Professional Documents
Culture Documents
Poorest 50%: 1%
Wealthiest 10%: 90%
Russia:
124 mg (8%)
China:
314 mg (16%)
USA:
55,704 mg (3150%)
India:
Mexico: Nigeria: 43 mg (4%)
0.8 mg (0.2%)
562 mg (36%)
Bolivia:
74 mg (6%)
Source: Author calculations using INCB (2010-13) and GHE 2015 (www.incb.org,
http://www.who.int/healthinfo/global_burden_disease/en/) . See Data Appendix for methods.
The Opportunity to Survive (M/I)
Should Not Be Defined by Income
Breast
100% 100%
Survival inequality gap
Children Cervix
Prostate
China
Non-hodkins
Tyroid
Canada
Leukaemia
% avoidable mortality
30 50 36 45
(cancer)
% avoidable mortality
40 67 47 58
(16 cancers)
Knaul, Arreola, Rodriguez et al, 2018. Avoidable mortality: the core of the global cancer divide.
Forthcoming. Journal of Global Oncology.
“Avoidable” cancer deaths:
Breast and Cervical,
Numeros correctos?
The Americas and Checar
LMICs nues
JGO paper
Breast Cervical
Latin America
and the 57% 64%
Caribbean
Low and middle
75% of breast
income 75% 95%
95% of cervical
countries
Challenge and disprove the
myths about cancer
M1. Unnecessary
M2. Unaffordable
The costs of inaction are huge:
Invest IN action
Total economic cost of cancer:
2-4% global GDP
• At current
prices: $US600
million
• At best
international
prices: $US145
millones
• For all children with SHS in low income countries:
$US 1,034,000
Prices can drop:
through effective global action, aggregate
platforms and public- private collaboration
M2. Unaffordable
M3. Inappropriate
The Diagonal Approach to
Health System Strengthening
Rather than focusing on either disease-specific vertical or
horizontal-systemic programs, harness synergies that
provide opportunities to tackle disease-specific priorities
while addressing systemic gaps and optimize available
resources
M2. Unaffordable
M3. Inappropriate
M4: Impossible
The Economist
Expansion of Financial Coverage:
Seguro Popular México, 2004-2018
Affiliation:
• 2004: 6.5 m
Benefits Package
Vertical Coverage
Benefit package:
• 2004: 113
• 2018: 294
• 65 in the
Catastrophic
Illness Fund Horizontal Coverage:
Beneficiaries
Seguro Popular now includes
cancers in the national,
catastrophic illness fund
Universal coverage by disease with an
effective package of interventions
2004/6: HIV/AIDS, cervical, ALL in kids
2007: pediatric cancers; breast cancer
2011: Testicular, Prostate and NHL
2012: Ovarian and colorectal
Seguro Popular and breast cancer:
Evidence of impact
Adherence to treatment:
2005: 200/600
2010: 10/900
> High
20%
10%
0%
High Medium Low Very Low
Source: Authors’ estimates with database from IMSS, 2014
Diagonalizing Delivery: Training primary care
promoters, nurses and doctors in early
detection of breast cancer
Health Promoters
8 Risk Score (0-10)
Significant increase in knowledge,
7 *
6
among health promoters,
5
especially
4 in clinical breast examination
(Keating, Knaul et al 2014, The Oncologist)
3
Pre Post 3-6 month
Diagonalizing delivery:
Inclusion of early detection of breast cancer in
the cash transfer, anti-poverty program Prospera
optimalist