Closing the Cancer Divide:

A BLUEPRINT TO EXPAND ACCESS IN LOW AND MIDDLE INCOME COUNTRIES

A Report of the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries
Overview

Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries

= global health + cancer care

HARVARD School of Public Health

HARVARD Medical School

Closing the Cancer Divide:

A BLUEPRINT TO EXPAND ACCESS IN LMICs

Applies a diagonal approach to avoid the false dilemmas between disease silos (CD/NCD) that continue to plague global health

115+ authors 56 countries 20+ cases Francine, Claudine, Abish, Anite, Juanita

UICC LIVESTRONG
HARVARD School of Public Health HARVARD Medical School

Closing the Cancer Divide:

A Blueprint to Expand Access in LMICs
I: Much should be done II: Much could be done III: Much can be done
1: Innovative Delivery 2: Access to Affordable Medicines, Vaccines & Technologies 3: Innovative Financing: Domestic and Global 4: Evidence for Decision-Making 5: Stewardship and Leadership

The Cancer Divide: An Equity Imperative

Cancer is a disease of both rich and poor; yet it is increasingly the poor who suffer:

Exposure to risk factors Cancers of infectious origin Death from treatable cancer Stigma and discrimination Avoidable pain and suffering

The most insidious example of the cancer divide is pain control The gap in access to pain control is tremendous: ranging from 54 milligrams per death in pain from HIV/AIDS or cancer in the poorest decile to almost 97,400 in the richest decile of the worlds countries. -GAPRI/UICC data

Investing In CCC: We Cannot Afford Not To

Health is an investment, not a cost Tobacco: a huge economic risk of 3.6% lower GPD p.a. Total economic cost of cancer, 2010: 2-4% of global GDP Prevention and treatment: potential world savings of $ US 131-850 billion mostly via productivity gains and reduced suffering

1/3-1/2 cancer deaths are avoidable 2.4-3.7 millions deaths 80% in LIMCs

Investing In CCC: The costs to close the cancer divide may be less than many fear:
All but 3 of 29 LMIC priority, candidate cancer chemotherapy and hormonal agents are off-patent generics: many available for under $100 per course Cost of drug treatments for cervical cancer, HL, and ALL in children in LMICs: One year of incident cases: $US 280 million Pain medication is cheap Prices drop:
HPV 2011: $US 100 per dose to PAHO $14 and GAVI $5

The Diagonal Approach to Health System Strengthening

Harness synergies that provide opportunities to tackle diseasespecific priorities while addressing systemic gaps in order to optimize available resources and bridge the divides lived by patients.

Health Systems Strengthening: Opportunities for Diagonal Strategies

Prevention healthy lifestyles: Tobacco control: helps prevent certain cancers, reduce CVD and respiratory diseases Survivorship care: Reducing stigma promotes gender equity Pain control and palliation Reducing barriers to access is essential for cancer, for other diseases, and for surgery.

Innovations in Delivery

Optimal tasking Infrastructure shifting ICTs and telemedicine

St. Judes IOP Uganda Program on Cancer and Infectious Diseases with FHCRC Mexico harnessing primary care for breast cancer care and control

Global and Domestic Financing

Levarge GAVI and Global Fund to promote, pool and invest new monies RMNCH provides models for international partnership and commitment-building Recent diagonal initiatives are promising
pink ribbon red ribbon Several LMICs have integrated CCC into national insurance programs:
Mexico, Colombia, Dominican Republic, Peru, China, India, Taiwan, Rwanda

Increase Evidence for Decision Making

Strengthen cancer registries in LMICs Develop and apply novel research and monitoring methodologies Expand health services and implementation research

Stewardship and Leadership

UNHLM: Harness opportunities and fill gaps Lack of public goods global and domestic Leverage global institutions
WHO, IARC, UICC UNICEF, Global Fund, GAVI, private sector

Strengthen capacity in-country: facilitate local multi-stakeholder Commissions

MOBILIZE all public and private stakeholders in the cancer, health and development arenas to close the cancer divide

Closing the Cancer Divide:

A BLUEPRINT TO EXPAND ACCESS IN LOW AND MIDDLE INCOME COUNTRIES

A Report of the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries
Overview

HARVARD School of Public Health

HARVARD Medical School

The Opportunity to Survive (M/I) Should Not Be Defined by Income

100%

Children

Adults

Survival inequality gap

Leukaemia

All cancers LOW INCOME

Cervix Breast Testis Prostate

LOW INCOME

HIGH INCOME

HIGH INCOME
HL N HL

In Canada, almost 90% of children with leukemia survive. In the poorest countries only 10% survive.
Source: Knaul, Arreola, Mendez. estimates based on IARC, Globocan, 2010.