Jill Bennett Academic Community Lecture, Seattle, WA, 19 de junio de 2013

2. January, 2008

4. From anecdote …
… to evidence

5. GTF.CCC
=
global health
+
cancer care

7. Closing the Cancer Divide:
An Equity Imperative
I: Should be done
II: Could be done
III: 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: Meds, Vaccines & Tech
3: Innovative Financing
4: Evidence for Decision-Making
5: Stewardship and Leadership

8. 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. Treatable cancer death and disability
4. Stigma and discrimination
5. Avoidable pain and suffering
The Cancer Divide:
An Equity Imperative
Facets

9. Adults
Leukaemia
All cancers
Source: Knaul, Arreola, Mendez. estimates based on IARC, Globocan, 2010.
Children
LOW
INCOME
HIGH
INCOME
Survival
inequalitygap
LOW
INCOME
HIGH
INCOME
100%
The Opportunity to Survive
Should Not Be Defined by Income
In Canada, almost 90% of children with
leukemia survive.
In the poorest countries only 10%.

10. Cancer – especially in
women and children - adds a
layer of discrimination onto
ethnicity, poverty, and
gender.

11. Insidious injustice:
lack of access to pain control
Non-methadone, Morphine Equivalent opioid
consumption per death from HIV or cancer in pain:
Poorest 10%: 54 mg per death
Richest 10%: 97,400 mg per death

12. -5.8 m deaths to 8 m
-25% increase in % of deaths
-deaths in LMICs: 55% to 61%
-DALYs lost: 148 m, 5.9%. 188 m, 7.6%
- LMICs % of DALYS lost to cancer:
-62% to 69%
The Global Burden of
Cancer is increasing:
1990-2010
Fuentes: WHO, 2008

13. #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.
For children & adolescents
5-14 cancer is
Fuentes: WHO, 2008

14. " Mirrors the epidemiological transition
" LMICs increasingly face both infection-
associated cancers, and all other cancers.
The Cancer Transition
Double burden for health systems
" Cancers increasingly only of the poor, are
not the only cancers affecting the poor
" LMICs account for >95% of cervical and >60%
of breast cancer deaths. Both are leading killers
of – especially young - women.

15. Cancer transition in Mexico:
Breast and Cervical mortality
México
0
4
8
12
161955
1960
1970
1980
1990
2000
2010
Mortalityrateadjustedbyage
Oaxaca
(Poorest)
Nuevo León
(Wealthiest)
Source: Knaul et al., 2008. Reproductive Health Matters, and updated by Knaul, Arreola-Ornelas and Méndez.
0
10
20
30
1980
1990
2000
2010
0
10
20
30
1980
1990
2000
2010

16. 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

17. The Diagonal Approach to
Health System Strengthening
" Rather 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 and optimize available resources
" Diagonal strategies:  X = > Σ parts
" Bridge disease divides: respond to patient needs,
lifecycle
" Generate positive externalities: e.g. women’s cancer
programs also combat gender discrimination

18. ‘Diagonalizing’ Cancer Care:
Financing & Delivery
• Integrate cancer care and control into
national insurance and social security
programs beginning with cancers of women
and children
• Harness platforms by integrating breast and
cervical cancer prevention, screening and
survivorship care into MCH, SRH, HIV/
AIDS, social welfare and anti-poverty
programs.

19. Positive Externalities
" Promoting prevention and healthy lifestyles:
" Reduces risk for cancer and many other
diseases
" Reducing stigma around women’s cancers:
" Reduces gender discrimination
" Pain control and palliation
" Reducing barriers to access is essential for
cancer as well as for for other diseases and
for surgery.

20. Investing In CCC:
We Cannot Afford Not To
" Tobacco is a huge economic risk: 3.6% lower GDP
" Total economic cost of cancer, 2010: 2-4% of global GDP
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
✓
✓

21. Challenge and disprove the
myths about cancer

22. Mexico: The Human Face of
Financial Protection for Cancer:
Abish Romeo

23. Guillermina
Avila
Trujillo

25. Juanita:

26. Effective financial coverage of a
chronic disease: breast cancer
Mexico: Large and exemplary investment in financial
protection for cancer prevention and treatment for
women, yet a low survival rate.
Opportunities to improve delivery
Cancer Control-Care continuum
Primary
Prevention
Early
Detection Diagnosis Treatment Survivorship Palliation

27. ‘Diagonalizing’ Delivery
Tómatelo a Pecho, INSP, Seguro Popular
Results: 000´s promoters, nurses, doctors
Harnessing the primary level of care