Global Health Forum on Cancer, Taipei November 21, 2013 Felicia Marie Knaul, PhD
Harvard Global Equity Initiative, Global Task Force on Expanded Access to Cancer Care and Control in LMICs Tmatelo a Pecho A:C. Mxico Mexican Health Foundation
From anecdote
to evidence
From anecdote
to evidence
Miembros
GTF.CCC
1: Innovative Delivery 2: Access: Affordable Meds, Vaccines & Techs 3: Innovative Financing: Domestic and Global 4: Evidence for Decision-Making 5: Stewardship and Leadership
Facets
Leukaemia
Russia
All cancers
LOW INCOM HIGH INCOME LOW INCOM HIGH INCOME
In Canada, almost 90% of children with leukemia survive. In the poorest countries only 10% survive.
Facet 5: The most insidious injustice: the pain divide Non-methadone, Morphine
N. America
Equivalent opioid consumption per death from HIV or cancer in pain: Poorest 10%: 54 mg Richest 10%: 97,400 mg US/Canada: 270,000 mg
Asia
India
Africa
Data: http://www.treatthepain.com/methodology Calculations: HGEI/Funsalud Knaul et al. Eds Closing the Cancer Divide.
Latin America
M2. Unaffordable
M3. Inappropriate M4: Impossible
1/3-1/2 of cancer deaths are avoidable: 2.4-3.7 million deaths, of which 80% are in LIMCs
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 (as of 2011) Pain medication is cheap
M3. Inappropriate
M4: Impossible
Women and mothers in LMICs face many risks through the life cycle
Women 15-59, annual deaths
Mortality in childbirth
-35% in 30 year
Breast cancer
Cervical cancer
Diabetes
342,900
166,577
142,744
120,889
Applies a diagonal approach to avoid the false dilemmas between disease silos -CD/NCD- that continue to plague global health
M4: Impossible
Huge steps in the transition thru reform toward Universal Health Coverage in many countries
Examples: Brazil China Colombia Chile EEUU (Affordable Care Act) El Salvador Peru South Africa Taiwan Mexico: Seguro Popular de Salud
Yetoften in the
context of rapid, profound, polarized and complex epidemiological transition or battling fragmented health systems
Affiliation:
2012: 54.6 m
Benefit package:
2004: 113
2012: 284+57
Horizontal Coverage:
Beneficiaries
Key aspect of Seguro Popular: diagonal, financial protection for catastrophic illness
Accelerated, universal, vertical coverage by disease with an effective package of interventions 2004/6: HIV/AIDS, cervical cancer, ALL in children 2007: All pediatric cancers; Breast cancer 2011: Testicular and Prostate cancer and NHL 2012: Ovarian (colorectal) cancer
The human faces of Seguro Popular: Guillermina Avila & Abish Romero
Diagnosis
Treatment
Stewardship
Financing
Delivery
Resource Generation
Diagnosis
Treatment
Survivorship
Palliation
Mexico: Large and exemplary investment in financial protection for breast cancer prevention and treatment, yet..a low survival rate. Strengthen early detection, survivorship and palliation: diagonalize delivery
RIch
Poor
Juanita:
Advanced metastatic breast cancer is the result of a series of missed opportunities
Diagonalizing Delivery 1: Integration of cervical & breast cancer educatio into anti-poverty programs, Oportunidades
Include information in manuales for community workers 1.5 million promoters > 90% of poor Mexican households: 5.8 million families
Diagonalizing Delivery 2: Training primary care providers in early detection of breast cancer
Promoters (+4000), Nurses & MDs (+1400) medical students (+750)
Nuevo Leon, Jalisco, Morelos, Puebla
Be an optimist optimalist