Background
Cancer remains a major public health challenge across Europe, with incidence and prevalence projected to rise significantly in the coming decades. Europeans account for 25% of global annual cancer cases despite representing only 10% of the world’s population, underscoring the scale of the challenge and the persistence of inequalities in prevention, diagnosis, treatment, and survival. These disparities are influenced by broader social determinants and systemic health system factors, which continue to hinder progress despite advances in medical science and policy efforts.
Objectives
This policy brief aims to deepen understanding of how core health system functions, including governance, financing, service delivery and resource generation, shape equity in cancer care across Europe. It seeks to (1) examine the role these functions play in reducing inequalities throughout the cancer care continuum, and (2) identify barriers and enablers to implementing initiatives that promote equitable access and outcomes. The brief is designed to inform policymakers at European, national, and regional levels by aligning with Europe’s Beating Cancer Plan.
Methods
Developed under the OBS?Learning From Progress In Addressing Cancer In Europe (OBS?PACE) project with DG SANTE, this policy brief draws on a rapid literature review and selected country case studies. The analysis incorporates evidence on how governance structures, financing mechanisms, service delivery models and workforce and resource strategies influence equity in cancer care. It integrates practical experience from European countries to assess alignment with EU?level priorities and identify areas for system improvement.
Results
Findings highlight that governance, characterised by clear policy vision, evidence?based decision?making, and inclusive stakeholder engagement, is essential for reducing cancer inequalities. Embedding patient and public voices, integrating equity into legislation and regulation, and aligning national priorities with EU frameworks significantly strengthen implementation efforts. Sustainable and equitable financing mechanisms are also shown to be critical. Countries that adopt progressive revenue strategies, cancer investments, and equitable purchasing approaches perform better in ensuring access to effective interventions and innovative therapies. Service delivery reforms that enhance safety, effectiveness, and timely access across the full cancer continuum play a transformative role in reducing disparities. However, ongoing challenges such as fragmented care models, geographic variations, and long waiting times persist. Workforce shortages are a major constraint across many countries, limiting the responsiveness of cancer services; effective strategies include developing new skill mixes, strengthening multidisciplinary teams, and supporting informal caregivers. Digitalisation offers opportunities for improved coordination and early detection, though policymakers must ensure digital tools do not exacerbate inequalities for vulnerable populations.
Conclusions / Implications for practice or policy
Persistent barriers, including limited financial resources, regulatory complexity, workforce gaps, and the exclusion of marginalised groups, continue to impede equitable cancer care. However, enablers included strategic alignment between EU and national initiatives, participatory governance, cross?sector and multidisciplinary collaboration, and investment in digital readiness and workforce capacity. A comprehensive, integrated health system approach is necessary to address cancer inequalities effectively. Policymakers should prioritise aligning top?down strategies with local, community?centred implementation to ensure that European cancer policy translates into equitable, person?centred and sustainable cancer care for entire populations.

Health system approach to reducing cancer inequalities framework