Paper short abstract:

This paper investigates the category of 'hard-to-reach' through relevant literature in cancer prevention and in health research in the UK. We argue that conceptualising people as 'hard-to-reach' risks contributing to long-standing inequalities in cancer research and care.

Paper long abstract:

Within UK public health initiatives researchers and policymakers constantly attempt to define and understand different patient profiles based on the ways in which eligible users engage with available services or do not; some of the most elusive populations are described as hard-to-reach.

This seemingly homogenising catch-all category - hard-to-reach - has been used to outline people who evade cancer prevention efforts (as described in academic literature) because they are: "ill informed", "not interested", or "facing barriers," all of which ostensibly prevent them from engaging with the discourses promoted by available services.

Through exploratory fieldwork on the themes of cancer prevention, risk, and care with 100+ people from so-called hard-to-reach populations including: those affected by physical disabilities; mental health conditions; people 64+; people in disparate rural areas; rough sleepers; Gipsy Roma Travellers; recovering addicts; and migrants; we have set out to ethnographically examine the category of hard-to-reach in a single and vastly diverse English region.

In addition to tracing this category through relevant literature in cancer prevention and the political effects of othering in health research in the UK, we will present an ethnographic overview of the groups within the region, focusing on the ways that different hard-to-reach communities conceive of 'care' and 'risk'. We argue that conceptualising people as "hard-to-reach" risks conflation of the diverse dynamics of social exclusion with epistemic opacity, potentially contributing to long-standing

inequalities in cancer research and care.