Cancer continues to be a compelling example of inequity in health care. Differential access to cancer services is not just a problem between high-income and low- or middle-income countries, we also see it within countries and regions. Accessing treatment and care for cancer is pushing patients and their families into financial difficulty or to near bankruptcy. As a result, the international focus on Universal Health Coverage (UHC), including financial risk protection, represents a significant opportunity for cancer patients, irrespective of where they live.
Universal Health Coverage (UHC) is a concept that has been talked about for decades. The concept of ‘health for all’ is reflected in WHO’s constitution and was the key driver in the 1978 Alma-Ata declaration on primary health care (PHC). Huge challenges emerged to achieving ‘health for all’ through development initiatives such as Structural Adjustment Programmes (SAPs), which cut back public investment in health services and widened health inequities, particularly in the most resource-poor settings. Consequently, the inclusion of a target on UHC in the Sustainable Development Goals (SDGs) that includes financial risk protection, as well as access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines, is a significant political step. If accompanied by national action, it can transform the lives of millions of people.
While some countries are making progress on including cancer in UHC plans, others are not. One possible explanation for this is that, unlike other interventions such as safe motherhood or programmes to reduce child mortality, the level of need for NCDs, including cancer, is less well known, making it difficult to assess health service utilisation levels for planning and costing. Another more pervasive reason is that cancer interventions are seen as being prohibitively expensive and infeasible through public funds. Neither of these arguments hold up. Improvements in cancer surveillance provide important information on the most prevalent cancers in a country and, increasingly, data on mortality and survival. Investment cases on interventions related to cancer and other NCDs have demonstrated a high return on health and economic outcomes and are included in the ‘WHO best buys’.
Strong primary health care is a foundation for achieving UHC. PHC ensures people receive comprehensive care, ranging from promotion and prevention to treatment, rehabilitation and palliative care across the life course and in the communities where they live. This provides an important opportunity for cancer control where cancer prevention and early detection can be feasibly integrated into the health system alongside other, existing services, for example:
As articulated in the 2017 cancer resolution adopted by the World Health Assembly, the establishment of centres of excellence, with skilled staff and essential medicines and technologies, must also be set up by governments to meet the needs of patients with complex NCD treatment and care needs. As such, diagnosis, treatment and care for cancer must also be included in any national UHC package. Just as UHC is about progressive realisation, countries can begin with implementing a selected set of cancer interventions and increase this over time.
In October this year, a bold, new declaration on PHC was agreed in Astana, Kazakhstan. It is therefore timely that, following the UN High-Level Meeting on UHC in September 2019, the next World Cancer Leaders’ Summit will focus on Cancer and Universal Health Coverage and be held in Almaty, Kazakhstan. This constellation of events offers the cancer community the chance to collaborate with different stakeholders to develop a package of interventions that can integrate cancer into health systems as part of UHC. Achieving this has the potential to help us achieve another key target of the SDGs; a reduction of premature mortality for cancer and other NCDs by a third by 2030