Health beyond the horizon

Health beyond the horizon

Cancer and the Global Equity Divide: A Call for Action.

This article was written by Toni Kuguru, Sebastian Rodríguez Llamazares, Alessandro Demaio and A/Prof Felicia Knaul.

This year more than half of the nearly 13 million new cancer cases diagnosed worldwide and two-thirds of cancer deaths will occur in the world’s low and middle income countries (LMICs). Nearly a third of these deaths could have been prevented with the knowledge and technology already available today. For example, only 10% of children diagnosed with leukemia in the 25 poorest countries of the world will survive compared to 90% of children diagnosed with leukemia in Canada.

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The disease burden in developing nations is growing. Caused by an inequity in health, healthcare and resulting disease, the disparities across the cancer care continuum found between rich and poor countries remain largely unaddressed.  The cancer divide is the result of these disparities – explained in the report of the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries-GTF.CCC and in the book Closing the Cancer Divide:  An Equity Imperative.

The Cancer Divide

Evidence of this growing burden in LMICs is only beginning to be translated into effective and practical solutions. Traditional rhetoric argues that the challenge of addressing cancer in poor countries is unnecessary, unaffordable, unrealistic, and detracts resources from other more pressing development programs.  However, the impending cancer crisis in LMICs remains too large to be ignored. The Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries-GTF.CCC, building on work of agencies such as the World Economic Forum and the American Cancer Society, estimates the worldwide economic losses from cancer (including loss of income and suffering) amount to 4% of global GDP. Further, cancer affects human development as it has the potential to be both the cause and outcome of poverty.  And in many cases, cancer will only drive the poor into deeper poverty. Inaction is unaffordable at both the micro and macro settings.

In LMICs, for many cancers, over half of deaths could have either been prevented or avoided. In 2008, infection-related cancers accounted for almost one in four of diagnosed cancers in LMICs compared to less than one in ten in richer nations.  For some cancers such as breast and cervical, early detection and treatment are key to successful outcomes.  However, due to weak health systems struggling to deliver screening programs, many cancers are diagnosed late and cancers that should be treatable become terminal.

A lack of access and availability of affordable drugs and chemotherapies in LMICs, essential in treating or even curing many cancers, further drives avoidable mortality.  Similarly concerning, given that LMICs account for less than 6% of worldwide morphine consumption, millions of cancer patients in LMICs needlessly die in pain due to a lack of access to basic pain medications.

Some Good News

Closing the cancer divide is an equity and moral imperative.  While the challenges seem daunting, there is good news.  Affordable and effective cancer care programs already exist and demonstrate that strategies for prevention, detection, treatment and relief of suffering can succeed in resource-poor settings.

  • Promoting healthy lifestyles, including tobacco control, can significantly impact the cancer burden in LMICs where more than 80% of smokers reside and tobacco use accounts for over 30% of cancer deaths.
  • Integrating detection programs with current initiatives such as MCH and HIV/AIDS programs can also increase the likelihood of early detection resulting in better outcomes.
  • Innovative service delivery strategies such as telemedicine are in operation or being explored, linking hospitals in LMICs to specialty centers, such as St. Jude Hospital in Tennessee.
Globally, governments, funding bodies and development-partners of LMIC are beginning to recognize the growing burden of cancer. Nations such as Kenya are developing national cancer control strategies. Kenya’s first Cancer Prevention and Control Bill was tabled in Parliament in 2011, which focused on cancer registration and prevention as well as introduced policies protecting the cancer patient against discrimination in the workplace, schools, insurance schemes, and health institutions. Similar comprehensive strategies in Mexico have demonstrated that including childhood cancers in its Seguro Popular insurance program increases survival significantly.


Our Call: What we can do together

Today is World Cancer Day. To celebrate, highlight lessons learnt globally and promote affordable, effective, country-specific cancer care and control (CCC) initiatives, the Student Government of HSPH, Students in Latino Public Health, the Harvard Global Equity Initiative, and the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, are raising awareness and dispelling the myths about cancer. Dedicated to improving global health, we are empowered to translate what we are learning and sharing in the classroom into evidence-based advocacy. As global advocates, we are mobilizing students and people from around the world to collectively have our voices heard: we will not ignore the cancer divide.

We strive to empower people that live with cancer as well as those who seek to support efforts to meet the challenge of the disease in LMICs.  We aim to dispel the myths and collaborate with the global movement launched and led by the Union for International Cancer Control (UICC) by collecting signatures for the World Cancer Declaration. We feel it is time to raise our voice and undertake this challenge.

Inaction is unacceptable.  Join us in this call-to-action to close the cancer divide and sign the World Cancer Declaration today.



Toni Kuguru is a MSc candidate (2014) at the Harvard School of Public Health (HSPH) and an intern at the Harvard Global Equity Initiative (HGEI). At HGEI, she is researching cancer survivorship in low and middle income countries. She also serves on the Harvard Africa Development Conference planning committee. Prior to HSPH, she worked at the Nairobi Cancer Registry at the Kenya Medical Research Institute (KEMRI).

Dr. Sebastián Rodríguez-Llamazares is a Mexican physician with experience working in underserved rural communities. Because of this, he is now pursuing a Master in Public Health degree at Harvard School of Public Health. He strives to design and implement feasible interventions that bridge the gaps of health inequities worldwide.

Dr Alessandro Demaio is a medical doctor, originally from Melbourne, Australia, with a Masters in Public Health. In 2010, Sandro began a PhD in Global Health with the University of Copenhagen, focusing on Non-Communicable Diseases (NCDs). His primary research project is based in Mongolia. As a Director for NCD Action, in 2013 Alessandro will be a fellow at the Copenhagen School of Global Health and Harvard Medical School.

Dr Felicia Knaul is the Director of the Harvard Global Equity Initiative and Associate Professor at the Harvard Medical School. She is also a Senior Associate with the Mexican Health Foundation, where she has collaborated with since 1994. As a result of her personal experience, she founded Cáncer de Mama: Tómatelo a Pecho (Breast Cancer: Take it to Heart) in 2007, a program that undertakes and promotes research, advocacy, awareness and early detection initiatives on breast cancer in Latin America.