Time is right to make cancer control a development priority

Aug 27 2008

For public health, the complexity of cancer control has increased enormously following the shift of the disease burden from wealthy to less affluent countries. Cancer causes around 7.9 million deaths worldwide each year. Of these deaths, more than 72% are now occurring in low- and middle-income countries. This is a shocking statistic, with huge implications for human suffering, health systems, health budgets, and the drive to reduce poverty.

Today, cancer touches every country in the world, sometimes in deeply disturbing ways. The time is right to make cancer control a development priority.

Diseases like cancer are a leading cause of so-called catastrophic health expenditure. This is especially true in low- and middle-income countries, where most people rely on out-of-pocket payments for health care. WHO estimates that catastrophic payments for health care push an estimated 100 million people below the poverty line each year. For cancer, out-of-pocket payment is a double-edged sword. It discourages people from seeking treatment early, when the chances of cure are greatest. And it deepens household and community poverty.

Health systems in developing countries can usually cope with the intermittent emergencies caused by infectious diseases. The patient either survives or dies. In contrast, the demands of chronic care can push a fragile health system to the breaking point. First-rate interventions - and the money to buy them - will have little impact in the absence of systems for their delivery.

For cancer control in low- and middle-income countries, breakthroughs do not come in the form of spectacular new drugs for cure. True breakthroughs come when research shows how existing tools can be adapted to work well in resource-poor settings.

Unfortunately, virtually no country in the world is doing enough to prevent cancer. Tobacco control is the world's best opportunity to prevent cancer on a grand scale.

Developing countries are now face-to-face with problems that affluent countries confronted decades ago. Policies were devised. Lessons were learned. Clinical advances raced ahead. Incidence rates for some cancers dropped, while survival rates dramatically improved. These experiences need to be shared as urgently as possible. We are not starting from scratch. Screening programmes, diagnostic tests, and treatments are costly. But with the shift in the cancer burden, a nation's resource level can no longer be viewed as a barrier to cancer control.

There is too much at stake - for health and economic development, for equity and social justice, for human suffering, and for the dignity of human life.