By Anil D’Cruz
Informing someone that they have cancer is indescribably difficult. It is all the more heart-wrenching when we know that their disease possibly could have been detected and treated earlier, thus increasing their survival chances, or even prevented entirely.
Ten million people died prematurely from cancer in 2020. Half of these deaths could have been prevented by greater awareness of risk factors and early warning signs, earlier consultations, and easier and more timely access to health services and high-performance testing equipment. Moving swiftly towards universal health coverage (UHC) can help to achieve this goal.
There are several reasons why we currently are not all equal before cancer. These “social determinants of health” – such as where we are born and grow up, where we currently live and work, and our income level – influence our perceptions and understanding of cancer and the risks that contribute to its development.
Crucially, these factors also help to determine the quality of care we can access, which depends on the robustness of our local health system, the number of available health facilities or specialised doctors, the ease of travelling to a facility and staying for care, and the cost of the care itself.
A range of personal, social, cultural, and religious influences also play a role. Stigma and discrimination related to age, sexual orientation, and ethnicity, for example, create real barriers that prevent people from receiving the level of health care they need.
Extending health coverage to everyone can help to overcome socioeconomic inequities in healthcare access, thereby preventing millions of cancer-related deaths. At the same time, resource-efficient measures that all countries can take to reduce the cancer burden – developed and implemented via national cancer control planning – can facilitate the move to UHC. In this sense, cancer control and UHC go hand in hand.
For example, most people do not think of cancers as being preventable through vaccination, because they are non-communicable diseases that arise due to changes or mutations in the body’s cells rather than from transmissible pathogens. But 70% of cervical cancer cases are caused by the human papillomavirus (HPV), which is contagious through intimate contact and can be contained, if not eliminated, through vaccination.
Furthermore, the earlier cervical cancer is detected, the higher the survival rate. The international community has thus committed to vaccinating 90% of girls aged 9-15 against HPV by 2030, and to screening 70% of women between the ages of 35 and 45 for cervical cancer. Achieving these targets would save millions of lives over the coming decades. HPV is also responsible for causing several other genital cancers, as well as for the dramatic rise in oropharyngeal cancers (affecting the tonsils and the base of the tongue) in the West over the last decade.
Early detection is also vital to treating other cancers. The five-year survival rate for breast cancer can be above 90% in well-resourced countries such as the United States, where women have greater access to health information and services. But in countries where cancers are often detected later and are thus harder to treat, the five-year survival rates are much lower – 66% in India and 40% in South Africa, for example. Effective implementation of recommended screenings for prostate, colorectal, and lung cancers, where early diagnosis can significantly increase survival rates, would save even more lives.
We have the technology to control cancer more effectively, but we must reach all populations everywhere. That means ensuring that everyone can receive an HPV vaccine, access screening programmes, and benefit from essential cancer services such as early diagnosis, targeted treatment, and palliative care.
UHC not only saves lives and upholds people’s fundamental right to health and human dignity, but also contributes to social and political stability and yields valuable economic benefits. After all, the healthier a population is overall, the more resilient and productive it tends to be.
For example, in my home country, India, a majority of the population lacks health insurance. The federal government’s National Health Protection Scheme (NHPS, or Ayushman Bharat, popularly known as Modicare) is a welcome first step towards making health services more accessible and affordable, particularly for the poor and in rural areas where such services are most needed.
The economic burden of moving towards UHC and ensuring better health for all is not as heavy as might be expected. According to the World Health Organisation, eliminating cervical cancer would cost an average of $0.40 per person per year in low-income settings, and $0.20 per person per year in lower-middle-income countries. This pales in comparison to the human, social, and economic cost of allowing people to die from a preventable disease. – Project Syndicate
• Anil D’Cruz, Director of Oncology at Apollo Hospitals, is President of the Union for International Cancer Control.
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