Theme 1: Health Systems Strengthening for Health Promotion and Squamous Cancer Prevention (Williams, Mathur)

A key focus of this theme will be on oral cancer, which is one of the most prevalent squamous cancers and an important public health problem (Williams et al., 2019). It is increasing in global prevalence, particularly among younger adults. Globally, cancers of lip and oral cavity are the eighth most commonly diagnosed cancers in males, with an incidence of 5.10 new cases per 100,000. Oral cancer rates are also on the rise, with an increase of almost 7% prevalence rates and 2% incidence rates between 1990-2017. The occurrence of oral cancer is highest in South Asian countries followed by European countries. Treatment is complex and expensive, requiring extensive specialised care and a prolonged period of rehabilitative care, and survival rates have not improved appreciably over the past 50 years. The overarching goal of this Theme is to reduce the prevalence of oral cancer through the implementation of effective, evidence-based public health prevention programmes. An associated goal is to improve the prognosis and quality of life of patients diagnosed with oral cancer through better early diagnosis and improved treatment.

A number of studies have looked at the socioeconomic inequalities in the prevalence of oral cancer in UK and elsewhere, particularly in India, and it is clear that the risk of being diagnosed with oral cancer is strongly associated with social deprivation. This is a particular health challenge in east London. However, a key unknown is whether these inequalities are associated with delayed diagnosis and accessing treatment of oral cancer. There is also a paucity of research on co-morbidities associated with oral cancer and their determinants. However, it is clear that there is an urgent need to strengthen health systems and integrate oral cancer prevention and treatment in Universal Health Care benefit packages, which are currently the most sought-after sustainable development target and a global aspiration.

This research theme will address co-morbidities associated with oral cancer and their determinants; the causal roles of socially patterned behaviours, such as tobacco, betel nut, and alcohol use; understanding social disparities in oral cancer; the impact of early life socioeconomic conditions on onset of oral cancer, and strengthening health systems for integrated prevention and treatment. Our three initial objectives are:

1. Data Management
    
   1. To undertake a review to identify research and non-research population and service delivery datasets collecting information on oral cancer.
   2. To identify opportunities and barriers for effective linking of identified datasets on oral cancer
   3. To create a database that provides a comprehensive picture of public health burden of oral cancer in UK
      
      
2. Diagnosis, co-morbidities and health impact
   
   
   1. To study the key factors determining the diagnosis (delay) and accessing treatment for oral cancer and associated individual and area level inequalities (multi-level analyses)
   2. To assess the most common clusters of co-morbid conditions associated with oral cancer and their determinants
   3. To evaluate the impact of oral cancer on quality of life
      
      
3. The public health burden of squamous cancer: an international perspective
   
   
   1. To identify European and international datasets to undertake harmonised analysis to better understand the public health burden of oral cancer.
   2. To develop international research collaborations to set up multi-centric studies filling critical evidence gaps in oral cancer research.

_{WILLIAMS, D. M., MOSSEY, P. A. & MATHUR, M. R. 2019. Leadership in global oral health. Journal of Dentistry, 87, 49-54.}