Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Harvard Global Equity Initiative, Harvard Medical School; GTF.CCC Tomatelo a Pecho; Fundacin Mexicana para la Salud
Latin American nations, much of eastern Europe and central Asia, China, India, many other parts of south Asia, and even countries in Africa, [are] facing a painful double burden of diseasenot only the persistence of infectious threats, child and maternal mortality, and undernutrition, but also the emergence of new dangers, notably diabetes, obesity, cardiovascular disease, stroke, cancer, mental ill-health, and injuries. This double burden requires a double response, a predicament that places huge responsibilities on the stewards of JULIO systems. national health FRENK & RICHARD HORTON HEALTH REFORM IN MEXICO SERIES; THE LANCET, 2006
From evidence
to anecdote
July, 2007
January, 2008
Harvard, Breast Cancer in Developing Countries Nov 4, 2009; Nobel Laureat Amartya Sen, Cancer survivor
From anecdote
to evidence
OUTLINE:
1. Evidence to anecdote to evidence
The opportunity to survive should not be an accident of geography or defined by income. Yet it is. But . there is scope for action.
~ case fatality (incidence/mortality)
63% 60 48%
Breast
52%
48% 37%
40
40%
Cervix
38%
24% 20
Low-income countries
Lower middle
Upper middle
High-income countries
Source: Author estimates based on IARC, Globocan, 2008 and 2010. Quote: HRH Princess Dina Mired
Countries with similar levels of income have very different case fatality. WHY?
100
Breast cancer
80
Lethality SSA
Rate x 100,000
60
40
MENA
20
Mandate: Design, develop and implement global, regional and local strategies to improve the financing, procurement and delivery of cancer care, control, treatment and palliation in a sustainable 27 members manner applying innovative representing the global health and service delivery models appropriate to health systems cancer in the developing world. communities
White Paper for policy and strategy & Lancet Commission Report
A strategic document focused on providing a road-map and evidence-based recommendations for program development, local and global policy making and research priorities to expand access to cancer care and control in lower and middle-income countries.
Authored by; GTF.CCC experts from the cancer care and global health communities convened by the Harvard School of Public Health, the Harvard Medical School, the Harvard Global Equity Initiative and the Dana-Farber Cancer Institute.
Rationale
Global distribution of cancer burden
Framework
Innovation Initiatives - pilot programs in Haiti, Rwanda, Malawi, Jordan, Mexico to inform work in an iterative fashion
#2 cause of death in wealthy countries #3 in upper middle-income #4 in lower middle-income and # 8 in low-income countries
More than 85% of pediatric cancer cases and 95% of deaths occur in developing countries that use less than 5% of the world resources.
Children <15
Adults (15+)
0.8
0.8
0.6
0.6
0.4
0.4
0.2
0.2
0 Low income Lower middle income Upper middle income High income Low income Lower middle income Upper middle income High income
Breast
Leukaemia
All cancers
Testis
5/80cancer desquilibrium
(Frenk/Lancet 2010)
Almost 80% of the DALYs (disabilityadjusted life-years) lost worldwide to cancer are in LMICs, yet these countries have only a very small share of global resources for cancer ~ 5% or less. worse in certain regions:
Africa: only 02% of global cancer medical costs, 1% of global spending on health, 64% of new cancer cases, and 15% of the global population
HPV Vaccine
Death from preventable and treatable cancer is `more exclusive` to the poor Avoidable pain and suffering particularly at end of life is only permitted for the poor Financial impoverishment from the costs of care and effects of the disease is concentrated among the poor
Models:
ACCESS QUALITY
FINANCIAL PROTECTION
Low-income: Rwanda-Malawi-Haiti
Outcomes in MDR-TB patients in Lima, Peru receiving at least four months of therapy
failed therapy died 8% 8%
abandon therapy 2%
cured 83%
98%
0 oncologists
Central Haiti
Status post-CHOP in Central Haiti: Still in remission three years later
Source: Paul Farmer., 2009
OUTLINE:
1. Evidence to anecdote to evidence 2. Cancer in LMICs: so much more can be done
More than half of cases and almost 2/3 of deaths deaths occur in the developing world.
a disease of
large proportion of cases and 60% of deaths in women < 54. More deaths and DALYs lost to breast cancer, in all developing regions other than SEAsia and SSAfrica.
LMICs:
15-44
37%
63%
64%
36%
45-54 >55
Age at death
7%
59%
22%
78%
15%
Mortality and age at death: breast and cervical cancer in Mexico 1955-2007
16
60 58
12 56
8 54
4 52 50
Cervix Breast
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
2005
2008
1985
1955
1960
1965
1970
1975
1980
1990
1995
2000
2005
2006: BC>CC.
for the first time in more than 5 decades.
Gap = ~2 years.
As of the early 80s, the average age at death from BC is lower than CC.
Fuente:Lozano, Knaul, Gmez-Dants, Arreola-Ornelas y Mndez, 2008, Tendencias en la mortalidad por cncer de mama
en Mxico, 1979-2007. FUNSALUD, Documento de trabajo. Observatorio de la Salud, con base en datos de la OMS y la Secretara de Salud de Mxico.
2008
As of Feb 2007 all Mexican women diagnosed with breast cancer have the right to financial protection in health for breast cancer treatment
2-3 4
84% 27%
IMSS Mxico: 40-50% of cases are detected in stages III-IV. 85+ in II+
50%
30% 10%
1992 2002 2006
Stage I
Stage II
Why?
Health, social and health system barriers
30%
20%
21% 22%
16%
24%
10%
0%
+ Poorest Q1 Least poor Q2 Q3 Q4 QV
Fuente: ENSANUT, 2006
Only 1 in 5 women 40-69 report a preventive health visit including mamography 2006
women diagnosed with bc reported problems with providers when seeking diagnosis.
In routine, annual repro health/OBGYN visit/ PAP screening, there was no BCE Physician insisted woman was overreacting and sent her home with no diagnosis Health professionals and first-level care providers report lack of sensitivity of health personnel relating to the requests of women regarding breast health
RESULTS FROM A NATIONAL QUALITATIVE STUDY NIGENDA ET AL, 2009
Identify and apply innovations in country- and health system-specific delivery mechanisms
Optimize human and physical resources and harness the primary and secondary levels of care:
Nuevo Len
Morelos Jalisco
Participating institutions:
Comisin Nacional de Proteccin Social en Salud Ministry of Health of Jalisco, Morelos, Nuevo Leon National Cancer Institute of Mexico
The Global Task Force on Expanded Cancer Care and Control in Developing Countries through the Secretariat based at the Harvard Global Equity Initiative: HSPH, HMS, DFCI
MSH
Harvard Global Equity Initiative, Harvard Medical School; GTF.CCC Tomatelo a Pecho; Fundacin Mexicana para la Salud