Date post: | 04-Apr-2018 |
Category: |
Documents |
Upload: | presentacionesfk |
View: | 215 times |
Download: | 0 times |
of 28
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
1/28
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
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
2/28
January, 2008
June, 2007
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
3/28
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
4/28
Breast cancer champions
Abish Romeo,
Mxico, patient Seguro Popular
Drew G. Faust
President of Harvard University22+ year BC survivor
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
5/28
From anecdote
to evidence
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
6/28
GTF.CCCMembers
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
7/28
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.
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
8/28
Global Task Force on Expanded
Access to Cancer Care and
Control in Developing Countries
= global health + cancer care
WHO, 2012
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
9/28
Applies a diagonal
approach to managechronicity and avoid
the false dilemmasbetween disease silos
-CD/NCD- that
continue to plague
global health
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
10/28
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
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
11/28
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
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
12/28
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%.
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
13/28
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
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
14/28
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.
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
15/28
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.
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
16/28
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
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
17/28
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
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
18/28
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
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
19/28
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
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
20/28
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
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
21/28
Universal Health Coverage in Mexico
through Seguro Popular
Horizontal Coverage:
> 54.6 million Beneficiaries
VerticalCoverage
Diseasesa
nd
Interventions:
Expanded
BenefitPackage
S P l
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
22/28
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
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
23/28
% 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
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
24/28
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
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
25/28
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
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
26/28
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
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
27/28
Be anoptimist
optimalist
Expanding access to cancer care and control in
LMICs: Should, Could, and Can be done
7/29/2019 Closing the cancer divide for women: An opportunity of lifetimes
28/28
From anecdote
t id