Maximising health outcomes

Abstract

In 2020, I wrote an editorial in this Journal on social determinants of health, defined by the WHO as “The conditions in which people are born, grow, live, work and age” (BJOG. 2020;127(4):431–2). Therefore, I am really pleased that in this issue we are able to give our readers a highly relevant Scientific Impact Paper on precisely this subject. It aims to inform all of us about the relationship between social determinants of health and the risk of maternal death. The paper is written on behalf of the Royal College of Obstetricians and Gynaecologists and for this reason it has a UK focus, but anyone who reads it will see that the extensive literature review and recommendations are of relevance everywhere. Social determinants have a strong inf luence on a person's health and it is crucial to understand and appreciate that this remains the case even within a public health system such as the UK National Health Service (NHS), where reproductive and maternity services are provided for free. The COVID pandemic clearly meets the criteria and definition of an important Social Determinant of Health. In this issue, Davies and colleagues (1133–1139) present data on the effects of the pandemic on the diagnosis of cervical cancer, from six major cancer centres in the North of England. They observed a reduction in cancer diagnoses (by 25%) when comparing data from May to October 2020 to a similar period in 2019. Sadly, these data do not suggest a reduction in cancer: rather they are due to early disease that has gone undetected during the pandemic. The authors use these observations to develop forecasts, also taking into account the temporary cessation in screening during the pandemic; these projections suggest there will be a significant increase in cervical cancer cases presenting over the next 3 years. Usefully, the authors also suggest what changes are required (including increases in surgical capacity) to deal with this increase, and demonstrate that associated morbidity or mortality could be mitigated. The associated minicommentary by Leslie Massad (1140) brilliantly explains how the pandemic is likely to disrupt cervical cancer prevention efforts well into the future and highlights the need for health DOI: 10.1111/1471-0528.17196