Closing the cancer divide: Lessons from Mexico

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Jill Bennett Academic Community Lecture, Seattle, WA, 19 de junio de 2013

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Closing the cancer divide: Lessons from Mexico

  1. 1. January, 2008
  2. 2. From anecdote … … to evidence
  3. 3. GTF.CCC = global health + cancer care
  4. 4. 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: Meds, Vaccines & Tech 3: Innovative Financing 4: Evidence for Decision-Making 5: Stewardship and Leadership
  5. 5. Cancer is a disease of both rich and poor; yet it is increasingly the poor who suffer: 1.  Exposure to risk factors 2.  Preventable cancers (infection) 3.  Treatable cancer death and disability 4.  Stigma and discrimination 5.  Avoidable pain and suffering The Cancer Divide: An Equity Imperative Facets
  6. 6. 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% The Opportunity to Survive Should Not Be Defined by Income In Canada, almost 90% of children with leukemia survive. In the poorest countries only 10%.
  7. 7. Cancer – especially in women and children - adds a layer of discrimination onto ethnicity, poverty, and gender.
  8. 8. Insidious injustice: 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
  9. 9. -5.8 m deaths to 8 m -25% increase in % of deaths -deaths in LMICs: 55% to 61% -DALYs lost: 148 m, 5.9%. 188 m, 7.6% - LMICs % of DALYS lost to cancer: -62% to 69% The Global Burden of Cancer is increasing: 1990-2010 Fuentes: WHO, 2008
  10. 10. #2 cause of death in wealthy countries #3 in upper middle-income #4 in lower middle-income and # 8 in low-income countries More than 85% of pediatric cancer cases and 95% of deaths occur in developing countries. For children & adolescents 5-14 cancer is Fuentes: WHO, 2008
  11. 11. "  Mirrors the epidemiological transition "  LMICs increasingly face both infection- associated cancers, and all other cancers. The Cancer Transition Double burden for health systems "   Cancers increasingly only of the poor, are not the only cancers affecting the poor "   LMICs account for >95% of cervical and >60% of breast cancer deaths. Both are leading killers of – especially young - women.
  12. 12. Cancer transition in Mexico: Breast and Cervical mortality México 0 4 8 12 161955 1960 1970 1980 1990 2000 2010 Mortalityrateadjustedbyage Oaxaca (Poorest) Nuevo León (Wealthiest) Source: Knaul et al., 2008. Reproductive Health Matters, and updated by Knaul, Arreola-Ornelas and Méndez. 0 10 20 30 1980 1990 2000 2010 0 10 20 30 1980 1990 2000 2010
  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. 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: respond to patient needs, lifecycle "   Generate positive externalities: e.g. women’s cancer programs also combat gender discrimination
  15. 15. ‘Diagonalizing’ Cancer Care: Financing & Delivery •  Integrate cancer care and control into national insurance and social security programs beginning with cancers of women and children •  Harness platforms by integrating breast and cervical cancer prevention, screening and survivorship care into MCH, SRH, HIV/ AIDS, social welfare and anti-poverty programs.
  16. 16. Positive Externalities "   Promoting prevention and healthy lifestyles: "  Reduces risk for cancer and many other diseases "   Reducing stigma around women’s cancers: "  Reduces gender discrimination "   Pain control and palliation "  Reducing barriers to access is essential for cancer as well as for for other diseases and for surgery.
  17. 17. Investing In CCC: We Cannot Afford Not To "   Tobacco is a huge economic risk: 3.6% lower GDP "   Total economic cost of cancer, 2010: 2-4% of global GDP 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 ✓ ✓
  18. 18. Challenge and disprove the myths about cancer
  19. 19. Mexico: The Human Face of Financial Protection for Cancer: Abish Romeo
  20. 20. Guillermina Avila Trujillo
  21. 21. Juanita:
  22. 22. Effective financial coverage of a chronic disease: breast cancer Mexico: Large and exemplary investment in financial protection for cancer prevention and treatment for women, yet a low survival rate. Opportunities to improve delivery Cancer Control-Care continuum Primary Prevention Early Detection Diagnosis Treatment Survivorship Palliation
  23. 23. ‘Diagonalizing’ Delivery Tómatelo a Pecho, INSP, Seguro Popular Results: 000´s promoters, nurses, doctors Harnessing the primary level of care

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