Escolar Documentos
Profissional Documentos
Cultura Documentos
-35%
Mortality Breast Cervical
in 30 in
years cancer cancer
childbirth
= 326,000
Source: Estimates based on data from IHME 2016
Leading causes of death among women
15 to 49 years, select LA countries, 2016
Chile Costa Rica México Brasil
10 10
8 8
6 6
4 4
2 2
0 0
1979
1985
1990
1995
2000
2005
2013
1979
1985
1990
1995
2000
2005
2012
2013
20 25
18
Puebla Oaxaca
16 20
14
12 15
10
8 10
6
4 5
2
0 0
2013
1979
1985
1990
1995
2000
2005
2011
1979
1985
1990
1995
2000
2005
2013
Source: Estimaciones propias basadas en datos de DGIS. Base de datos de defunciones 1979-2013. SINAIS. Secretaría de Salud.
“Avoidable” cancer deaths:
Breast and Cervical,
The Americas and LMICs
Breast Cervical
Latin America
and the 57% 64%
Caribbean
Low and middle
75% of breast
income 75% 95%
95% of cervical
countries
Trends in breast cancer mortality:
USA, Canada, Australia,
Mexico, Colombia
USA
Age-adjusted mortality rate
Canada
Australia
Colombia Mexico
0 ¿2030?
1975 1980 1985 1990 1995 2000 2005 2010 2014
Source: Data extracted from CI5plus.
Late Detection:
Latin America and USA
Lat
Stage Peru Colom Brazil Mexico Chile Urug´y USA
Am
I 18% 22% 18% 12% 20% 40% 21% 80%
II-III 75% 67% 72% 81% 74% 58% 71% 19%
IV 7% 11% 10% 7% 6% 2% 7% 1%
Sources: Justo, Wilking, Johnsson, Luciani, Cazab, 2014, The Oncologist; and ACS. Facts & figures, 2015-2016.
In LMICs a very large % of Breast Cancer cases
and deaths are in women <55
Latin America High Income
Age at
Diagnosis
33%
62%
15-39
40-54
>55
Age at
Death 34%
61%
Fuente: Estimaciones de los autores basadas en IARC, Globocan 2012
Outline
1. Growing health priority for LAC
2. Health systems
strengthening
through a diagonal
approach
3. Examples from Mexico
4. Evidence-based advocacy
Universal Health Coverage
All people must obtain the health services they
require - prevention, promotion, treatment,
rehabilitation and palliative care - without the risk
of impoverishment (WHO)
Stewardship
Financing
Delivery
Resource
Generation and
evidence
buliding
The Diagonal Approach to
Health System Strengthening
Rather than focusing on either disease-specific vertical or
horizontal-systemic programs, harness synergies that
provide opportunities to tackle disease-specific priorities
while addressing systemic gaps and optimize available
resources
Diagonal strategies add value:
Exploit existing platforms – e.g. anti-poverty programs
Compound, which means increase effectiveness at a given cost
Generate positive externalities
Bridge disease divides using a life cycle response
Avoid the false dilemma of disease silos
‘Diagonalizing’ Cancer Care:
Financing & Delivery
1. Financing: Integrate cancer care into national social
insurance and social security programs and reforms
2. Delivery: Integrate cancer prevention, survivorship
and palliative care into primary care platforms,
maternal and child health and anti-poverty programs.
3. Advocacy: integrate advocacy around women´s
cancer to harness & catalyze women´s health and
empowerment, health system reform, & SDGs
4. Pain control and palliative care: reducing barriers to
access for cancer care improves access for all, and
strengthens surgical platforms
Outline
1. Growing health priority for LAC
2. Health systems strengthening through
a diagonal approach
3. Examples from
Mexico
4. Evidence-based advocacy
Juanita:
Advanced metastatic breast
cancer is the result of a series
of missed opportunities
Expansion of Financial Coverage:
Seguro Popular México
Affiliation:
• 2004: 6.5 m
Benefits Package
Vertical Coverage
Benefit package:
• 2004: 113
• 2016: 287
• 61 in the
Catastrophic
Illness Fund Horizontal Coverage:
Beneficiaries
Seguro Popular now includes
cancers in the national,
catastrophic illness fund
Universal coverage by disease with an
effective package of interventions
2004/6: HIV/AIDS, cervical, ALL in kids
2007: pediatric cancers; breast cancer
2011: Testicular, Prostate and NHL
2012: Ovarian and colorectal
Seguro Popular and breast cancer:
Evidence of impact
Adherence to treatment:
2005: 200/600
2010: 10/900
High %
Stage IV
0%
Marginalized High Access
Source: Authors’ estimates with database from IMSS, 2014
Barrier: Low quality primary care
services
½ of women diagnosed with breast cancer reported
problems with medical attention in the diagnostic process
> 16,000
Health Promoters
8 Risk Score (0-10) Significant increase in knowledge,
7 *
among health promoters,
6
especially
5
in clinical breast examination
4
(Keating, Knaul et al 2014, The Oncologist)
3
Pre Post 3-6 month
Diagonalizing delivery:
Inclusion of early detection of breast cancer in
Opportunities program (Today Prospera)
4. Evidence-based
advocacy to close
divides
Vision:
Improve capacity to respond to the challenge
of women's cancers throughout Latin
America.
Mission:
ULACCAM is a regional, civil society
network dedicated to influencing policy
making on women's cancers and promoting
universal access to information, preventive
services, early detection, effective diagnosis,
and high quality treatment in all stages of
disease.
Yes
No
Not available
Closing the cancer divide
for women in the Americas:
diagonal health system innovations
Women’s Cancer Prevention and Control in the Americas
Tuesday, 6 February 2018
Pan American Health Organization, Washington D.C.