Closing the Cancer Divide: An Equity Imperative


Cancer has become a leading cause of death and disability and a serious yet unforeseen challenge to health systems in low- and middle-income countries. A protracted and polarized cancer transition is under way and fuels a concentration of preventable risk, illness, suffering, impoverishment from ill health, and death among poor populations. Closing this cancer divide is an equity imperative. The world faces a huge, unperceived cost of failure to take action that requires an ...

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Cancer has become a leading cause of death and disability and a serious yet unforeseen challenge to health systems in low- and middle-income countries. A protracted and polarized cancer transition is under way and fuels a concentration of preventable risk, illness, suffering, impoverishment from ill health, and death among poor populations. Closing this cancer divide is an equity imperative. The world faces a huge, unperceived cost of failure to take action that requires an immediate and large-scale global response.

Closing the Cancer Divide presents strategies for innovation in delivery, pricing, procurement, finance, knowledge-building, and leadership that can be scaled up by applying a diagonal approach to health system strengthening. The chapters provide evidence-based recommendations for developing programs, local and global policy-making, and prioritizing research. The cases and frameworks provide a guide for developing responses to the challenge of cancer and other chronic illnesses. The book summarizes results of the Global Task Force on Expanding Access to Cancer Care and Control in Developing Countries, a collaboration among leaders from the global health and cancer care communities worldwide, originally convened by Harvard University. It includes contributions from civil society, global and national policy-makers, patients and practitioners, and academics representing an array of fields.

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Product Details

  • ISBN-13: 9780982914403
  • Publisher: Harvard
  • Publication date: 12/17/2012
  • Series: Global Health and Equity, #2
  • Pages: 404
  • Sales rank: 1,013,090
  • Product dimensions: 5.90 (w) x 8.90 (h) x 0.50 (d)

Meet the Author

Felicia Marie Knaul, Ph.D., is Director of the Harvard Global Equity Initiative, Associate Professor at Harvard Medical School, and Senior Economist at the Mexican Health Foundation. She is also the founder of Cáncer de mama: Tómatelo a Pecho.

Julie R. Gralow, M.D., is Professor of Medicine at the University of Washington School of Medicine and Director of Breast Medical Oncology at the Seattle Cancer Care Alliance.

Rifat Atun is Professor of International Health Management and Head of the Health Management Group at Imperial College London.

Afsan Bhadelia is a Research Associate at the Harvard Global Equity Initiative.

Harvey V. Fineberg is President of the Institute of Medicine, Washington, DC.

Amartya Sen, winner of the 1998 Nobel Prize in Economics, is Lamont University Professor at Harvard University.

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Table of Contents

Stories That Inspired This Volume

Abish xvii

Anite xxi

Claudine xxiv

Francine xxvii


Her Royal Highness Princess Dina Mired xxix

Lance Armstrong xxxii


Harvey V. Fineberg xxxv

Amartya Sen xxxvii


The history of this volume xxxix

Organization of this volume xli

Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries xliii


To Amanda Jaclyn Berger xlvii

Editor's Acknowledgments xlix

Part I Much Should Be Done 1

Chapter 1 Closing the Cancer Divide: Overview and Summary Felicia Marie Knaul Julie R. Gralow Rifat Atun Afsan Bhadelia Julio Frenk Jonathan Quick Lawrence Shulman Paul Farmer 3

1.i Introduction 3

1.ii Myths and opportunities 4

1.iii Much should be done: The cancer divide 10

1.iv Much could be done: A solution-oriented framework 16

1.v Much can be done: Spheres of action 20 Moving forward 26

Chapter 2 The Global Cancer Divide: An Equity Imperative Felicia Marie Knaul Hans-Olov Adami Clement Adebamowo Hector Arreola-Ornelas Amanda J. Berger Afsan Bhadelia James Cleary David J. Hunter Nancy Keating Anthony Mbewu Oscar Mendez Claire Neal Meg O'Brien Peggy Porter Isabel dos Santos Silva Rola Shaheen Julio Frenk 29

2.i Introduction 29

2.ii The cancer transition 31

Text Box 2.1: Cancer care and control in high income countries: elements of progress 36

2.iii Facets of the cancer divide and sources of disparities 40

Text Box 2.2: Understanding and combating stigma: a Livestrong research and outreach program 51

2.iv Conclusions 58

Appendix 2.1: Non-methodone Opioid Consumption (Morphine Equivalent), 2008 60

Chapter 3 Investing in Cancer Care and Control Felicia Marie Knaul Hector Arreola-Ornelas Rifat Atun Oscar Méndez Ramiro Guerrero Marcella Alsan Janice Seinfeld 71

3.i Introduction 72

3.ii The economic burden of chronic and noncommunicable disease 73

3.iii The "avoidable" cancer burden 75

3.iv The economic value of investing in cancer care and control 78

3.v A longer-term view 82

Text Box 3.1: The economic benefits of early detection and prevention: cervical, breast, and colorectal cancer Janice Seinfeld Arlette Beltrán Edmundo Morocho 84 Conclusions 88

Part II Much Could be Done 93

Chapter 4 Health System Strengthening and Cancer: A Diagonal Response to the Challenge of Chronicity Felicia Marie Knaul George Alleyne Peter Piot Rifat Atun Julie R. Gralow Claire Neal Jaime Sepulveda Julio Frenk 95

4.i Introduction 96

4.ii The challenge of chronicity 97

4.iii The diagonal approach to health system strengthening 100

Panel: Applications of the diagonal approach to cancer across the cancer care control continuum 104

Text Box 4.1: Rwanda: Partners in Health chronic care integration for endemic noncommunicable Diseases Julia Lu Gloria Sangiwa Agnes Binagwaho 106

4.iv The cancer care control continuum and health system strengthening 108

Text Box 4.2: Survivorship 108

4.v Conclusions 111

Appendix 4.1: A hypothetical case study of late diagnosis of breast cancer turned into lessons for implementing a diagonal response in Mexico 113

Chapter 5 Core Elements for Provision of Cancer Care and Control in Low and Middle Income Countries Julie R. Gralow Eric Krakauer Benjamin O. Anderson Andre Ilbawi Peggy Porter Mary Gospodarowicz Sarah Feldman Carlos Rodriguez-Galindo Lindsay Frazier Leslie Lehman Lawrence Shulman 123

5.i Introduction 125

Text Box 5.1: Assumptions underlying analysis and recommendations regarding core elements of a cancer care and control strategy for low and middle income countries 126

5.ii Core elements of cancer care and control 127

Text Box 5.2: Jordan: Creating a regional center of excellence for cancer care as a focus for a national program on cancer care and control Afsan Bhadelia Imad Treish Zaid Bitar Ruba Anastas Mahmoud Sarhan 129

5.iii Categorization of "candidate cancers" amenable to care and control in low and middle income countries 145

5.iv Conclusions 147

Appendix 5.1: Categorization of "candidate cancers" amenable to care and control in low and middle income countries 148

Part III Much can be Done 167

Chapter 6 Innovative Delivery of Cancer Care and Control in Low-Resource Scenarios Felicia Marie Knaul Afsan Bhadelia Rashid Bashshur Amanda J. Berger Agnes Binagwaho Erin Blackstock Amy Judd Ana Langer Doug Pyle Mounica Vallurupalli Julie R. Gralow 169

6.i Introduction 170

6.ii Innovations in delivery 171

Text Box 6.1: Optimal tasking: A partial review of literature 173

Text Box 6.2: Breast and cervical cancer: examples of innovative delivery 178

6.iii Case studies of cancer care and control delivery innovations 180

Case 1: PIH-DFCI-BWH Partnership: Innovative Delivery Strategies for Cancer Care in Rural Rwanda, Malawi, and Haiti Luke Messac Megan McLaughlin Kelly Bogaert Jarred Mcateer David Shulman Amy Sievers Sara Stulac Amy Judd 181

Case 2: UCI/Hutchinson Center Cancer Alliance: A collaboration between the Fred Hutchinson Cancer Research Center and the Uganda Cancer Institute Corey Casper Erica Sessle Warren Phipps Jessica Yager Lawrence Corey Jackson Orem 184

Case 3: Expanding access to gynecological cancer care and control in Peru through an MOH-PATH collaboration Vivien Tsu 185

Case 4: Twinning in pediatric oncology: Models for the innovative use of information and communication technology to bridge distance Felicia Marie Knaul Afsan Bhadelia Carlos Rodriguez-Galindo Lindsay Frazier 187

Case 5: International training and exchanges: American Society of clinical oncology Doug Pyle 189

6.iv Conclusions 191

Chapter 7 Access to Affordable Medicines, Vaccines, and Health Technologies Niranjan Konduri Jonathon Quick Julie R. Gralow Massoud Samiei Philip Castle Ramiro Guerrero 197

7.i Challenges in affordable access to cancer medicines, vaccines, and technologies 199

7.ii Systems approach to affordable access to quality pharmaceuticals and health technologies 201

7.iii Medicines and vaccines for cancer care and control 203

7.iv Health technologies for cancer detection, diagnosis, and treatment 208

7.v Pricing, procurement, quality, and regulation 217

Text Box 7.1: Working towards affordable pricing for HPV vaccines for developing countries: the role of GAVI Alliance Aurelia Nguyen S. Deblina Datta Nina Schwalbe Diane Summers Geoff Adlide 226

Text Box 7.2: Partnership and pooled procurement for a life-saving health technology 231 Treatment affordability and unmet need for cancer medicines 235

Text Box 7.3: Estimating the global unmet need for cancer medicines: Hodgkin lymphoma, cervical cancer, childhood acute lymphoblastic leukemia, and breast cancer Ramiro Guerrero Jaime Andrés Giraldo Héctor Arreola-Ornelas Felicia Marie Knaul 235

7.vii Engaging the private sector 243

Text Box 7.4: "Frugal Innovation" for high-cost technologies 246

7.viii Conclusions and recommendations 247

Chapter 8 Innovative Financing: Local and Global Opportunities Rifat Atun Felicia Marie Knaul 257

8.i Introduction 259

8.ii Innovative global financing 260

8.iii Innovative domestic financing: effective and equitable options 267

Case 1: Mexico Felicia Marie Knaul Salomón Chertorivski Woldenberg Héctor Arreola-Ornelas 269

Case 2: Colombia Ramiro Guerrero Ana María Amaris 271

Case 3: The Dominican Republic Magdalena Rathe 273

Case 4: Peru Janice Seinfeld 274

Case 5: Rwanda Agnes Binagwaho Afsan Bhadelia 275

Case 6: Taiwan Tsung-Mei Cheng 277

Case 7: China Jing Ma 280

Case 8: India Arogyasri community health insurance scheme and Rishtriya Swasthya Bima Yojana Maja Pleic Suneeta Krishnan 281

Chapter 9 Evidence for Decision-Making: Strengthening Health Information Systems and the Research Base Nancy Keating Elena Kouri Julie R. Gralow Kathy Cahill Jo Anne Zujewski Peggy Porter Gustavo Nigenda Rifat Atun Felicia Marie Knaul 289

9.i Introduction 291

9.ii Priority areas for research to strengthen the evidence base 291

Text Box 9.1: Increasing awareness and enhancing early detection of breast cancer in Gaza strip Rola Shaheen 295

9.iii Strengthening data and health information systems for cancer care and control 296

Text Box 9.2: Leveraging collaborations to establish cancer registries in low and middle income countries: Examples from Colombia and Uganda 300

9.iv Capacity-building 301

Text Box 9.3: International, multi-institutional partnerships for capacity-building in cancer research: Uganda Program on Cancer and Infectious Disease Corey Casper 302

Text Box 9.4: Strengthening collaboration for implementation and evaluation research 305

9.v Opportunities for global and national uptake 307

Chapter 10 Strengthening Stewardship and Leadership to Expand Access to Cancer Care and Control Felicia Marie Knaul George Alleyne Rifat Atun Flavia Bustreo Julie R. Gralow Mary Gospodarowicz Peter Piot Doug Pyle Julio Frenk 311

10.i Introduction 312

10.ii Stewardship in health and cancer care and control 313

Text Box 10.1: Stewardship 313

10.iii Stewardship and leadership for cancer care and control: Building global and local stakeholder networks 315

10.iv The myriad of players in global and national cancer care and control 316

Text Box 10.2: Mapping of the CCC Arena in Jordan Afsan Bhadelia Imad Treish Zaid Bitar 318

Text Box 10.3: International Agency for Research on Cancer 322

Text Box 10.4: Eastern Europe/Central Asia breast cancer education, outreach, and advocacy: Connecting the United States, Eastern Europe, and Central Asia to improve women's health Ksenia Koon Julie R. Gralow Tanya Soldak Jo Anne Zujewski 326

Text Box 10.5: Femama: Promoting policy change in Brazil through civil society Maira Caleffi 328

Text Box 10.6: The Union for International Cancer Control 329

Text Box 10.7: American Society of Clinical Oncology's evolving engagement in global cancer control 331

Text Box 10.8: An integrated partnership in Rwanda: Comprehensive National Cervical Cancer Prevention Program and the Rwanda Task Force on Expanded Access to CCC Afsan Bhadelia 334

10.v Beyond the Declaration: Action to address the global cancer and noncommunicable disease burden 336

Appendix Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries 343

Leadership 343

Members 344

Technical Advisory Committee 347

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