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\"A wave of teacher strikes in the 1960s and 1970s roiled urban communities. Jon Shelton illuminates how this tumultuous era helped shatter the liberal-labor coalition and opened the door to the neoliberal challenge at the heart of urban education today. Drawing on a wealth of research ranging from school board meetings to TV news reports, Shelton puts readers in the middle of fraught, intense strikes in Newark, St. Louis, and three other cities where these debates and shifting attitudes played out. He also demonstrates how the labor actions contributed to the growing public perception of unions as irrelevant or even detrimental to American prosperity. Foes of the labor movement, meanwhile, tapped into cultural and economic fears to undermine not just teacher unionism but the whole of liberalism\"-- Provided by publisher.

The Education Myth questions the idea that education represents the best, if not the only, way for Americans to access economic opportunity. As Jon Shelton shows, linking education to economic well-being was not politically inevitable. In the eighteenth and nineteenth centuries, for instance, public education was championed as a way to help citizens learn how to participate in a democracy. By the 1930s, public education, along with union rights and social security, formed an important component of a broad-based fight for social democracy. Shelton demonstrates that beginning in the 1960s, the political power of the education myth choked off powerful social democratic alternatives like A. Philip Randolph and Bayard Rustin's Freedom Budget. The nation's political center was bereft of any realistic ideas to guarantee economic security and social dignity for the majority of Americans, particularly those without college degrees. Embraced first by Democrats like Lyndon Johnson, Jimmy Carter, and Bill Clinton, Republicans like George W. Bush also pushed the education myth. The result, over the past four decades, has been the emergence of a deeply inequitable economy and a drastically divided political system.

BackgroundChanging population-level exposure to modifiable risk factors is a key driver of changing cancer incidence. Understanding these changes is therefore vital when prioritising risk-reduction policies, in order to have the biggest impact on reducing cancer incidence. UK figures on the number of risk factor-attributable cancers are updated here to reflect changing behaviour as assessed in representative national surveys, and new epidemiological evidence. Figures are also presented by UK constituent country because prevalence of risk factor exposure varies between them.MethodsPopulation attributable fractions (PAFs) were calculated for combinations of risk factor and cancer type with sufficient/convincing evidence of a causal association. Relative risks (RRs) were drawn from meta-analyses of cohort studies where possible. Prevalence of exposure to risk factors was obtained from nationally representative population surveys. Cancer incidence data for 2015 were sourced from national data releases and, where needed, personal communications. PAF calculations were stratified by age, sex and risk factor exposure level and then combined to create summary PAFs by cancer type, sex and country.ResultsNearly four in ten (37.7%) cancer cases in 2015 in the UK were attributable to known risk factors. The proportion was around two percentage points higher in UK males (38.6%) than in UK females (36.8%). Comparing UK countries, the attributable proportion was highest in Scotland (41.5% for persons) and lowest in England (37.3% for persons). Tobacco smoking contributed by far the largest proportion of attributable cancer cases, followed by overweight/obesity, accounting for 15.1% and 6.3%, respectively, of all cases in the UK in 2015. For 10 cancer types, including two of the five most common cancer types in the UK (lung cancer and melanoma skin cancer), more than 70% of UK cancer cases were attributable to known risk factors.ConclusionTobacco and overweight/obesity remain the top contributors of attributable cancer cases. Tobacco smoking has the highest PAF because it greatly increases cancer risk and has a large number of cancer types associated with it. Overweight/obesity has the second-highest PAF because it affects a high proportion of the UK population and is also linked with many cancer types. Public health policy may seek to mitigate the level of harm associated with exposure or reduce exposure levels—both approaches may effectively impact cancer incidence. Differences in PAFs between countries and sexes are primarily due to varying prevalence of exposure to risk factors and varying proportions of specific cancer types. This variation in turn is affected by socio-demographic differences which drive differences in exposure to theoretically avoidable ‘lifestyle’ factors. PAFs at UK country level have not been available previously and they should be used by policymakers in devolved nations. PAFs are estimates based on the best available data, limitations in those data would generally bias toward underestimation of PAFs. Regular collection of risk factor exposure prevalence data which corresponds with epidemiological evidence is vital for analyses like this and should remain a priority for the UK Government and devolved Administrations.

BackgroundCancer incidence variation between population groups can inform public health and cancer services. Previous studies have shown cancer incidence rates vary by ethnic group in England. Since their publication, the completeness of ethnicity recording in cancer data has improved, and relevant inequalities (e.g. risk factor prevalence and healthcare access) may have changed.MethodsAge-standardised incidence rates were calculated for Asian, Black, Mixed/Multiple and White ethnic groups in England in 2013–2017, using almost 3 million diagnoses across 31 cancer sites. Rate ratios were calculated with the White ethnic group as reference. Sensitivity analyses used imputed ethnicity for cases with missing data and perturbed population estimates.ResultsIncidence rates for most cancer sites and ethnic group and sex combinations were lower in non-White minority ethnic groups compared with the corresponding White group, with particularly low rate ratios (below 0.5) for melanoma skin cancer and some smoking-related cancers (lung, bladder and oesophageal cancers). Exceptions included prostate cancer (2.1 times higher in males of Black ethnicity), myeloma (2.7–3.0 times higher in people of Black ethnicity), several gastrointestinal cancers (1.1–1.9 times higher in people of Black ethnicity, 1.4–2.2 times higher in people of Asian ethnicity), Hodgkin lymphoma (1.1 times higher in males of Asian ethnicity, 1.3 times higher in males of Black ethnicity) and thyroid cancers (1.4 times higher in people of Asian ethnicity, 1.2 times higher in people of Black ethnicity). Sensitivity analyses did not materially alter these results (rate ratios changed by a maximum of 12 percentage points, the direction and significance of results were unchanged in all but two cancer site/sex/ethnic group combinations).ConclusionsPeople of non-White minority ethnicity in England generally have lower cancer risk than the White population, though there are a number of notable exceptions. These results should galvanise efforts to better understand the reasons for this variation, and the possible impact on cancer services, patient experiences and outcomes.

ObjectivesCancer stage at diagnosis is a determinant of treatment options and survival. Previous research has shown differences in barriers to presentation with cancer between ethnic groups. The completeness and quality of cancer stage and ethnicity data has improved markedly over recent years in England, allowing for comparison of stage distributions at diagnosis between ethnic groups. This study aimed to assess relationships between ethnic group and two outcomes: unknown stage cancer and late stage (stages 3 and 4) cancer, after adjustment for confounders.Design and settingA retrospective secondary data analysis using data from NHS Digital’s National Cancer Registration and Analysis Service and Hospital Episode Statistics records from 2012 to 2016.ParticipantsThis study analysed newly diagnosed breast, colon, non-small cell lung cancer (NSCLC), ovary, prostate and uterine cancers in white British, Caribbean, African, Chinese and Asian patients aged 15–99 in England.ResultsCaribbean, African and Asian women with breast or ovarian cancer, Caribbean and African women with uterine or colon cancer, Caribbean women with NSCLC and Caribbean men with colon cancer had increased odds of late-stage disease at diagnosis compared with the white British cohort. In contrast, Caribbean and African men with prostate cancer had decreased odds of late-stage cancer. Where stage was known, there were variations in late-stage cancer by ethnic group.ConclusionsLow symptom awareness and barriers to presentation can cause delays, resulting in later stage diagnosis. Targeted intervention campaigns to help raise awareness of cancer signs and symptoms and the benefits of early diagnosis, along with removing barriers to appropriate referrals, could help to improve these inequalities.

More deprived populations typically experience higher cancer incidence rates and smoking prevalence compared to less deprived populations. We calculated the proportion of cancer cases attributable to smoking by socio-economic deprivation in England and estimated the impact smoking has on the deprivation gap for cancer incidence. Data for cancer incidence (2013-2017), smoking prevalence (2003-2007) and population estimates (2013-2017) were split by sex, age-group and deprivation quintile. Relative risk estimates from meta-analyses were used to estimate the population attributable fraction (PAF) for 15 cancer types associated with smoking. The deprivation gap was calculated using age-specific incidence rates by deprivation quintile. Smoking-related cancer PAFs in England are 2.2 times larger in the most deprived quintile compared to the least deprived quintile (from 9.7% to 21.1%). If everyone had the same smoking prevalence as the least deprived quintile, 20% of the deprivation gap in cancer incidence could have been prevented. If nobody smoked, 61% of the deprivation gap could have been prevented. The majority of the deprivation gap in cancer incidence could have been prevented in England between 2013-2017 if nobody had smoked. Policy makers should ensure that tobacco control policies reduce overall smoking prevalence by tackling smoking inequalities.

IntroductionPCCRC is a key quality indicator for the detection and prevention of colorectal adenocarcinoma (CRC). It is not known whether rates of PCCRC are changing over time. There is limited evidence of factors associated with PCCRC that might be amenable to quality improvement interventions.This study investigated trends in rates of PCCRC in the NHS in England; the extent of variation between NHS trusts; and potential causal associations with PCCRC.MethodsUsing linked national Hospital Episode Statistics and National Cancer Registration and Analysis Service data all individuals who had undergone a colonoscopy procedure between 1/1/2006 and 31/12/2012 and who developed a CRC to 31/12/2015 were identified. NHS trust provider status and potential associations with PCCRC were included in the analysis.International consensus methodology was used to calculate the PCCRC – 3 year rate (PCCRC-3 yr).1 2 Colonoscopies were labelled as true positive (CRC within 0 to 6 months of the procedure), false negative (CRC within 6 to 36 months) and true negative (CRC beyond 36 months). The PCCRC-3 yr rate was calculated as: false negatives/(true positive +false negative) x 100%.The PCCRC-3 yr rate was calculated for each year from 2006 to 2012. In addition, the rate in each colonoscopy provider was calculated, and organisations grouped using quintiles. PCCRC rates were calculated in relation to patient and tumour characteristics.ResultsBetween 2006 and 2012 1 08 908 colonoscopies followed by a diagnosis of CRC were identified. Of these, 93 240 (86%) were labelled true positive, 7781 (7%) were false negatives, and 7887 (7%) were true negative tests. There was a significant reduction in PCCRC-3 yr rates, from 8.6% in 2006 to 7.5% in 2012 (Chi2 for trend p<0.01). There was variation in unadjusted, mean PCCRC-3 yr rate between NHS Trusts from 5% (SD ±2%) in the highest performing quintile to 11% (SD ±2%) in the lowest. PCCRCs were significantly associated with female sex, right-sided colonic lesions, inflammatory bowel disease and diverticular disease diagnosis, mucinous CRC and in individuals with metachronous CRC.ConclusionThere has been a significant reduction in PCCRC-3 yr rates from 2006 to 2012, likely to be related to improvements in colonoscopic quality: particularly improved caecal intubation and bowel preparation resulting in improved lesion recognition and removal. There appears to be unwarranted variation of PCCRC-3 yr rates across NHS trusts. Reasons for this variation need to be explored and subject to quality improvement projects. Evidence from this study can be used to help target those at highest risk of PCCRC.References. Morris EJA, et al. Gut2014;64:1248–56.. Beintaris I, et al. UEG J2017;5:PO436.

AbstractObjectiveTo examine and interpret trends in UK cancer incidence and mortality for all cancers combined and for the most common cancer sites in adults aged 35-69 years.DesignRetrospective secondary data analysis.Data sourcesCancer registration data, cancer mortality and national population data from the Office for National Statistics, Public Health Wales, Public Health Scotland, Northern Ireland Cancer Registry, NHS England, and the General Register Office for Northern Ireland.Setting23 cancer sites were included in the analysis in the UK.ParticipantsMen and women aged 35-69 years diagnosed with or who died from cancer between 1993 to 2018.Main outcome measuresChange in cancer incidence and mortality age standardised rates over time.ResultsThe number of cancer cases in this age range rose by 57% for men (from 55 014 cases registered in 1993 to 86 297 in 2018) and by 48% for women (60 187 to 88 970) with age standardised rates showing average annual increases of 0.8% in both sexes. The increase in incidence was predominantly driven by increases in prostate (male) and breast (female) cancers. Without these two sites, all cancer trends in age standardised incidence rates were relatively stable. Trends for a small number of less common cancers showed concerning increases in incidence rates, for example, in melanoma skin, liver, oral, and kidney cancers. The number of cancer deaths decreased over the 25 year period, by 20% in men (from 32 878 to 26 322) and 17% in women (28 516 to 23 719); age standardised mortality rates reduced for all cancers combined by 37% in men (−2.0% per year) and 33% in women (−1.6% per year). The largest decreases in mortality were noted for stomach, mesothelioma, and bladder cancers in men and stomach and cervical cancers and non-Hodgkin lymphoma in women. Most incidence and mortality changes were statistically significant even when the size of change was relatively small.ConclusionsCancer mortality had a substantial reduction during the past 25 years in both men and women aged 35-69 years. This decline is likely a reflection of the successes in cancer prevention (eg, smoking prevention policies and cessation programmes), earlier detection (eg, screening programmes) and improved diagnostic tests, and more effective treatment. By contrast, increased prevalence of non-smoking risk factors are the likely cause of the observed increased incidence for a small number of specific cancers. This analysis also provides a benchmark for the following decade, which will include the impact of covid-19 on cancer incidence and outcomes.

In 1977, a bill to better enforce the National Labor Relations Act (NLRA) sailed quickly through the House of Representatives. Facing a Senate filibuster, its proponents weakened the proposal—making it, according to historian Jefferson Cowie, \"lean, moderate, and basically unchallenging to the corporate order.\"1 Even in its attenuated state, however, the bill would have curbed the most flagrant violations of private-sector workers' rights. Though this version reached the precipice of the supermajority necessary to invoke cloture, it ultimately fell two votes short.This article seeks to understand how antiunion activists defeated organized labor's last big legislative opportunity to reverse its fortunes in the wake of deindustrialization and an onslaught of corporate attacks in the 1970s. Indeed, the right's success in stymieing labor reform was decidedly momentous, especially because the law represented such a modest change. Kim Phillips-Fein has shown that a half a century of activism from market fundamentalist intellectuals and anti–New Deal businessmen paved the way for the formation of the Business Roundtable—a group of powerful CEO's from Fortune 500 companies—and politicized other somnolent forces like the [End Page 378] Chamber of Commerce. In fact, she shows that by the 1970s there was a robust, consciously political \"business activist movement.\"2 Kim Moody's account of the failure of the bill—as \"labor's major agenda point of the decade\"—centers on the pushback from anti-labor corporate activism, in particular the Roundtable.