1
|
Krakauer EL, Kwete XJ, Rassouli M, Arreola-Ornelas H, Ashrafizadeh H, Bhadelia A, Liu YA, Méndez-Carniado O, Osman H, Knaul FM. Palliative care need in the Eastern Mediterranean Region and human resource requirements for effective response. PLOS Glob Public Health 2023; 3:e0001980. [PMID: 37922240 PMCID: PMC10624269 DOI: 10.1371/journal.pgph.0001980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/01/2023] [Indexed: 11/05/2023]
Abstract
Integration of palliative care into health care systems is considered an ethical responsibility, yet no country in the Eastern Mediterranean Region (EaMReg) has achieved integration. Data on palliative care need and cost are crucial forEaMReg health care planners and implementers in the region. Using data from the Lancet Commission on Palliative Care and Pain Relief, we estimated the number of people in each EaMReg country who needed palliative care in 2015 and their degree of access. In three countries, we estimated the number of days during which an encounter for palliative care was needed at each level of the health care system. This enabled calculation of the number of full-time equivalents (FTEs) of clinical and non-clinical staff members needed at each level to administer the essential package of palliative care recommended by WHO. In 2015, 3.2 million people in the EaMReg needed palliative care, yet most lacked access to it. The most common types of suffering were pain, fatigue, weakness, anxiety or worry, and depressed mood. To provide safe, effective palliative care at all levels of health care systems, between 5.4 and 11.1 FTEs of trained and supervised community health workers per 100,000 population would be needed in addition to 1.0-1.9 FTEs of doctors, 2.2-4.3 FTEs of nurses, and 1.4-2.9 FTEs of social workers. Data from our study enables design of palliative care services to meet the specific needs of each EaMReg country and to calculate the cost or cost savings.
Collapse
Affiliation(s)
- Eric L. Krakauer
- Program in Global Palliative Care, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Palliative Care & Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Xiaoxiao J. Kwete
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Maryam Rassouli
- School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Héctor Arreola-Ornelas
- Fundación Mexicana para la Salud, Mexico City, Mexico
- Institute for Obesity Research, Tecnologico de Monterrey, Mexico, Mexico
| | | | - Afsan Bhadelia
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | | | - Hibah Osman
- Program in Global Palliative Care, Harvard Medical School, Boston, Massachusetts, United States of America
- Balsam Lebanese Center for Palliative Care, Beirut, Lebanon
- Dana Farber Cancer Institute, Boston, Massachusetts, United States of America
| | - Felicia M. Knaul
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, Florida, United States of America
| |
Collapse
|
2
|
Serván-Mori E, Gómez-Dantés O, Contreras D, Flamand L, Cerecero-García D, Arreola-Ornelas H, Knaul FM. Increase of catastrophic and impoverishing health expenditures in Mexico associated to policy changes and the COVID-19 pandemic. J Glob Health 2023; 13:06044. [PMID: 37883200 PMCID: PMC10602209 DOI: 10.7189/jogh.13.06044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
Background In 2003, the Mexican Congress approved a major reform to provide health care services to the poor population through the public insurance scheme Seguro Popular. This program was dismantled in 2019 as part of a set of health system reforms and substituted with the Health Institute for Welfare (INSABI). These changes were implemented during the initial phases of the coronavirus (COVID-19) pandemic. We aimed to examine the impact of these reforms and the COVID-19 pandemic on financial risk protection in Mexico between 2018 and 2020. Methods We performed a population-based analysis using cross-sectional data from the 2018 and 2020 rounds of the National Household Income and Expenditures Survey. We used a pooled fixed-effects multivariable two-stage probit model to determine the likelihood of catastrophic health expenditure (CHE), impoverishing health expenditure (IHE), and excessive health expenditure (EHE) among Mexican households. We also mapped the quintiles of changes in EHE in households without health insurance by state. Results The percentage of households without health insurance almost doubled from 8.8% (three million households) in 2018 to 16.5% (5.8 million households) in 2020. We also found large increases in the proportion of households incurring in CHE (18.4%; 95% confidence interval (CI) = 6.1, 30.7) and EHE (18.7%; 95% CI = 7.9, 29.5). Significant increases in CHE, IHE, and EHE were only observed among households without health insurance (CHE: 90.7%; 95% CI = 31.6, 149.7, EHE: 73.5%; 95% CI = 25.3, 121.8). Virtually all Mexican states (n/N = 31/32) registered an increase in EHE among households without health insurance. This increase has a systematic territorial component affecting mostly central and southern states (range = -1.0% to 194.4%). Conclusions The discontinuation of the Seguro Popular Program and its substitution with INSABI during the first stages of the COVID-19 pandemic reduced the levels of health care coverage in Mexico. This reduction and the pandemic increased out-of-pocket expenditure in health and the portion of CHE and EHE in the 2018-2020 period. The effect was higher in households without health insurance and households in central and southern states of the country. Further studies are needed to determine the specific effect both of recent policy changes and of the COVID-19 pandemic on the levels of financial protection in health in Mexico.
Collapse
Affiliation(s)
- Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Octavio Gómez-Dantés
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - David Contreras
- Institute for Obesity Research, Tecnologico de Monterrey, Mexico
- School Government and Public Transformation, Tecnologico de Monterrey, Mexico
| | - Laura Flamand
- Center for International Studies, El Colegio de Mexico, Mexico City, Mexico
| | - Diego Cerecero-García
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
- Public Health Policy Evaluation Unit, Imperial College London, London, United Kingdom
| | - Héctor Arreola-Ornelas
- Institute for Obesity Research, Tecnologico de Monterrey, Mexico
- School Government and Public Transformation, Tecnologico de Monterrey, Mexico
- Mexican Health Foundation (FUNSALUD), Mexico
- Tomatelo a Pecho, A.C., Mexico
| | - Felicia M Knaul
- Mexican Health Foundation (FUNSALUD), Mexico
- Tomatelo a Pecho, A.C., Mexico
- The University of Miami Institute for Advanced Study of the Americas, USA
- Miller School of Medicine, University of Miami, USA
| |
Collapse
|
3
|
Pérez-Cruz PE, Undurraga E, Arreola-Ornelas H, Corsi O, Jiang Kwete XX, Krakauer EL, Rosa WE, Knaul FM. Bridging gaps to universal palliative care access in Chile: serious health-related suffering and the cost of expanding the package of care services. Lancet Reg Health Am 2023; 19:100425. [PMID: 36950031 PMCID: PMC10025417 DOI: 10.1016/j.lana.2022.100425] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/24/2022] [Accepted: 12/15/2022] [Indexed: 01/05/2023]
Abstract
Background The Lancet Commission on Palliative Care (PC) and Pain Relief quantified the burden of serious health-related suffering (SHS), proposing an Essential Package of PC (EPPC) to narrow the global PC divide. We applied the EPPC framework to analyze PC access in Chile, identify gaps in coverage, and provide recommendations to improve PC access. Methods Total SHS and population in need of PC was estimated using official 2019 government data. We differentiated between cancer and non-cancer related SHS given guaranteed Chilean PC coverage for cancer. We calculated differences between the Chilean PC package and the Lancet Commission EPPC to estimate the cost of expanding to achieve national coverage of palliative care. Findings In 2019, nearly 105,000 decedent and non-decedent Chileans experienced SHS with a lower-bound estimate of 12.1 million days and an upper-bound estimate of 42.4 million days of SHS. Each individual experienced between 116 and 520 days of SHS per year. People living with a cancer diagnosis had PC access with financial protection, accounting for almost 42% of patients in need. People with non-cancer diagnoses-about 61 thousand patients-lacked PC coverage. Expanding coverage of the EPPC for all patients in need would cost just above $123 million USD, equivalent to 0.47% of Chilean National Health Expenditure. Interpretation Achieving universal PC access is urgent and feasible for Chile, classified as a high-income country. Expanding PC services and coverage to the EPPC standard are affordable and critical health system responses to ensuring financial protection for patients with SHS. In Chile, this requires closing large gaps in PC coverage pertaining to patients with non-cancer conditions and treatment of symptoms that go beyond pain. Our research provides an empirical approach for applying the Lancet Commission SHS framework to estimate the cost of achieving national universal PC access anchored in a package of health care services. Funding This research was partially funded by the Chilean Government through the Fondo Nacional de Ciencia y Tecnología (Fondecyt Regular) grant number 1201721, the U.S. Cancer Pain Relief Committee grant AWD-003806 awarded to the University of Miami and by the University of Miami Institute for Advanced Study of the Americas. We acknowledge NIH/NCI award P30CA008748.
Collapse
Affiliation(s)
- Pedro E. Pérez-Cruz
- Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina, Pontificia Universidad Católica de Chile (PUC), Santiago, Chile
- Sección Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Católica de Chile (PUC), Santiago, Chile
- Corresponding author. Programa Medicina Paliativa y Cuidados Continuos, Departamento Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, Oficina 523, Santiago, 8330077, Chile.
| | - Eduardo Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile (PUC), Santiago, Chile
- CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, ON, Canada
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Chile
| | - Hector Arreola-Ornelas
- Institute for Obesity Research, Tecnológico de Monterrey, México
- Escuela de Gobierno y Transformación Pública, Tecnológico de Monterrey, México
- Tómatelo a Pecho, AC, México
- Fundación Mexicana para la Salud, México
| | - Oscar Corsi
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile (PUC), Santiago, Chile
| | | | - Eric L. Krakauer
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, USA
| | - William E. Rosa
- Institute for Advanced Study of the Americas, University of Miami, Miami, FL, USA
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Felicia M. Knaul
- Tómatelo a Pecho, AC, México
- Institute for Advanced Study of the Americas, University of Miami, Miami, FL, USA
- Miller School of Medicine, University of Miami, Miami, FL, USA
| |
Collapse
|
4
|
Arreola-Ornelas H, Merino-Juárez GA, Contreras-Loya D, Méndez-Carniado O, Morales-Juárez L, Bernal-Serrano D, Arizmendi-Barrera KA, Vargas-Martínez C, Razo C, Knaul FM, Gakidou E, Dai X, Cogen R, Ahmad NS. Burden of overweight and obesity in Mexico from 1990 to 2021. GAC MED MEX 2023; 159:543-556. [PMID: 38386886 DOI: 10.24875/gmm.m24000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/31/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Overweight and obesity (OW/OB) represent a serious challenge in Mexico, with effects on health, society and economy. Demographic, epidemiological, nutritional, social and economic factors have exacerbated this problem. OBJECTIVE To analyze mortality and years of healthy life lost in Mexico due to OW/OB in the 1990-2021 period. MATERIAL AND METHODS The Global Burden of Disease and Risk Factors 2021 study was used to analyze data on elevated body mass index (BMI) as a risk factor and its evolution in Mexico. RESULTS In 2021, 118 thousand deaths attributable to high BMI were recorded, which accounted for 10.6% of total deaths and more than 4.2 million disability-adjusted life years lost. CONCLUSIONS The obesogenic environment, influenced by social determinants of health, has had a significant impact on mortality, burden of disease, and economic costs. Addressing OW/OB requires multisector interventions to strengthen the Mexican health system.
Collapse
Affiliation(s)
- Héctor Arreola-Ornelas
- Public Policies Unit, Institute of Research on Obesity, Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico
- Fundación Mexicana para la Salud, A. C., Mexico City, Mexico
| | - Gustavo A Merino-Juárez
- Public Policies Unit, Institute of Research on Obesity, Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico
- School of Government and Public Transformation, Tecnológico de Monterrey, Mexico City, Mexico
| | - David Contreras-Loya
- Public Policies Unit, Institute of Research on Obesity, Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico
- School of Government and Public Transformation, Tecnológico de Monterrey, Mexico City, Mexico
| | | | - Linda Morales-Juárez
- Public Policies Unit, Institute of Research on Obesity, Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico
- School of Government and Public Transformation, Tecnológico de Monterrey, Mexico City, Mexico
| | - Daniel Bernal-Serrano
- School of Government and Public Transformation, Tecnológico de Monterrey, Mexico City, Mexico
| | - Klaudia A Arizmendi-Barrera
- Public Policies Unit, Institute of Research on Obesity, Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico
- School of Government and Public Transformation, Tecnológico de Monterrey, Mexico City, Mexico
| | - Carolina Vargas-Martínez
- Public Policies Unit, Institute of Research on Obesity, Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico
- School of Government and Public Transformation, Tecnológico de Monterrey, Mexico City, Mexico
| | - Christian Razo
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Felicia M Knaul
- Tómatelo a Pecho, A. C., Mexico City, Mexico
- Fundación Mexicana para la Salud, A. C., Mexico City, Mexico
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, Florida, United States of America
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Xiaochen Dai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Rebecca Cogen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Noah S Ahmad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| |
Collapse
|
5
|
Moreno PI, Penedo FJ, Knaul FM, Oltmann C, Huber MT, Khawand-Azoulai M. EHR-Integrated Patient-Reported Outcomes in Ambulatory Oncology: A Critical Opportunity for Timely and Targeted Palliative Care. J Natl Compr Canc Netw 2023; 21:2-5. [PMID: 36630895 DOI: 10.6004/jnccn.2022.7079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
6
|
Blofield M, Knaul FM, Calderón-Anyosa R, Peterman A, Franzoni JM, O'Donnell M, Bustreo F. A diagonal and social protection plus approach to meet the challenges of the COVID-19 syndemic: cash transfers and intimate partner violence interventions in Latin America. Lancet Glob Health 2022; 10:e148-e153. [PMID: 34838201 PMCID: PMC8670753 DOI: 10.1016/s2214-109x(21)00444-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/07/2021] [Accepted: 09/15/2021] [Indexed: 01/07/2023]
Abstract
Latin America has been particularly hard hit by the COVID-19 syndemic, including the associated economic fallout that has threatened the livelihoods of most families. Social protection platforms and policies should have a crucial role in safeguarding individual and family wellbeing; however, the response has been insufficient to address the scale of the crisis. In this Viewpoint, we focus on two policy challenges of the COVID-19 syndemic: rapidly and effectively providing financial support to the many families that lost livelihoods, and responding to and mitigating the increased risk of intimate partner violence (IPV). We argue that building programmatic linkages between social protection platforms, particularly cash transfers, and IPV prevention, mitigation, and response services, creates synergies that can promote freedom from both poverty and violence.
Collapse
Affiliation(s)
| | - Felicia M Knaul
- University of Miami Institute for Advanced Study of the Americas, Miami, FL, USA,Correspondence to: Prof Felicia M Knaul, University of Miami Institute for Advanced Study of the Americas, Miami, FL 33124, USA
| | | | - Amber Peterman
- Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | |
Collapse
|
7
|
Wilson BE, Jacob S, Do V, Amir E, Bray F, Ferlay J, Knaul FM, Elawawy A, Pearson SA, Barton MB. Are NCCN Resource-Stratified Guidelines for Breast Cancer Systemic Therapy Achievable? A Population-Based Study of Global Need and Economic Impact. JCO Glob Oncol 2021; 7:1074-1083. [PMID: 34228485 PMCID: PMC8457816 DOI: 10.1200/go.21.00028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
PURPOSE Resource-stratified guidelines (RSG) for cancer provide a hierarchy of interventions, based on resource availability. We quantify treatment need and cost if National Comprehensive Cancer Network (NCCN) RSGs for breast cancer (BC) are adopted globally. METHODS We developed decision trees for first-course systemic therapy, merged with SEER and Global Cancer Observatory 2018 incidence data to estimate treatment need and cost if NCCN RSG are implemented globally based on country-level income. Simulations were used to quantify need and cost of globally scaling up services to Maximal. RESULTS Based on NCCN RSG, first-course chemotherapy is indicated in 0% (Basic), 87% (Core), and 86% (Enhanced) but declined to 50% (Maximal) because of incorporation of genomic profiling. First-course endocrine therapy (ET) is indicated in 80% in all settings. In 2018, treatment need was 1.4 million people for chemotherapy, 183,943 for human epidermal growth factor receptor 2 (HER2) therapies and 1.6 million for ET. The cost per person for chemotherapy or HER2 or immunotherapy increased by 17-fold from Core to Maximal ($1,278-$22,313 Australian dollars [AUD]). The cost of ET per person rose eight-fold from Basic to Maximal ($1,236-$9,809 AUD). If all patients with BC globally were treated with Maximal resources, the need for chemotherapy would decline by 28%, whereas cost of first-course treatment would rise by 1.8-fold ($21-$37 billion AUD) because of more costly therapies. CONCLUSION NCCN RSGs for BC could result in chemotherapy overtreatment in Core and Enhanced settings. The absence of chemotherapy in Basic settings should be reconsidered, and future iterations of RSG should perform cross-tumor comparisons to ensure equitable resource distribution and maximize population-level outcomes. Our model is flexible and can be tailored to the costs, population attributes, and resource availability of any institution or country for health-services planning.
Collapse
Affiliation(s)
- Brooke E Wilson
- Collaboration for Cancer Outcomes, Research and Evaluation, South West Clinical School, University of New South Wales, Liverpool, New South Wales, Australia.,Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Susannah Jacob
- Collaboration for Cancer Outcomes, Research and Evaluation, South West Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Viet Do
- Collaboration for Cancer Outcomes, Research and Evaluation, South West Clinical School, University of New South Wales, Liverpool, New South Wales, Australia.,Liverpool Hospital, Department of Radiation Oncology, Liverpool, New South Wales, Australia
| | - Eitan Amir
- Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Cancer Research, Lyon, France
| | - Jacques Ferlay
- Cancer Surveillance Section, International Agency for Cancer Research, Lyon, France
| | - Felicia M Knaul
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL.,Department of Public Health Sciences, Leonard M. Miller School of Medicine, Miami, FL.,Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL.,Tómatelo a Pecho, A.C., Mexico City, Mexico.,Mexican Health Foundation (FUNSALUD), Mexico City, Mexico
| | - Ahmed Elawawy
- Suez Canal University, Ismailia, Egypt.,Alsoliman Radiation and Oncology Center, Port Said, Egypt
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, UNSW, Sydney, Australia.,Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
| | - Michael B Barton
- Collaboration for Cancer Outcomes, Research and Evaluation, South West Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| |
Collapse
|
8
|
Casanova F, Knaul FM, Rodriguez NM. Harvesting Health Knowledge: Breast Cancer Perceptions in the South Florida Latinx Farmworker Community. Qual Health Res 2021; 31:1423-1436. [PMID: 33834911 PMCID: PMC8277692 DOI: 10.1177/10497323211003542] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
South Florida agricultural regions, home to Latinx immigrant farmworkers, report higher rates of late-stage breast cancer diagnosis than national, state, and county-level averages. We conducted a community-based qualitative study on the needs, health knowledge gaps, barriers to breast cancer screening, and the role of community health workers (CHWs) in supporting the community's access to early detection services. We conducted three CHW focus groups (FGs) (n = 25) and in-depth interviews (n = 15), two FGs (n = 18) and in-depth interviews (n = 3) with farmworker community members, and informal interviews with cancer clinicians (n = 7). Using a grounded theory approach, five core themes regarding the community's barriers to accessing health care services emerged: (a) lack of information; (b) social and economic barriers; (c) cultural factors; (d) fears and mistrust; and (e) psychosocial concerns. Findings yield implications for community health practice, the potential impact of CHWs, and the production of breast cancer education to improve health equity along with the care continuum.
Collapse
|
9
|
Gospodarowicz MK, Jaffray DA, Knaul FM. Vision 2020: looking back and thinking forward on The Lancet Oncology Commissions. Lancet Oncol 2020; 21:1144-1146. [PMID: 32888451 PMCID: PMC7462593 DOI: 10.1016/s1470-2045(20)30481-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 11/25/2022]
|
10
|
Rodin D, Burger EA, Atun R, Barton M, Gospodarowicz M, Grover S, Hanna TP, Jaffray DA, Knaul FM, Lievens Y, Zubizarreta E, Milosevic M. Scale-up of radiotherapy for cervical cancer in the era of human papillomavirus vaccination in low-income and middle-income countries: a model-based analysis of need and economic impact. Lancet Oncol 2019; 20:915-923. [PMID: 31151906 DOI: 10.1016/s1470-2045(19)30308-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/29/2019] [Accepted: 04/03/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Radiotherapy is standard of care for cervical cancer, but major global gaps in access exist, particularly in low-income and middle-income countries. We modelled the health and economic benefits of a 20-year radiotherapy scale-up to estimate the long-term demand for treatment in the context of human papillomavirus (HPV) vaccination. METHODS We applied the Global Task Force on Radiotherapy for Cancer Control investment framework to model the health and economic benefits of scaling up external-beam radiotherapy and brachytherapy for cervical cancer in upper-middle-income, lower-middle-income, and low-income countries between 2015 and 2035. We estimated the unique costs of external-beam radiotherapy and brachytherapy and included a specific valuation of women's caregiving contributions. Model outcomes life-years gained and the human capital and full income net present value of investment. We estimated the effects of stage at diagnosis, radiotherapy delivery system, and simultaneous HPV vaccination (75% coverage) up to a time horizon set at 2072. FINDINGS For the period from 2015 to 2035, we estimated that 9·4 million women in low-income and middle-income countries required treatment with external-beam radiotherapy, of which 7·0 million also required treatment with brachytherapy. Incremental scale-up of radiotherapy in these countries from 2015 to meet optimal radiotherapy demand by 2035 yielded 11·4 million life-years gained, $59·3 billion in human capital net present value (-$1·5 billion in low-income, $19·9 billion in lower-middle-income, and $40·9 billion in upper-middle-income countries), and $151·5 billion in full income net present value ($1·5 billion in low-income countries, $53·6 billion in lower-middle-income countries, and $96·4 billion in upper-middle-income countries). Benefits increased with advanced stage of cervical cancer and more efficient scale up of radiotherapy. Bivalent HPV vaccination of 12-year-old girls resulted in a 3·9% reduction in incident cases from 2015-2035. By 2072, when the first vaccinated cohort of girls reaches 70 years of age, vaccination yielded a 22·9% reduction in cervical cancer incidence, with 38·4 million requiring external-beam radiotherapy and 28·8 million requiring brachytherapy. INTERPRETATION Effective cervical cancer control requires a comprehensive strategy. Even with HPV vaccination, radiotherapy treatment scale-up remains essential and produces large health benefits and a strong return on investment to countries at different levels of development. FUNDING None.
Collapse
Affiliation(s)
- Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre Toronto, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
| | - Emily A Burger
- Center for Health Decision Science, Harvard University, Boston, MA, USA; Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Rifat Atun
- Department of Global Health and Population, Harvard University, Boston, MA, USA; Harvard T H Chan School of Public Health, and the Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Michael Barton
- Ingham Institute for Applied Medical Research, University of New South Wales Sydney, Liverpool, NSW, Australia
| | - Mary Gospodarowicz
- Radiation Medicine Program, Princess Margaret Cancer Centre Toronto, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Surbhi Grover
- Botswana-UPenn Partnership and Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy P Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute and Department of Oncology, Queen's University, Kingston, ON, Canada
| | - David A Jaffray
- Radiation Medicine Program, Princess Margaret Cancer Centre Toronto, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Felicia M Knaul
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | | | - Michael Milosevic
- Radiation Medicine Program, Princess Margaret Cancer Centre Toronto, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
11
|
Hubbeling HG, Rosenberg SM, González-Robledo MC, Cohn JG, Villarreal-Garza C, Partridge AH, Knaul FM. Psychosocial needs of young breast cancer survivors in Mexico City, Mexico. PLoS One 2018; 13:e0197931. [PMID: 29787612 PMCID: PMC5963789 DOI: 10.1371/journal.pone.0197931] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/10/2018] [Indexed: 12/21/2022] Open
Abstract
Objective Young breast cancer survivors in Mexico face distinct psychosocial challenges that have not been characterized. This study aims to describe the psychosocial needs of young breast cancer survivors in Mexico at 5 or more years of survivorship, identifying areas of focus for early interventions. Methods Breast cancer patients diagnosed at age 40 or prior with 5 or more years since diagnosis were invited to participate in one-on-one 30–60 minute semi-structured audio-recorded interviews at the Instituto Nacional de Cancerología in Mexico City. Transcripts were coded using thematic analysis with NVivo software. Results 25 women participated. Five major phenomena emerged from analysis: (1) minimization of fertility concerns; (2) persistence of body image disturbance over time; (3) barriers to employment during survivorship; (4) impact on family relationships and social networks; & (5) unmet psychological care and informational needs. Conclusions Early interventions with a focus on fertility loss education, access to reconstructive surgery and body image support, guidance during return-to-work, assistance with childcare, integration of psychological care and the fulfillment of informational needs could ameliorate long-term psychological and social distress for young breast cancer survivors in Mexico.
Collapse
Affiliation(s)
- Harper G. Hubbeling
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Shoshana M. Rosenberg
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
| | | | - Julia G. Cohn
- David Rockefeller Center for Latin American Studies, Harvard University, Boston, Massachusetts, United States of America
| | - Cynthia Villarreal-Garza
- Departamento de Investigación y de Tumores Mamarios, Instituto Nacional de Cancerología, Mexico City, Mexico
- Centro de Cáncer de Mama, Tecnológico de Monterrey, Monterrey N.L., Mexico
- Joven y Fuerte: Programa para la Atención e Investigación de Mujeres Jóvenes con Cáncer de Mama, Mexico City, Mexico
| | - Ann H. Partridge
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
| | - Felicia M. Knaul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Coral Gables, Florida, United States of America
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, Florida, United States of America
- Programa Universalidad y Competitividad en Salud, Fundación Mexicana para la Salud, Mexico City, Mexico
- Tómatelo a Pecho, Mexico City, Mexico
| |
Collapse
|
12
|
Jamison DT, Alwan A, Mock CN, Nugent R, Watkins D, Adeyi O, Anand S, Atun R, Bertozzi S, Bhutta Z, Binagwaho A, Black R, Blecher M, Bloom BR, Brouwer E, Bundy DAP, Chisholm D, Cieza A, Cullen M, Danforth K, de Silva N, Debas HT, Donkor P, Dua T, Fleming KA, Gallivan M, Garcia PJ, Gawande A, Gaziano T, Gelband H, Glass R, Glassman A, Gray G, Habte D, Holmes KK, Horton S, Hutton G, Jha P, Knaul FM, Kobusingye O, Krakauer EL, Kruk ME, Lachmann P, Laxminarayan R, Levin C, Looi LM, Madhav N, Mahmoud A, Mbanya JC, Measham A, Medina-Mora ME, Medlin C, Mills A, Mills JA, Montoya J, Norheim O, Olson Z, Omokhodion F, Oppenheim B, Ord T, Patel V, Patton GC, Peabody J, Prabhakaran D, Qi J, Reynolds T, Ruacan S, Sankaranarayanan R, Sepúlveda J, Skolnik R, Smith KR, Temmerman M, Tollman S, Verguet S, Walker DG, Walker N, Wu Y, Zhao K. Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition. Lancet 2018; 391:1108-1120. [PMID: 29179954 PMCID: PMC5996988 DOI: 10.1016/s0140-6736(17)32906-9] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/01/2017] [Accepted: 11/15/2017] [Indexed: 12/23/2022]
Abstract
The World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition (DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises the main messages from all the volumes and contains cross-cutting analyses. This Review draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around 21 essential packages that were developed in the nine volumes. Each essential package addresses the concerns of a major professional community (eg, child health or surgery) and contains a mix of intersectoral policies and health-sector interventions. 71 intersectoral prevention policies were identified in total, 29 of which are priorities for early introduction. Interventions within the health sector were grouped onto five platforms (population based, community level, health centre, first-level hospital, and referral hospital). DCP3 defines a model concept of essential universal health coverage (EUHC) with 218 interventions that provides a starting point for country-specific analysis of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income countries would reduce premature deaths by an estimated 4·2 million per year. Estimated total costs prove substantial: about 9·1% of (current) gross national income (GNI) in low-income countries and 5·2% of GNI in lower-middle-income countries. Financing provision of continuing intervention against chronic conditions accounts for about half of estimated incremental costs. For lower-middle-income countries, the mortality reduction from implementing the EUHC can only reach about half the mortality reduction in non-communicable diseases called for by the Sustainable Development Goals. Full achievement will require increased investment or sustained intersectoral action, and actions by finance ministries to tax smoking and polluting emissions and to reduce or eliminate (often large) subsidies on fossil fuels appear of central importance. DCP3 is intended to be a model starting point for analyses at the country level, but country-specific cost structures, epidemiological needs, and national priorities will generally lead to definitions of EUHC that differ from country to country and from the model in this Review. DCP3 is particularly relevant as achievement of EUHC relies increasingly on greater domestic finance, with global developmental assistance in health focusing more on global public goods. In addition to assessing effects on mortality, DCP3 looked at outcomes of EUHC not encompassed by the disability-adjusted life-year metric and related cost-effectiveness analyses. The other objectives included financial protection (potentially better provided upstream by keeping people out of the hospital rather than downstream by paying their hospital bills for them), stillbirths averted, palliative care, contraception, and child physical and intellectual growth. The first 1000 days after conception are highly important for child development, but the next 7000 days are likewise important and often neglected.
Collapse
Affiliation(s)
- Dean T Jamison
- University of California, San Francisco, San Francisco, CA, USA.
| | - Ala Alwan
- University of Washington, Seattle, WA, USA
| | | | | | | | | | | | - Rifat Atun
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | | | | | | | - Robert Black
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mark Blecher
- National Treasury of South Africa, Cape Town, South Africa
| | - Barry R Bloom
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Dan Chisholm
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | | | | | | | - Haile T Debas
- University of California, San Francisco, San Francisco, CA, USA
| | - Peter Donkor
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Tarun Dua
- World Health Organization, Geneva, Switzerland
| | - Kenneth A Fleming
- Center for Global Health, National Cancer Institute, Bethesda, MD, USA; University of Oxford, Oxford, UK
| | | | | | - Atul Gawande
- Harvard T. H. Chan School of Public Health, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA
| | - Thomas Gaziano
- Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA
| | | | - Roger Glass
- Fogarty International Center, US National Institutes of Health, Bethesda, MD, USA
| | | | - Glenda Gray
- University of the Witwatersrand, Johannesburg, South Africa
| | - Demissie Habte
- International Clinical Epidemiology Network, New Delhi, India
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Carol Medlin
- Praxis Social Impact Consulting, Washington, DC, USA
| | - Anne Mills
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Zachary Olson
- University of California, Berkeley, Berkeley, CA, USA
| | | | | | - Toby Ord
- University of Oxford, Oxford, UK
| | | | - George C Patton
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
| | - John Peabody
- University of California, San Francisco, San Francisco, CA, USA
| | - Dorairaj Prabhakaran
- London School of Hygiene & Tropical Medicine, London, UK; Public Health Foundation of India, New Delhi, India
| | - Jinyuan Qi
- Princeton, University, Princeton, NJ, USA
| | | | | | | | - Jaime Sepúlveda
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Kirk R Smith
- University of California, Berkeley, Berkeley, CA, USA
| | | | | | | | | | - Neff Walker
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yangfeng Wu
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Kun Zhao
- China National Health Development Research Center, Beijing, China
| |
Collapse
|
13
|
|
14
|
Knaul FM, Bhadelia A, Rodriguez NM, Arreola-Ornelas H, Zimmermann C. The Lancet Commission on Palliative Care and Pain Relief—findings, recommendations, and future directions. The Lancet Global Health 2018. [DOI: 10.1016/s2214-109x(18)30082-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
15
|
Kaasa S, Knaul FM, Mwangi-Powell F, Rodin G. Supportive care in cancer: new directions to achieve universal access to psychosocial, palliative, and end-of-life care. The Lancet Global Health 2018. [DOI: 10.1016/s2214-109x(18)30086-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
16
|
Knaul FM, Rodriguez NM, Bhadelia A, Garcia P, Atun R. Progress on women's health—lessons and opportunities for global cancer control. The Lancet Global Health 2018. [DOI: 10.1016/s2214-109x(18)30085-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
17
|
Knaul FM. Abstract IS-1: Health System Responses to Women's Cancers in the Americas: Closing Divides to Achieve Universal Health Coverage. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-is-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
To address the challenges of the increasing cancer burden, low- and middle-income country health systems must function in an integrated manner across the care continuum from prevention to palliative care. Health systems must address disease-specific priorities and systemic challenges synergistically, as envisioned in a diagonal approach to health systems strengthening, which overcomes the barriers between vertical (disease-specific) and horizontal (systemic) approaches by making full use of potential synergies between different programs and allows the development of common delivery platforms that consider shared risk factors across diseases to optimize available resources.
The challenges of meeting the double burden of cancer are epitomized by women's cancers in Latin America: the persistence of preventable cancers like cervical cancer that are especially prevalent among the poor; and the emerging challenge of cancers like breast cancer, that cannot be prevented, but whose impact could be dramatically reduced through early detection and treatment and that affect women of all socio-economic strata. Further, women face specific challenges associated with stigma and discrimination that exacerbate their risks of dying and suffering from cancer, especially those affecting reproductive health. As many Latin American countries continue making strides to ensure health care access for all through universal health coverage, they must aim to effectively meet the challenge of these chronic illnesses across the entire care continuum.
We outline strategies to strengthen health systems through a diagonal approach using the example of how the Mexican health system has responded to the challenge of breast cancer to illustrate effective universal health coverage along the chronic disease continuum and across health systems functions. We also present innovative financing and delivery models, as well as educational interventions that build on overall efforts to strengthen primary care by linking to existing platforms related to reproductive and maternal and child health.
Citation Format: Knaul FM. Health System Responses to Women's Cancers in the Americas: Closing Divides to Achieve Universal Health Coverage [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr IS-1.
Collapse
|
18
|
Magaña-Valladares L, González-Robledo MC, Rosas-Magallanes C, Mejía-Arias MÁ, Arreola-Ornelas H, Knaul FM. Training Primary Health Professionals in Breast Cancer Prevention: Evidence and Experience from Mexico. J Cancer Educ 2018; 33:160-166. [PMID: 27357140 PMCID: PMC5762772 DOI: 10.1007/s13187-016-1065-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
To analyze the key successful factors of a national educational strategy for early breast cancer detection developed in Mexico for primary health care personnel from 2008 to 2014, an educational strategy to train physicians, nurses, health promoters, and medical students from local ministries of health with a competency-based approach was developed and implemented using diverse educational modalities, face-to-face, blended, and a massive open online course (MOOC). Formative and summative evaluations were used during the implementation of the course. A total of 19,563 health professionals were trained from 2008 to 2014. The graduation rate, an average of all educational modalities, was 91 %, much higher than those previously reported in the literature. The factors that might have influenced this success were (1) the training strategy, which was designed according to the characteristics and specific needs of the target groups; (2) the political will and commitment of the country's health authorities; (3) the technological and educational models used; and (4) the punctual follow-up of participants. This study shows that carefully designed educational interventions can improve service professionals' competencies and that regardless of the modality, face-to-face, blended learning, or MOOC, high graduation rates can be achieved. Further evaluation is required to demonstrate that the competencies remained in all target groups after 6 months of the intervention and that the women served by the trained personnel were provided accurate information and timely diagnoses of breast cancer.
Collapse
Affiliation(s)
- Laura Magaña-Valladares
- Secretaría Académica, Instituto Nacional de Salud Pública, México, Universidad 655, Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - María Cecilia González-Robledo
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, México, Avenida Universidad 655, Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico.
| | - Cynthia Rosas-Magallanes
- Secretaría Académica, Instituto Nacional de Salud Pública, México, Universidad 655, Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - Miguel Ángel Mejía-Arias
- Secretaría Académica, Instituto Nacional de Salud Pública, México, Universidad 655, Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - Héctor Arreola-Ornelas
- Competitividad y Universalidad en Salud, Fundación Mexicana para la Salud, A.C., Periférico Sur 4809, El Arenal Tepepan, Tlalpan, 14610, México, DF, Mexico
- Tómatelo a Pecho, A.C. Periférico Sur 4809, El Arenal Tepepan, Tlalpan, 14610, México, DF, Mexico
| | - Felicia M Knaul
- Competitividad y Universalidad en Salud, Fundación Mexicana para la Salud, A.C., Periférico Sur 4809, El Arenal Tepepan, Tlalpan, 14610, México, DF, Mexico
- Tómatelo a Pecho, A.C. Periférico Sur 4809, El Arenal Tepepan, Tlalpan, 14610, México, DF, Mexico
- Miller School of Medicine, University of Miami, 1601 NW 12th Ave, Miami, FL, 33136, USA
| |
Collapse
|
19
|
Rodriguez NM, Brant JM, Pendharkar D, Arreola-Ornelas H, Bhadelia A, de Lima Lopes G, Knaul FM. Thinking Differently in Global Health in Oncology Using a Diagonal Approach: Harnessing Similarities, Improving Education, and Empowering an Alternative Oncology Workforce. Am Soc Clin Oncol Educ Book 2017; 37:416-425. [PMID: 28561680 DOI: 10.1200/edbk_175246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Cancer is a leading global cause of death, and diverse and minority populations suffer worse outcomes compared with white people from Western societies. Within the United States, African Americans and other blacks, Hispanics, Asians, and American Indians have lower cancer survival rates than whites. In the rest of the world, those from low- and middle-income countries have the greatest disparities, but even those from non-Western high-income countries such as Oman and the United Arab Emirates are diagnosed with cancer at later stages and suffer increased mortality. Although considerable differences exist among these populations, similarities and synergies are also apparent. Challenges can be very similar in reaching these populations effectively for cancer control to improve outcomes, and innovative strategies are needed to effectively make change. In this review, the authors discuss new approaches to the prevention and early detection of cancer as well as the implementation of programs in global oncology and put in evidence cultural similarities and challenges of different populations, highlighting strategies to improve cancer survival and quality care around the world through innovations in training and education, empowerment of an alternative workforce, and a diagonal approach to cancer care using case studies drawn from the authors' work and experience.
Collapse
Affiliation(s)
- Natalia M Rodriguez
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
| | - Jeannine M Brant
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
| | - Dinesh Pendharkar
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
| | - Hector Arreola-Ornelas
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
| | - Afsan Bhadelia
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
| | - Gilberto de Lima Lopes
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
| | - Felicia M Knaul
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
| |
Collapse
|
20
|
Ong WL, Schouwenburg MG, van Bommel ACM, Stowell C, Allison KH, Benn KE, Browne JP, Cooter RD, Delaney GP, Duhoux FP, Ganz PA, Hancock P, Jagsi R, Knaul FM, Knip AM, Koppert LB, Kuerer HM, McLaughin S, Mureau MAM, Partridge AH, Reid DP, Sheeran L, Smith TJ, Stoutjesdijk MJ, Vrancken Peeters MJTFD, Wengström Y, Yip CH, Saunders C. A Standard Set of Value-Based Patient-Centered Outcomes for Breast Cancer: The International Consortium for Health Outcomes Measurement (ICHOM) Initiative. JAMA Oncol 2017; 3:677-685. [PMID: 28033439 DOI: 10.1001/jamaoncol.2016.4851] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A major challenge in value-based health care is the lack of standardized health outcomes measurements, hindering optimal monitoring and comparison of the quality of health care across different settings globally. The International Consortium for Health Outcomes Measurement (ICHOM) assembled a multidisciplinary international working group, comprised of 26 health care providers and patient advocates, to develop a standard set of value-based patient-centered outcomes for breast cancer (BC). The working group convened via 8 teleconferences and completed a follow-up survey after each meeting. A modified 2-round Delphi method was used to achieve consensus on the outcomes and case-mix variables to be included. Patient focus group meetings (8 early or metastatic BC patients) and online anonymized surveys of 1225 multinational BC patients and survivors were also conducted to obtain patients' input. The standard set encompasses survival and cancer control, and disutility of care (eg, acute treatment complications) outcomes, to be collected through administrative data and/or clinical records. A combination of multiple patient-reported outcomes measurement (PROM) tools is recommended to capture long-term degree of health outcomes. Selected case-mix factors were recommended to be collected at baseline. The ICHOM will endeavor to achieve wide buy-in of this set and facilitate its implementation in routine clinical practice in various settings and institutions worldwide.
Collapse
Affiliation(s)
- Wee Loon Ong
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia2Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne Australia
| | - Maartje G Schouwenburg
- International Consortium for health outcomes Measurement, Cambridge, Massachusetts4Dutch Institute for Clinical Auditing, Leiden, the Netherlands
| | - Annelotte C M van Bommel
- International Consortium for health outcomes Measurement, Cambridge, Massachusetts4Dutch Institute for Clinical Auditing, Leiden, the Netherlands
| | - Caleb Stowell
- International Consortium for health outcomes Measurement, Cambridge, Massachusetts
| | - Kim H Allison
- Department of Pathology, Stanford University, Stanford, California
| | - Karen E Benn
- EUROPA DONNA, The European Breast Cancer Coalition
| | - John P Browne
- Department of Epidemiology and Public Health, University of College Cork, Cork, Ireland
| | - Rodney D Cooter
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Geoff P Delaney
- Ingham Health and Medical Research Institute, South Western Sydney Local Health District, NSW, Australia9South Western Sydney Clinical School, University of New South Wales
| | - Francois P Duhoux
- King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Patricia A Ganz
- Department of Health Policy & Management, UCLA Fielding School of Public Health, California
| | | | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Michigan
| | - Felicia M Knaul
- Miami Institute for the Americas, University of Miami, Florida15Cáncer de Mama: Tómatelo a Pecho, Mexico City, Mexico
| | - Anne M Knip
- Dutch Breast Cancer Association (BVN), Utrecht, the Netherlands
| | - Linetta B Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - Henry M Kuerer
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Texas
| | | | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Massachusetts
| | | | - Lisa Sheeran
- Breast Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Thomas J Smith
- Department of Oncology and Palliative Medicine, Johns Hopkins Medical Institutions, Maryland
| | - Mark J Stoutjesdijk
- Department of Radiology, Ikazia Hospital, Rotterdam, the Netherlands26Breast Center ZuidHollandZuid, Rotterdam, the Netherlands
| | | | - Yvonne Wengström
- Division of Nursing, Karolinska Institutet, Department NVS, Stockholm, Sweden29Department of Oncology & Pathology, Radiumhemmet, Karolinska University Hospital, Stockholm, Sweden
| | - Cheng-Har Yip
- Department of Surgery, Subang Jaya Medical Centre, Malaysia
| | | |
Collapse
|
21
|
Álvarez-Águila N, Cook H, Prada D, Mota-García A, Herrera LA, Mohar-Betancourt A, Meneses-García A, Knaul FM. Radiotherapy for Metastatic Breast Cancer in Mexico: Results from the 2015 National Survey. Rev Invest Clin 2017; 69:11-19. [PMID: 28239177 DOI: 10.24875/ric.17002034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Radiation therapy is a keystone to improve survival and quality of life in breast cancer patients. In Mexico, however, scarce information is available on the obstacles faced by radio-oncologists to provide appropriate treatment. OBJECTIVE To determine the most frequent issues faced by physicians to provide radiation therapy for metastatic breast cancer in Mexico. METHODS A survey of 16 multiple-choice questions to be answered electronically by 167 radio-oncologists currently working in Mexico was designed and thereafter analyzed for differences between private and public practices, based on the responses from the surveyed participants. RESULTS 98.5% of surveyed responders attended patients with breast cancer. We observed a significant difference between private vs. public practice for the main difficulties in providing radiation therapy, with an increased frequency (85.8%) of "treatment cost by itself" in private practice vs. 50.7% in public practice (p < 0.05). Significant differences were observed in the "Time to initiate treatment" question, with "Less than one week" as the response in 86% of those physicians in private practice vs. 50% for those in public practice (p < 0.001). CONCLUSIONS Using a survey targeted at radio-oncologists, we analyzed the most important obstacles for accessing radiation therapy for metastatic breast cancer in Mexico. This information may be useful for healthcare decisions related to radiation therapy in women with breast cancer in Mexico.
Collapse
Affiliation(s)
- Nora Álvarez-Águila
- Department of Radiotherapy, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Hilary Cook
- Harvard Global Equity Initiative, Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Diddier Prada
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA.,Biomedical Research Unit in Cancer, Instituto Nacional de Cancerología and Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Aida Mota-García
- Department of Radiotherapy, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Luis A Herrera
- Biomedical Research Unit in Cancer, Instituto Nacional de Cancerología and Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Alejandro Mohar-Betancourt
- Biomedical Research Unit in Cancer, Instituto Nacional de Cancerología and Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Abelardo Meneses-García
- Biomedical Research Unit in Cancer, Instituto Nacional de Cancerología and Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Felicia M Knaul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Coral Gables, Florida, USA.,University of Miami Institute for Advanced Study of the Americas, Coral Gables, Florida, USA.,Programa Universalidad y Competitividad en Salud, Fundación Mexicana para la Salud, Mexico City, Mexico.,Asociación "Tómatelo a Pecho", Mexico City, Mexico
| |
Collapse
|
22
|
Rodin D, Grover S, Elmore SN, Knaul FM, Atun R, Caulley L, Herrera CA, Jones JA, Price AJ, Munshi A, Gandhi AK, Shah C, Gospodarowicz M. The power of integration: radiotherapy and global palliative care. Ann Palliat Med 2017; 5:209-17. [PMID: 27481320 DOI: 10.21037/apm.2016.06.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/10/2016] [Indexed: 11/06/2022]
Abstract
Radiotherapy (RT) is a powerful tool for the palliation of the symptoms of advanced cancer, although access to it is limited or absent in many low- and middle-income countries (LMICs). There are multiple factors contributing to this, including assumptions about the economic feasibility of RT in LMICs, the logical challenges of building capacity to deliver it in those regions, and the lack of political support to drive change of this kind. It is encouraging that the problem of RT access has begun to be included in the global discourse on cancer control and that palliative care and RT have been incorporated into national cancer control plans in some LMICs. Further, RT twinning programs involving high- and low-resource settings have been established to improve knowledge transfer and exchange. However, without large-scale action, the consequences of limited access to RT in LMICs will become dire. The number of new cancer cases around the world is expected to double by 2030, with twice as many deaths occurring in LMICs as in high-income countries (HICs). A sustained and coordinated effort involving research, education, and advocacy is required to engage global institutions, universities, health care providers, policymakers, and private industry in the urgent need to build RT capacity and delivery in LMICs.
Collapse
Affiliation(s)
- Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Felicia M Knaul
- Miami Institute for the Americas, University of Miami, Miami, FL, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard School of Public Health, Harvard University, Boston, MA, USA
| | - Lisa Caulley
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, Canada
| | - Cristian A Herrera
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Joshua A Jones
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Ajeet K Gandhi
- All India Institute of Medical Sciences, New Delhi, India
| | - Chiman Shah
- Cancer Care Kenya, M.P. Shah Hospital, Nairobi, Kenya
| | - Mary Gospodarowicz
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| |
Collapse
|
23
|
Jaffray DA, Knaul FM, Atun R, Adams C, Barton MB, Baumann M, Lievens Y, Lui TYM, Rodin DL, Rosenblatt E, Torode J, Van Dyk J, Vikram B, Gospodarowicz M. Global Task Force on Radiotherapy for Cancer Control. Lancet Oncol 2016; 16:1144-6. [PMID: 26419349 DOI: 10.1016/s1470-2045(15)00285-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 08/26/2015] [Indexed: 12/13/2022]
Affiliation(s)
- David A Jaffray
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Centre, 610 University Avenue, M5G 2M9, Toronto, ON, Canada; TECHNA Institute, University Health Network, Toronto, ON, Canada
| | - Felicia M Knaul
- Harvard Global Equity Initiative, Harvard University, Cambridge, MA, USA; Harvard Medical School, Harvard University, Cambridge, MA, USA
| | - Rifat Atun
- Harvard TH Chan School of Public Health, Harvard University, Cambridge, MA, USA
| | - Cary Adams
- Union for International Cancer Control, Geneva, Switzerland
| | - Michael B Barton
- Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, NSW, Australia
| | - Michael Baumann
- Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Yolande Lievens
- Ghent University Hospital, Ghent, Belgium; Ghent University, Ghent, Belgium
| | - Tracey Y M Lui
- TECHNA Institute, University Health Network, Toronto, ON, Canada
| | - Danielle L Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | | | - Julie Torode
- Union for International Cancer Control, Geneva, Switzerland
| | - Jacob Van Dyk
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Bhadrasain Vikram
- National Cancer Institute, US National Institutes of Health, Bethesda, MD, USA
| | - Mary Gospodarowicz
- Princess Margaret Cancer Centre, 610 University Avenue, M5G 2M9, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
24
|
Hannon B, Zimmermann C, Knaul FM, Powell RA, Mwangi-Powell FN, Rodin G. Provision of Palliative Care in Low- and Middle-Income Countries: Overcoming Obstacles for Effective Treatment Delivery. J Clin Oncol 2016; 34:62-8. [DOI: 10.1200/jco.2015.62.1615] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Despite being declared a basic human right, access to adult and pediatric palliative care for millions of individuals in need in low- and middle-income countries (LMICs) continues to be limited or absent. The requirement to make palliative care available to patients with cancer is increasingly urgent because global cancer case prevalence is anticipated to double over the next two decades. Fifty percent of these cancers are expected to occur in LMICs, where mortality figures are disproportionately greater as a result of late detection of disease and insufficient access to appropriate treatment options. Notable initiatives in many LMICs have greatly improved access to palliative care. These can serve as development models for service scale-up in these regions, based on rigorous evaluation in the context of specific health systems. However, a multipronged public health approach is needed to fulfill the humane and ethical obligation to make palliative care universally available. This includes health policy that supports the integration of palliative care and investment in systems of health care delivery; changes in legislation and regulation that inappropriately restrict access to opioid medications for individuals with life-limiting illnesses; education and training of health professionals; development of a methodologically rigorous data and research base specific to LMICs that encompasses health systems and clinical care; and shifts in societal and health professional attitudes to palliative and end-of-life care. International partnerships are valuable to achieve these goals, particularly in education and research, but leadership and health systems stewardship within LMICs are critical factors that will drive and implement change.
Collapse
Affiliation(s)
- Breffni Hannon
- Breffni Hannon, Camilla Zimmermann, and Gary Rodin, Princess Margaret Cancer Centre, University Health Network; and University of Toronto, Toronto, Ontario, Canada; Felicia M. Knaul, Harvard Global Equity Initiative and Harvard Medical School, Boston, MA; Richard A. Powell, Independent Global Health Researcher; Faith N. Mwangi-Powell, University Research Company, Nairobi, Kenya
| | - Camilla Zimmermann
- Breffni Hannon, Camilla Zimmermann, and Gary Rodin, Princess Margaret Cancer Centre, University Health Network; and University of Toronto, Toronto, Ontario, Canada; Felicia M. Knaul, Harvard Global Equity Initiative and Harvard Medical School, Boston, MA; Richard A. Powell, Independent Global Health Researcher; Faith N. Mwangi-Powell, University Research Company, Nairobi, Kenya
| | - Felicia M. Knaul
- Breffni Hannon, Camilla Zimmermann, and Gary Rodin, Princess Margaret Cancer Centre, University Health Network; and University of Toronto, Toronto, Ontario, Canada; Felicia M. Knaul, Harvard Global Equity Initiative and Harvard Medical School, Boston, MA; Richard A. Powell, Independent Global Health Researcher; Faith N. Mwangi-Powell, University Research Company, Nairobi, Kenya
| | - Richard A. Powell
- Breffni Hannon, Camilla Zimmermann, and Gary Rodin, Princess Margaret Cancer Centre, University Health Network; and University of Toronto, Toronto, Ontario, Canada; Felicia M. Knaul, Harvard Global Equity Initiative and Harvard Medical School, Boston, MA; Richard A. Powell, Independent Global Health Researcher; Faith N. Mwangi-Powell, University Research Company, Nairobi, Kenya
| | - Faith N. Mwangi-Powell
- Breffni Hannon, Camilla Zimmermann, and Gary Rodin, Princess Margaret Cancer Centre, University Health Network; and University of Toronto, Toronto, Ontario, Canada; Felicia M. Knaul, Harvard Global Equity Initiative and Harvard Medical School, Boston, MA; Richard A. Powell, Independent Global Health Researcher; Faith N. Mwangi-Powell, University Research Company, Nairobi, Kenya
| | - Gary Rodin
- Breffni Hannon, Camilla Zimmermann, and Gary Rodin, Princess Margaret Cancer Centre, University Health Network; and University of Toronto, Toronto, Ontario, Canada; Felicia M. Knaul, Harvard Global Equity Initiative and Harvard Medical School, Boston, MA; Richard A. Powell, Independent Global Health Researcher; Faith N. Mwangi-Powell, University Research Company, Nairobi, Kenya
| |
Collapse
|
25
|
Yerramilli P, Dugee O, Enkhtuya P, Knaul FM, Demaio AR. Exploring Knowledge, Attitudes, and Practices Related to Breast and Cervical Cancers in Mongolia: A National Population-Based Survey. Oncologist 2015; 20:1266-73. [PMID: 26417038 DOI: 10.1634/theoncologist.2015-0119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 08/21/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Mongolia bears the second-highest cancer burden in the world (5,214 disability-adjusted life years per 100,000 people, age standardized). To determine drivers of the growing burden of noncommunicable diseases, including breast and cervical cancers, a national knowledge, attitudes, and practices (KAP) survey was implemented in 2010. METHODS This paper analyzed the results of the 2010 KAP survey, which sampled 3,450 households nationally. Reflecting Mongolian screening policies, women aged 30 and older were included in analyses of questions regarding breast and cervical cancer (n = 1,193). Univariate and multivariate odds ratios (MORs) were derived through logistic regression to determine associations between demographic covariables (residence, age, education, employment) and survey responses. RESULTS This study found that 25.7% (95% confidence interval [CI]: 23.3-28.3) and 22.1% (95% CI: 19.8-24.5) of female participants aged 30 years or older self-rated their knowledge of breast and cervical cancers, respectively, as "none." Employment and education were associated with greater awareness of both cancers and participation in screening examinations (p < .05). Clinical breast examinations were more common among rural than urban participants (MOR: 1.492; 95% CI: 1.125-1.979). Of all female participants, 17% (95% CI: 15.3-18.5) knew that cervical cancer is vaccine preventable. CONCLUSION Our results suggest that cancer control in Mongolia should emphasize health education, particularly among lower-educated, rural, and unemployed women. The health infrastructure should be strengthened to reflect rural to urban migration. Finally, although there is awareness that early detection improves outcomes, a significant proportion of women do not engage in screening. These trends warrant further research on barriers and solutions. IMPLICATIONS FOR PRACTICE The rising burden of breast and cervical cancers, particularly in low- and middle-income countries, necessitates the development of effective strategies for cancer control. This paper examines barriers to health service use in Mongolia, a country with a high cancer burden. The 2010 national knowledge, attitude and practices survey data indicate that cancer control efforts should focus on improving health education among lower-educated, rural, and unemployed populations, who display the least knowledge of breast and cervical cancers. Moreover, the findings support the need to emphasize individual risk for disease in cancer education and ensure that the health-care infrastructure reflects Mongolia's urbanization.
Collapse
Affiliation(s)
- Pooja Yerramilli
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Otgonduya Dugee
- Public Health Institute, Ministry of Health of Mongolia, Ulaanbaatar, Mongolia
| | - Palam Enkhtuya
- Public Health Institute, Ministry of Health of Mongolia, Ulaanbaatar, Mongolia
| | - Felicia M Knaul
- Harvard Global Equity Initiative, Harvard Medical School, Boston, Massachusetts, USA
| | - Alessandro R Demaio
- Harvard Global Equity Initiative, Harvard Medical School, Boston, Massachusetts, USA School of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
26
|
Langer A, Meleis A, Knaul FM, Atun R, Aran M, Arreola-Ornelas H, Bhutta ZA, Binagwaho A, Bonita R, Caglia JM, Claeson M, Davies J, Donnay FA, Gausman JM, Glickman C, Kearns AD, Kendall T, Lozano R, Seboni N, Sen G, Sindhu S, Temin M, Frenk J. Women and Health: the key for sustainable development. Lancet 2015; 386:1165-210. [PMID: 26051370 DOI: 10.1016/s0140-6736(15)60497-4] [Citation(s) in RCA: 216] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ana Langer
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Afaf Meleis
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Felicia M Knaul
- Harvard Global Equity Initiative, Harvard Medical School, Boston, MA, USA
| | - Rifat Atun
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | | | - Ruth Bonita
- University of Auckland, Auckland, New Zealand
| | - Jacquelyn M Caglia
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | | | | | - Jewel M Gausman
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | - Annie D Kearns
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Tamil Kendall
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rafael Lozano
- National Institute of Public Health, Cuernavaca, Mexico
| | - Naomi Seboni
- International Planned Parenthood Federation Governing Council, London, UK
| | - Gita Sen
- Indian Institute of Management, Bangalore, India
| | | | - Miriam Temin
- Center for Global Development, Washington, DC, USA
| | - Julio Frenk
- Harvard T H Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
27
|
Krishnan S, Dhillon PK, Bhadelia A, Schurmann A, Basu P, Bhatla N, Birur P, Colaco R, Dey S, Grover S, Gupta H, Gupta R, Gupta V, Lewis MA, Mehrotra R, McMikel A, Mukherji A, Naik N, Nyblade L, Pati S, Pillai MR, Rajaraman P, Ramesh C, Rath GK, Reithinger R, Sankaranarayanan R, Selvam J, Shanmugam MS, Shridhar K, Siddiqi M, Squiers L, Subramanian S, Travasso SM, Verma Y, Vijayakumar M, Weiner BJ, Reddy KS, Knaul FM. Report from a symposium on catalyzing primary and secondary prevention of cancer in India. Cancer Causes Control 2015; 26:1671-84. [PMID: 26335262 PMCID: PMC4596898 DOI: 10.1007/s10552-015-0637-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/16/2015] [Indexed: 12/25/2022]
Abstract
Purpose Oral, breast, and cervical cancers are amenable to early detection and account for a third of India’s cancer burden. We convened a symposium of diverse stakeholders to identify gaps in evidence, policy, and advocacy for the primary and secondary prevention of these cancers and recommendations to accelerate these efforts.
Methods Indian and global experts from government, academia, private sector (health care, media), donor organizations, and civil society (including cancer survivors and patient advocates) presented and discussed challenges and solutions related to strategic communication and implementation of prevention, early detection, and treatment linkages. Results Innovative approaches to implementing and scaling up primary and secondary prevention were discussed using examples from India and elsewhere in the world. Participants also reflected on existing global guidelines and national cancer prevention policies and experiences. Conclusions Symposium participants proposed implementation-focused research, advocacy, and policy/program priorities to strengthen primary and secondary prevention efforts in India to address the burden of oral, breast, and cervical cancers and improve survival.
Collapse
Affiliation(s)
- Suneeta Krishnan
- Research Triangle Institute Global India Pvt. Ltd, Suite 405, Paharpur Business Center, 21 Nehru Place, New Delhi, 110019, India.
| | - Preet K Dhillon
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Sector 44, Gurgaon, 122002, India.
| | - Afsan Bhadelia
- Harvard Global Equity Initiative, Harvard University, 651 Huntington Avenue, Room 632, Boston, MA, 02115, USA
| | - Anna Schurmann
- Independent Public Health Consultant, 2C Alsa Terraces, 26 Langford Gardens, Bangalore, 560025, India
| | - Partha Basu
- Chittaranjan National Cancer Institute, 37, S. P. Mukherjee Road, Kolkata, 700026, India
| | - Neerja Bhatla
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Praveen Birur
- Biocon Foundation, 20th KM Hosur Road, Electronic City, Bangalore, 560100, India
| | - Rajeev Colaco
- RTI International, 701 13th St NW #750, Washington, DC, 20005, USA
| | - Subhojit Dey
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, 122002, India
| | - Surbhi Grover
- University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Harmala Gupta
- CanSupport, KanakDurgaBastiVikasKendra, Sector 12 R. K. Puram, Near New CGHS Dispensary, New Delhi, 110022, India
| | - Rakesh Gupta
- Rajasthan Cancer Foundation, B-113, 10 B Scheme, Gopalpura Bypass, Jaipur, 302018, India
| | - Vandana Gupta
- V Care Foundation, A102, Om Residency, J W Road, Near Tata Memorial Hospital, Parel (East), Mumbai, 400012, India
| | - Megan A Lewis
- RTI International, 3040 Cornwallis Rd., PO Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Ravi Mehrotra
- Institute of Cytology and Preventive Oncology (ICMR), I-7, Sector-39, Noida, 201301, India
| | - Ann McMikel
- American Cancer Society, Inc., 250 Williams Street NW, Atlanta, GA, 30303, USA
| | - Arnab Mukherji
- Center for Public Policy, IIM Bangalore, Bannerghatta Road, Bangalore, 560076, India
| | - Navami Naik
- American Cancer Society, Inc., 250 Williams Street NW, Atlanta, GA, 30303, USA
| | - Laura Nyblade
- RTI International, 701 13th St NW #750, Washington, DC, 20005, USA
| | - Sanghamitra Pati
- Indian Institute of Public Health Bhubaneswar, Public Health Foundation of India, Infocity Road, Patia, Bhubaneswar, 751024, India
| | - M Radhakrishna Pillai
- Rajiv Gandhi Centre for Biotechnology (Government of India, Ministry for Science and Technology), Millennium Avenue, Jagathy, Thiruvananthapuram, 695014, India
| | - Preetha Rajaraman
- Center for Global Health, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20892-9760, USA
| | | | - G K Rath
- All India Institute of Medical Science, Gautam Nagar, Ansari Nagar East, New Delhi, 110029, India
| | | | - Rengaswamy Sankaranarayanan
- International Agency for Research on Cancer (WHO-IARC), 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France
| | - Jerard Selvam
- Tamil Nadu Health Systems Project, 3rd Floor, DMS Annex New Building 259 Anna Salai, Teynampet, Chennai, 600006, India
| | - M S Shanmugam
- Tamil Nadu Health Systems Project, 3rd Floor, DMS Annex New Building 259 Anna Salai, Teynampet, Chennai, 600006, India
| | - Krithiga Shridhar
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Sector 44, Gurgaon, 122002, India
| | - Maqsood Siddiqi
- Cancer Foundation of India, 47/2D, Selimpur Road, Kolkata, 700031, India
| | - Linda Squiers
- RTI International, 701 13th St NW #750, Washington, DC, 20005, USA
| | - Sujha Subramanian
- RTI International, 1440 Main Street, Suite 310, Waltham, MA, 02451-1623, USA
| | - Sandra M Travasso
- St. Johns Research Institute, 100 Feet Road, Koramangala, Bangalore, 560034, India
| | - Yogesh Verma
- S.T.N.M Hospital, NH 31A, Gangtok, Sikkim, 737101, India
| | - M Vijayakumar
- Kidwai Memorial Institute of Oncology, Dr. M.H Marigowda Road, Bangalore, 560029, India
| | - Bryan J Weiner
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7411, USA
| | - K Srinath Reddy
- Public Health Foundation of India, Delhi NCR, Plot No. 47, Sector 44, Gurgaon, Haryana, 122 003, India
| | - Felicia M Knaul
- Harvard Global Equity Initiative, Harvard University, 651 Huntington Avenue, Room 632, Boston, MA, 02115, USA
| |
Collapse
|
28
|
Atun R, Jaffray DA, Barton MB, Bray F, Baumann M, Vikram B, Hanna TP, Knaul FM, Lievens Y, Lui TYM, Milosevic M, O'Sullivan B, Rodin DL, Rosenblatt E, Van Dyk J, Yap ML, Zubizarreta E, Gospodarowicz M. Expanding global access to radiotherapy. Lancet Oncol 2015; 16:1153-86. [PMID: 26419354 DOI: 10.1016/s1470-2045(15)00222-3] [Citation(s) in RCA: 620] [Impact Index Per Article: 68.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/01/2015] [Accepted: 08/03/2015] [Indexed: 12/31/2022]
Abstract
Radiotherapy is a critical and inseparable component of comprehensive cancer treatment and care. For many of the most common cancers in low-income and middle-income countries, radiotherapy is essential for effective treatment. In high-income countries, radiotherapy is used in more than half of all cases of cancer to cure localised disease, palliate symptoms, and control disease in incurable cancers. Yet, in planning and building treatment capacity for cancer, radiotherapy is frequently the last resource to be considered. Consequently, worldwide access to radiotherapy is unacceptably low. We present a new body of evidence that quantifies the worldwide coverage of radiotherapy services by country. We show the shortfall in access to radiotherapy by country and globally for 2015-35 based on current and projected need, and show substantial health and economic benefits to investing in radiotherapy. The cost of scaling up radiotherapy in the nominal model in 2015-35 is US$26·6 billion in low-income countries, $62·6 billion in lower-middle-income countries, and $94·8 billion in upper-middle-income countries, which amounts to $184·0 billion across all low-income and middle-income countries. In the efficiency model the costs were lower: $14·1 billion in low-income, $33·3 billion in lower-middle-income, and $49·4 billion in upper-middle-income countries-a total of $96·8 billion. Scale-up of radiotherapy capacity in 2015-35 from current levels could lead to saving of 26·9 million life-years in low-income and middle-income countries over the lifetime of the patients who received treatment. The economic benefits of investment in radiotherapy are very substantial. Using the nominal cost model could produce a net benefit of $278·1 billion in 2015-35 ($265·2 million in low-income countries, $38·5 billion in lower-middle-income countries, and $239·3 billion in upper-middle-income countries). Investment in the efficiency model would produce in the same period an even greater total benefit of $365·4 billion ($12·8 billion in low-income countries, $67·7 billion in lower-middle-income countries, and $284·7 billion in upper-middle-income countries). The returns, by the human-capital approach, are projected to be less with the nominal cost model, amounting to $16·9 billion in 2015-35 (-$14·9 billion in low-income countries; -$18·7 billion in lower-middle-income countries, and $50·5 billion in upper-middle-income countries). The returns with the efficiency model were projected to be greater, however, amounting to $104·2 billion (-$2·4 billion in low-income countries, $10·7 billion in lower-middle-income countries, and $95·9 billion in upper-middle-income countries). Our results provide compelling evidence that investment in radiotherapy not only enables treatment of large numbers of cancer cases to save lives, but also brings positive economic benefits.
Collapse
Affiliation(s)
- Rifat Atun
- Harvard TH Chan School of Public Health, Harvard University, Cambridge, MA, USA.
| | - David A Jaffray
- Princess Margaret Cancer Centre, Toronto, ON, Canada; TECHNA Institute, University Health Network, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Michael B Barton
- Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, NSW, Australia
| | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Michael Baumann
- Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Bhadrasain Vikram
- National Cancer Institute, US National Institutes of Health, Bethesda, MD, USA
| | - Timothy P Hanna
- Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, NSW, Australia; Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Felicia M Knaul
- Harvard Global Equity Initiative, Harvard University, Cambridge, MA, USA; Harvard Medical School, Harvard University, Cambridge, MA, USA
| | - Yolande Lievens
- Ghent University Hospital, Ghent, Belgium; Ghent University, Ghent, Belgium
| | - Tracey Y M Lui
- TECHNA Institute, University Health Network, Toronto, ON, Canada
| | | | - Brian O'Sullivan
- Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Danielle L Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | | | - Jacob Van Dyk
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Mei Ling Yap
- Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, NSW, Australia
| | | | - Mary Gospodarowicz
- Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
29
|
Knaul FM, Farmer PE, Bhadelia A, Berman P, Horton R. Closing the divide: the Harvard Global Equity Initiative-Lancet Commission on global access to pain control and palliative care. Lancet 2015; 386:722-4. [PMID: 25762055 DOI: 10.1016/s0140-6736(15)60289-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
30
|
Atun R, de Andrade LOM, Almeida G, Cotlear D, Dmytraczenko T, Frenz P, Garcia P, Gómez-Dantés O, Knaul FM, Muntaner C, de Paula JB, Rígoli F, Serrate PCF, Wagstaff A. Health-system reform and universal health coverage in Latin America. Lancet 2015; 385:1230-47. [PMID: 25458725 DOI: 10.1016/s0140-6736(14)61646-9] [Citation(s) in RCA: 334] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Starting in the late 1980s, many Latin American countries began social sector reforms to alleviate poverty, reduce socioeconomic inequalities, improve health outcomes, and provide financial risk protection. In particular, starting in the 1990s, reforms aimed at strengthening health systems to reduce inequalities in health access and outcomes focused on expansion of universal health coverage, especially for poor citizens. In Latin America, health-system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities. In most of the countries studied, government financing enabled the introduction of supply-side interventions to expand insurance coverage for uninsured citizens--with defined and enlarged benefits packages--and to scale up delivery of health services. Countries such as Brazil and Cuba introduced tax-financed universal health systems. These changes were combined with demand-side interventions aimed at alleviating poverty (targeting many social determinants of health) and improving access of the most disadvantaged populations. Hence, the distinguishing features of health-system strengthening for universal health coverage and lessons from the Latin American experience are relevant for countries advancing universal health coverage.
Collapse
Affiliation(s)
- Rifat Atun
- Harvard School of Public Health, Harvard University, Boston, MA, USA.
| | | | | | | | | | - Patricia Frenz
- School of Public Health, University of Chile, Santiago, Chile
| | - Patrícia Garcia
- School of Public Health and Administration (FASPA), Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Felicia M Knaul
- Harvard Global Equity Initiative, Harvard University, Boston, MA, USA
| | - Carles Muntaner
- Institute for Global Health Equity and Innovation, Dalla Lana School of Public Health, University of Toronto, ON, Canada
| | | | - Felix Rígoli
- Pan American Health Organization, Brasília, Brazil
| | | | | |
Collapse
|
31
|
Knaul FM, Bhadelia A, Ornelas HA, de Lima L, del Rocio Sáenz Madrigal M. Closing the pain divide: the quest for effective universal health coverage. The Lancet Global Health 2015. [DOI: 10.1016/s2214-109x(15)70154-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
32
|
Abstract
Noncommunicable diseases (NCDs) have become the major contributors to death and disability worldwide. Nearly 80% of the deaths in 2010 occurred in low- and middle-income countries, which have experienced rapid population aging, urbanization, rise in smoking, and changes in diet and activity. Yet the health systems of low- and middle-income countries, historically oriented to infectious disease and often severely underfunded, are poorly prepared for the challenge of caring for people with cardiovascular disease, diabetes, cancer, and chronic respiratory disease. We have discussed how primary care can be redesigned to tackle the challenge of NCDs in resource-constrained countries. We suggest that four changes will be required: integration of services, innovative service delivery, a focus on patients and communities, and adoption of new technologies for communication.
Collapse
Affiliation(s)
- Margaret E Kruk
- At the time of the study, Margaret E. Kruk was with the Department of Health Policy and Management and Better Health Systems Initiative, Mailman School of Public Health, Columbia University, New York, NY. At the time of the study, Gustavo Nigenda was with the Harvard Global Equity Initiative, Harvard University, Boston, MA. Felicia Marie Knaul is with the Department of Global Health and Social Medicine, Harvard Medical School, Boston, and the Harvard Global Equity Initiative, Boston
| | | | | |
Collapse
|
33
|
|
34
|
Denburg AE, Knaul FM, Atun R, Frazier LA, Barr RD. Beyond the bench and the bedside: economic and health systems dimensions of global childhood cancer outcomes. Pediatr Blood Cancer 2014; 61:572-6. [PMID: 24249518 DOI: 10.1002/pbc.24858] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 10/18/2013] [Indexed: 11/11/2022]
Abstract
Globally, the number of new cases of childhood cancer continues to rise, with a widening gulf in outcomes across countries, despite the availability of effective cure options for many pediatric cancers. Economic forces and health system realities are deeply embedded in the foundation of disparities in global childhood cancer outcomes. A truly global effort to close the childhood cancer divide therefore requires systemic solutions. Analysis of the economic and health system dimensions of childhood cancer outcomes is essential to progress in childhood cancer survival around the globe. The conceptual power of this approach is significant. It provides insight into how and where pediatric oncology entwines with broader political and economic conditions, and highlights the mutual benefit derived from systems-oriented solutions.
Collapse
Affiliation(s)
- Avram E Denburg
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; Dana-Farber Children's Cancer Center, Boston, Massachusetts; Harvard Global Equity Initiative, Harvard University, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | | | | |
Collapse
|
35
|
|
36
|
Knaul FM, Bhadelia A, Gralow J, Arreola-Ornelas H, Langer A, Frenk J. Meeting the emerging challenge of breast and cervical cancer in low- and middle-income countries. Int J Gynaecol Obstet 2012; 119 Suppl 1:S85-8. [DOI: 10.1016/j.ijgo.2012.03.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
37
|
|
38
|
Abstract
This article discusses the nature of the health challenges created by globalization and proposes new forms of international cooperation to confront them. The discussion of global health challenges includes both the transfer of health risks, with an emphasis on infectious diseases, and the international dissemination of health opportunities, including the transfer of knowledge and technology. The authors argue that the health-related challenges and opportunities of an increasingly interdependent world demand new forms of international cooperation. The authors suggest the promotion of 3 elements that, in their essence, contain the idea of collaboration: exchange, evidence, and empathy.
Collapse
Affiliation(s)
- Julio Frenk
- Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Octavio Gómez-Dantés
- Center for Health Systems Research, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, México
| | - Felicia M. Knaul
- Department of Global Health and Social Medicine, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| |
Collapse
|
39
|
Gómez Dantés O, Sesma S, Becerril VM, Knaul FM, Arreola H, Frenk J. [The health system of Mexico]. Salud Publica Mex 2011; 53 Suppl 2:s220-s232. [PMID: 21877087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
This paper describes the Mexican health system. In part one, the health conditions of the Mexican population are discussed, with emphasis in those emerging diseases that are now the main causes of death, both in men and women: diabetes, ischaemic heart disease, cerebrovascular diseases and cancer. Part two is devoted to the description of the basic structure of the system: its main institutions, the population coverage, the health benefits of those affiliated to the different heath institutions, its financial sources, the levels of financial protection in health, the availability of physical, material and human resources for health, and the stewardship functions displayed by the Ministry of Health and other actors. This part also discusses the role of citizens in the monitorization and evaluation of the health system, as well as the levels of satisfaction with the rendered health services. In part three the most recent innovations and its impact on the performance of the health system are discussed. Salient among them are the System of Social Protection in Health and the Popular Health Insurance. The paper concludes with a brief analysis of the short- and middle-term challenges faced by the Mexican health system.
Collapse
Affiliation(s)
- Octavio Gómez Dantés
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Morelos. México.
| | | | | | | | | | | |
Collapse
|
40
|
Farmer P, Frenk J, Knaul FM, Shulman LN, Alleyne G, Armstrong L, Atun R, Blayney D, Chen L, Feachem R, Gospodarowicz M, Gralow J, Gupta S, Langer A, Lob-Levyt J, Neal C, Mbewu A, Mired D, Piot P, Reddy KS, Sachs JD, Sarhan M, Seffrin JR. Expansion of cancer care and control in countries of low and middle income: a call to action. Lancet 2010; 376:1186-93. [PMID: 20709386 DOI: 10.1016/s0140-6736(10)61152-x] [Citation(s) in RCA: 487] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Substantial inequalities exist in cancer survival rates across countries. In addition to prevention of new cancers by reduction of risk factors, strategies are needed to close the gap between developed and developing countries in cancer survival and the effects of the disease on human suffering. We challenge the public health community's assumption that cancers will remain untreated in poor countries, and note the analogy to similarly unfounded arguments from more than a decade ago against provision of HIV treatment. In resource-constrained countries without specialised services, experience has shown that much can be done to prevent and treat cancer by deployment of primary and secondary caregivers, use of off-patent drugs, and application of regional and global mechanisms for financing and procurement. Furthermore, several middle-income countries have included cancer treatment in national health insurance coverage with a focus on people living in poverty. These strategies can reduce costs, increase access to health services, and strengthen health systems to meet the challenge of cancer and other diseases. In 2009, we formed the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, which is composed of leaders from the global health and cancer care communities, and is dedicated to proposal, implementation, and evaluation of strategies to advance this agenda.
Collapse
|
41
|
Abstract
OBJECTIVES This study examined the extreme medical unemployment and underemployment in the urban areas of Mexico. The conceptual and methodological approach may be relevant to many countries that have experienced substantial increases in the supply of physicians during the last decades. METHODS On the basis of 2 surveys carried out in 1986 and 1993, the study analyzed the performance of physicians in the labor market as a function of ascription variables (social origin and gender), achievement variables (quality of medical education and specialty studies), and contextual variables (educational generation). RESULTS The study reveals, despite some improvement, persistently high levels of open unemployment, qualitative underemployment (i.e., work in activities completely outside of medicine), and quantitative underemployment (i.e., work in medical activities but with very low levels of productivity and remuneration). The growing proportion of female doctors presents new challenges, because they are more likely than men to be unemployed and underemployed. CONCLUSIONS While corrective policies can have a positive impact, it is clear that decisions regarding physician supply must be carefully considered, because they have long-lasting effects. An area deserving special attention is the improvement of professional opportunities for female doctors.
Collapse
Affiliation(s)
- J Frenk
- Center for Health and the Economy, Mexican Health Foundation, Mexico City, Mexico.
| | | | | | | |
Collapse
|