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Shifting Horizons,
Princess Margaret Cancer Centre:
1995-2015-2035
Toronto ON,
December 1, 2015
Outline
Under 5 mortality
1950: 28/100
1990: <10/100,
2011: 5/100
Published by Oxford University Press on behalf of the Infectious Diseases Society of America
2014. This work is written by (a) US Government employee(s) and is in the public domain in the
US
80
70
60
50
40
30
5000
10000
15000
20000
Income per capita
(1991 international dollars)
25000
1990 to 2010:
maternal deaths fell
546 000 to 287 000
Year
The frontier line indicates female life expectancy in the best-performing country in that year, which has been Japan for the past 20
years. Data from references 36 and 37 and Vallin J, Institut national dtudes dmographiques, personal communication.
Outline
1. The promise of progress: health at the forefront
Healthy economies
Women and health: motor of the future
Effective Universal Health Coverage (eUHC)
Measurement and transparency
6%
9%
65%
64%
6%
4%
6%
32%
60%
% DALYs
6%
80%
71%
90%
40%
62%
20%
29%
27%
0%
Injuries
Non-communicable
Source: Estimates based on Global Burden od Disease Study, 2013. IHME, 2015.
14%
23%
6%
Communicable, maternal
and nutritional
Costa Rica
Mxico
Brasil
Haiti
Bolivia
Per
Panam
- 35%
in 30
years
Mortality
in
childbirth
291,000
Breast
cancer
Cervical
cancer
150,000195,000
105,000131,000
Diabetes
110,000139,000
= 373,000 465,000
Source: Estimates based on data from WHO: Global Health Observatory, 2008 and Murray et al Lancet 2011.
Outline
1. The promise of progress: health at the forefront
2. Victims of success
3. New horizons
1. Healthy economies
2. Women and health: motor of the future
3. Effective Universal Health Coverage (eUHC)
Health is
an investment.
Not a cost
Macroeconomic
Impact of Health
Improvements in health and nutrition =
30% of GDP growth in UK from 1780-1979
1 year of LE = 1-4% of GDP growth
Reductions in adult mortality=11% of
economic growth in LMICs 19702000
24% of the increase in full income 19902011 was from years of life gained
a
n
d
a
a
n
Ca
Jap
85
80
USA
75
70
65
0
1000
2000
3000
4000
5000
Women's Contributions
to Health and the Economy - the choice:
Do we aspire to a Virtuous or a Vicious Cycle?
Virtuous Cycle
Healthy women
invest time
effectively in
producing health
and preventing
disease
Healthy and more
education
women women
produce more
health care
More economic
growth means
more money to
invest in health
and human
development
More health is
produced for men,
women and children
Vicious Cycle
Unhealthy women
invest time ineffectively
in an attempt to prevent
disease and loss of life
Unhealthy, poor,
More equal
disenfranchised
opportunitie
women produce
s
Children learn
less health care
better and adults
are more
productive
Less
health for
men,
women
and
children
Unhealthy children
learn less and
adults are less
productive
Suboptimal
development
of human
capital
Inequality of
opportunities
More
poverty
Less money to
invest in health
and human
development
Outline
1. The promise of progress: health at the forefront
2. Victims of success
3. New horizons
1. Healthy economies
Ireland
UK
Germany
Hungary
Norway
Poland
Bulgaria
Netherlands
France
Romania
Spain
Greece
1950
Canada
Czech Republic
Cuba
South Africa
Argentina
Panama
Italy
Mexico
14
Peru
Uruguay
Portugal
China
Nicaragua
Turkey
India
Pakistan
Benin
12
10
Panama
Jamaica
Ecuador
United States
Argentina
Uruguay
Guyana
Canada
Men
Dominican Rep.
Paraguay
Trinidad & T.
El Salvador
Nicaragua
Colombia
300
Peru
Costa Rica
Guatemala
Honduras
Venezuela
Brazil
Mexico
200
100
40
Canada
Czech
Republi
c
Denmark
30
Israel
20
Portugal
United
Kingdom
United States
2012
2010
2005
2000
1995
1990
1985
10
1980
60
PAID:
51.2%
UNPAID:
48.8%
922
women/t
otal
Women
Men
No.
No.
1901 - 1920
101
4%
1921 - 1940
99
5%
1941 - 1960
113
4%
1961 - 1980
176
3%
1981 - 2000
11
286
4%
2001 - 2014
17
147
10%
Period
MEN
Work outside
of the home
20
R&R
WOMEN
Domestic work
12
hours/da
y
Source: Own estimates based on INEGI 2012 and CEPAL..
56
r?
&
t
s
e
R 6 /da
s
r
u
o
y
h
41
41
42
Women are
the motors of economic growth
and
produce the majority of health care
- paid & unpaid
Yet, health systems are disabling
instead of enabling to women
Outline
1. The promise of progress: health at the forefront
2. Victims of success
3. New horizons
1. Healthy economies
2. Women and health: motor of the future
UHC requires
a strong, efficient, well-run health
system;
a system for financing health
services;
access to essential medicines and
technologies;
sufficient supply of well-trained,
motivated health workers.
(WHO, World Health Report, 2013).
Primary prevention
Early detection
Diagnosis
Treatment
Survivorship
Palliative care
Stewardship
Financing
Delivery
Resource
Generation and
evidence
buliding
Primary
Prevention
Secondary
prevention/
early
detection
Diagnosis
Treatment
Survivorship/
Rehabilitation
Palliation/
End-of-life care
Outline
1. The promise of progress: health at the forefront
2. Victims of success
3. New horizons
1. Healthy economies
2. Women and health: motor of the future
3. Effective Universal Health Coverage (eUHC)
Diagonal Strategies:
Positive Externalities
Promoting prevention and healthy lifestyles:
Reduce risk for cancer and other diseases
Reducing stigma for womens cancers:
Contributes to reducing gender discrimination.
Investing in treatment produces champions
Pain control and palliative care:
Reducing barriers to access is essential for
cancer, for other diseases, and for surgery.
Diagonalizing:
Implementation
Harness anti-poverty, maternal and
child health, SRH, HIV and other large
programs for cancer education,
prevention, treatment & survivorship
Integrate cancer care and control and
pain control and palliative care into
UHC national health reform, insurance
and social security programs
Outline
1. The promise of progress: health at the forefront
2. Victims of success
3. New horizons
1. Healthy economies
2. Women and health: motor of the future
3. Effective Universal Health Coverage (eUHC)
Apply a diagonal
approach to avoid
the false dilemmas
between disease
silos that continue
to plague global
health
Champions
the economics of hope:
Drew G. Faust
President of Harvard U
25+ year BC survivor
Nobel
Amartya
Sen,
Cancer
survivor
diagnosed
and treated
in India 65
years ago
Harvard, Breast Cancer in Developing Countries,
10 `09
Children
Zimbawe
India
Leukaemia
Testis
Zimbawe
India
China
Canada
LOW
INCOME
Breast
Cervix
Adults
HIGH
INCOME
LOW
INCOME
China
Prostat
e
Tyroid
Canada
HIGH
INCOME
100% die
India: 467 mg
333 mil mg
Africa
Mexico:3
,500 mg
Jordan: 14,000 mg
Latin America
16
Cervical cancer
Source: Estimaciones propias basada en Knaul et al., 2008. Reproductive Health Matters, and updated by Knaul, Arreola-Ornelas and
Mndez based on WHO data, WHOSIS (1955-1978), and Ministry of Health in Mexico (1979-2012)
Source: Data extracted from CI5plus.
2012
2005
0
1985
1955
Mexico
Breast cancer
Be an
optimist
optimalist