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From anecdote
to evidence
The night of my high school prom visiting my father, Sigmund Knaul, at Mount Sinai Hospital, Toronto a few weeks before his death from cancer. May 1984.
From anecdote
to evidence
GTF.CCC=
global health cancer care
Facets
1. 2. 3. 4.
Exposure to risk factors Preventable cancers (infection) Death and disability from treatable cancers Stigma and discrimination
Level 1: Unknown Level 2: Building Capacity Level 3a: Isolated provision Level 3.b: Widespread provision Level 4a: Preliminary integration Level 4b: Advanced integration Not applicable
Source: Based on WPCA-OMS, 2014, Global Atlas of Palliative Care at the end of life .
37,000 mg
272,000 mg
Mexico: 2,300
Africa
Latin America
1970
1980
1990
2000
2010
Fuente: Pain & Policy Studies Group. Opioid Consumption Motion Chart. University of Wisconsin. (http://ppsg-production.heroku.com/chart )for 2007 (accessed April 22 2011).
The costs to close the pain divide are less than many fear:
The majority of pain control meds are off patent and cheap YET: The poor overpay because prices are higher in low income countries
1 month morphine: $1.80-$5.40 versus $60-180
BUT: WE CAN GET THE PRICE RIGHT AND INCREASE ACCESS THROUGH COLLECTIVE ACTION: Global regulation focuses on control of illicit use Delivery & financing platforms are underutilized Innovation is undeveloped Purchasing is fragmented, procurement is unstable
Mexico.
Universal health care through reform that created Seguro Popular Innovative legal framework: 2009 Palliative Care Law: 2013 in General Health Law
Yet.
Almost 80% - 65,500 - of the 83,771 registered deaths from cancer or HIV/AIDS in 2010, died in pain
Prevention Survival
Regulation
Financing
Delivery
Lacking units and levels for delivery Supply chain and distribution is sporadic and spotty
Lack of trained personnel Fear of prescription Topic not available in medical school curriculum No published research related to health system
Source: Adapted from Knaul, F. M., Gralow, J. R., Atun, R., & Bhadelia, A. (Eds.). Closing the Cancer Divide. Harvard University Press, 2012.
N = 30 of 32 states
Fuente: Dr. Alfonso Petersen Farah, Presentacin: Clnicas del Dolor, Foro Internacional Promoviendo las Oportunidades de los Cuidados Paliativos en Mxico. Octubre 11, 2013
PREVENTION AND CONTROL OF ILLEGAL USE AND MEDICAL SUPPORT FOR ADDICTIONS
PATIENT AWARENESS
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