Duality:
evidence and advocacy
Evidence-based
advocacy
Advocacyinspired
evidence
Action:
projects, programs, policies
Outline
1. From anecdote... to evidence
2. Great transitions: Health, employment, education and
women in the world
3. Women's cancer transition: Challenge for global health
and health systems
4. Answers of health systems. The Seguro Popular
5. Specific experiences: The breast cancer in Mexico
Enero,
Junio,2008
2007
From evidence
to action
=
Salud global + atencin del cncer
Outline
1. From anecdote... to evidence
11
12
41
44
48
16
13
62
68
22
19
16
21
60%
40%
15
71
85
71
45
20%
45
40
0%
Injuries
Non-communicable
Source: Estimates based on Global Burden od Disease Study, 2010. IHME, 2012.
13
Communicable, maternal
and nutritional
Ireland
UK
Germany
Hungary
Norway
Poland
Bulgaria
Netherlands
France
Romania
Spain
Greece
1950
Canada
Czech Republic
Cuba
South Africa
Argentina
Panama
Italy
Mexico
14
Peru
Uruguay
Portugal
China
Nicaragua
Turkey
India
Pakistan
Benin
12
10
2014
60
50
40
30
20
10
0
Nicaragua South Cuba Mexico Turkey
Africa
India
LMIC
Source: ILO, 2014. ( http://www.ilo.org/ilostat/faces/home/statisticaldata/data_by_subject )
High Income
500
Women
400
300
200
United
Kingdom
Sweeden
Germany
Italy
Greece
Netherlands
Ireland
Portual
Spain
Norway
Poland
Turkey
Hungary
India
Argentina
South Africa
Mexico
Panama
Cuba
100
Nicaragua
High Income
60
Australia
50
Canada
Czech
Republi
c
Denmark
40
Israel
Portugal
30
United
Kingdom
United States
20
2012
2010
2005
2000
1995
1990
1985
10
1980
1990
60
2000
2011
40
20
Engineers
,
Architects
Lawyers
Source: Estimaciones propias con base en la ENEU, segundo trimestre, 1990 y 2000 y ENOE 2011.
Physicians
Men
No.
No.
1901 - 1920
101
4%
1921 - 1940
99
5%
1941 - 1960
113
4%
1961 - 1980
176
3%
1981 - 2000
11
286
4%
2001 - 2014
17
147
10%
Period
47
922
women/t
otal
Women
Outline
1. From anecdote... to evidence
2. Great transitions: Health, employment, education and
women in the world
Survival
inequality gap
48%
40%
2
0
38%
24%
Low
Income
High
Income
16
40
20
Cervical cancer
Breast cancer
Source: Estimaciones propias basada en Knaul et al., 2008. Reproductive Health Matters, and updated by Knaul, Arreola-Ornelas and
Mndez based on WHO data, WHOSIS (1955-1978), and Ministry of Health in Mexico (1979-2012)
Source: Data extracted from CI5plus.
2002
2000
1990
1980
2012
2005
0
1985
1955
Mexico
16
14
14
12
12
10
10
4
2
Oaxaca
20
15
10
Source: Estimaciones propias basadas en datos de DGIS. Base de datos de defunciones 1979-2012. SINAIS. Secretara de Salud.
2012
2005
2000
1995
1990
1985
5
1979
2005
2000
1995
2012
25
Puebla
2012
20
18
16
14
12
10
8
6
4
2
0
1990
0
1985
Nuevo Len
18
16
1979
18
Facets
355,000 mg
Non-methadone, Morphine
Equivalent opioid consumption per
death from HIV or cancer in pain:
Poorest 10%: 179 mg
Richest 10%: 99,000 mg
US/Canada: 344,000 mg
Europe
China: 1,593 mg
144,000
333,000 mil mg
India:
467
Mexico
3,500
Africa
Latin America
Qu esmortalidad materna?
Las mujeres y las madres en los pases de ingresos
bajos y medios enfrentan muchos riesgos a travs
del ciclo de vida
-35% en
30 aos
Mortalidad
materna
Cncer de
mama
Cncer de
cervix
Diabetes
291,000
150,000195,000
105,000131,000
110,000139,000
= 373, 000-465,000
Fuentee: Estimaciones propias basadas en datos del Institute for Health Metrics and Evaluation (http://www.healthdata.org/gbd/data ) .
HIV/AIDs (KS)
NCD
Breast cancer
Acute
Diarrhea
Respiratory infection
Outline
1. From anecdote... to evidence
2. Great transitions: Health, employment, education and
women in the world
3. Women's cancer transition: Challenge for global health
and health systems
4.
Pa
Q ck
Population
(Horizontal)
In ual ag
(d te ity eep rv
th e n &
)
tio
ns
PackageDiseases
& Interventions
(Vertical)
Source: Modified from the WHO, World Health Report, 2013 andSchreyogg, et al., 2005.
4th
dimension:
Financing
to ensure
equity and
efficiency
with $
protection
Financial protection
Integrated across the life cycle: diseases
and people
UHC requires
a strong, efficient, well-run health
system;
a system for financing health
services;
access to essential medicines and
technologies;
sufficient supply of well-trained,
motivated health workers.
(WHO, World Health Report, 2013).
Primary prevention
Early detection
Diagnosis
Treatment
Survivorship
Palliative care
Stewardship
Financing
Delivery
Resource
Generation and
evidence
buliding
Primary
Prevention
Secondary
prevention/
early
detection
Diagnosis
Treatment
Survivorship/
Rehabilitation
Palliation/
End-of-life care
FUCTIONS
Steward
ship
Financin
g
l,
synergi
stic:vert
ical
and
horizont
al
integrat
ion
Specific:
vertical
integratio
n,
horizontal
segmenta
tion
Generalize
d:
vertical
segmentati
on,
horizontal
integration
vertical
and
horizontal
segmenta
tion
Revenue
collection
Fund Pooling
Purchasing
Provision
Revenue
generati
on
Adapted from Murray and Frenk; WHO Bulletin 2000
Disease
1
Disease
2
Disease
A diagonal approach
Delivery: Harness platforms by integrating breast
and cervical cancer prevention, screening and
survivorship care into MCH, SRH, HIV/AIDS,
social welfare and anti-poverty programs.
Examples:
Integration of breast and
1943
Social Security
Ministry of Health
with residual
funding
Poor, informal sector,
non-salaried, rural
areas:
~50%
of population
Seguro
Popular
Benefit package:
2004: 113
2014: 285
59 in the
Catastrophic
Illness Fund
Benefits Package
2014: 55.6 m
Vertical Coverage
Diseases and Interventions:
2004: 6.5 m
Horizontal Coverage:
Beneficiaries
Early detection
Palliative care
Survivorship
Poor
Rich
Covered population: 54.6 million Beneficiaries
Outline
1. From anecdote... to evidence
2. Great transitions: Health, employment, education and
women in the world
3. Women's cancer transition: Challenge for global health
and health systems
4. Answers of health systems. The Seguro Popular
5. Specific experiences:
The breast cancer in Mexico
RIch
Poor
Juanita:
Cncer de mama
avanzado y metastsico
como resultado de una
br
serie de oportunidades
perdidas
Diagonalizing Delivery:
Training primary care providers in early
detection of breast cancer
Total > 16,000
Health promoters
Nurses
Physicians
8
Health Promoters
Risk Score (0-10)
6
5
4
Significant increase in
knowledge, especially among
health promoters and in clinical
breast examination
(Keating, Knaul et al 2014, The Oncologist)
3
Pre
Post
3-6 month
Calificacin
(% de puntos logrados por score)
90
Nurses
N=2,243
Physicians
N=4,872
85
Risk Factors
Global
80
75
PRE
POST
PRE
POST
Stewardship
Financing
Delivery
Resource
Generation and
evidence
buliding
Primary
Prevention
Secondary
prevention/
early
detection
Diagnosis
Treatment
Survivorship/
Rehabilitation
Palliation/
End-of-life care
Be an
optimist
optimalist