Enhancing Private Sector Engagement to Expand Access to Cancer Care and Control in Low and Middle Income Countries

September 5th, 2012 Harvard Faculty Club, Cambridge, MA

Felicia Marie Knaul, PhD Harvard Global Equity Initiative; Global Task Force on Expanded Access to Cancer Care Mexican Health Foundation, Competitividad y Salud Tmatelo a Pecho UICC Board Member 2012-14

GTF.CCC
Members

= global health + cancer care

Multi-stakeholder partnership:
government, academia, media, civil society, private sector, int agencies, health care providers, patients

History
2009: convened by Harvard Global Equity Initiative (Secretariat), Harvard Medical School, Harvard School of Public Health, and Dana Farber Cancer Institute 2011: dual Secretariat established at Harvard Global Equity Initiative and Fred Hutchinson Cancer Research Center/University of Washington, School of Medicine

Members and Committees

Task Force: 36 leaders from global health and

cancer communities
Secretariat: Harvard Global Equity Initiative and the Fred Hutchinson Cancer Research Center Committees and Initiatives Technical Advisory Committee Private Sector Engagement Initiative Strategic Advisory Committee Working Groups: childhood cancer, womens cancer, pain and palliation, infection-associated cancer

Leadership
HONORARY CO-PRESIDENTS

Her Royal Highness Princess Dina Mired

Director-General, King Hussein Cancer Foundation, Program, Hashemite Kingdom of Jordan

Lance Armstrong
Founder, LIVESTRONG Lance Armstrong Foundation

CO-

CHAIRPERSONS

Julio Frenk, MD, MPH, PhD

Dean of the Faculty, Harvard School of Public Health Former Minister of Health, Mexico

Lawrence Corey, MD
President and Director, Fred Hutchinson Cancer Research Center

SECRETARIAT CO- DIRECTORS

Julie R. Gralow, MD Felicia Marie Knaul, PhD

Director, Harvard Global Equity Initiative Founder, Tmatelo a Pecho Director, Breast Medical Oncology, Seattle Cancer Care Alliance Jill Bennett Professor of Breast Cancer, U Washington School of Medicine

GTF.CCC: Mandate
to design, promote and evaluate global, regional and local multistakeholder strategies to improve the financing, procurement and delivery of cancer prevention, detection, treatment and palliation applying innovative service delivery models appropriate to low and middle income countries. Working with local partners, the GTF.CCC participates in innovative service delivery models to scale up access to cancer care and control, and to strengthen health systems in developing countries.

Challenge and Disprove the Myths About Cancer

M1. Unnecessary M2. Impossible M3. Unaffordable M4: Inappropriate

Expanding access to cancer care and control in LMICs: Should, Could, and Can be done

Applies a diagonal approach to avoid the false dilemmas between disease silos -CD/NCDthat continue to plague global health

 THE LANCET, 2010: Expansion of cancer care and control in countries of low and middle income: a call to action Farmer, Frenk, Knaul, et al

Closing the Cancer Divide 115+ authors 56 countries 20+ cases

Book: English Report: English, Spanish, Russian, (Arabic)

Investing in CCC: We Cannot Afford Not To

Health is an investment, not a cost Economic cost of cancer, 2010: 2-4% of global GDP

1/3-1/2 of cancer deaths are avoidable: 2.4-3.7 million deaths, 80% in LIMCs
Prevention and treatment offer potential, untapped world savings of $US 100-200 billion The costs of prevention and treatment are often less that many fear especially using a diagonal approach

Outcome-oriented, Cross-Cutting Strategies and Interventions in-country

GTFCCC: Priority Areas for Action BY HEALTH POLICY INTERVENTION AREAS

Pediatric Cancers Women's Cancers Infection-Related Cancers Pain and Palliative Care

Health Policy
Health Workforce

Delivery and Technology Access to Drugs, Vaccines, Treatment

Financing

Evidence and Information Global Stewardship and Leadership

The Cancer Divide: An Equity Imperative

Cancer is a disease of both rich and poor; yet it is increasingly the poor who suffer:
1. 2. 3. 4. 5. Exposure to risk factors Preventable cancers (infection) Treatable cancers: death and disability Stigma and discrimination Avoidable pain and suffering

Facets

The cancer transition in LMICs: breast and cervical cancer

LMICs account for >90% of cervical cancer deaths and >60% of breast cancer deaths. Both diseases are leading killers especially of young women.
% Change in # of deaths 1980-2010
53%

19%

20%

0%

LMICs

High income
-31%

Source: Knaul, Arreola, Mendez. estimates based on IHME, 2011.

For children & adolescents 5-14 cancer is

#2 cause of death in wealthy countries #3 in upper middle-income #4 in lower middle-income and # 8 in low-income countries
More than 85% of pediatric cancer cases and 95% of deaths occur in developing countries.

The Opportunity to Survive (M/I) Should Not Be Defined by Income

100%

Children

Adults Survival inequality gap

Leukaemia

All cancers LOW INCOME HIGH INCOME LOW INCOME HIGH INCOME

Source: Knaul, Arreola, Mendez. estimates based on IARC, Globocan, 2010.

In Canada, almost 90% of children with leukemia survive. In the poorest countries only 10%.

The most insidious injustice: lack of access to pain control

Non-methadone, Morphine Equivalent opioid consumption per death from HIV or cancer in pain: Poorest 10%: 54 mg per death Richest 10%: 97,400 mg per death

Priority Areas for Action GTF.CCC Working Groups

Strategy

Activities: examples of GTF.CCC work, by strategy

Pediatric Cancers

Women's Cancers

InfectionRelated Cancers

Pain and Palliative Care

Process-oriented, Cross-Cutting Strategies

Multi-sectoral engagement

Private Sector Engagement Group;

National and sub-national task forces
Pilots and demonstration projects; training, education and capacity building

Delivery (human resources) and Technology

Evidence and Information

Research and translation of research and evaluation

Global Stewardship and Leadership

Advocacy, Capacity building

Objectives
1. Respond to the ethical, moral and health objective of expanding access in LMICs for the sole sake of shared value and enhanced social and economic development in country 2. Identify effective, collaborative, replicable initiatives 3. Identify global and national projects in which PSE can be an especially effective catalyst 4. Develop and promote a research agenda that includes shared value and implementation evaluation 5. Contribute to and develop key data bases on existing PSE projects and global and in-country initiativates that will catalyze a level playing field 6. Generate a platform for private sector engagement through joint learning and experience-sharing that horizontal and diagonal (with other institutions)

Be an optimist optimalist: Solutions exist

Expanding access to cancer care and control in LMICs: Should, Could, and Can be done

AGENDA
10:00-11:00: Session 1 PSE Engagement in CCC: Opportunities and Impediments 11:00-12:00: Session 2 Private Sector Engagement to Catalyze Global Programs 12:10-13:00: Lunch at the Faculty Club Presentation: The Diagonal Approach to Health System Strengthening 13:15-14:15: Session 3 Private Sector Engagement to Catalyze National/Local Programs

14:15-15:00: Session 4 Role and Opportunities for Research and Joint Learning
15:15-16:00: Key Inputs for More Effective PSE and the Future Role of the GTF.CCC PSE Initiative

16:00-16:30: Wrap-up and next steps