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From anecdote
to evidence
Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries
Applies a diagonal approach to avoid the false dilemmas between disease silos -CD/NCD- that continue to plague global health
Facets
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 countries
More than 85% of pediatric cancer cases and 95% of deaths occur in developing countries that use less than 5% of the world resources.
Lower middle
Perinatal conditions Infectious and parasitic dis. Unintentional injuries Respiratory infections Congenital anomalies Digestive dis. Nutritional deficiencies Cardiovascular dis. Malignant neoplasm Endocrine disorders
Upper middle
Perinatal conditions Infectious and parasitic dis. Congenital anomalies Unintentional injuries Respiratory infections Malignant neoplasm Respiratory dis. Nutritional deficiencies Neuropsychiatric conditions Cardiovascular dis.
5-14
40%
30%
30%
20%
20%
10%
10%
5% 1979 2008
Injuties Congenital anomalies
0%
1979
2008
0%
Children
Leukaemia
All cancers LOW INCOME HIGH INCOME LOW INCOME HIGH INCOME
In Canada, almost 90% of children with leukemia survive. In the poorest countries only 10%.
Chronic diseases and Stigma: disability add a layer of discrimination onto ethnicity, poverty, and gender.
A) Should be done:
Myth 1. Unnecessary
C) Can be done
Myth 4: Impossible
Pain control and palliation Reducing barriers to access is essential for cancer, for other diseases, and for surgery.
C) Can be done
Myth 4: Impossible
Prevention and treatment offers potential world savings of $ US 131-850 billion mostly due to productivity gains and reducing suffering
1/3-1/2 of cancer deaths are avoidable: 2.4-3.7 million deaths Of which 80% are in LIMCs
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 < $100 / course Cost of chemo ALL(0-14) Afr, LAC, ASIA year of incident cases: $17m, $29m, $63m Pain medication is cheap Prices drop:
HPV 2011: $US 100 /dose to GAVI $5 and PAHO $14
Diagonal partnership initiatives - pink ribbon red ribbon Aggregate purchasing and sustainable procurement through existing funds and platforms
UNICEF PAHO
A) Should be done: necessary and appropriate B) Could be done: affordable C) Can be done
Myth 4: Impossible
Champions:
Nobel Amartya Sen,
Cancer survivor diagnosed in India 50 years ago, age 18
Abish Romeo
Patient, 24 years old
Advocate, Tmatelo a Pecho
abandon therapy 2%
cured 83%
Mitnick et al, Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru. NEJM 2003; 348(2): 119-28.
Embryonal Rhabdomyosarcoma
RESOURCES INVESTED
5.8
100 Millions of $US Dollars 91.5
102.6
80.9
75 54.0 50
4.3
4
3.0
2
1.9 0.8
25
2007
Source: Comisin Nacional de Proteccin Social en Salud. Informes de Resultados. Available at: http://www.seguro-popular.gob.mx
Horizontal and vertical financial protection strategies: Seguro Popular and SSPH for Children, Mexico
Benefits: covered interventions
Catastrophic Illness ACCELERATED VERTICAL COVERAGE: Ex: childrens cancer, neonatal care, HIV/AIDS
Poor
Rich
Be an optimist optimalist.