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The Cancer Divide: From Recognition to Action

The cancer disease burden in developing countries is growing rapidly. This year over half of the nearly 13 million cancer cases diagnosed worldwide and two-thirds of cancer deaths will occur in the world’s low and middle income countries (LMICs). By 2030, LMICs will bear the brunt of an estimated 27 million new cancer cases and 17 million cancer deaths. However, only 5% of global cancer spending takes place in LMICs.

Each case of cancer is a tragedy in and of itself for the individuals affected, and their family members and loved ones. Beyond that, cancer also has immense economic costs. According to a report by the World Economic Forum, the worldwide economic losses from cancer amount to 2.5 trillion USD, or 4% of global GDP.

Perhaps the biggest tragedy behind cancer in LMICs is that a large part of the cases and deaths could either be prevented or avoided (80% of the 2.4 – 3.7 million avoidable deaths from cancer are in LMICs). For breast and cervical cancer, early detection and treatment are key to successful outcomes. Yet weak health systems are not delivering screening tests to those that need them. Coverage of the HPV vaccine in LMICs is still low, although GAVI is seeking to increase access through providing a sustainable supply to poor countries for as low as US$ 4.50 per dose. A lack of awareness among the general populations of these countries about the risks of smoking is another major driver of cancer. And while the cancer disease burden is now largest in the LMICs, these countries account for less than 6% of worldwide morphine consumption. Millions of cancer patients are not only left untreated, but also suffer from immense pain.

There is growing recognition of the cancer divide. In 2009, Harvard’s Global Equity Initiative launched the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries (GTF CCC) to design, promote, and evaluate innovative, multi-stakeholder strategies for expanding access to cancer prevention, detection, and care in LMICs. The Secretariat’s Co-Director and a leading voice in the field, Felicia M. Knaul, has also co-authored the recent book Closing the Cancer Divide. She argues rightfully and forcefully that closing the cancer divide is both an equity and a moral imperative.

Besides helping to raise awareness for the cancer disease burden in LMICs and putting the subject on political agendas, these initiatives are also providing recommendations with regards to achieving better outcomes at different intervention levels. Recognizing weak national health systems as a major barrier to progress, the GTF CCC’s blueprint advocates a host of measures not only strengthen Cancer Control and Care, but also improve health systems more broadly by seeking synergies with other disease control efforts.

  • Prevention: Promoting healthy lifestyles reduces the risk of cancer and of many other NCDs. Especially tobacco control is key to preventing certain cancers, but also reduces the risk of cardiovascular and respiratory diseases.
  • Early detection: Early detection programs for breast and cervical cancer can also be used to control HIV/AIDS, and to promote Maternal and Child Health.
  • Diagnostics and treatment: Teleoncology facilitates diagnosis and treatment of cancer (and other diseases), and is crucial for training and capacity building.
  • Survivorship: Efforts to reduce stigmas around cancer can help reduce discrimination suffered by other groups (e.g. patients with HIV/AIDS or tuberculosis, women, or families living in poverty).
  • Pain control and palliation: Strengthening health systems to increase access to pain control medication is essential for cancer, but also for a host of other diseases and for surgery.

The good news is that awareness around the cancer divide is growing. Countries like Kenya and Mexico are developing national cancer control strategies, and funding bodies as well as other development partners are beginning to recognize the costs of inaction.

Still, more needs to be done. Ideally, the private sector will increasingly see shared value opportunities in addressing the cancer divide. As we know from our work, collaborative action involving actors from all sectors is most effective in bringing about change. In this case, change means saving lives. The time is ripe to move from recognition of the cancer divide to taking action against it.

Simon Meier

Former Associate Director, FSG