Closing the cancer divide for women: An opportunity of lifetimes

7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes

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Closing the cancer divide

for women:

An opportunity of lifetimes

Womens Cancer InitiativePan American Health Organization (PAHO)

February 5th, 2013

Felicia Marie Knaul, PhDHarvard Global Equity Initiative, Global Task Force on Expanded Access to

Cancer Care and Control in LMICs

Union for International Cancer Control

Tmatelo a Pecho A:C. MxicoMexican Health Foundation

WORLD

CANCER

DAY

Seminar


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January, 2008

June, 2007


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Breast cancer champions

Abish Romeo,

Mxico, patient Seguro Popular

Drew G. Faust

President of Harvard University22+ year BC survivor


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From anecdote

to evidence


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GTF.CCCMembers


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GTF.CCC:

Mission and Vision design, participate in implementation, and

evaluate innovative strategies for expandingaccess to cancer prevention, detection and carethat provide local and cross-country evidence for

scaling up access to cancer care and control, andstrengthening health systems in LMICs.

facilitate action through the production of newknowledge and through multi-stakeholder

frameworks and partnerships that demonstrateeffective models of care that can be replicated andscaled up in LMICs.


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Global Task Force on Expanded

Access to Cancer Care and

Control in Developing Countries

= global health + cancer care

WHO, 2012


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Applies a diagonal

approach to managechronicity and avoid

the false dilemmasbetween disease silos

-CD/NCD- that

continue to plague

global health


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Closing the Cancer Divide:An Equity Imperative

I: Shouldbe done

II: Couldbe doneIII: 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 Meds, Vaccines & Techs3: Innovative Financing: Domestic and Global

4: Evidence for Decision-Making

5: Stewardship and Leadership


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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 disability4. Stigma and discrimination

5. Avoidable pain and suffering

Closing the Cancer Divide

is an Equity Imperative

Face

ts


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Adults

Leukaemia

All cancers

Source: Knaul, Arreola, Mendez. estimates based on IARC, Globocan, 2010.

Children

LOW

INCOME

HIGH

INCOME

Sur

vival

inequa

lity

gap

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%.


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Facet 5: The most insidious injustice

is lack of access to pain controlNon-methadone, Morphine Equivalent opioidconsumption per death from HIV or cancer in pain:

Poorest 10%: 54 mg per death

Richest 10%: 97,400 mg per death


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Mirrors the 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

Double burden for health systems.


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LMICs account for

>90% of cervicalcancer deaths and

>60% of breast

cancer deaths. Bothare 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

20101955

Mexico: cervical cancer.


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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


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Investing In CCC:

We Cannot Afford Not ToTotal 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


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The Diagonal Approach to

Health System StrengtheningRather 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 andoptimize available resources

Diagonal strategies: X = > parts

Bridge disease divides: respond to patient needs, lifecycle

Generate positive externalities: e.g. womens cancer

programs also combat gender discrimination


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The costs to close the cancer divide

may be less than many fear:

All but 3 of 29 LMIC priority cancer agents are off-patentPain medication is cheap

Prices drop: HepB and HPV vaccines

Delivery & financing platforms & innovations areunderutilized, undeveloped, purchasing is fragmented,

procurement is unstable

Pink Ribbon Red Ribbon- a diagonal initiative

Global Paediatric Financing Entity

PAHO Strategic Fund: includes NCDs, 2012

Pink Ribbon Red Ribbon: diagonal partnership


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Diagonalizing Domestic

Financing:Integrate cancer care and control into

national insurance and social security

programs to express previously suppresseddemand beginning with cancers of women

and children:

Mexico, Colombia, Dom Rep, PeruChina, India, Thailand

Rwanda, Ghana, South Africa


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Universal Health Coverage in Mexico

through Seguro Popular

Horizontal Coverage:

> 54.6 million Beneficiaries

VerticalCoverage

Diseasesa

nd

Interventions:

Expanded

BenefitPackage

S P l


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Seguro Popular: cancer

Accelerated, universal, vertical coverage by disease

with an effective package of interventions2005: Cervical cancer

2006: ALL in children

2007: All pediatric cancers; Breast cancer2011: Testicular and Prostate cancer and NHL

2012: Colorectal cancer

Evidence of impact:Breast cancer adherence to treatment:INCAN:

2005: 200/600

2010: 10/900


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% 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

ec ve nanc a coverage requ res


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ec ve nanc a coverage requ resattention to the chronicity of illness

Breast cancer and Seguro Popular

Primary prevention

Secondary prevention (early detection)

Diagnosis

Treatment

Survivorship care

Palliative care

Large and exemplary investment in treatment

for women and the health system, yet low

survival. By applying a diagonal approach,

this can and is bein remedied.

S l ti


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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 cancerawareness and screening

into the national anti-

poverty program

Oportunidades Results: 000s promoters, nurses, doctors

Harnessing the primary level of care


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Where are the opportunities?

LMICsnot 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 givenprice permeability

Harness global and national health system and financingplatforms

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


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Be anoptimist

optimalist

Expanding access to cancer care and control in

LMICs: Should, Could, and Can be done


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From anecdote

t id

Documents

Closing the cancer divide for women: An opportunity of lifetimes