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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