Cancer Control Opportunities in Low- and Middle-Income Countries (2007) / Chapter Skim
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Pages 1-16
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sector agencies and organizations that provide advice, assistance at a variety of levels, products and services, and financial support for health and health care. As the burden of cancer and other chronic diseases increases, LMCs and the global community at large should be increasing resources proportionately, yet this has not happened to any noticeable degree.
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Rather, it recognizes certain global priorities and approaches that are feasible at low resource levels, in the context of national cancer control planning. However, without assistance from the broader global health community -- the same span of public- and private-sector agencies and organizations involved in traditional developing country health issues such as infant mortality, child and maternal health, tropical infectious diseases, and HIV/AIDS -- it is unlikely that countries will be able to make substantial progress in cancer control.
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Where cancer shares risk factors with other chronic diseases -- tobacco being by far the most important, but also including diet -- control measures will produce benefits for a number of diseases. Within the health care system, some aspects of cancer control can be integrated into primary and higher level health care levels (e.g., vaccinations for HBV and human papillomavirus [HPV]
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The plan does not have to cover every aspect of cancer control: e.g., an initial focus on tobacco control and palliative care can lead to success in those areas and open the door to adding further goals later.
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· Complete adertising and promotion bans on tobacco products · Mandating that public spaces be smoke free · Large, explicit cigarette packet warnings in local languages (which also helps to reduce smuggling) · Support of counteradertising to publicize the health damage from tobacco and the benefits of stopping tobacco use Lier Cancer and Hepatitis B Vaccination HBV is the cause (often in conjunction with a co-factor)
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RECOMMENDATION. GAVI and other international partners should continue to assist countries to incorporate HBV vaccination into their childhood immunization programs as quickly as possible, with support from the global cancer community.
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Governments and the international health community should take concrete steps now to develop HPV immunization policies and the means to pay for what is currently an expensive vaccine. Operational issues (e.g., developing immunization schedules, including the optimal age for immunization; deciding whether to immunize only girls or both girls and boys)
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Financial support initially came from a foundation devoted to breast cancer with later support from the National Cancer Institute (NCI) and others.
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Financing to initiate and operate cancer centers in LMCs can come from a variety of public and private sources, including taxes on tobacco products.
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Institutional "twinning" is an approach that should see expanded use in improving and expanding cancer control in LMCs. Twinning involves longterm pairings of established cancer centers with new or existing centers in LMCs.
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Progress in the past 10 years has demonstrated that barriers to opioid availability can be overcome and that palliative care can be delivered effectively and inexpensively, even in LMCs. A major barrier to making morphine available to cancer patients in severe pain is the irrational fear of opioids that continues to exist among policy makers, regulators, law enforcement, health professionals, and the public.
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WHO has developed standardized survey instruments in "STEPS," a Stepwise Approach to Chronic Disease Risk Factor Surveillance. Questionnaire-based data gathering about tobacco use, alcohol consumption, diet, and physical activity constitute the first "step." Steps 2 and 3 add physical and physiological measurements of risk factors for the other major chronic diseases: weight and blood pressure measurements; and blood glucose and cholesterol, respectively.
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Where new or existing cancer centers are deeloped into centers of excellence, registries in the catchment area should be a part of the deelopment. The Global Community Cancer control will not advance in LMCs without support from the global health and development community for the invariably small constituencies within these countries.
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For this to happen, faculty and administrators must become aware of new types of projects, in cancer and other areas, that are possible, in addition to the traditional emphases on infectious and nutritional diseases. Cancer centers in the United States and other wealthy countries also may not be aware of opportunities for twinning and other collaborations with centers in LMCs.
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CANCER CONTROL OPPORTUNITIES RECOMMENDATION. The Academic Community Universities with active global health programs should consider opportunities in cancer control, as well as the more traditional areas of focus.
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