Cancer in poor countries: Too big to tackle?

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Copyright: Ivan Kashinsky / Panos

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A revealing metaphor kicked off a day of discussions about tackling cancer in poor countries at the Royal Society of Medicine this week.

If you think of global health as Mount Everest, cancer control would be a small flag at its peak, said Richard Sullivan, professor at the King’s Health Partners science centre in London, UK. The statement was meant to symbolise how systems to tackle cancer are built on a vast set of capabilities, from complex infrastructure to technological capacity to end-of-life care.

The rest of his presentation, and the discussions that followed, backed this up. They touched on issues from power and development goals to data gaps and the private sector to radiography, pain management, health insurance and gender.

The metaphor is revealing in the level of challenge and ambition it conveys, which could explain why cancer is rarely a main feature of policy discussions around global health and development — a complaint that, rather unsurprisingly, came up more than once in the course of the day.

This is despite statistics showing that 87 per cent of people in low and middle-income countries aren’t covered by a cancer health plan. Many of these countries also struggle with other common and emerging diseases, and have weak health systems.

There’s been little support for cancer in development aid, said Julie Torode, deputy CEO of the Union for International Cancer Control — partly because the Millennium Development Goals make no mention of non-communicable diseases (NCDs). But this is changing with the 2030 agenda, she added: NCDs feature across the Sustainable Development Goals (SDGs).

What countries may declare on official registries can be very different from the reality on the ground.

Richard Sullivan, Kings Health Partners 

Still, the changes needed to work towards the SDGs will take a revolution, said Sullivan — development has a huge impact on social determinants of cancer control. And estimates of the billions of dollars needed to follow global policy agendas feed the policy inertia.

So, faced with a mountain before you get to cancer control, where do you begin?

"Politicians don't do things that are too difficult,” Baroness Delyth Morgan said as she summed up the day. “Simple, clear messages are important."

A few of these emerged in the course of the day: providing simple diagnostic technologies that can be maintained, training non-specialists to treat common cancers with basic procedures, doing more to manage pain, treating each country’s needs differently and pressing aid agencies and the private sector for more support.

And there was talk about data: the need for it — “what gets measured gets done” was a popular adage in the room — and the difficulty getting it from developing countries.

Claudia Allemani, from the London School of Hygiene and Tropical Medicine, presented global statistics on survival rates that exposed the poor availability of cancer registry data in the developing world, particularly in African countries. Collecting this data can be expensive — it often means paying people to take surveys door to door, said Allemani.

But we heard little of solutions to this familiar problem.

Is the use of mobile technologies helping to bridge that gap, and do cancer registries feature in plans for Africa’s data revolution?

Sullivan raised another issue with statistics: what countries may declare on official registries can be very different from the reality on the ground. And what’s often missing is the qualitative research that should go along with the data.

He told me this could be interviews with community leaders, not just clinic or hospital staff. And it’s necessary because policies are often based purely on quantitative data, but this isn’t enough to make meaningful changes in policy.