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Bridging Divides:
The diagonaloptimalist approach
Felicia Marie Knaul
Tuesday, June 14, 2011
Global Health Council
Washington, DC
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January, 2008
July, 2007
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The Cancer Divide: disparities inoutcomes between poor and rich directlyrelated to inequities in access anddifferences in underlying socio-economicand health conditions.
The divide is the result of concentratingrisk factors, preventable disease,suffering, impoverishment from ill healthand death among poor populations.
fueled by progress in cutting-edgescience and medicine in high-income
countries.
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Adults
Breast
Cervix Prostate
Testis
HL
N HL
Leukaemia
All cancers
Source: Knaul, Arreola, Mendez. estimates based on IARC, Globocan, 2010.
Children
LOW
INCOME
HIGH
INCOME
Survival
inequalityga
p
LOW
INCOME
HIGH
INCOME
100%
The opportunity to survive (M/I)
should not be defined by income.
Yet it is.
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LMICs: 83% of avoidable
Avoidable cancer deaths
Income Region % of deaths considered
avoidable
Low income 65Lower middle income 53
Upper middle income 46
High income 29
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Cancer is a disease of rich and poor yet,
it is increasingly the poor who suffer:
Exposure to risk factors
Cancers of infectious origin
Death from treatable cancer
Stigma and discrimination
Avoidable pain and suffering
Impoverishment
The cancer divide:
an equity imperative
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Challenge and disprove the
minimalists:
myths about cancer& NCD
M1. Unnecessary: Not a health priority for the poor
M2. Impossible: Nothing we can do about it
M3. Unaffordable: .for the poor
M4: Inappropriate:Challenging cancer implies taking resources
away from other diseases of the poor
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Rather than focusing on disease-specific
vertical programs or only horizontally on
system constraints, harness synergies that
provide opportunity to tackle disease-specific
priorities while addressing systemic gaps.
Optimize available resources so that thewhole is more than the sum of the parts
Bridge the divides as patients suffer diseases
over a lifetime, most of it chronic
The diagonal approach
to health system strengthening
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1. Harness platforms: Integrate disease prevention,screening and survivorship into MCH, SRH,
HIV/AIDs, social welfare/anti-poverty programs
2. Delivery: Catalyze, employ and deploycommunity health workers and expert patients
3. Financing: social protection strategies that
include horizontal and vertical coverage
4. Stewardship: Improve regulatory frameworks to
remove non-price barriers to pain control
Diagonal strategies
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Juanita:Her cancer was detected late -- a
series of missed opportunities toapply the diagonal approach
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Be an
optimist
optimalist:
apply the
economicsof hope
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Restructuring health
systems in the face of
chronicity:The diagonal
optimalist approach
Felicia Marie Knaul
Tuesday, June 14, 2011
Global Health Council
Washington, DC