Ladies and Gentlemen, Colleagues,My contribution in today’s hearing will draw on my professional experiences working with many governments and civil societies in Africa, and on the development concepts of UNDP. Within the next 10 minutes, I will try to put my arguments forward in a way which is hopefully relevant for consideration by the EU.
To clarify this first important issue with one slide for the records: Yes, cancer is a public health challenge in Africa. It has reached half the incidence compared to European and American populations, and the trend is increasing. There are many more data available to prove the case. However, in contrast to the European region, behind the figures from Africa stays the suffering of millions of individuals without access to services and without social protection. How to approach this situation?
In contrast to a purely charitable global health approach or an approach driven by security concerns for the home populations of the northern hemisphere: Health is a basic human right! The turning points in history were the UN 1948 Universal Declaration of Human Rights which mentioned health as a basic human right for the first time specifically. It was further detailed in the 1966 International Covenant on Economic, Social and Cultural Rights, stipulating among others the right of everyone to the highest sustainable standard of health including all aspects of prevention, treatment, care and support. It has been signed by 160 parties by 2011.We have understood basic human rights when it comes to gender, race, political prisoners etc.; but somehow we still find it most difficult in a globalized world that basic human rights do not have boundaries of nation states or continents, and that they are as a principal a shared responsibility. The translation of health as a basic human right into practice in Africa is therefore a shared responsibility.
While in the past the global health focus in Africa has been on communicable diseases, mother and child health, sexual and reproductive health etc., there is now a global commitment and evolving coordination for non-communicable diseases, NCDs, among them cancer. This was clearly demonstrated during the high-level meeting of the UN General Assembly on NCDs in September 2011 in New York to which UNDP contributed.
There are international and national strategies. They start with the primary prevention of cancer: Through the reduction of environmental, socio-economic and behavioural risk factors or through vaccinations against infections associated with cancer. This requires a multi-sectoral approach. A very good example is the WHO Framework Convention on Tobacco Control, the first WHO treaty under the article 19 of the WHO constitution.
There are international and national strategies:For secondary prevention, comprising universal access to screening and universal access to early diagnosis.For treatment, care and support comprising universal access to primary, secondary and tertiary service levels and referral models.And we have learnt an important lesson from other chronic diseases, in particular from HIV/AIDS: The critical importance of the health systems approach addressing inequities and gender imbalances.
We need solutions for sustainable financing. In the global health world, we have a multitude of multilateral funding bodies, like the Global Fund, GAVI, UNITAID etc., in addition to bilateral funders, all in one way or another linked to and in the ideal world complementing national health financing systems. Most of the global health financing has and still is focusing on communicable diseases. (Press animation ‘entrance’)Do we need a new funding body? For cancer? For NCDs? Or a restructuring away from disease specific to “whole health” funding? Or – and maybe even more importantly to consider after the recent shortfall of disbursements compared to pledges in the context of the financial crisis – is it time to move away from charitable funding through pledges to more binding commitments in terms of global risk pooling and financing? We still have an obvious paradox to solve: how can a basic human right to health be implemented by pledges?
We need to lower unit costs, particularly in view of making medicines and medical technologies affordable. How? We have learnt this too from the HIV/AIDS movement and programming, we know the role of TRIPS flexibilities, of economies of scale and the importance of functional and transparent national and global procurement systems. We should use current dynamics and commitments, for example related to the MDG 8 as pointed out during the UN high-level meeting on NCDs.We will have more success if the right hand (health and development) knows what the left hand (trade negotiators) is doing.
Of course, we need solutions for better quality and efficiencies of services.(Read bullet points of slide)These are governance and management tasks, they need to be solved on every continent and in every country, and should not be taken as arguments for the principle infeasibility of implementing human rights in Africa and thereby excuse our complacency.
Following the strategies and principles outlined so far: Investment in health is investment in sustainable development. It contributes substantially to GDP, to employment and to increased human productivity.The principal of global risk pooling and universal access to health services is a major pillar for social justice and inclusive development.The link between primary prevention of cancer and environmental protection is very obvious considering the multi-sectoral approach; and doing the things we do in the health sector in an environmentally friendly way should become a given.There is hardly any better investment for the blue path combining in a balanced way intelligent economic growth, social justice and environmental protection, than investment in health.
I have kept this slide for the end, since it is such a crucial experience from the HIV/AIDS movement:‘Nothing about us without us’: Without empowering people, which includes the knowledge of rights and the capacity to enforce them, without involving civil society there will be know universal access to equitable cancer services. And prevention will fall short by appealing to individual behaviour change neglecting interdependencies with socio-economic determinants.
Health systems are already in transition in Africa. The photo (infectious disease hospital in Nigeria) demonstrates that the massive investments around global health initiatives are resulting into infrastructure improvements and provisions of health services, including services for chronic diseases like HIV/AIDS, which were thought of as completely unfeasible in Africa even in 2000. (Press animation ‘entrance’)Using a rights-based public health approach, cancer can be prevented and treated in Africa, and not only for the few who can afford it by out-of-pocket payments or private health insurances.
Cancer in Africa - a Rights-based Public Health Approach
Cancer in Africa:A rights-based public health approach Dr. Christoph Hamelmann Regional Practice Leader HIV, Health and Development UNDP Europe and Central Asia EPP Group Hearing ‘Cancer in Africa’ Session I: The problem of health care in Africa; role of different organizations of fighting diseases in Africa Brussels, 27 June 2012
Cancer: A Public Health Challenge in Africa Age-standardized incidence of all cancers (excluding non- melanoma skin cancer) per 100,000 WHO Global Status Report On Non-Communicable Diseases 2010
Health is a Basic Human Right UN 1948 Universal Declaration of Human Rights, Article 25 UN 1966 International Covenant on Economic, Social and Cultural Rights • Right of everyone to the highest sustainable standard of health • Prevention, treatment, careEleanor Roosevelt with United Nations Universal Declaration of Human Rights and support • Signed by 160 countries, 2011
International and National Strategies Primary Prevention Example: • Environmental, socio-ecomomic and behavioural risk factor reduction • Vaccinations against infections associated with cancer • Multi-sectoral approach
International and National Strategies Secondary Prevention Treatment, Care and Support• Universal access to • Universal access to screening primary, secondary and• Universal access to early tertiary service levels and diagnostis referral models Health Systems Approach addressing: • Inequities • Gender imbalances
We Need Solutions: Sustainable Financing Global Cancer Fund ???? National Health Financing Systems
We Need Solutions: Affordable Medicines Target 8.E: In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries Target 8.F: In cooperation with the private sector, make available benefits of new technologies, especially information and communications
We Need Solutions: Quality and Efficiency• Improved governance: Integrity in the health sector• Improved management: Defined standards and accountable implementation, public- private mix• Inclusive and equitable services• Client and patient orientation
Investment in Health – Investment in Sustainable Development Social Economic justice growth• Risk pooling • GDP• Universal access • Employment to health services • Human productivity Environmental protection • Link with primary prevention • ‘Greening’ of health services
Learn from Other Global Health Initiatives ‘Nothing about us without us!’Empowering people, involving civil society
A Rights-Based Public Health ApproachCancer can be prevented and treated in Africa
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