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Closing the Cancer Divide:A BLUEPRINT TO EXPAND ACCESS
IN LOW AND MIDDLE INCOMECOUNTRIES
A Report of the Global Task Forceon Expanded Access to CancerCare and Control in Developing
Countries
Overview
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HARVARD
School of Public Health
HARVARD
Medical School
Global Task Force on Expanded
Access to Cancer Care and
Control in Developing Countries
= global health + cancer care
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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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115+ authors
56 countries
20+ cases
Francine,Claudine, Abish,
Anite, Juanita
HARVARD
School of Public Health
HARVARD
Medical School
UICC
LIVESTRONG
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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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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 Cancer Divide:An Equity Imperative
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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 richestdecile of the worlds countries.
-GAPRI/UICC data
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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 mostlyvia productivity gains and reduced suffering
1/3-1/2 cancer deaths are avoidable
2.4-3.7 millions deaths
80% 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
chemotherapy and hormonal agents are off-patentgenerics: 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
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The Diagonal Approach toHealth System Strengthening
Harness synergies that provide
opportunities to tackle disease-
specific priorities while addressing
systemic gaps in order to optimize
available resources and bridge thedivides lived by patients.
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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.
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Innovations in Delivery
Optimal tasking
Infrastructure shifting
ICTs and telemedicine St. Judes IOP
Uganda Program on Cancer andInfectious Diseases with FHCRC
Mexicoharnessing primary carefor breast cancer care and control
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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 nationalinsurance programs:
Mexico, Colombia, Dominican Republic, Peru, China, India,
Taiwan, Rwanda
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Increase Evidence forDecision Making
Strengthen cancer registries inLMICs
Develop and apply novel researchand monitoring methodologies
Expand health services andimplementation research
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Stewardship and Leadership
UNHLM: Harness opportunities and fill gaps
Lack of public goodsglobal and domestic
Leverage global institutions WHO, IARC, UICC
UNICEF, Global Fund, GAVI, private sector
Strengthen capacity in-country: facilitate localmulti-stakeholder Commissions
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MOBILIZE all public and
private stakeholders in
the cancer, health anddevelopment arenas to
close the cancer divide
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Closing the Cancer Divide:A BLUEPRINT TO EXPAND ACCESS
IN LOW AND MIDDLE INCOMECOUNTRIES
HARVARD
School of Public Health
HARVARD
Medical School
A Report of the Global Task Forceon Expanded Access to Cancer
Care and Control in DevelopingCountries
Overview
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Adults
Breast
Cervix
Prostate
Testis HL
N HL
Leukaemia
All cancers
Source: Knaul Arreola Mendez estimates based on IARC Globocan 2010
Children
LOW
INCOME
HIGH
INCOME
Survi
val
inequalitygap
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% survive.