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Cancer and children:

Strategy in Action

NCD Child Conference

Oakland CA, March 21st

Felicia Marie KnaulHarvard Global Equity Initiative,

Global Task Force on Expanded Access to Cancer Care and

Control in Low and Middle Income Countries

Mexican Health Foundation

Tmatelo a pecho

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From anecdote

to evidence

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Global Task Force on Expanded

Access to Cancer Care and

Control in Developing Countries

= global health + cancer care

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Closing the Cancer Divide:A Blueprint to Expand Access in LMICs

I: Much should be doneII: Much could be done

III: Much can be done

1: Innovative Delivery

2: Access to Affordable Medicines,

Vaccines & Technologies

3: Innovative Financing: Domesticand Global

4: Evidence for Decision-Making

5: Stewardship and Leadership

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Applies a diagonal

approach to avoid

the false dilemmasbetween disease silos

-CD/NCD- thatcontinue to plague

global health

Closing the Cancer Divide:A BLUEPRINT TO EXPAND ACCESS IN LMICs

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Challenge and disprove the

myths about

cancer/NCD/Chronic illness

M1. Unnecessary

M2. Unaffordable

M3. Impossible

M4: Inappropriate

Should,

Could, and

Can..

be done

Expanding access to cancer care and control in

low and middle income countries:

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Cancer is a disease of both rich and poor;

yet it is increasingly the poor who suffer:

1. Exposure to risk factors

2. Preventable cancers (infection)

3. Death and disability fromtreatable cancer

4. Stigma and discrimination

5. Avoidable pain and suffering

The Cancer Divide:

An Equity Imperative

Fac

ets

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For children & adolescents

5-14 cancer is

#2 cause of death in wealthy countries

#3 in upper middle-income#4 in lower middle-income

and # 8 in low-income countriesMore than 85% of pediatric cancer cases and 95% of

deaths occur in developing countries that use less than

5% of the world resources.

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Distribution of mortality, 1-15

years Mexico, 1979-2008

Malignant tumors

Respiratory infections

Infectious and parasitic diseases

Injuties

Congenital anomalies

0%

10%

20%

30%

40%

1979

2008

1-4

0%

10%

20%

30%

40%

1979

2008

5-14

Malignant tumors

5%

16%

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Adults

Leukaemia

All cancers

Source: Knaul, Arreola, Mendez. estimates based on IARC, Globocan, 2010.

Children

LOW

INCOME

HIGH

INCOME

Sur

vival

inequa

litygap

LOW

INCOME

HIGH

INCOME

100%

The Opportunity to Survive (M/I)

Should Not Be Defined by Income

In Canada, almost 90% of children with

leukemia survive.

In the poorest countries only 10%.

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Stigma:Chronic diseases and

disability add a layer of

discrimination onto ethnicity,

poverty, and gender.

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The most insidious example of

injustice is access to pain controlNon-methadone, Morphine

Equivalent opioid consumption per

death from HIV or cancer in pain

Poorest 10%: 54 mg;

Richest 10%: 97,400 mg

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A) Should be done:

B) Could be done:

C) Can be done

Myth 1. Unnecessary

Myth 2. Inappropriate

Myth 3. Unaffordable

Myth 4: Impossible

Expanding access to cancer

care and control in LMICs:

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The Diagonal Approach to

Health System Strengthening

Rather than focusing on disease-specific vertical

programs or only on horizontal system

constraints, harness synergies that provideopportunities to tackle disease-specific priorities

while addressing systemic gaps.

Optimize available resources so that the whole ismore than the sum of the parts.

Bridge the divide as patients suffer diseases over a

lifetime, most of it chronic.

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Diagonal Strategies:

Positive ExternalitiesPromoting prevention and healthy lifestyles:

Reduce risk for cancer and many other diseases

Promoting access to education for children w CI

Reduces poverty, contributes to social developmentIntroducing child cancer treatment

Improves hygiene and reduce intra-hospital infections

Social insurance for childrenKick-starts broader social insurance for populations

Pain control and palliation

Reducing barriers to access is essential for cancer, for

other diseases, and for surgery.

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A) Should be done: necessary

and appropriate

B) Could be done:

C) Can be done

Myth 3. Unaffordable

Myth 4: Impossible

Expanding access to cancer

care and control in LMICs:

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Investing in.

We Cannot Afford Not To

Health is an investment, not a cost

Tobacco is a huge economic risk:

3.6% lower GDP

Prevention and treatment offers potential world

savings of $ US 131-850 billion mostly due to

productivity gains and reducing suffering

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Avoidable childhood cancer deaths

from Leukemia by income region

Income Region LethalityAvoidable deaths

Social justice/3

Low income 0.73 0.45

Lower middleincome

0.72 0.38

Upper middle

income0.57 0.35

High income 0.18 0.08

1/3-1/2 of cancer deaths are avoidable:

2.4-3.7 million deaths

Of which 80% are in LIMCs

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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

chemo and hormonal agents are off-patent: many