global inequities, children & ncds – what can we learn from childhood cancer? 140611

8/2/2019 Global inequities, children & NCDs what can we learn from childhood cancer? 140611

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Global inequities,

children & NCDswhat

can we learn fromchildhood cancer?

Don't forget our children! Global

approaches to NCDs and children

Tuesday, June 14, 2011

Global Health Council

Washington, DC

Felicia Marie Knaul

Hector Arreola


2/19


3/19

GTF.CCC:

Challenge and disprove the myths

about cancer& NCDM1. 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 resources

away from other diseases of the poor`


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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


5/19

Source: : WHO. The global burden of disease: 2004.

Child mortality (5-14): high

income versus LMICs

% of total diseases % of total diseases

0 10 20 30 40

Nutritional deficiencies

Digestive diseases

Congenital anomalies

Cardiovascular diseases

Respiratory infections

Neuropsychiatric conditions

Intentional injuries

Malignant neoplasms

Infectious and parasitic diseases

Unintentional injuries

0 10 20 30 40


Respiratory diseases


Endocrine disorders

Cardiovascular diseases

Congenital anomalies

Intentional injuries

Neuropsychiatric conditions

Unintentional injuries

LMICs HICs

Malignant neoplasms


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Distribution of mortality, 1-15 years

Mexico, 1979-2008

0

40%

1979 2008

1-4 5-14

Malignant tumors

40%

5%

16%



%

1979 2008

0


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More than 85% of pediatric cancer cases

and 95% of deaths occur in developing

countries that use less than 5% of the

world resources.

Level ofIncome

Incidence Mortality Population

Low 21% 27% 20%Low middle 50% 55% 57%

Upper middle 15% 15% 13%

High 15% 5% 10%

Distribution of childhood cancer

globally by level of income (< 15)


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Concentration curves of incidence and

mortality by type and country income

0.2

0.4

0.6

0.8

1

00.2 0.4 0.6 0.8 1

Non-Hodgkin lymphoma

0.2

0.4

0.6

0.8

1

0 0.2 0.4 0.6 0.8 1

Leukaemia

Children (


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The opportunity to survive should not be an accident of

geography or defined by income.

Yet it is.

But . there is scope for action.

Source: Author estimates based on IARC, Globocan, 2008 and 2010.

Quote: HRH Princess Dina Mired

0

0.2

0.4

0.6

0.8

Low income

countries

Lower middle

income

Upper middle

income

High income

countries

All cancers, < 15

~case

fatality(morta

lity/incidence)

Leukaemia,


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Avoidable childhood cancer deaths

from ALL by income region

1/ Estimaciones propias basadas en datos de GLOBOCAN 2010.

2/ Se consideran como letalidad de justicia de factibilidad a la letalidad que los pases podran alcanzar en condiciones de igualdad de ingresos, por lo cual se determina a

partir de la letalidad ms baja en cada regin de ingresos.

3/Se consideran como letalidad evitable a la letalidad que todos y cada uno de los pases debiesen aspirar independientemente de su nivel de ingresos y se determina como

la letalidad media lograda por los diez pases con la letalidad ms baja en todo el mundo.

Income Region Total LethalityAvoidable lethality

Social justice/3

Low income 0.73 0.45

Lower middle

income0.72 0.38

Upper middle

income0.57 0.35

High income 0.18 0.08


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Severely resource-constrained settings:

PIH-DFCI-BWH Financial protection/insurance: Mexico

International partnership: St Judes IOP

Survivorship: Sigamos Aprendiendo enel Hospital

Pediatric cancer treatment:

innovations


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Mexico Seguro Popular

Insurance:

Fund for catastrophic illness

Accelerated universal vertical coverage by

disease with a specified package ofinterventions

2004/5: ALL in children, cervical,

HIV/AIDS 2006: all pediatric cancers

2007: breast

2011: testicular and NHL


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Horizontal Coverage: Beneficiaries

A diagonal approach to social insurance and

childhood cancers


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Significant improvement in

outcomes in pediatric cancer

30-month survival rates have

increased from 3/10 to 7/10

Adherence to treatment has

decreased from 30% to 5%

Access and equity: evidence from apharmacy


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St. Jude IOP:

global partnership innovation model

Institutional commitment: St. JudeHospital dedicates a % of their budget

to International Outreach Program Strategy: Partnership and twinning -

assessment, specify model, implement

services, and monitor outcome Evaluation and implementation

research


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St. Jude International Outreach

Program

20 countries including Mexico and Jordan

El Salvador

5-year survival rate for children with ALL

increased from 10% to 60% during the first five

years of collaboration

Recife, Brazil

Since 1994, the cure rate for childhood cancers inincreased from 29% to 70%

Cure4Kids

Over 24,000 users in more than 175 countres


17/19

MOH+MOE

65 Sigamos Aprendiendo

classrooms in 23 statesthe majority of tertiarylevel hospitals

Survivorshipcare through

education


18/19

Mexico:


19/19

Cancer:

so much can be done for so many.Making this happen:

Lessons from pediatric cancercan guide work on adult

cancer and chronic illness,

and on health system

strengthening

global inequities, children & ncds – what can we learn from childhood cancer? 140611

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