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Closing the cancer divide for women: An opportunity of lifetimes Women´s Cancer Initiative

Closing the cancer divide for women: An opportunity of lifetimes Women´s Cancer Initiative



Pan American Health Organization (PAHO), 5 de febrero de 2013

Pan American Health Organization (PAHO), 5 de febrero de 2013



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    Closing the cancer divide for women: An opportunity of lifetimes Women´s Cancer Initiative Closing the cancer divide for women: An opportunity of lifetimes Women´s Cancer Initiative Presentation Transcript

    • January,  2008  June,  2007  
    • From anecdote … … to evidence
    • GTF.CCC Members  
    • GTF.CCC: Mission and Vision •  design, participate in implementation, and evaluate innovative strategies for expanding access to cancer prevention, detection and care that provide local and cross-country evidence for scaling up access to cancer care and control, and strengthening health systems in LMICs. •  facilitate action through the production of new knowledge and through multi-stakeholder frameworks and partnerships that demonstrate effective models of care that can be replicated and scaled up in LMICs.
    • = global health + cancer care
    • Abish Romeo, México Drew G. Faust President of Harvard University 22+ year BC survivor
    • Closing the Cancer Divide: An Equity Imperative I: Should be done II: Could be done III: Can be done M1. Unnecessary M2. Unaffordable M3. Impossible M4: Inappropriate Expanding access to cancer care and control in LMICs: 1: Innovative Delivery 2: Access: Affordable Med’s, Vaccines & Tech’s 3: Innovative Financing: Domestic and Global 4: Evidence for Decision-Making 5: Stewardship and Leadership
    • Cancer is a disease of both rich and poor but the poor suffer even more: 1.  Exposure to risk factors 2.  Preventable cancers (infection) 3.  Treatable cancer death and disability 4.  Stigma and discrimination 5.  Avoidable pain and suffering Closing the Cancer Divide is an Equity Imperative Facets
    • Adults Leukaemia All cancers Source: Knaul, Arreola, Mendez. estimates based on IARC, Globocan, 2010. Children LOW INCOME HIGH INCOME Survival inequalitygap LOW INCOME HIGH INCOME 100% Facet 3: The Opportunity to Survive Should Not, but Is Defined by Income In Canada, almost 90% of children with leukemia survive. In the poorest countries only 10%.
    • Facet 5: The most insidious injustice is lack of access to pain control Non-methadone, Morphine Equivalent opioid consumption per death from HIV or cancer in pain: Poorest 10%: 54 mg per death Richest 10%: 97,400 mg per death
    • "  Mirrors the overall epidemiological transition "   LMICs increasingly face both infection- associated cancers, and all other cancers. The Cancer Transition "   Cancers increasingly only of the poor, are not the only cancers affecting the poor.
    • LMICs account for >90% of cervical cancer deaths and >60% of breast cancer deaths. Both are leading killers – especially of young women. Did you know????? The second or third most common cause of death, especially among young women? In LAC, BC is:   The cancer transition: women 0   4   8   12   16   2010  1955   Mexico: cervical cancer.
    • Women and mothers in LMICs face many risks through the life cycle Women 15-59, annual deaths Diabetes 120,889 Breast cancer 166,577 Source: Estimates based on data from WHO: Global Health Observatory, 2008 and Murray et al Lancet 2011. Cervical cancer 142,744 Mortality in childbirth 342,900 - 35% in 30 years = 430, 210 deaths
    • Investing In CCC: We Cannot Afford Not To "   Total economic cost of cancer, 2010: 2-4% of global GDP "   Tobacco is a huge economic risk: 3.6% lower GDP "   Inaction reduces efficacy of health and social investments Prevention and treatment offers potential world savings of $ US 130-940 billion 1/3-1/2 of cancer deaths are “avoidable”: 2.4-3.7 million deaths, of which 80% are in LIMCs and women ✓  
    • The Diagonal Approach to Health System Strengthening "   Rather than focusing on either disease-specific vertical or horizontal-systemic programs, harness synergies that provide opportunities to tackle disease- specific priorities while addressing systemic gaps and optimize available resources "   Diagonal strategies:  X = > Σ parts "   Bridge disease divides: patients suffer over a lifetime, most of it chronic. "   Generate positive externalities: e.g. women’s cancer programs also combat gender discrimination; access to pain control supports surgery platforms
    • The costs to close the cancer divide may be less than many fear: "   All but 3 of 29 LMIC priority cancer agents are off-patent "   Pain medication is cheap "   Prices drop: HepB and HPV vaccines "   Delivery & financing platforms & innovations are underutilized, undeveloped, purchasing is fragmented, procurement is unstable Pink  Ribbon  Red  Ribbon-­‐  a  diagonal  ini3a3ve   Global  Paediatric  Financing  En3ty   PAHO  Strategic  Fund:  includes  NCDs,  2012     Pink  Ribbon  Red  Ribbon:  diagonal  partnership  
    • ‘Diagonalizing’ Domestic Financing: Integrate cancer care and control into national insurance and social security programs to express previously suppressed demand beginning with cancers of women and children: "  Mexico, Colombia, Dom Rep, Peru "  China, India, Thailand "  Rwanda, Ghana, South Africa
    • Universal Health Coverage in Mexico through Seguro Popular Horizontal  Coverage:     >  54.6  million  Beneficiaries   Ver3cal  Coverage       Diseases  and  Interven3ons:      Expanded  Benefit  Package      
    • Seguro Popular: cancer "   Accelerated, universal, vertical coverage by disease with an effective package of interventions "   2005: Cervical cancer "   2006: ALL in children "   2007: All pediatric cancers; Breast cancer "   2011: Testicular and Prostate cancer and NHL "   2012: Colorectal cancer Evidence of impact: "   Breast cancer adherence to treatment: "   INCAN: "   2005: 200/600 "   2010: 10/900
    • % diagnosed in Stage 4 by state • # 2 killer of women 30-54 • Only 5-10% of cases in Mexico are detected in Stage 1 or in situ • Poor municipalites: 50% Stage 4; 5x rich Delivery failure: Breast Cancer Juanita Poor/Marginalized  
    • Effective financial coverage requires attention to the chronicity of illness Breast cancer and Seguro Popular –  Primary prevention –  Secondary prevention (early detection) –  Diagnosis –  Treatment –  Survivorship care –  Palliative care
    • Harness platforms by integrating breast and cervical cancer prevention, screening and survivorship care into MCH, SRH, HIV/AIDS, social welfare and anti-poverty programs. Solution: ‘Diagonalizing’ Delivery Examples: •  Integration of breast and cervical cancer awareness and screening into the national anti-poverty program Oportunidades Results: 000´s promoters, nurses, doctors Harnessing the primary level of care
    • Where are the opportunities? •  LMICs – not months but whole lifetimes to be gained •  Focus on prevention but do not stop there! –  No prevent/treat dichotomization •  Do not take prices as fixed or given – price permeability •  Harness global and national health system platforms •  Redefine and reformulate health systems to manage chronicity •  Innovate in implementation, delivery and financing –  Evaluate, replicate and scale up –  Leapfrog and give forward •  Harness cancer to strengthen health and social systems •  Recognize LMICs as part of a global solution:  investment in learning, research and human beings
    • Expanding access to cancer care and control in LMICs: Should, Could, and Can be done
    • From anecdote … … to evidence