Cancer Inequalities in Surrey: Resource Hub
Cancer Inequalities in Surrey: Resource Hub
Welcome to Surrey County Council’s Cancer Inequalities resource hub. This page hosts evidence-based insights and tools to help identify and address cancer inequalities in Surrey.
1. What are cancer inequalities?
Cancer inequalities are a type of health and healthcare inequality. As defined by The Kings Fund (2022):
- Health inequalities are avoidable, unfair and systematic differences in health between different groups of people.
- Healthcare inequalities are an aspect of health inequalities, and relate to inequalities in the access people have to health services and in their experiences of and outcomes from healthcare.
- Health and healthcare inequalities can occur by socio-economic factor, geography, possession of specific characteristics, or membership of socially excluded (or ‘inclusion’) groups.
Inequalities can occur across the cancer care continuum, from prevention, diagnosis and treatment, through to survivorship and end of life care; there are shared as well as unique barriers across cancer types, groups of people and individuals.
For information about wider Health Inequalities, and how Surrey Health and Wellbeing Board are addressing and reducing them as a key priority, visit the Health Inequalities webpage.
2. Why do we need a Surrey Cancer Inequalities Plan?
2.1 Cancer in Surrey
In 2023, cancer was the leading cause of death in Surrey, responsible for 23.9% of deaths across the county (Surrey Context JSNA).
Cancer is also the second largest contributor to the gap in life expectancy between the most and least deprived quintiles in Surrey in females, after circulatory disease, and third largest in males after circulatory and respiratory disease (OHID Fingertips Segment Tool, Figure 1).
In Surrey, the cancers with the highest incidence, prevalence and mortality rates are prostate, breast, colorectal and lung – the same pattern as seen nationally (National Disease Registration Service). But we know from local data there is variation in cancer incidence and mortality rates between different areas in Surrey (OHID Fingertips Cancer Services). For example:
- Between 2015-2019, 122 people per 100,000 living in Shepperton Town were diagnosed with cancer, compared to 70 per 100,000 in Woldingham.
- Between 2016-2020, the under 75 mortality ratio in Okewood, and Godalming Farncombe and Catteshall was 137 per 100, compared to 25 in Ewhurst (where 100 is the number of deaths from all cancer that would be expected if the local area experienced the same age specific mortality rates as for England)
We also know from national data that there is variation in outcomes by gender, age, deprivation and other factors (OHID Fingertips Cancer Services). For example:
- Between 2021-2023, 148.2 people in the most deprived decile (IMD2019) died from cancer per 100,000, compared to 105.2 per 100,000 in the least deprived decile. Of the four most common cancers, this deprivation gap is particularly large for lung cancer.
Figure 1. Breakdown of the life expectance gap between the most and least deprived quintiles of Surrey by cause of death, 2020-2021 (OHID Fingertips Segment Tool)
2.2 Cancer inequalities are a national and local priority
2.2.1 NHS England CORE20Plus5
CORE20Plus5 is the NHS England approach to inform targeted action to reduce healthcare inequalities at a national and system level.
The approach defines two target populations and 5 key clinical areas of focus:
- Core20: the most deprived 20% of the national population, defined by the Index of Multiple Deprivation. In Surrey, these are defined as the Key Neighbourhoods in the Health and Wellbeing Strategy.
- PLUS: population groups identified at a local level. In Surrey, this includes both the Priority Populations defined in the Surrey Health and Wellbeing Strategy, and inclusion health groups
- 5: Early diagnosis of cancer (at Stage 1 or 2) is defined as one of five core clinical areas of focus
The Core20Plus5 framework is aligned with the Surrey Health and Wellbeing Strategy, which provides more detail on which groups in Surrey fall with the Core20 and PLUS populations:
2.2.2 Surrey Health and Wellbeing Strategy
The Surrey Health and Well-Being Strategy sets out Surrey Health and Wellbeing Board’s vision to be a uniquely special place where everyone has a great start to life, people live healthy and fulfilling lives, are enabled to achieve their full potential and contribute to their community and no one is left behind. The Strategy’s focus is on a commitment to reduce health inequalities. To achieve this aim, the Strategy identifies specific groups of people who experience health inequalities, known as priority populations. Surrey’s priority populations incorporate:
- 21 key neighbourhoods: these are the areas in Surrey experiencing the highest levels of deprivation, based on the 2019 Index of Multiple Deprivation’s rankings for Lower Super Output Areas. Summaries about the key neighbourhoods are available on Surrey-i.
- People who experience the poorest health outcomes: Further information about these populations are found in the Surrey Context JSNA Chapter.
Supporting this vision are three priorities. The commitment to addressing cancer inequalities in Surrey is aligned with Priority 1: Supporting people to lead healthy lives by preventing physical ill health and promoting physical well-being. This includes ensuring people are eating healthily and are active, addressing individual lifestyle factors including addiction, with specialist support where these addictions are compounded with several other disadvantages (‘multiple disadvantage’), such as mental health/behavioural issues, homelessness or risk of homelessness, contact with the criminal justice system and/or domestic abuse. Ensuring access to diagnostics and immunisations to prevent disease and support is available to live well independently for as long as possible is also key.
2.2.3 Inclusion health groups
Inclusion health is defined by the NHS as “an umbrella term used to describe people who are socially excluded, who typically experience multiple overlapping risk factors for poor health, such as poverty, violence and complex trauma. This includes people who experience homelessness, drug and alcohol dependence, vulnerable migrants, Gypsy, Roma and Traveller communities, sex workers, people in contact with the justice system and victims of modern slavery.” There is some overlap between inclusion health groups and Surrey’s priority populations (see Figure 2), which is being considered as part of a Surrey system level inclusion health self-assessment.
Intersectionality and multiple disadvantage
Interacting, additive and mutually reinforcing inequalities
| 21 key neighbourhoods
Wards which include the most deprived “pockets” within the county, based on Index of Multiple Deprivation (IMD) score |
Surrey Priority Populations
Communities which are often overlooked and most at risk of experiencing poor health outcomes identified by Surrey’s COVID Community Impact Assessment and Rapid Needs Assessments. *People experiencing homelessness |
OHID Inclusion groups
Population groups who are socially excluded, who typically experience multiple overlapping risk factors for poor health and are often not accounted for in electronic records. *People experiencing homelessness |
| Looked after children and adults with care experience Children with additional needs and disabilities |
To manage scope, programme has a focus on adult cancer care pathways, although we are mindful of childhood cancers, and impacts on young carers and will look for opportunities to address through future partnerships |
Figure 2. Overview of populations in Surrey at risk of experiencing cancer inequalities
*Population groups defined both as a Surrey priority population and inclusion health group.
How are Surrey County Council identifying and addressing cancer inequalities?
Macmillan Cancer Support have funded Surrey County Council to carry out a two-year cancer inequalities programme, working closely with Surrey Heartlands Integrated Care System, running from April 2024. The objectives of the programme are to:
- Improve our knowledge and understanding of groups experiencing inequalities in relation to cancer outcomes and experiences of cancer care across Surrey
- Provide recommendations to address inequalities in prevention, screening, diagnostics referrals, treatment, personalised care, access, experience and outcomes
Collaboration and knowledge exchange
Tackling cancer inequalities requires a collaborative partnership approach. Between September – November 2024, Surrey County Council ran a survey to identify recently completed, ongoing or planned work aiming to identify or address cancer inequalities in Surrey. Figure 3 maps the range of projects being undertaken across Surrey identified through this survey. More detail about each project is included in the Surrey Cancer Inequalities Index. To read more about each project, including how the results have been used to inform our approach to addressing cancer inequalities in Surrey, please read the full survey report.
If you would like to add a project to the map, or are interested in working together on cancer inequalities projects in Surrey, please contact Daisy McInnerney, the Senior Public Health Programme Lead and Researcher for the Surrey Cancer Inequalities programme, on [email protected]
Figure 3. Map of planned, ongoing or recently completed work to tackle cancer inequalities in Surrey, identified through Surrey Cancer Inequalities Survey 2024.
Cancer inequalities resources for Surrey
The table below shares some of the key insights and resources developed through this Macmillan-funded programme, as well as relevant work being carried about by partners across Surrey and beyond. This table will be updated as resources are developed over the programme.
If you have developed any resources that you would like to share in this list, please contact [email protected]
| Resource | Purpose | Authors | Date produced |
| Surrey Cancer Inequalities Survey Report | This report describes the results of the Surrey Cancer Inequalities Survey 2024, which mapped planned, ongoing or recently completed projects aiming to tackle cancer inequalities across Surrey. The report makes recommendations to guide strategic action on cancer inequalities at a system level. | Daisy McInnerney (SCC) Negin Sarafraz-Shekary (SCC) Alex Greenway (Surrey Heartlands ICS) |
May 2025 |
| Surrey Cancer Inequalities Index | The Index summarises projects being undertaken across Surrey aiming to identify, understand or address local cancer inequalities, identified through the Surrey Cancer Inequalities Survey 2024. The Index can be used to identify key collaborators and existing insights to inform new inequalities work. | Daisy McInnerney (SCC) Negin Sarafraz-Shekary (SCC) Alex Greenway (Surrey Heartlands ICS) |
March 2025 |
| Surrey Cancer Inequalities Plan May 2025 | This report describes a series of evidence-based recommendations for cross-system action to identify, understand and tackle cancer inequalities across Surrey, developed as part of Surrey’s Macmillan-funded cancer inequalities programme. | Daisy McInnerney (SCC) Negin Sarafraz-Shekary (SCC) Alex Greenway (Surrey Heartlands ICS) |
May 2025 |
| Surrey CI Datapack 1: Variations in key cancer epidemiology in Surrey |
One of a set of data packs collating key insights from publicly available data sources (e.g. Cancer Data Hub, OHID Fingertips) in relation to cancer inequalities in Surrey. | Daisy McInnerney (SCC) | April 2024 – April 2025 |
| Surrey CI Datapack 2: Variations in exposure to key cancer risk factors and wider determinants of health in Surrey |
One of a set of data packs collating key insights from publicly available data sources (e.g. Cancer Data Hub, OHID Fingertips) in relation to cancer inequalities in Surrey. | Daisy McInnerney (SCC) | April 2024 – April 2025 |
| Surrey CI Datapack 3: Diagnosis of cancer in Surrey |
One of a set of data packs collating key insights from publicly available data sources (e.g. Cancer Data Hub, OHID Fingertips) in relation to cancer inequalities in Surrey. | Daisy McInnerney (SCC) | April 2024 – April 2025 |
| Surrey CI Datapack 4: Variations in type and time to treatment |
One of a set of data packs collating key insights from publicly available data sources (e.g. Cancer Data Hub, OHID Fingertips) in relation to cancer inequalities in Surrey. | Daisy McInnerney (SCC) | April 2024 – April 2025 |
| Surrey CI Datapack 5: Patient experience and quality of life |
One of a set of data packs collating key insights from publicly available data sources (e.g. Cancer Data Hub, OHID Fingertips) in relation to cancer inequalities in Surrey. | Daisy McInnerney (SCC) | April 2024 – April 2025 |
| Surrey CI Datapack 6: Key cancer data for Surrey Districts and Boroughs |
One of a set of data packs collating key insights from publicly available data sources (e.g. Cancer Data Hub, OHID Fingertips) in relation to cancer inequalities in Surrey. | Daisy McInnerney (SCC) | April 2024 – April 2025 |
| From Awareness to Action: Tools to Close the Cancer Health Equity Gap | This training slide set provides an introduction to approaches to designing research to identify and address local cancer inequalities, as well as linking to several helpful resources. It was first delivered as a breakout session at Macmillan Professionals Conference 2024. | Daisy McInnerney (SCC) Negin Sarafraz-Shekary (SCC) |
November 2024 |
| Report: Effectiveness of cervical cancer screening programme and its overall uptake as well as reach to vulnerable groups | This briefing outlines the effectiveness of the cervical cancer screening programme and its overall uptake as well as reach to vulnerable groups and provide recommendations to increase cervical screening uptake and HPV vaccine coverage. | Negin Sarafraz-Shekary (SCC) | March 2024 |
| Physical Activity and Cancer: Mapping the evidence base to inform recommendations for Surrey |
Narrative synthesis of evidence related to the impact of physical activity on cancer incidence and outcomes, and associated inequalities. |
Will Peer (Active Surrey) Daisy McInnerney (Surrey County Council) |
January 2026 |
| Inequalities in lung cancer screening: evidence review and recommendations to inform equitable implementation | Narrative synthesis of existing research into inequalities in lung cancer screening and approaches to preventing and/or addressing them. | Daisy McInnerney (Surrey County Council) | February 2026 |