Monday, August 23, 2010

[EQ] Expansion of cancer care and control in countries of low and middle income: a call to action

Expansion of cancer care and control in countries of low and middle income: a call to action

Paul Farmer a, Julio Frenk b, Felicia M Knaul c , Lawrence N Shulman d, George Alleyne e, Lance Armstrong f, Rifat Atun g, Douglas Blayney h, Lincoln Chen  i,  Richard Feachem j, Mary Gospodarowicz k, Julie Gralow l, Sanjay Gupta m, Ana Langer  b, Julian Lob-Levyt n, Claire Neal  f, Anthony Mbewu o, Dina Mired p, Peter Piot q, K Srinath Reddy r, Jeffrey D Sachs s, Mahmoud Sarhan t, John R Seffrin u

a Harvard Medical School, Boston, MA, USA - b Harvard School of Public Health, Boston, MA, USA
c Harvard Global Equity Initiative, Boston, MA, USA  - d Dana-Farber Cancer Institute, Boston, MA, USA
e Pan American Health Organization, PAHO/WHO Washington, DC, USA -f Lance Armstrong Foundation, Austin, TX, USA
g Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva,Switzerland - h American Society of Clinical Oncology, Alexandria, VA, USA
i China Medical Board, Cambridge, MA, USA - j Global Health Group, University of California, San Francisco and Berkeley, CA, USA
k Princess Margaret Hospital, Toronto, ON, Canada  - l Seattle Cancer Care Alliance, Seattle, WA, USA
m CNN, Atlanta, GA, USA - n Global Alliance for Vaccine and Immunization, Geneva, Switzerland
o Global Forum for Health Research, Geneva, Switzerland - p King Hussein Cancer Foundation, Amman, Jordan
q Institute for Global Health, Imperial College London, London, UK - r Public Health Foundation of India, New Delhi, India
s Earth Institute, Columbia University, New York, NY, USA - t King Hussein Cancer Center, Amman, Jordan - u American Cancer Society, Atlanta, GA, USA

 


The Lancet - 16 August 2010 - doi:10.1016/S0140-6736(10)61152-X

 

Summary at: http://bit.ly/bSqR9D


“……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….”

Supplementary webappendix
Supplement to: Farmer P, Frenk J, Knaul FM, et al. Expansion of cancer care and control in countries of low and middle income: a call to action.
Lancet 2010; published online Aug 16. DOI:10.1016/S0140-6736(10)61152-X.

http://download.thelancet.com/mmcs/journals/lancet/PIIS014067361061152X/mmc1.pdf?id=5bbe37e152166496:1d1f5329:12a9fedd17b:-a91282588302758

 


The global burden of cancer—challenges and opportunities.


Beaulieu Nancy, Bloom David, Bloom Lakshmi Reddy, Stein Richard
A report from the Economist Intelligence Unit,  August 2009
.


Available online PDF [73p.] at http://bit.ly/b7qbrA


“………Cancer. The word is ripe with meaning. The mystery and stigma associated with the disease is so great that in some societies and cultures the word is rarely used and the illness never discussed. There is tragic irony in that. Cancer is widespread. It is the second-leading cause of death and disability in the world, behind only heart disease. Based on the most complete and current data available, cancer accounts for one out of every eight deaths annually (Mathers and Loncar. 2006). More people die from cancer every year around the world than AIDS, tuberculosis and malaria combined.

 

Cancer deaths occur with nearly six times the frequency of traffic fatalities on an annual basis, and 42 times the frequency of deaths from injuries suffered in war. While at one time the disease was widely thought to afflict only the elderly in affluent countries—where it was seen as a death sentence—cancer has now moved beyond high income countries of the developed world. In the low and middle income countries of the developing world the consequences of the growing burden of new cancer cases and deaths is expected to continue to worsen ……..”

Content:
Preface

Introduction

Time to act

What this report does

A tool for policymakers

Key facts and fi ndings

Next steps 1

What is cancer?

The health and economic burden of cancer

Cancer incidence, 2009-20

Today–2009

Tomorrow–2020

Case fatality rates, 2002: Who lives? Who dies?

The costs of cancer, 2009

Identifying the cancer funding gap: The best practice treatment and care frontier

Why cancer outcomes vary worldwide

Conclusions

Appendix A: Country data: new cancer cases and costs

Appendix B: Cancer epidemiology: Background and useful definitions

Appendix C: An overview of the spectrum of cancer control

Appendix D: Data sources

Appendix E: Methodology

Appendix F: Notes

Appendix G: Multiple regression analyses

Appendix H: References http://livestrongblog.org/GlobalEconomicImpact.pdf


 
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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
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[EQ] Renewing Primary Care: Lessons Learned From The Spanish Health Care System

Renewing Primary Care:
Lessons Learned From The Spanish Health Care System

Jeffrey Borkan1,*, Charles B. Eaton2, David Novillo-Ortiz3, Pablo Rivero Corte4 and Alejandro R. Jadad5

1 Jeffrey Borkan, chair of the Department of Family Medicine at the Alpert Medical School, Brown University, in Providence, Rhode Island.
2 Charles B. Eaton, director of the Center for Primary Care and Prevention at the Alpert Medical School and director of the Heart Disease
  Prevention Center at Memorial Hospital of Rhode Island, Brown University.
3 David Novillo-Ortiz, adviser for e-health at the Pan-American Health Organization PAHO/WHO, in Washington, D.C.,
  and a lecturer in the Department of Library Science and Documentation, Carlos III University, in Madrid, Spain.
4 Pablo Rivero Corte, Director General of Quality, Ministry of Health and Social Policy (Spain), in Madrid.
5 Alejandro R. Jadad, chief innovator and founder of the Centre for Global eHealth Innovation and holds the Canada Research Chair in
  eHealth Innovation and the Rose Family Chair in Supportive Care. Professor in the Departments of Health Policy, Management, and Evaluation
  and of Anesthesia, and in the Dalla Lana School of Public Health, University Health Network and University of Toronto, in Ontario, Canada.


August 2010 29:8 Health Affairs - doi: 10.1377/hlthaff.2010.0023 HEALTH AFFAIRS 29, NO. 8 (2010): 1432–1441
©2010 Project HOPE— The People-to-People Health Foundation, Inc

Abstract: http://bit.ly/9kILlO  [Subscription required]

"….From 1978 on, Spain rapidly expanded and strengthened its primary health care system, offering a lesson in how to improve health outcomes in a cost-effective manner.
The nation moved to a tax-based system of universal access for the entire population and, at the local level, instituted primary care teams coordinating prevention, health promotion, treatment, and community care. Gains included increases in life expectancy and reductions in infant mortality, with outcomes superior to those in the United States. In 2007 Spain spent $2,671 per person, or 8.5 percent of its gross domestic product on health care, versus 16 percent in the United States.

Despite concerns familiar to Americans—about future shortages of primary care physicians and relatively low status and pay for these physicians—the principles underlying the Spanish reforms offer lessons for the United States. ……"

"….The Spanish experience has shown that it is possible to transform primary care, as part of an overall health care transformation conducted in a short time frame with modest investments, and still achieve impressive improvement in the health of the population….".



 
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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

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and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
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[EQ] The Story of DETERMINE. Mobilizing Action for Health Equity in the EU

The Story of DETERMINE. Mobilizing Action for Health Equity in the EU

 

This final report of DETERMINE (2007 – 2010) by Ingrid Stegeman, Caroline Costongs and Clive Needle
EuroHealthNet on behalf of the DETERMINE Consortium April 2010


Available online PDF [36p.] at: http://bit.ly/9W0Jbt


The European Union’s aim, set out in the EU Treaty of 2009 (Title 1 Article 3) is to “promote peace, its values and the well-being of its people”. Concepts of ‘health’ and ‘well-being’ are closely correlated, including in the founding WHO Charter. The existence of health inequities means that the EU is not effective in achieving its aim to protect the well-being of a large proportion of its citizens.


European societies value the concept of ‘equal opportunity’. The fact that the socio-economic status that we are born into is a strong determinant of our health, which is important to our ability to take up other chances, belies the notion that we all have equal opportunities.


Health inequities signal a loss of human potential. Investing in the reduction of health inequities would unlock the productive and creative potentials of a wide number of people that are currently suffering from illness, mental health problems, or dying prematurely.



Content:

Our main messages and introduction


Part I: Contributing to understanding the problem

A. What policies, programmes, tools and mechanisms are currently being applied across Europe?

B. Other policy-sectors’ awareness of health inequities, and the current nature of collaboration between health and other policy sectors.

C. The economic costs of health inequities

D. ‘Innovative’ approaches to improving the health of vulnerable populations.

Part II: Highlighting potential solutions

A. Awareness raising and advocacy

B. Leadership from the health sector

C. Achieving mandates for cross-sectoral work

D. Participatory approaches

Part III: Stimulating action and greater engagement

A. Bringing partners together

B. Strengthening local level action

C. Skill development and training

D. Further plans to increase capacity

Conclusions

• Annex – key messages in full

• List of DETERMINE consortium partners

• References

 


 
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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
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Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

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[EQ] Globalization, medical tourism and health equity

Globalization, medical tourism and health equity


Abdullahel Hadi

This paper is prepared to present at the Symposium on Implications of Medical Tourism
for Canadian Health and Health Policy on November 13, 2009 in Ottawa, Canada.

Available online PDF [29p.] at: http://bit.ly/94VS5g


“………..Medical tourism has never been new in history. What is new is the recognition of its emergence:
i) as a global medical business potentially challenging the dominance of health care markets in the developed world, and
ii) as a threat, pushing health disparities even further in developing countries.

 

Based on a review of available literature, this paper discusses the origin and growth of medical tourism as a new global business, identifies the key enabling factors of growth, and assesses its impact on health care, generally, and equity in health care, specifically.

This paper begins by looking at the recent trend of the flow of patients seeking medical care abroad and the amount of money invested in host countries. An outline of a conceptual framework is constructed to show how globalization, market economy and technological innovations have changed global health markets to create a space for the expansion of medical tourism.

 

This paper illustrates how increasing health care costs and long waiting periods in the developed world, low wage and competitive health markets in the developing world, availability of low cost transportation, and access to advanced information technologies have created opportunity to expand medical tourism in many developing countries. Medical tourism is argued to have contributed to expanding health sectors, generating additional revenues and improving quality of and access to health services in provider countries. On the other hand, it may have become a threat to these same health systems by accelerating an internal brain-drain from public to private hospitals and promoting health disparities in destination countries.

 

This paper concludes that medical tourism as an alternative approach to health care is neither positive nor negative in itself, but a historical process in continuous evolution in health care systems. Finally, the paper proposes to develop an agenda for medical tourism governance to routinely monitor its growth and establish a regulatory framework for in order to translate its benefits for all…..”


 
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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

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and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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