Table 1.

The 3-I framework and examples from cancer equity (11,79,80)

Policy decisions are influenced by actors’ interests, ideas, and institutions
3-I	Definition	Examples in cancer care
Interests	Interests are the “agendas of societal groups, elected officials, civil servants, researchers, and policy entrepreneurs” (11)	Political interests initiated and have since sustained cancer centers in India, such as the Thiruvananthapuram Regional Cancer Center, operational since 1981, and the Tata Memorial Center, operational since 1941 (18,20). The 2022 Cancer Moonshot in the United States has galvanized efforts to reduce financial toxicity among cancer survivors.
Ideas	Ideas can be understood as “knowledge or beliefs about what is (eg, research knowledge), views about what ought to be (eg, values), or combinations of the two” (11)	The vast majority of cancer clinical trials are conducted in high-income settings, furthering global epistemic inequities and therefore the power to define what is true in medicine (39,41,43). Pharmaceutical companies exert great influence over which clinical trials are funded and therefore which interventions are assessed for suitability in patient care (45,46).
Institutions	Institutions are the “formal and informal rules, norms, precedents, and organizational factors that structure political behavior” (11) (ie, “the rules of the game”) (2)	Histories marked by racism and colonialism have demonstrated far-reaching effects on disparate access to cancer care both in the United States and globally (4, 65). International global health collaborations, led by in-country leaders and community health workers and co-financed by the government of Rwanda, have increased access to cancer care, even for those most socioeconomically disadvantaged (67).