Closing the Global Cancer Divide 010411

8/2/2019 Closing the Global Cancer Divide 010411

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Felicia Marie Knaul,Harvard Global Equity Initiative, Harvard Medical School;Global Task Force on Expanded Access to Cancer Careand Control in Developing Countries;

Tomatelo a Pecho; Fundacin Mexicana para la Salud

GLOBAL HEALTHAND THE ARTS 2011:Understanding andTackling Cancer inthe 21st Century

Long Wharf Theater

April 1st, 2011New Haven, CT

Closing the cancer

divide:an equity imperative


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From evidence

to anecdote


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July, 2007


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January, 2008


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Sor Mara Surez Vzquez y Felicia Marie Knaul, 2006


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EL PASO DEL CANGREJO

Gela Garca,

Photograher, breast cancer


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Gerardo

NigendaLpezblind diabetic hoto ra her


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br

Juanita:Her cancer is the result of aseries of missedopportunities by the healthsystem


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From anecdote

to evidence


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GTF.CCC:Challenge and disprove the

myths about cancerM1. Unnecessary:

Not a problem of the poorM2. Impossible:

Nothing we can do about it

M3. Unaffordable: .for the poor

M4: Inappropriate:

Challenging cancer implies taking resourcesaway from other diseases of the poor`


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LMICS: More than 85% of pediatric cancercases and 95% of deaths.

Distribution of childhood cancer globallyby level of income (< 15)

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


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Mexico: breast cancer

Since 2006 breast cancer is the #2cause of death among women age 30

to 54 years; and the leading tumor-

related cause

Only 5-10% of cases are detected instage 1 or in-situ, compared toapproximately 60% in US.


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M/I by cancer type and country income

Adults (15+)

Breast

Cervix uteri Prostate

Testis

Hodgkin lymphoma

N HL

Leukaemia

All cancers

Source: Knaul, Arreola, Mendez. estimates basedon IARC, Globocan, 2010.

Children


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Cancer is a disease of rich and poor

Yet, transition is polarizing the burden so that itis increasingly the poor who suffer:

Incidence and death: preventable cancers

Death: treatable cancer

Avoidable pain and suffering

Financial impoverishment from the costs of care andeffects of the disease

The cancer divide

H d B t C i D l i C t i


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Harvard, Breast Cancer in Developing CountriesNov 4, 2009; Nobel Laureat Amartya Sen, Cancer survivor


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Fuente:Lozano, Knaul, Gmez-Dants, Arreola-Ornelas y Mndez, 2008, Tendencias en la mortalidad por cncer de mama en Mxico, 1979-2007.

FUNSALUD, Documento de trabajo. Observatorio de la Salud, con base en datos de la OMS y la Secretara de Salud de Mxico.

Mortality from breast and cervical cancer inMexico1955-2008: less death from cervical

2006: BC>CC.Por primera vez en ms de 5 dcadas.

Rate for100,000 womenadjusted for age

0

4

8

12

16

1

955

1

965

1

975

1

985

1

995

2

005


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Rural Rwanda, Burkitts lymphoma

Source: Paul Farmer., 2009

Regimen ofvincristine,cyclophospha

mide,intrathecal

methotrexate

Status post-CHOPin Central Haiti:Still in remissionthree years later

Central Haiti

0o

ncolo

gists


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Ha

rne

ss

the


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Mexico: Seguro Popular

As of Feb 2007 all Mexicanwomen diagnosed with breast

cancer have the right to financialprotection in health for breast

cancer treatment

Also: pediatric cancers, cervical,testicular, NHL


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S i M h 2011 L t A t 2010


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Science, March 2011 Lancet, August 2010

Closing the Global Cancer Divide 010411

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