Your SlideShare is downloading. ×
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Cancer- Did you know? Disproving the myths about cancer in resource-constrained settings

103

Published on

Harvard School of Public Health. Primero de febrero de 2013

Harvard School of Public Health. Primero de febrero de 2013

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
103
On Slideshare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. CC i ?i ?CancerCancer-- Did you Know?Did you Know? Disproving the MythsDisproving the MythsDisproving the MythsDisproving the Myths About Cancer inAbout Cancer in WORLDWORLD CANCERCANCER ResourceResource--constrained Settingsconstrained Settings CANCERCANCER DAYDAY SeminarSeminar HarvardHarvard SchoolSchool ofof PublicPublic HealthHealth FebruaryFebruary 1st, 20131st, 2013 SeminarSeminar Felicia Marie Knaul, PhDFelicia Marie Knaul, PhD Harvard Global Equity Initiative, Global Task Force on Expanded Access toHarvard Global Equity Initiative, Global Task Force on Expanded Access to Cancer Care and Control in LMICsCancer Care and Control in LMICsCancer Care and Control in LMICsCancer Care and Control in LMICs Tómatelo a Pecho A:C. MéxicoTómatelo a Pecho A:C. México Mexican Health FoundationMexican Health Foundation Union for International Cancer ControlUnion for International Cancer Control
  • 2. Thank youThank you
  • 3. GlobalGlobal TaskTask ForceForce onon ExpandedExpanded AccessAccess toto CancerCancer Care andCare and Control inControl in DevelopingDeveloping CountriesCountriesControl inControl in DevelopingDeveloping CountriesCountries l b l h lth= global health + cancer care
  • 4. GTF.CCC Members
  • 5. Applies a diagonalApplies a diagonal approach to manageapproach to manageapproach to manageapproach to manage ‘‘chronicitychronicity’ and avoid’ and avoidchronicitychronicity and avoidand avoid the false dilemmasthe false dilemmas between disease silosbetween disease silos CD/NCDCD/NCD th tth t--CD/NCDCD/NCD-- thatthat continue to plaguecontinue to plaguecontinue to plaguecontinue to plague global healthglobal healthgg
  • 6. Closing the Cancer Divide: An Equity Imperative Expanding access to cancer care and control in LMICs: I: Should be doneM1. Unnecessary II: Could be done M2. Unaffordable M3 Impossible III: Can be done M3. Impossible M4: Inappropriatepp p
  • 7. The Cancer Transition i h id i l i l i i The Cancer Transition Mirrors the epidemiological transition LMICs increasingly face both infectionLMICs increasingly face both infection- associated cancers, and all other cancers. Cancers increasingly only of the poor, are not the only cancers affecting the poor.not the only cancers affecting the poor.
  • 8. Did you know?????Did you know????? LMICs account for >90% of cer ical For children & adolescents>90% of cervical cancer deaths and #2 f d h i l h i For children & adolescents 5-14 cancer is: >60% of breast cancer deaths. Both #2 cause of death in wealthy countries #3 in upper middle-income #4 in lower middle-income are leading killers – especially of young #4 in lower middle income and # 8 in low-income countries especially of young women.
  • 9. Closing the Cancer Divide C i di f b h i h d b is an Equity Imperative Cancer is a disease of both rich and poor but the poor suffer even more:the poor suffer even more: 1. Exposure to risk factors1. Exposure to risk factors 2. Preventable cancers (infection) 3. Treatable cancer death and disability acets 4. Stigma and discrimination 5 Avoidable pain and suffering Fa 5. Avoidable pain and suffering
  • 10. The Opportunity to Survive Should Not, b I D fi d b I 100% but Is Defined by Income AdultsChildren ine Leukaemia Surviv equality All cancers val ygap LOW INCOME HIGH INCOME LOW INCOME HIGH INCOME In Canada, almost 90% of children with leukemia survive Source: Knaul, Arreola, Mendez. estimates based on IARC, Globocan, 2010. leukemia survive. In the poorest countries only 10%.
  • 11. The most insidious injustice is lack of access to pain controlof 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
  • 12. Challenge and disprove theChallenge and disprove the myths about cancer M1 Unnecessary NECESSARYNECESSARYM1. Unnecessary NECESSARYNECESSARY M2. Unaffordable: ….for the poorUnaffordable: ….for the poorpp M3. Inappropriate: either/or Ch ll i i li kiChallenging cancer implies taking resources away from other ‘diseases of the poor’ M4: Impossible
  • 13. Investing In CCC: We Cannot Afford Not To Inaction reduces efficacy of health and social investments Total economic cost of cancer, 2010: 2-4% of global GDPg Tobacco is a huge economic risk: 3.6% lower GDP 1/3-1/2 of cancer deaths are “avoidable”: 2 4 3 7 million deaths✓ 2.4-3.7 million deaths, of which 80% are in LIMCs ✓ Prevention and treatment offers potentialeve o d e e o e s po e world savings of $ US 130-940 billion
  • 14. The costs to close the cancer divide b l th fmay be less than many fear: All b 3 f 29 LMIC i i h dAll but 3 of 29 LMIC priority cancer chemo and hormonal agents are off-patent Pain medication is cheap P i d H B d HPV iPrices drop: HepB and HPV vaccines Delivery and financing innovations arey g underutilized and undeveloped: purchasing is fragmented and procurement is unstablefragmented and procurement is unstable Global Paediatric Financing EntityGlobal Paediatric Financing Entity
  • 15. Challenge and disprove theChallenge and disprove the myths about cancer M1 Unnecessary NECESSARYNECESSARYM1. Unnecessary NECESSARYNECESSARY M2. Unaffordable: AFFORDABLEAFFORDABLE M3. ImpossibleM3. Impossible M4 I i t ith /M4 I i t ith /M4. Inappropriate: either/orM4. Inappropriate: either/or Challenging cancer implies taking resourcesg g p g away from other ‘diseases of the poor’
  • 16. Women and mothers in LMICs f i k th h th lif lface many risks through the life cycle Women 15-59, annual deathsWomen 15 59, annual deaths Diabetes Breast cancer Cervical cancer Mortality in childbirth- 35% in 30 years 120,889166,577 142,744342,900 430 210 d h Source: Estimates based on data from WHO: Global Health Observatory, 2008 and Murray et al Lancet 2011. = 430, 210 deaths
  • 17. Harvard, Breast Cancer in DevelopingHarvard, Breast Cancer in Developing Countries, Nov 4, `09Countries, Nov 4, `09 Champions Harvard, Breast Cancer in DevelopingHarvard, Breast Cancer in Developing Countries, Nov 4, 09Countries, Nov 4, 09 Nobel Amartya Sen, Cancer survivor diagnosed in India Drew G. Faust President of Harvard University Cancer survivor diagnosed in India 50 years ago President of Harvard University 22+ year BC survivor
  • 18. Young champions, from LMICsg p , Abish Romeo, México Breast cancer, 23Breast cancer, 23 Beneficiary of Seguro PopularSeguro Popular
  • 19. PIH Rural Rwanda: 0 oncologists Burkitt´s lymphoma Embryonal RhabdomyosarcomaRhabdomyosarcoma Source: Paul Farmer., 2009
  • 20. The Diagonal Approach to Health System Strengthening Rather than focusing on disease-specific vertical programs or only on horizontal systemprograms or only on horizontal system constraints, harness synergies that provide t iti t t kl di ifi i itiopportunities to tackle disease-specific priorities while addressing systemic gaps. Optimize available resources so that the whole is more than the sum of the partsmore than the sum of the parts. Bridge the divide as patients suffer diseases over aBridge the divide as patients suffer diseases over a lifetime, most of it chronic.
  • 21. Domestic, Diagonal financing innovations Integrate CCC into national insurance programs to express previously suppressedprograms to express previously suppressed demand, beginning with cancers of women and children: Mexico Colombia DominicanMexico, Colombia, Dominican Republic, Peru China, India, Taiwan R d KRwanda, Kenya
  • 22. México Seguro Popular: Cancer and the Fund for Protection fromCancer and the Fund for Protection from Catastrophic Illness Accelerated, universal, vertical coverage by disease with an effective package of interventionsp g 2004: HIV/AIDS i l2005: cervical cancer 2006: ALL in children2006: ALL in children 2007: All pediatric cancers; Breast cancer 2011: Testicular and Prostate cancer and NHL 2012 C l t l2012: Colorectal cancer
  • 23. México Seguro Popular and cancer: Evidence of impact Access to medicines Since the incorporation of childhood cancers into the Seguro Popularinto the Seguro Popular Adherence to treatment: 70% to 95% Breast cancer adherence to treatment: 2005: 200/6002005: 200/600 2010: 10/900
  • 24. Delivery failure: México Breast Cancer •# 2 killer of % diagnosed in Stage 4 by state # 2 killer of women 30-54 •Only 5 10% of•Only 5-10% of cases in Mexico d d iare detected in Stage 1 or in situ •Poor municipalites: Poor/Marginalizedmunicipalites: 50% Stage 4; 5x rich oo / a g a ed rich
  • 25. Juanita:Jua ta: Advanced metastatic breast f i fcancer, the result of a series of missed opportunitiesssed oppo tu t es
  • 26. Solution: ‘Diagonalizing’ Delivery Harness platforms by integrating breast and cervical cancer prevention, screening andcervical cancer prevention, screening and survivorship care into MCH, SRH, HIV/AIDS, social welfare and anti poverty programssocial welfare and anti-poverty programs. Examples: Harnessing the primary level of care • Integration of breast and cervical cancer awareness and screening into the national anti- poverty program Oportunidades Results: 000´s promoters, nurses, doctors
  • 27. Where are the opportunities?Where are the opportunities? LMIC h b h h l lif i• LMICs: not months but rather whole lifetimes to be gained • Recognize cancer in LMICs as an integral component of our common search for globalcomponent of our common search for global health solutions: investment in learning, research, knowledge-sharing and translation andknowledge sharing and translation, and ultimately in human beings
  • 28. From anecdoteFrom anecdote … t id… to evidence
  • 29. January, 2008June, 2007
  • 30. BeBe ananBeBe anan optimistoptimistoptimistoptimist optimalistoptimalistoptimalistoptimalist Expanding access to cancer care and control inExpanding access to cancer care and control in LMICs: Should, Could, and Can be done

×