Professional Documents
Culture Documents
Drew G. Faust
President of Harvard University 22+ year BC survivor
From anecdote
to evidence
Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries
1: Innovative Delivery 2: Access: Affordable Meds, Vaccines & Techs 3: Innovative Financing: Domestic and Global 4: Evidence for Decision-Making 5: Stewardship and Leadership
16 12 8 4 0
30
1955
1990
20
2010
Nuevo Len
20
Oaxaca
(Poorest)
10
(Wealthiest)
10
1980
2010
1980
2010
Source: Knaul et al., 2008. Reproductive Health Matters, and updated by Knaul, Arreola-Ornelas and Mndez.
Facets
Leukaemia
Russia
All cancers
LOW INCOM HIGH INCOME LOW INCOM HIGH INCOME
In Canada, almost 90% of children with leukemia survive. In the poorest countries only 10% survive.
Facet 5: The most insidious injustice: the pain divide Non-methadone, Morphine
N. America
Equivalent opioid consumption per death from HIV or cancer in pain: Poorest 10%: 54 mg Richest 10%: 97,400 mg US/Canada: 270,000 mg
Asia
India
Africa
Data: http://www.treatthepain.com/methodology Calculations: HGEI/Funsalud Knaul et al. Eds Closing the Cancer Divide.
Latin America
M2. Unaffordable
M3. Inappropriate M4: Impossible
1/3-1/2 of cancer deaths are avoidable: 2.4-3.7 million deaths, of which 80% are in LIMCs
The costs to close the cancer divide are and may be less than many fear:
All but 3 of 29 LMIC priority cancer chemo and hormonal agents are off-patent Pain medication is cheap Prices drop: HepB and HPV vaccines Delivery & financing innovations are underutilized & undeveloped so that purchasing is fragmented and procurement is unstable
PAHO 2013 Strategic Fund for NCDs includes key cancer drugs
M3. Inappropriate
M4: Impossible
Women and mothers in LMICs face many risks through the life cycle
Women 15-59, annual deaths
Mortality in childbirth
-35% in 30 year
Breast cancer
Cervical cancer
Diabetes
342,900
166,577
142,744
120,889
Applies a diagonal approach to avoid the false dilemmas between disease silos -CD/NCD- that continue to plague global health
M4: Impossible
Huge steps in the transition thru reform toward Universal Health Coverage in many countries
Examples: Brazil China Colombia Chile EEUU (Affordable Care Act) El Salvador Peru South Africa Taiwan Mexico: Seguro Popular de Salud
Yetoften in the
context of rapid, profound, polarized and complex epidemiological transition or battling fragmented health systems
2003 REFORM: ELIMINATE SEGMENTATION IN ACCESS TO HEALTH INSURANCE BY GENERATING A SYSTEM FOR SOCIAL PROTECTION IN HEALTH THAT INCLUDES PUBLICALLY FUNDED HEALTH INSURANCE FOR FAMILIES EXCLUDED FROM SOCIAL SECURITY
1943
Social Security
2001/3: Pilot of PHI 2003: Law Jan. 1, 2004: SSPH 2010: Universal coverage of PHI
Frenk et al., 2004.
Seguro
Popular
Affiliation:
2012: 54.6 m
Benefit package:
2004: 113
2012: 284+57
Horizontal Coverage:
Beneficiaries
500 450
57
400
FPCHE EPHS
108 110 49 17 20 49 116
128
128
MING + SP
Number of interventions
350
EPI
CBP
49
57
57
FPCHE 57 interventions
CAUSES 91 FPCHE 6
6 83 6 65 8 65 6 65 12 65 12 65 176 184 189 189
198
198
206
12 65
12 65
13 65
2004
2005
2006
2007
2008
2009
2010
2011
2012
Notes: SP = Seguro Popular MING = Medical Insurance for a New Generation (Children born after December 1, 2006 and until they are 5 years of age) FPCHE = Fung for Protection against Catastrophic Health Expenditure EPHS =Essential Personal Health Services EPI = Expanded Programme of Immunisations CBP= Community-based package
Key aspect of Seguro Popular: diagonal, financial protection for catastrophic illness
Accelerated, universal, vertical coverage by disease with an effective package of interventions 2004/6: HIV/AIDS, cervical cancer, ALL in children 2007: All pediatric cancers; Breast cancer 2011: Testicular and Prostate cancer and NHL 2012: Ovarian (colorectal) cancer
The human faces of Seguro Popular: Guillermina Avila & Abish Romero
Diagnosis
Treatment
Survivorship
Palliation
Mexico: Large and exemplary investment in financial protection for breast cancer prevention and treatment, yet..a low survival rate. Strengthen early detection, survivorship and palliation: diagonalize delivery
AIDS
Poor Beneficiaries
Rich
Stewardship
Financing
Prevention Survival
Regulation
Financing
Delivery
Lacking units and levels for delivery Supply chain and distribution is sporadic and spotty
Lack of trained personnel Fear of prescription Topic not available in medical school curriculum No published research related to health system
Source: Adapted from Knaul, F. M., Gralow, J. R., Atun, R., & Bhadelia, A. (Eds.). Closing the Cancer Divide. Harvard University Press, 2012.
RIch
Poor
Juanita:
Advanced metastatic breast cancer is the result of a series of missed opportunities
Diagonalizing Delivery 1: Integration of cervical & breast cancer educatio into anti-poverty programs, Oportunidades
Include information in manuales for community workers 1.5 million promoters > 90% of poor Mexican households: 5.8 million families
Diagonalizing Delivery 2: Training primary care providers in early detection of breast cancer
Promoters (+4000), Nurses & MDs (+1400) medical students (+750)
Nuevo Leon, Jalisco, Morelos, Puebla
Be an optimist optimalist