Intended for healthcare professionals


Cancer inequalities endure despite NHS reforms

BMJ 2018; 360 doi: (Published 14 March 2018) Cite this as: BMJ 2018;360:k989
  1. Diana Sarfati, professor1,
  2. Christopher Jackson, senior lecturer2
  1. 1Department of Public Health, University of Otago, Wellington, New Zealand
  2. 2Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  1. Correspondence to: D Sarfati diana.sarfati{at}

Real progress requires a more comprehensive approach

Much of the success of modern medicine has been built on the fundamentals of scientific method—observation, hypothesis generation, intervention, measurement, and comparison. Evidence is expected before implementation. This disciplined, assiduous, and deliberate approach led to many of the most important medical advances in the past 400 years. Do the same standards apply to public policy, arguably the biggest intervention of all?

In this issue, Exarchakou and colleagues (doi:10.1136/bmj.k764) evaluated whether the NHS Cancer Plan (2000) and associated reforms had any impact on cancer survival, and whether any gains were evenly distributed across the English population.1 Dishearteningly, they conclude that the policy has had little impact on rate of improvement in survival, or on socioeconomic disparities in survival. Does this mean the NHS cancer reforms failed?

The authors’ attempt to evaluate the impact of the reforms in a rigorous manner is laudable. Such efforts are fraught with difficulty—there are multiple …

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