Investing in cancer control

Adequate and effective investment is often considered the Achilles heel of global cancer control. While there has been strong progress in the development of global commitments and frameworks on Noncommunicable diseases (NCDs) and Universal Health Coverage (UHC) important gaps remain in access to services and financial protection for cancer patients, particularly in low- and middle-income countries (LMICs). In part, this has been attributed to challenges in mobilising the financial resources and political will needed to scale-up national cancer control activities both nationally and globally.

Cancer continues to pose a significant cost to patients and health systems alike, with estimates suggesting that the annual economic cost of cancer is likely to exceed US$1.2 trillion.[1] This would mean that more healthcare costs are attributed to cancers than all of the 15 leading causes of death worldwide, placing health systems under significant strain. Making the case for increased and focused investment in national cancer control is therefore a pressing advocacy priority for UICC.

Modelling data indicates that investing in a core package of cancer services is feasible and affordable in nearly all countries. Investing ambitiously to scale up cancer services to 90% coverage by 2030 would cost US$40 billion. This would equate to investments of US$2.70 per person in LICs, US3.95 in lower-middle income countries and US$8.15 in high-income countries (HICs) and has the potential to save 7.3 million lives by 2030. Making these investments could add an additional US$325 billion in direct productivity gains and a further US$990 in societal gains by averting preventable cancer mortality.[2]

Health financing

Financing for health is one of the core building blocks of health systems, and includes three main activities:

  • Raising funds to invest in health services
  • Reducing financial barriers to access health services across the continuum of care, from health promotion and prevention through to diagnosis, treatment, and palliative care
  • Assessing the distribution of investments to increase the effectiveness of health systems and to reduce inequities.

With the adoption of the Sustainable Development Goals (SDGs), there has been an even greater focus on health financing as one of the key mechanisms needed to deliver UHC. This provides cancer advocates with a valuable window to call for the integration of cancer services in national UHC plans and budgets. Cancer advocacy can encompass all three aspects of health financing – from campaigning to increase the budget allocated to cancer interventions, to the inclusion of selected cancer services in national UHC packages, or calling for the reallocation of resources to improve access to vulnerable groups.

Investment challenges

Some of the key challenges facing cancer advocates include:

  • The misconception that cancer control is too expensive or too complicated to deliver, particularly in LMICs, significantly reducing the willingness of Governments to invest in cancer control services
  • Limited data on national investment needs. A 2018 review of national cancer control plans found that only 10% included estimates of costs and strategies to resource national plans, without which it is difficult to make a compelling case for investment within government[3]
  • Poor awareness of cost-effective interventions for cancer, such as the ‘Best Buys’, or likely returns on investment in cancer services
  • Ineffective use of current resources or limited familiarity with the most cost-effective and efficient investments for cancer.
  • Difficulties integrating cancer within international financing mechanisms, to provide catalytic funding for LMICs particularly.

Driving change

Since 2015, the international community has adopted a series of commitments which support increased investment in health to deliver UHC, encompassing increased investments in cancer and other NCDs. These include the 2019 UN Political Declaration on UHC, which calls on Governments to ensure financial risk protection as part of UHC and increase investment in health by an additional 1% of GDP, the 2017 World Health Assembly Cancer Resolution, 2018 Political Declaration on NCDs, and the Addis Ababa Action Agenda.

These commitments provide a useful framework for advocacy. UHC efforts are being advanced by governments and other stakeholders around the world but a key question remains around how cancers, which often require long-term and more complex care, will be integrated into national plans and budgets. Achieving comprehensive coverage for cancer and other NCDs can pose a significant financial challenge, particularly for LMICs where resources for health are more constrained. While data is limited, particularly for LMICs, it appears that a number of national UHC plans include access to basic cancer diagnostics and limited treatment.

In response, UICC is working with our members to advocate for the progressive realisation of cancer control in UHC i.e. the stepwise investments needed to establish and scale-up essential cancer services in countries across all income levels. This requires concerted long-term and evidence-based advocacy that draws on economic data, cancer surveillance and other information to provide a strong case for investment in cancer control, as well as assessments of the costs populations and the economy if increased investment is not made.

Further reading and useful links

Data on health spending:

Investment cases for cancer and NCDs:

 

 

[1] Knaul FM, Arreola-Ornelas H, Atun R, Mendez O, Guerrero R, Alsan M, Seinfeld J.: Investing in cancer care and control. Chapter 3 in: Knaul FM, Gralow JR, Atun R, Bhadelia A. editors for the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries. Closing the Cancer Divide: An Equity Imperative. Cambridge, MA: Harvard GlobalEquity Initiative; 2012. Distributed by Harvard University Press

[2] WHO (2020) WHO report on cancer – setting priorities, investing wisely and providing care for all https://www.who.int/publications/i/item/who-report-on-cancer-setting-priorities-investing-wisely-and-providing-care-for-all

[3] Romero Y, Trapani D, Johnson S, Tittenbrun Z, Given L, Hohman K et al (2018) National cancer control plans: a global analysis. Lancet Oncology, 19(10):E546-E555

 
Last update: 
Monday 10 August 2020
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