out of pocket cost or assistance for non-medical expenses to accessing treatment.
  • Innovative, evidence-based models of care for people in lower socioeconomic groups that include links to financial and other social support services such as financial counsellors, housing assistance, etc.
  • Innovative, evidence-based models of care that extend the application of telehealth and digital health to all types of care and services.
-
3.2.4
Develop and refine integrated care models to maximise access to high-quality, timely and evidence-based palliative and end-of-life care, including voluntary assisted dying.
  • Integrated care models that expand access to at-home palliative care, advance care planning, end-of-life care and VAD options and ensure consumers, carers and family members are made aware of these options.
  • Integrated care models that provide digital health opportunities for palliative care, advance care planning, end-of-life care and VAD to reduce requirements for travel.
  • Integrated care models that improve access to financial counselling for carers and family members of consumers engaging with palliative care, advance care planning, end-of-life care and VAD.
-

2 Years

Actions

3.2.1
Develop and implement a national framework that standardises the development, update, evaluation and uptake of Optimal Care Pathways (OCPs), including for priority population groups.
  • National framework that provides virtual care and electronic referrals into cancer care services for people in lower socioeconomic groups.
  • Educating and empowering consumers on available financial counselling, financial support systems and broader support services.
-
3.2.2
Develop a national framework for networked, distributed comprehensive cancer care, to facilitate provision of services as close as safely possible to where patients live. This will include the role of Comprehensive Cancer Centres to enhance patient outcomes, strengthen transparency and accountability, and drive continuous improvements for all patients across the network regardless of where the care is provided.
  • National framework for networked comprehensive cancer care designed to provide additional support to reduce the financial burden for people in lower socioeconomic groups.
  • Comprehensive cancer care that provides equitable access for all Australians, regardless of ability to pay or income level.
-
3.2.3
Implement innovative, evidence-based and cost-effective models of care for people living with and beyond cancer.
  • Innovative, evidence-based models of care that expand and/or diversify financial support to reduce out of pocket cost or assistance for non-medical expenses to accessing treatment.
  • Innovative, evidence-based models of care for people in lower socioeconomic groups that include links to financial and other social support services such as financial counsellors, housing assistance, etc.
  • Innovative, evidence-based models of care that extend the application of telehealth and digital health to all types of care and services.
-
3.2.4
Develop and refine integrated care models to maximise access to high-quality, timely and evidence-based palliative and end-of-life care, including voluntary assisted dying.
  • Integrated care models that expand access to at-home palliative care, advance care planning, end-of-life care and VAD options and ensure consumers, carers and family members are made aware of these options.
  • Integrated care models that provide digital health opportunities for palliative care, advance care planning, end-of-life care and VAD to reduce requirements for travel.
  • Integrated care models that improve access to financial counselling for carers and family members of consumers engaging with palliative care, advance care planning, end-of-life care and VAD.
-

Strong and dynamic foundations

Stakeholder input

Digital technologies such as telehealth and other digital interventions were identified as cost-effective ways to support consumers with limited ability to afford ongoing costs associated with their care.

Stakeholders emphasised the need to provide infrastructure and support so that people in lower socioeconomic groups have consistent access to digital technologies such as telehealth, virtual care, and digital therapeutics.

2 Years

Actions

4.2.1
Develop an agreed national cancer data framework to improve accessibility, consistency and comprehensiveness of integrated data assets.
  • Collection of linked data that goes beyond public health to ensure that planning, delivery, and continuous improvements of cancer care address the social and commercial determinants of health.
-
4.2.2
Ensure targeted and innovative research investment into areas of unmet and emerging need; and improve clinical trial design and equitable access.
  • Improve access to clinical trials for people living in lower socioeconomic groups by extending patient travel assistance schemes to include clinical trial participation and including cost-effective telehealth options into clinical trial design.
-
4.2.3
Identify opportunities to improve equitable cancer care through the digital health ecosystem.
  • Digital health ecosystem designed to prioritise cost-effectiveness.
  • Expand financial support provided to people in lower socioeconomic groups for digital connectivity to ensure that a digital health ecosystem does not exacerbate the gap in accessibility for those who have less access to digital infrastructure.
-

2 Years

Actions

4.2.1
Develop an agreed national cancer data framework to improve accessibility, consistency and comprehensiveness of integrated data assets.
  • Collection of linked data that goes beyond public health to ensure that planning, delivery, and continuous improvements of cancer care address the social and commercial determinants of health.
-
4.2.2
Ensure targeted and innovative research investment into areas of unmet and emerging need; and improve clinical trial design and equitable access.
  • Improve access to clinical trials for people living in lower socioeconomic groups by extending patient travel assistance schemes to include clinical trial participation and including cost-effective telehealth options into clinical trial design.
-
4.2.3
Identify opportunities to improve equitable cancer care through the digital health ecosystem.
  • Digital health ecosystem designed to prioritise cost-effectiveness.
  • Expand financial support provided to people in lower socioeconomic groups for digital connectivity to ensure that a digital health ecosystem does not exacerbate the gap in accessibility for those who have less access to digital infrastructure.
-

Workforce to transform the delivery of cancer care

Stakeholder input

Stakeholders stated that health literacy can be poorer for those in lower socioeconomic groups. As a result of poorer health literacy, people in lower socioeconomic groups may face challenges in communicating with healthcare providers and understanding their healthcare needs.

Opportunities exist to upskill the current cancer care workforce in complex communication skills, such as communicating with people who have poorer health literacy. In doing so, people in lower socioeconomic groups will face fewer challenges navigating their healthcare.

2 Years
5 Years

Actions

5.2.1
Identify current and emerging workforce undersupply in line with cancer workforce modelling and other national health workforce strategies, and initiate planning with the sector towards building future workforce capacity and capability.
  • Identify gaps in supportive care roles such as providing financial counselling or cost-effective telehealth support to people in lower socioeconomic groups.
-
5.2.2
Build on existing capability of the primary care workforce to collaboratively and sustainably support the needs of consumers.
  • Expand primary care workforce capability to deliver services in low socioeconomic areas and include advice and/or referrals to those experiencing financial hardship and who have reduced access to healthcare services.
-

2 Years

Actions

5.2.1
Identify current and emerging workforce undersupply in line with cancer workforce modelling and other national health workforce strategies, and initiate planning with the sector towards building future workforce capacity and capability.
  • Identify gaps in supportive care roles such as providing financial counselling or cost-effective telehealth support to people in lower socioeconomic groups.
-
5.2.2
Build on existing capability of the primary care workforce to collaboratively and sustainably support the needs of consumers.
  • Expand primary care workforce capability to deliver services in low socioeconomic areas and include advice and/or referrals to those experiencing financial hardship and who have reduced access to healthcare services.
-

5 Years

Actions

5.5.2
Assist the sector to support all cancer care practitioners to work at the top of their scope of practice, increase retention and ensure ongoing access to continuing professional development.
  • Increase investment in the professional development of health workforces in low socioeconomic areas.
  • Australia’s National Digital Health Strategy[148] outlines a need to increase workforce capability in using new digital tools, creating cost-effective care options for people in lower socioeconomic groups.
-

Achieving equity in cancer outcomes for Aboriginal and Torres Strait Islander people

The Australian Cancer Plan considers an intersectional and health equity approach for Aboriginal and Torres Strait Islander people. This is more than recognising the multiple backgrounds, experiences, and ways Aboriginal and Torres Strait Islander people identify. This approach addresses the way membership of multiple groups may impact people's health and wellbeing needs and ability to access care.

Implementation of each action should consider the compounding impacts of intersectionality across other priority population groups.

2 Years
5 Years

Actions

6.2.1
Embed Aboriginal and Torres Strait Islander voices in policymaking on cancer prevention, care delivery and standards through leadership, collaboration and co-design processes.
6.2.2
Strengthen collaboration with service providers, regulatory authorities and the Aboriginal and Torres Strait Islander cancer workforce to establish clear accountability for culturally safe care and compliance with national standards.
6.2.3
Establish and enhance collaborative partnerships with communities and Aboriginal and Torres Strait Islander-led organisations.

2 Years

Actions

6.2.1
Embed Aboriginal and Torres Strait Islander voices in policymaking on cancer prevention, care delivery and standards through leadership, collaboration and co-design processes.
6.2.2
Strengthen collaboration with service providers, regulatory authorities and the Aboriginal and Torres Strait Islander cancer workforce to establish clear accountability for culturally safe care and compliance with national standards.
6.2.3
Establish and enhance collaborative partnerships with communities and Aboriginal and Torres Strait Islander-led organisations.

5 Years

Actions

6.5.1
Establish ongoing place-based engagement with Aboriginal and Torres Strait Islander people to understand emerging needs across the cancer care continuum.
6.5.2
Implement strategies to embed culturally safe care within cancer-related services for Aboriginal and Torres Strait Islander people.

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