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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
acc...
= 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. U...
Cancer is a disease of both rich and poor but
the poor suffer even more:
1.  Exposure to risk factors
2.  Preventable canc...
Adults
Leukaemia
All cancers
Source: Knaul, Arreola, Mendez. estimates based on IARC, Globocan, 2010.
Children
LOW
INCOME
...
Facet 5: The most insidious injustice
is lack of access to pain control
Non-methadone, Morphine Equivalent opioid
consumpt...
"  Mirrors the overall epidemiological
transition
"   LMICs increasingly face both infection-
associated cancers, and all ...
LMICs account for
>90% of cervical
cancer deaths and
>60% of breast
cancer deaths. Both
are leading killers –
especially o...
Women and mothers in LMICs
face many risks through the life cycle
Women 15-59, annual deaths
Diabetes
120,889
Breast
cance...
Investing In CCC:
We Cannot Afford Not To
"   Total economic cost of cancer, 2010: 2-4% of global GDP
"   Tobacco is a hug...
The Diagonal Approach to
Health System Strengthening
"   Rather than focusing on either disease-specific
vertical or horiz...
The costs to close the cancer divide
may be less than many fear:
"   All but 3 of 29 LMIC priority cancer agents are off-p...
‘Diagonalizing’ Domestic
Financing:
Integrate cancer care and control into
national insurance and social security
programs...
Universal Health Coverage in Mexico
through Seguro Popular
Horizontal	
  Coverage:	
  	
  
>	
  54.6	
  million	
  Benefici...
Seguro Popular: cancer
"   Accelerated, universal, vertical coverage by disease
with an effective package of interventions...
% 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 ...
Effective financial coverage requires
attention to the chronicity of illness
Breast cancer and Seguro Popular
–  Primary p...
Harness platforms by integrating breast and
cervical cancer prevention, screening and
survivorship care into MCH, SRH, HIV...
Where are the opportunities?
•  LMICs – not months but whole lifetimes to be gained
•  Focus on prevention but do not stop...
Expanding access to cancer care and control in
LMICs: Should, Could, and Can be done
From anecdote …
… to evidence
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
Closing the cancer divide for women: An opportunity of lifetimes Women´s Cancer Initiative
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Closing the cancer divide for women: An opportunity of lifetimes Women´s Cancer Initiative

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

Published in: Health & Medicine
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Closing the cancer divide for women: An opportunity of lifetimes Women´s Cancer Initiative

  1. 1. January,  2008  June,  2007  
  2. 2. From anecdote … … to evidence
  3. 3. GTF.CCC Members  
  4. 4. 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.
  5. 5. = global health + cancer care
  6. 6. Abish Romeo, México Drew G. Faust President of Harvard University 22+ year BC survivor
  7. 7. 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
  8. 8. 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
  9. 9. 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%.
  10. 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
  11. 11. "  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.
  12. 12. 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.
  13. 13. 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
  14. 14. 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 ✓  
  15. 15. 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
  16. 16. 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  
  17. 17. ‘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
  18. 18. Universal Health Coverage in Mexico through Seguro Popular Horizontal  Coverage:     >  54.6  million  Beneficiaries   Ver3cal  Coverage       Diseases  and  Interven3ons:      Expanded  Benefit  Package      
  19. 19. 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
  20. 20. % 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  
  21. 21. 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
  22. 22. 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
  23. 23. 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
  24. 24. Expanding access to cancer care and control in LMICs: Should, Could, and Can be done
  25. 25. From anecdote … … to evidence

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