The Persistent Poverty Initiative's Framework to Address Social and Economic Determinants of Cancer

Social determinants of health are known drivers of a broad range of cancer outcomes. These determinants influence factors at the structural and institutional levels of society, which disproportionately affects those living in persistent poverty. Americans living in persistent poverty areas experience higher cancer incidence, delayed cancer diagnosis and treatment, and greater cancer morbidity and mortality. This report describes the aims of the NCI's Persistent Poverty Initiative, a novel research program developed to study the association of structural and institutional factors that affect cancer outcomes in persistent poverty areas. The goals of the five funded centers located across the country are described. A detailed multilevel conceptual framework was developed to incorporate the perspectives of the five centers. The framework serves as a model for other researchers studying the complex social factors and pathways that contribute to cancer outcomes. Future research can build upon this work to integrate multilevel intervention models that can examine the association of upstream social determinants of health factors and cancer outcomes. The Persistent Poverty Initiative can serve as a model for addressing cancer outcomes at the structural and institutional levels, which will hopefully lead to improved local, state, and national strategies in an effort to achieve optimal health for all.