Promoting greater equity

Every country can seek to support Treatment for All by identifying inequities and working to provide solutions to reduce premature cancer and non-communicable disease mortality.​ Cancer control leaders around the world share their responses to this call to translate global commitments into national action.

Click on the country names, to see their messages.

QuotesArgentinaAustraliaBrazilCanadaEgyptHong KongIndiaJordanMalaysiaMoroccoSouth AfricaTurkeyUnited KingdomUnited States

Responses of global cancer control leaders


Inequity is:

"Cervical cancer is the second leading cause of cancer death in women in Argentina and, according to data from the National Cancer Institute (INC), there are 4,900 new cases annually and about 2,000 deaths. The burden of disease and mortality varies by province, and is significantly higher in populations with lower levels of socioeconomic and educational development. The national map shows the inequality of the disease impact. Provinces like Corrientes, Chaco, Jujuy or Misiones have mortality rates much higher than those of Tierra del Fuego, Buenos Aires, Córdoba or La Pampa."

Treatment for All includes:

"The National Cervical Cancer Program of the National Cancer Institute (INC) is part of a comprehensive strategy for the prevention of cervical cancer,  which includes primary prevention through the HPV vaccine (for boys and girls , mandatory through a National Vaccination Calendar and for free) , and secondary prevention based on the screening of women (with PAP or HPV test). This program is complemented by data provided by the Epidemiological Surveillance System and Cancer Report (SIVER-Ca), including vital statistics and cancer registries; the Hospital Argentine Tumor Registry (RITA) and the Population-Based Cancer Registries."


Sanchia Aranda
Inequity is:

“Cancer outcomes in Australia are amongst the best in the world, with overall five year survival at 68-70%. However, national data shows that those in the lowest socio-economic group have a 30% higher age-standardised mortality from cancer than those in the highest socio-economic group (Australian Institute for Health and Welfare 2017). Data from the largest state also shows that the gap between the lowest and highest groups is widening over time (Tervonen, Aranda et al, 2017). This result is important, as it controls for remoteness, age, sex, cancer site and summary stage at diagnosis, factors often used to explain the difference.”

Treatment for All includes:

“Cancer mortality in Australia is around 7% higher in rural and remote areas compared with large cities, with disparities increasing in step with remoteness. There has, however, been significant progress to address regional inequalities in recent years, including a $694 million capital investment by the Australian Government from 2009 for the establishment and expansion of regional cancer centres to reach the approximate one third of Australians live outside major metropolitan centres. The aim of the regional cancer centres initiative is to significantly reduce the distance the majority of people in Australia’s rural population need to travel to access multidisciplinary cancer care. The capital investment included new and enhanced radiotherapy and chemotherapy facilities in 26 projects, including a mix of newly established and upgraded centres and improved networking.”



Inequity is:

"It is estimated that approximately 57,000 new cases of breast cancer will be diagnosed in Brazil in 2017. It is also estimated that over 50% of all breast cancer cases diagnosed through Brazil's public health system (SUS – Sistema Único de Saúde) will already be in advanced stages. In Brazil, treatments for metastatic breast cancer have not been incorporated into the SUS for over 10 years. In other words, patients are receiving ineffective treatments that do not meet their needs and reduce their chances of survival. However, patients who can afford health insurance have accessed suitable therapies for treatment."

Treatment for All includes:

"Femama and its 65 Brazilians associates are committed to improve equity of access to breast cancer diagnosis and timely treatment across the whole country. In Latin America, we are joining forces with others in the cancer field to raise the urgent need to establish a fair access to medicines policy."


Inequity is:

"In Canada, there is universal access to health care, which covers all Canadians for medical visits and hospital stays. In hospitals, there is also coverage for pharmaceuticals, but few provinces cover the costs of pharmaceuticals outside of hospital. Cancer drug coverage is an exception, with intravenous drugs being provided to all patients at no cost in all provinces, even when provided as an outpatient. However, the coverage of oral chemotherapeutic agents remains uneven across the country. In some provinces, oral chemotherapeutic agents are provided at no cost. However, in many other provinces, coverage for oral chemotherapeutic agents depends on a patient’s eligibility for other programmes or third-party insurance plans that may have some co-payment expectations. As a result, even in a country with universal access to health care, there is some unevenness in access to cancer drugs."

Treatment for All includes:

"The first announcements of colorectal screening programs began ten years ago in Canada. Through the National Colorectal Cancer Screening Network, provinces agreed on and developed a set of quality programme determinants and fundamental key  elements, and then implemented programmes in their respective setting. Today, all provinces have programmes, uptake is increasing and there is ongoing monitoring of both programme quality and the uptake of colorectal cancer screening, with coordinated efforts to ensure that the service is accessible and acceptable to all Canadians."


Inequity is:

"The cost of cancer management in Egypt and most countries in the region depends on three main resources: the government, donations from people and civil societies, and individual out-of-pocket expenditure. We see a clear disparity between those who can afford high cost targeted therapies not covered under governmental health insurance and those who cannot. We also recognize that improved media campaigns draw more donation-based funds, but the media campaigns themselves require more financing."

Treatment for All includes:

"The development of a national cancer registry, a national cancer control plan, and national guidelines for cancer diagnosis and treatment have been developed and followed by the Egyptian national cancer control committee since 2010. This is a clear example of how a concerted effort, if properly implemented, can overcome the caveats of inequity in cancer control."

Hong Kong

Inequity is:

"Inadequate cancer data for public health use – Because of China’s massive population (1.37 Billion in 2015), previous national incidence and mortality estimates have been limited to small samples of the population (<2%) using data from the 1990s or based on data from a specific year. This led to uncertainty of the estimates and their degree of national representativeness, consequently affecting the evidence available to develop appropriate policies for effective cancer control. The National Central Cancer Registry of China was established in 2002 for the collection, evaluation, and publication of cancer data in China. Substantial improvements have been made, high-quality data from an additional number of population-based registries were incorporated, but analysis up to 2015, based on data from 72 local, population-based cancer registries (2009-2011), could still only represent 6.5% of the population (Ref: Chen et al, CA Cancer J Clin 2016).

Gross inadequacy of radiotherapy facilities - Detailed analyses of radiotherapy service provision showed that although the number of the Linear Accelerators in the whole country had increased from 264 in 1986 to 1413 in 2015, the number per million population was only 1.49 in 2015, and there was wide variation among different provinces, ranging from 0.33 to 3.28 (Ref: Lang et al, Chinese Journal of Radiation Oncology, 2016). A global analysis on the outcome of nasopharyngeal cancer, a cancer that is highly curable by radiotherapy, showed that the estimated ‘relative survival’ in China was only 36.8% (basing on data from Globocan 2012). The outcome was grossly below the world average of 50% (Ref: Lam et al, International J Radiation Oncology, Biology & Physics 2016)."

Treatment for All includes:

"In Hong Kong (population of 7 million), the public health system is heavily subsidized by the local government. With concerted efforts over the years, the above two issues are steadily improving.  The Hong Kong Cancer Registry can provide high quality data up to the highest standard depicted for developed countries by IARC. The completeness of registration is reckoned to be ≥98%, the proportion of morphologically-verified cases is 85% and cases identified by death certificate only is <1%. The number of Linear Accelerators was 5.2 per million population, and the estimated ‘relative survival’ for nasopharyngeal cancer was 62% for male and 70% for females in the corresponding period. China is developing very fast. The establishment of the National Central Cancer Registry of China was an important step to continually improve the coverage and quality of cancer data. Similarly, the efforts by the Chinese Society of Radiation Oncology, Chinese Medical Association to investigate the situation of radiotherapy services in mainland China, is an important step for providing valuable data to policy makers on the urgent need for improving cancer treatment provisions. Together with sharing of experience from Hong Kong, there is high hope that Mainland China will also develop effective cancer plan to strive for substantial improvements in cancer control."


Inequity is:

"Prevalence of cancer in India is estimated to be 3.9 million people, with reported incidence of 1.1 million in 2015. We are challenged with providing affordable access to an enormous population, where cancer is currently characterised by late diagnosis and inconsistent care. However, the opportunity to detect, diagnose and treat early for improved survival and quality of life is real, with breast and cervical cancers among women, and head and neck, lung and gastrointestinal cancers among men, representing over 60% of the burden."

Treatment for All includes:

"We are rising to this challenge, aiming to develop a robust public health sector response in the form of a national cancer grid. The grid includes 108 major cancer centres across the country. Our focus is patient care, with a common goal to build a network of expert cancer centres that ensure that patients have access to the same standard of cancer care, regardless of geographic location or socio economic status. Very much in line with the cancer resolution, we are developing uniform standards of care and evidence-based, resource-stratified management guidelines that are right for India. We have a common education and training strategy, with degree courses and skills training, sharing expertise between centres. Each centre has a fully fledged department of palliative care, where physicians, nurses and social workers in the referral network can also be trained. Importantly, we also have a network-wide collaborative research initiative for improving quality of care over time."


HRH Princess Dina Mired of Jordan
Inequity is:

"Jordan is a country with a significant refugee challenge, in addition to responding to the needs of Jordanians. Every day, we come face to face with the harsh reality of underprivileged cancer patients who have no one to turn to. In response, during my time as Director General the King Hussein Cancer Foundation, we established the Goodwill and Zakat Fund that has now saved the lives of over 1,700 underprivileged patients who would otherwise have faced a certain death. In addition, the King Hussein Cancer Foundation transformed and led the Cancer Care programme, helping thousands of patients secure limited insurance coverage for their cancer care. Membership to this innovative programme has grown from 5,000 members to 140,000 members and continues to rise."

Treatment for All includes:

"As honorary Chairperson of The Jordan Breast Cancer Programme (JBCP)2006-2016, JBCP responded to the number one cancer killer of women in Jordan. At initiation, 70% of our women presented with advanced or metastatic breast cancer stage 3 and 4. After a mere six years of the programme, through improved breast health awareness and early detection, we have been able to halve to 35% presentation of advanced breast cancers, giving many women the opportunity for curative treatment of their early stage breast cancer."


Saunthari Somasundaram
Inequity is:

"Affordable healthcare is available in Malaysia through its public hospitals. However, an expanding and ageing population, an increase of non-communicable diseases incidences, and an inadequate healthcare budget is causing the cancer burden to overwhelm the public care sector. Cancer incidence is expected to rise to 57,000 by 2025.  This widens the inequality among the population and results in an inconsistent quality of care. While there is a highly developed expectation of treatment, about 45% of cancer patients risk financial catastrophe one year after diagnosis, and 11% have to stop treatment. Those living in non-urban areas – 47% of the population -- are affected by location, often missing out on prevention, awareness or early diagnosis campaigns, and facing difficulties obtaining timely treatment."

Treatment for All includes:

"The Malaysian Ministry of Health has set up a National Cancer Institute in 2013. This multi-million dollar facility is the country’s first hospital dedicated solely to cancer treatment and research. Some patients have provided testimonials about the affordability, as well as excellent care at the Institute. NCI also acts as a reference centre for cancer control, and provides training on a holistic range of cancer-related challenges, including palliative care, malnutrition, grief support and pain intervention for primary care providers. The government plans to establish more of these institutes across the country."


Inequity is:

"In French speaking sub-Saharan Africa, children are dying of curable childhood cancers because of lack of availability or access to diagnosis, treatment and care. It is devastating to know that most of these children could be cured if they had access to accurate diagnosis and essential, and often cheap, treatment. The international community needs to respond by supporting governments in their efforts to build their health system and bridge this gap. The GFAOP (French African Paediatric Oncology Group) has demonstrated that, in many of these countries, survival of childhood cancer can be boosted to at least 50% through various support, including renovated hospital units, the provision of medication and supplies, training of health care providers, and support to families."

Treatment for All includes:

"In Morocco, we are fortunate to have the long term support and continuous work over the past 10 years of the Foundation Lalla Salma, in conjunction with Ministry of Health, to shape and implement a national cancer control strategy. This work has resulted in a network of 10 cancer centres, which means that cancer care is available in most cities. We have initiated a national programme for prevention and early detection, a cancer registry in Casablanca, and a palliative care programme. We are now working to improve the expertise of oncology teams and quality of care."

South Africa

Inequity is:

"In South Africa, 84% of the population only has access to the public health sector, with many people living in rural communities far from the 10 centres where cancer services are provided. Many of the cancer care centres, attached to tertiary institutions, do not have appropriate equipment nor fully trained professionals to provide essential services. For instance, this sector has 41 trained oncologists servicing the 10 facilities, as compared to the 139 oncologists servicing the 16% of the population in private care. It goes without saying the public health sector sees far more late stage presentations, with the resulting higher morbidity."

Treatment for All includes:

"In order to address the cervical cancer burden, which accounts for over 15% of women’s cancer in South Africa, we introduced a revised Cervical Cancer Prevention and Control Policy in April 2017. This policy aims to support people across the cancer care continuum, including prevention, screening, diagnosis, treatment and palliative care services. Given our high prevalence of HIV and the higher likeliness that HIV-positive women may be infected with HPV, we are also working to make sure our services are integrated with sexual and reproductive health services, HPV vaccination, HIV prevention and palliative care. These efforts are in line with critical national priorities that call for a new, aligned platform for health service provision."


Tezer Kutluk
Inequity is:

"Turkey has made significant progress in cancer care during recent years. The survival rate is about 67% for childhood cancers and 50% for adult cancers, consistent with what is expected for upper-middle-income countries. However, we still aim to close the gap in survival rates to be more in line with rates expected in high-income countries, which exceed 80% for childhood cancers and 60% in adult cancers. One way of addressing this gap is through our efforts to increase the number of skilled oncology healthcare professionals. We have so far seen a fourfold increase, but human resources continues to be an obstacle for our 80 million population."

Treatment for All includes:

"Turkey prepared its first cancer control plan in 2008. Since then, significant progress has been made on screening for early diagnosis. Before 2008, we saw rates of 3% or less for breast, cervical and colorectal screening. By 2014, these figures had grown as much as 10 times larger, though colorectal screening remains low. With continued investments from the Ministry of Health and the cancer community, we hope to see these figures continue to improve."

United Kingdom

Nick Grant
Inequity is:

"Cancer Research UK wants to see all patients receive an early diagnosis and access to the best evidence-based treatment for their condition. Unfortunately, there is variation in care across the UK. For instance, we know many patients are missing out on the best radiotherapy treatments, such as Intensity Modulated Radiotherapy (IMRT). IMRT targets tumours more precisely, meaning patients face fewer side-effects, improving quality of life. Guidelines* from the Radiotherapy Board show that around 50% of patients receiving curative radiotherapy should get IMRT, but patients in England face significant variation in access, with some hospitals only reaching 20% while other hospitals offer over 70% of patients this effective treatment."


Treatment for All includes:

"Be Clear on Cancer aims to improve early diagnosis of cancer by raising awareness of signs and symptoms. People across the UK are significantly more worried and embarrassed than those in other countries about seeing their doctor with a symptom that might be serious. Awareness campaigns that focus on the need to present if a set of symptoms exist are therefore essential. Cancer Research UK works in partnership with the Department of Health, NHS England and Public Health England to encourage people across England to see their general practitioner (GP) without delay through its joint campaign Be Clear on Cancer. Since 2010, the campaign has promoted awareness and early diagnosis of lung cancer, regionally and nationally. Treatment options for lung cancer remain limited, but, if diagnosed early, there is a better chance of successful treatment. Evaluation of the lung cancer campaign has showed significant impact. GP practices saw a 62% rise in the number of over 50’s presenting with a persistent cough. This equated to a 32% rise in urgent referrals between May and July 2012, with an estimated 700 additional cancers being diagnosed compared to the same period in the previous year. Many more lung cancer patients were being diagnosed earlier and around 300 additional patients had surgery as a first treatment."

United States

Sally Cowal
Inequity is:

"Within the United States, there is a disparity in the quality and availability of cancer care for black Americans and white Americans. Studies as far back as the early 1970s began pointing out that black Americans had higher rates of death from certain cancers than white Americans. Although the overall racial disparity in cancer death rates is decreasing, in 2012, the death rate for all cancers combined was 24% higher in black men and 14% higher in black women than in white men and women respectively, according to the SEER Cancer Statistics Review from the National Cancer Institute. While the American Cancer Society is working to close this gap, it will be difficult to make significant changes within this generation alone without the support of the US Government and health agencies working alongside us. More funding is needed for research, as the more these factors can be studied and understood, the more effectively they can be addressed. For all of the advances that have been made in treatment options and availability, these numbers are still far too large. Every person, man, woman, and child deserves to have the same quality and access to life-saving treatment regardless of where they live within the US and what their ethnic background is."

Treatment for All includes:

"The American Cancer Society has chosen to focus on prevention and early detection as one of the key messages domestically. While ground-breaking advances are being made due to research, many forms of cancer are still without viable treatment options in later stages. Certain types of cancer, such as colon cancer and cervical cancer, are highly treatable with early detection, and we have successful methods to do so. We have been working alongside both individuals and other health organizations and government agencies to educate the public on the importance of these screenings and early detections. The National Colorectal Cancer Roundtable, established by the American Cancer Society and the Center for Disease Control and Prevention in 1997, is a national coalition of public organizations, private organizations, voluntary organizations, and invited individuals dedicated to reducing the incidence of and mortality from colorectal cancer in the U.S. We are working toward the shared goal of reaching 80% of appropriate people screened for colorectal cancer by 2018."

Last update: 
Monday 26 February 2018