Cancer Prevention – Healthy People 2020 Objectives

Exploring a community related health issue identified in the Healthy People 2020 objectives – Assignment Instructions

You will explore a community related health issue identified in the Healthy People 2020 objectives. The goal of this study is to go beyond the basic framework on the Healthy People 2020 internet sources and thoroughly research printed professional literature. You will write a 15–20 page research paper that includes a title page and abstract as well as a thorough discussion of the science behind the issue using the theory, political and policy challenges, and resources for meeting the objective.

Cancer Prevention – Sample Paper

Introduction

Cancer is the second leading cause of premature death and suffering in the United States7. According to the most recent available data on cancer, 1633390 new cancer cases were reported in 2015, a total of 595919 death cases were reported in the same year in the United State. There were 438 reported new cases of cancer for every 100000 individuals and 159 cancer related deaths. Cancer is a serious health issue in the United States with every one out of four death being as a result of cancer in the country. The CDC latest approximations propose that over 1.9 million people in America will be diagnosed with cancer every year by 2020.  Although the Healthy People 2020 goal is to lower the number of new cases of cancer, the older adult population continuous growth ensures that the cancer burden will increase, especially with the new research findings that demonstrate cancer to be more prevalence among adults. The overwhelming impact of cancer on Americans health creates a domineering need to identify missing chances to delay or prevent the cancer development among the population in the country.

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In an effort to ensure health people and to limit the spread of cancer, Health People 2020 initiative defined a cancer objective, which is to lower the quantity of new cancer cases and death, disability and illness caused by cancer. The Health People 2020 focus on a 10 to 15% decline in specific cancer death rates by 2020. A huge number of researches have been employed to define ways to prevent specific forms of cancers based on their major causes and how they manifest in the body. This research reviews various cancer risks and measures that are being employed to reduce the spread of cancer, other than the common measures of regular screening and early diagnosis. The paper also reviews barriers to effective cancer prevention in the country.

Cancer Prevention Efforts

There are various measures employed to fight cancer among the population in the United States. One of these measures is cancer prevention. Cancer prevention focuses on reducing the number of new cancer cases, especially in the types of cancers caused by preventable measures. There are different approaches employed to enhance cancer prevention in the society based on the targeted population and availability of these measures. One of these measures includes collaboration among interested stakeholders. Collaboration among the community, government agencies, and nongovernmental organizations is one of the most successful ways of cancer prevention in the society. Collaboration is done with intention of identifying and implementing suitable activities, initiatives and policy that can enhance reducing the cancer related risks in the society. The collaborative measure was successful employed in the New York, in a cancer prevention strategy that was initiated in 2012 and implemented from 2013 to 2017. 

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New York employed a population-founded cancer prevention activities and strategies which prioritize on cancer early detection and prevention. The project which commenced on 2013 January and was to run up to 2017, aimed at mobilizing communities to support strategies which center on environmental, system, an policy changes to lower the cancer risks among community residents. The success of this program was attributed to community coalitions that were supported by nongovernmental and governmental resources and organizations. They employed evidence-based techniques employed at community level to enhance population health.  These coalitions integrated different partners that included healthcare providers, local businesses, community-founded organizations and health plans.

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 Every partner conducted a suitable role to implement and support three cancer prevention strategies. The first strategy involved environmental modification and it focused on increasing nutritious foods access by enhancing standards of food procurement within the area covered by the project. There was change of food procurement policy that described nutrition standards and that hoped to mold social norms, by altering eating habits for people visiting or working in a certain area. This hoped to eliminate cancers initiated by poor diet and food carcinogens. The second initiative involved the change of system and it focused on encouraging at least four obstetric and pediatric offices to implement policies that eliminate the free formula samples distribution among other sponsored materials that include gifts, notepads, or pamphlets which have logos of company, so as clinicians do no unintentionally endorse formula feeding against breastfeeding. Breast feeding is associated with low rate of breast cancer and lower childhood level of obesity. The third approach was a policy based approach that focused on eliminating barriers for obtaining timely recommended screenings of cancer, by collaborating with more than one municipality to enhance level of municipal workers policies. The recent research demonstrated that workers in a paid leave were highly probable to go through cancer screenings as recommended compared to workers without it. The project was created around four main activities that include engaging and educating communities, empowering and mobilizing communities, involving organizational decision makers and offering education to decision makers in the government. Although the program was regarded to be successful, its analyzers called for individual education as one of the measures that should be integrated in the future cancer prevention plans. This program demonstrated the power of collaboration of different agencies and the community in enhancing cancer prevention.  

Another common approach employed to prevent the spread of cancer is fighting health disparity in the United States. According to the research, cancer is highly prevalent among white compared to blacks in the country. However, in instances where cancer is caused by infectious agents, African-Americans lead in cancer incidences. This demonstrates the effect of health disparity on cancer preference among minority groups, especially individual living in low socioeconomic status, characterized by poor housing, poor hygiene and poor diet among other things. High level of infectious agents and their spread are experienced among population living in poverty. This has increased their chances of acquiring cancer caused by infectious agents. To address this situation, preventive measures employed should focus on fighting health disparities among the American population. According to the research, the American government both at the state and local levels has been passing policies and employing other strategic measures to uplift life of low income earners in the country. Although the level of success is considerably low, the success in the applied and intended measures can play a great role in eliminating preventable cancer caused by infectious agents and other behavioral issues associated with individual of low social status. Another approach that is advocated and has been employed in fighting health disparity is developing health literacy among the disadvantaged people in the society. This is being done by providing basic education on causes of infectious cancer and how they can be prevented. The information in most cases also covers other causes of cancer, especially, preventable causes that involve poor health behaviors and benefits of early regular screening procedures in enhancing early intervention. The approach to fight health disparities in most cases also focus on enhancing individual access to health care facilities for regular screening.  Measures such as Medicare and Medicaid have played a great role in enhancing minorities’ access to a healthy care including for cancer screening. Another measures employed to prevent cancer related to health disparity is educating the minority groups on importance of vaccine and encouraging them to consider these vaccines. Embracing vaccines such as Hepatitis B and HPV vaccines can play a great role in preventing a number of infectious agent related cancer cases in the population.

Cancer Prevention by Targeting of People Health Behaviors

The Health People 2020 cancer prevention goal focused on identifying preventable risk factors and avoiding them to reduce individual risk of developing cancer. According to research, chronic non-communicable diseases (NCDs) are the major cause of health care expenditure, disability and death in the United States. Six greatly modifiable risk factors and behaviors account for over 50% of premature death and significantly more disability and morbidity. These factors and behaviors include poor mental health, tobacco use, drug abuse, poor nutrition, alcohol abuse and physical inactivity. It is thus estimated that about 50% of NCDs can be prevent by changing the major risk behavior and an extra 20 to 30% by addressing environmental and social determinant of health. As a result, enhancing population health will comprehensively need implementing effectual evidence-based policies and programs that target these health determinants and can be sustained by the private-public partnership.

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 Cancer is among the NCD that can be prevented by behavior modification. According to research investing behavior changes especially among youths in colleges involved in drug, tobacco and alcohol abuse, using both secondary intervention methods, which include provision of internet based education, can play a great role in cancer prevention. Primary behavior intervention method also plays a great role in cancer prevention. Preventive strategies such as changing physical activity and food policies in early childhood education and schools programs to embrace physical activity and healthy eating from a young age, would be of great importance to the American population and cancer preventive measures. For instance, cancer primary intervention that influence children eating habits and physical activities engagement can instill a healthy culture which can be of great important to them even when they are older. This will happen when children embrace good diet and physical activities as life tradition.

Diet management is said to play a great role, specifically in preventing colorectal cancer and enhancing healthy life among colorectal cancer survivors. A research conducted to determine the role of diet in colorectal cancer demonstrated that diet which include alcohol intake is highly related to the colorectal cancer (CRC). Diet is also said to continue impacting the health of patients long after diagnosis based on the disease molarity, physical functioning and recurrence. High processed and red meat intake among CRC survivors have been associated with poorer health results, similar to the “Western dietary pattern” characterized by reliance on sweetened desserts, dairy, refined grains, and processed and red meat. Diet is in addition indirectly involved in the relation between cancer risks and excess body weight. The developing research body has integrated diet into extensive behavioral interventions especially among CRC survivors, demonstrating health benefits and well-being form boosting regular exercise and healthier eating habits. However, irrespective of reports of successes on the use of diet to prevent CRC, there has been limited reach of these efforts and there is still a great need for extensive approaches for CRC survivors’ education, regarding the role played by alcohol and diet in health. The research demonstrates lack of information on CRC survivors’ beliefs and awareness regarding dietary recommendations. Restricted information from a few international studies proposes that there is poor comprehension of nutrition recommendation among CRC survivors, and majority of those survivors do not regard diet as a significant factor in lasting health. The research recommend more information regarding what CRC survivors in the US know regarding dietary recommendations, their believe on the healthy drinking and drinking habits benefits, and the support they get for these practices, and barriers encountered in following and understanding dietary recommendations. This information according to the researchers will effectively enlighten public health effort and guide in disseminating and developing information regarding cancer survivors’ diet. 

Importance of Health Literacy in Cancer Prevention

Health literacy refers to the level to which persons have the aptitude to understand, process, and obtain basic health services and information required to make suitable health decisions. A number of studies have shown that low health literacy is playing a great role in promoting poor health outcomes and status, higher premature rate of mortality, lack of medical recommendations adherence, and higher indirect and direct health costs. The significance of health literacy is emphasized in various national guidelines and plans including the Health People 2020. These guidelines which are supported by peer-reviewed literature, define various interventions centered on enhancing customer comprehension of informed decision making regarding treatment, early screening, and prevention to enhance quality of life and health results, and to lower cost across various forms of cancer. 

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Recent researches have assessed the relation of health literacy with cancer-associated behavior, knowledge and attitudes to educate, and enhance patient involvement in decision making, self-efficacy, and trust. Systematic literature review on health literacy in early adults without and with chronic illnesses ascertains the relationship of reduced health literacy with adverse health results and more poor health behaviors. In addition, results of different research studies endorse that low health literacy is among the social determinants of health related to cancer-associated disparities. Research findings have also demonstrated that advancing partnerships with consumers and community-founded organizations handles unmet needs related to cancer disparities. In these partnerships, community is offered cancer educational materials and training. The health literacy in most cases is addressed to transverse cancer spectrum from survivorship, treatment, and prevention. The healthcare organizations focusing on cancer literacy ensure to conduct organization assessment to be able to identify literacy champions, who can be trained to work with community in providing literacy. A standing committee is also established to assess patient education materials and resources, and guide in the development of the most suitable technical resources for an extensive community. The materials developers ensure to use plain language that is easy to understand. Research has established a connection between cancer treatment, screening and prevention and health literacy and hence, improving community health literacy in cancer through plain language text messages, reading materials and teach-back can play a great role in enhancing cancer control through prevention, survivorship and treatment.

Improving Cancer Prevention by Targeting Young Adults

According to the research, early adulthood has been identified as an opportunity window for early intervention in cancer, based on various significant contextual aspects. For instance, early adulthood is the period of life transitions for many, where people get to be more independent and live life by their own terms and means. At this age, majority get to leave their homes, become patents, enter the workforce, and experience new stressors and challenges in life for the first time. In addition, young adults have been found to experience a number of health challenges including high levels of specific chronic health conditions, for instance obesity, though they tend to contain low application of preventive care services.  Young adults have also been found to be involved in various environmental, behavioral and social factors that can influence their cancer risk, especially among young adults in the United States. Although there is a variation in the strength of the association between cancer development and exposure, factors known to contribute to various forms of cancer include infectious agents such as helicobacter pylori, viral hepatitis, and human papillomavirus (HPV), medical conditions such as diabetes and obesity, alcohol, tobacco, dietary, exposed to occupational carcinogenic which include ultraviolent radiation, and chemicals used in the industries and other many environmental carcinogens. Breastfeeding and vigorous physical activities are some of the factors related to lower risks for particular forms of cancer. Dietary is another major factor, where food such as processed and red meat are said to increase the cancer risk while plant-based diet and sugar avoidance especially in drinks, serve a great purpose in cancer prevention.

In addition to the above factors, young adults are said to be involved in routines that are likely to disrupt their circadian rhythm which is influenced by generation of the melatonin hormone in the pineal gland. This hormone is said to regulate circadian rhythm, with evidence proposing that the melatonin hinders the growth of a tumor. However, melatonin production is said to be suppressed by night light, and this can distract the circadian natural rhythm. This implies that reducing circulating melatonin might increase risk of cancer by impacting other hormonal system. Routines such as insufficient sleep can add to disruption of circadian rhythm, a habit that is usual among young adults, especially those who take night shifts. Shiftwork engaging circadian disruption has been classified as possible carcinogenic to people, and it is related to endometrial, breast, colorectal, and prostate cancers, by the International Agency for Research on Cancer. Lowering exposure of night light which include urban environment light and electronic device use might lower cancer risk.

Another possible aspect contributing to high cancer risk is based on emerging evidence is chronic stress. Stress in America survey data demonstrate that young adults are inclined into reporting higher level of average stress compared to older adults. Chronic stress is said to impact progression of cancer via underlying molecular and cellular processes that drive growth of tumor and influence cancer biology. Stress-associated psychosocial aspects have been demonstrated to influence incidence of cancer in some researches and survival of patient in numerous studies, with the highest effects recorded in breast, liver, lung, head and neck, and ovarian hemotopoietic and lymphoid cancers. Activated pathways in reaction to chronic stress have been connected to tumor angiogenesis, inflammation, cancer cells protection from programmed cell death (anoikis), increased density of nerve, and changed microenvironment of tumor. Chronic inflammation might mediate the apparent association between stressors that include social isolation and outcomes of cancer. Research backs the idea that the social links safeguard young adults over risks of cancer and associated mortality, by lowering the response to physiologic stress. The chronic stress effect in young adulthood on lasting cancer risk might be reduced through behavioral interventions, to increase social support or reduce stress. Moreover, pharmacologic intervention to lower stress might contain the ability to lower risk of cancer.

Based on the above analysis, it is evident that young adults are at a higher risk of developing cancer based on their lifestyle, life routines, and life challenges encountered during this period of human transition and development. The changing risk factors and rates of cancer in the U.S can guide the prevention efforts targeting young adults. According to research, efforts to develop safer and healthier community environment contain the ability to reduce or modify risk factors for cancer development. Promotion of physical exercises in the community and work environment can play a great role in reducing risk of various forms of cancer among other chronic diseases. Addressing individual and community barriers to physical activity for instance physical and time limitations can be of great use in cancer prevention10. According to research, walking has been found to be an effective physical exercise with reduced injuries and without skills requirements. This should be encouraged by designing streets to encourage walking and changing local transportation practices and policies to offer access to attractive and safe areas to walk. For instance, transportation practice should include pedestrian crosswalks, well-maintained sidewalks, and parks. In addition, collaboration across various community sectors that include law enforcement, local government, schools and workplaces can enhance community-based strategies to enhance physical activity.

There are many other efforts that can be done to reduce cancer risks among young adults. For instance young adults are the main target of marketing in the country, especially for products that include alcohol, tobacco and sugar sweetened processed beverages. The government should add control to the marketing of these product that will inform the public that the products are highly carcinogenic. These advertisements should stop being misleading and give clear information that demonstrate the danger they can cause to human health. Public health should also consider taking counter-marketing effort to inform the public of the danger some of these products can cause to their health. Focusing on behavioral change measures such as discouraging unhealthy behaviors such as binge drinking, use of tobacco, poor nutrition, and lack of regular physical exercise can play a great role in reducing cancer among young adults. Other clinical measures can include encouraging people to take immunization especially among Asian Americans and other minorities and American immigrants who have high prevalence for infectious agents related to cancer. Young adults should consider taking available vaccine such as HPV vaccine and hepatitis B vaccine, and early diagnosis and treatment of hepatitis C virus infection.

Challenges Faced Addressing Cancer Prevention and Early Intervention

There are various causes of cancers identified today through research. Among the leading cancer causes are a number of which evidence-based among other interventions can lower the occurrence and alleviate the burden both at community and individual levels. Well recognized examples of such strategies based on the US preventive Service Task Force recommendations and guidelines include screening for revealing in lung, breast, colorectal, and cervical cancer, counseling for heavy consumption of alcohol and tobacco use, and education on other behavioral and lifestyle practice modification, especially in physical activity and diet. Regardless of there being evidence that supports application of these measures, their application has been ineffective in general subspecialty and primary care settings. One of the main reasons for this is the shortage of oncologists to handle emerging cancer cases. There has been documentation of oncologists shortage by the American Society of Clinical Oncology, which is modeled to go through 2020. The shortage is said make it hard for available oncologists to meet the developing need in the market. Despite of this documentation, only a small number of professionals have been able to center their attention on growing the physician workforce trained in control and prevention of cancer. In this regard, physicians contain restricted time with their patients and offering preventive services is normally less prioritized compared to addressing the most immediate medical needs of a patient. Due to the complexity of this challenge, some American Cancer Society developed guidelines for making informed decision on tests or screening for early cancer detection can vary from those provided by the US Preventive Services Task Force among other organizations. Consequently, physicians might struggle to settle the differences and establish the best intervention measure for their patients. Moreover, in various primary care settings, decision and organizational support constraints that include lack of care reminder at non-preventive visits, act as barrier to clinical services delivery for preventing cancer. The current situation act as a great barrier to realizing Healthy People 2020 cancer objective that focused on reducing the cases of cancer in the country by promoting cancer prevention, early diagnosis and treatment and high rate of cancer survivors. There is thus a great need to address the current deficiency of number of physicians trained and practicing in cancer control and prevention. Chances for increasing physician competencies and knowledge in cancer control and prevention span in the range of medical training and education, which include fellowship training, post-graduate residency, undergraduate medical education and ongoing medical and continuing experiential.

Another major challenge facing cancer prevention among other chronic non-communicable diseases in the United States is funding. According to research, directing the NIH funding in the right channels that create a great impact in the NCD disease prevention would make a significant difference in fighting NCD in the country. A research on NIH funding usage advocated for proper investigation on the funded intervention measures, to ensure that they create a great impact to the society, which is comparable to the amount of investment. According to research analysis, prevention has been receiving 18 to 20% of the NIH funds, which is the main funder in the health sector, accounting for 90% of health related funds. In most cases, this amount is directed to both NCD and infectious diseases prevention. Generally, there is underfunding for non-communicable diseases prevention in the United States. This has resulted to persistent negative view and historical trend of prevention value and historical trends.  Structural disadvantages in US prevention and public health is noted compared to healthcare services that include delayed and dispersed prevention benefits. To improve on preventive measures, strategic national priority should focus on investing on prevention to assist in enhancing the health of lagging US population when contrasted to other countries in industrialized regions.  

Conclusion The development of new cases of cancer and its spread across the US population is highly worrying. The statistics demonstrates the tendency of continuous growth of cancer, despite various measures put in place both at national and local level to fight the spread of cancer.  The analysis demonstrates that cancer is one of the most chronic preventable diseases that can be controlled or prevented by change of unhealthy behaviors and dangerous life routines. Simple chances such as regular physical exercises, change of diet, ensuring enough sleep, avoiding alcohol, tobacco and drugs, vaccination to various infectious agents, and avoiding identified carcinogenic food can play a great role in reducing risks of developing cancer in the population. However, the American population is experiencing a number of challenges which makes it hard to implement these preventive measures effectively. One of the main challenges is lack of healthy literacy among the American population, and high cost associated to development of cancer prevention literacy. In addition, the country experiences low level of experts with enough knowledge for cancer prevention and control. In addition to this, the available fund assigned to enhance cancer prevention among other non-communicable diseases is considerably low. In this has made it considerably hard for the country to manage employing all available ideas and strategies in promoting cancer prevention. Although measures such as recommended regular screening with cost covered by medical insurance, majority of beneficiary find it hard to sacrifice their time to partake these screenings. This makes it harder to enhance early intervention measures and increase the rate of cancer survivors in the country. Generally, a lot may need to be done especially in developing cancer literacy among the population to be able to meet the Health People 2020 cancer prevention and management objectives

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