Jeffrey L. Sturchio
Senior Partner, Rabin Martin
Jeffrey L. Sturchio is senior partner at Rabin Martin, a global health strategy firm in New York. Prior to joining the firm, he served as president and CEO of the Global Health Council. Before joining the Council, Dr. Sturchio was vice president of Corporate Responsibility at Merck & Co. Inc., president of the Merck Company Foundation and chairman of the U. S. Corporate Council on Africa, whose 150 member companies represent some 85 percent of total US private sector investment in Africa. He is a visiting scholar at the Institute for Applied Economics and the Study of Business Enterprise at Johns Hopkins University, a Fellow of the American Association for the Advancement of Science and a member of the Council on Foreign Relations. He received an AB in history from Princeton University and a PhD in the history and sociology of science from the University of Pennsylvania.
co-authored by Cary Adams.
All of us have been touched by cancer, whether personally or through the experience of our families and friends. For those of us living in the developed world, many types of cancer have ceased to be the “dread disease” they once were: Given the remarkable advances in basic science and oncology, it’s more a question of what the best course of treatment is, rather than one of availability or affordability. But for most of the world, access to cancer screening, detection, diagnosis and oncology care is still an unattainable luxury. Considering that nearly half of cancer cases — and 55 percent of the deaths — occur in less developed countries, we need to make progress now.
If left unchecked, the annual economic burden of cancer will be an estimated $458 billion by 2030, according to a study by the World Economic Forum and Harvard School of Public Health. But the human cost of 21.4 million new cases per year by 2030 is, quite simply, unacceptable. In commemoration of World Cancer Day (Today, February 4), we call for the global community to step-up its efforts to address cancer and other NCDs.
Cancers, along with other non-communicable diseases (NCDs) such as diabetes, upper respiratory infections and cardiovascular disease, are the leading causes of mortality around the world. Indeed, the number of cancer deaths alone surpasses those attributed to AIDS, tuberculosis and malaria combined. Once considered illnesses of the wealthy, 80 percent of the estimated 36 million NCD-related deaths actually occur in low- to middle- income countries, according to the World Health Organization. And while a global movement for action on NCDs has been gathering momentum in recent years, much remains to be done.
The Institute for Applied Economics, Global Health and the Study of Business Enterprise at Johns Hopkins University recently released a set of policy briefs that present recommendations for Addressing the Gaps in Global Policy and Research for Non-Communicable Disease. The publication compiles the findings of a Working Group of leading experts in the field and offers a road map of actionable recommendations for reducing the global burden of these diseases.
The report echoes many of the themes put forth by the global cancer community for achieving the goals articulated in the World Cancer Declaration. For starters, there needs to be a multi-sectoral approach to cancer. Governments, civil society, academe and the private sector must work together to leverage strengths and efficiencies to advance efforts to reduce the burden of cancer.
Greater participation by the private sector in a transparent and open way will improve efforts against the disease in coming years. Certainly, private-public partnerships to tackle cancer exist, but greater collaboration among stakeholders is needed. One suggestion may be to develop a knowledge exchange network for oncology researchers in industry and academe to accelerate the rate of progress in discovering and developing new vaccines, personalized medicines, pharmaceuticals and other essential medical technologies. While their most significant role is — and will continue to be — in R&D, the private sector can also lend considerable expertise in systems efficiencies, human resource development and supply chain management, to name just a few areas in which their capabilities can improve the global response to cancer.
Governments need to play a more active role in actively reducing and raising awareness about risk factors for cancer and other NCDs. They need to work with civil society and industry to reduce tobacco and excessive alcohol use, while promoting healthier diets and physical activity at the national and community levels. Again the private sector can play a lead role in improving the health impacts of their products to reduce the global growth in NCDs.
Countries need to make greater investments in building the capacity of local health workers so they are more capable of educating patients about reducing their cancer risk through behavior modification as well as immunization against human papilloma virus (HPV) and hepatitis B (HBV) infections (which can lead to cervical cancer and primary liver cancer, respectively). Health workers are the first line of defense, detecting hallmarks of disease and providing cancer screening, treatment and, when necessary, long-term care. Moreover, countries need to re-evaluate how they can retain health workers who are trained in cancer care. Without them, all interventions become impossible.
Finally, there needs to be greater focus on providing equitable access to screening, early diagnosis and treatment. Self-exams and visual inspection with acetic acid for breast cancer and cervical cancer screening respectively, are two excellent examples of effective, inexpensive, life-saving innovations that can be implemented even in low-resource settings. Integrating these methods into existing primary, reproductive and maternal health service models would help reduce the 750,000 deaths from cervical and breast cancer each year.
It’s a lot of work, but for many of us, cancer hits very close to home. By working together to combat cancer, each doing our part, we can begin to make a difference in the lives of millions — making cancer care and treatment not a luxury, but a reality.
Cary Adams is CEO of the Union for International Cancer Control (UICC), which helps the global health community accelerate the fight against cancer. Its growing membership of over 700 organisations in 155 countries features the world’s major cancer societies, ministries of health and patient groups and includes influential policy makers, researchers and experts in cancer prevention and control. Adams and his team focus on global advocacy to deliver the World Cancer Declaration targets by 2020, running global programs that address key cancer issues and use their membership reach to bring about the exchange of best practice globally. He recently became Chair of the NCD Alliance, a coalition of around 2,000 NGOs working on non-communicable diseases.
Jeffrey L. Sturchio and Doug Ulman
The Global Burden of Cancer
During those intense and often tragic periods, we usually have options — education, treatment, pain relief and sometimes, blessedly, remission and recovery — that is, if we happen to reside in a wealthy country. Not so for millions of others, adults and children alike, in poorer countries where more than 70 percent of all cancer deaths occur yet five percent or less of cancer resources are allocated to the people living there, despite the growing cancer burden.
Cancer is a growing cause of death worldwide. The cancer burden in low- and middle-income countries is increasingly disproportionate. Globally in 2009, there were an estimated 12.9 million cases of cancer, a number expected to double by 2020, with 60 percent of new cases occurring in low- and middle-income countries.
Not only do these countries carry more than half the disease burden, they lack the resources for cancer awareness and prevention, early detection, treatment or palliative options to relieve the staggering pain and human suffering if the disease is untreated — an unthinkable outcome for people who have cancer in rich nations.
Cancer also has the most devastating economic impact of any cause of death in the world, according to the recent landmark report, “The Global Economic Cost of Cancer,” released by the American Cancer Society and Livestrong. Premature deaths and disability from cancer cost the global economy nearly 1 trillion dollars a year. The data from this study provides compelling evidence that balancing the world’s global health agenda to address cancer more effectively will save not only millions of lives, but also billions of dollars.
By making cancer a global priority, as with many other non-communicable diseases, cancer deaths can be prevented an estimated 40 percent or more. This goal is a particular focus of this year’s World Cancer Day(today, February 4). But prevention can only be achieved through investments in awareness and education. Neglect of prevention leads to unaffordable treatment.
Even though tobacco use is the most preventable cause of cancer, lung cancer still kills more people worldwide than any other — a trend likely to surge unless efforts for global tobacco control are greatly accelerated. Tobacco use is responsible for 1.8 million cancer deaths per year, 60 percent in low- and middle-income nations, thanks to the tobacco industry’s unrelenting country-by-country approach to marketing their addictive product, including to youth. Last year, the Australian Broadcasting Corporation won a Global Health Council Excellence in Media Award for its hard-hitting and poignant exposé of tobacco marketing in Indonesia, “80 Million a Day: Big Tobacco’s New Frontier.” We need to cast more light on this invisible killer.
Other preventable risk factors for all cancers are unhealthy lifestyles (including alcohol abuse, inadequate diet and physical inactivity), exposure to occupational (e.g., asbestos) or environmental carcinogens (e.g., indoor air pollution), radiation (e.g., ultraviolet and ionizing radiation) and infections.
Cancers due to infectious diseases account for 8-10 percent of cases in high income countries, but 20-26 percent in developing countries. The human-to-human spread of viruses and bacteria can lead to liver and stomach cancers, lymphomas and leukemia. In addition to infections, many reproductive health diseases are linked to cancer. Strengthening the health systems of developing countries will pave the way for improved vaccine delivery and wider coverage of immunizations that will save lives and protect people’s health.
The Global Health Council and Livestrong call on global partners, allies, donors, policymakers, communities and individuals to work collaboratively to address the treatment expenditure gap and change the trajectory of this tidal wave of cancer. We have a choice – invest now or pay later with significant government spending and the loss of millions of lives and lessened productivity.
Capacity building is essential. Ministries of health, education and finance need to be engaged in developing and supporting plans that include both training of personnel to diagnose and treat cancer patients and strategies to reduce costs and strengthen health systems.
We need to focus on cancer surveillance to set standards to understand better the burden of cancer and the impacts of interventions. We need to implement relevant interventions at scale, including those that draw on successful models that address other diseases. We must rapidly expand information and awareness campaigns on a global scale to reach deeply into affected communities of developing countries. And we need continued investments in research and development for improved knowledge of the science of cancer and better drugs, vaccines and new tools for cancer prevention and control.
Starting today, advocates, governments, non-profits and the private sector must drive new and effective policies, programs and investments. Patients and survivors around the world cannot wait a moment longer for us to advance the global fight against cancer. Failing to act is indefensible — the human and economic costs are too high.
See more information at “Cancer in Developing Countries,” Global Health Council.
Jeffrey L. Sturchio and Pamela W. Barnes
The Best Investment in Global Women’s Health
Around the globe, from Cape Town to Kathmandu, from Manila to Mexico City, millions will be celebrating the 100th anniversary of International Women’s Day on March 8 — a day to honor the achievements made by and for women. Looking at this milestone through a global health lens, we see an increasingly positive picture, but the view is far from perfect. In fact, we stand at a crossroads.
Globally, we’ve seen a notable decline in maternal deaths from half a million women to 342,000 annually. This is still far too many, but it is an important step in the right direction. Yet this progress is at risk, with mounting efforts underway to deny access to one of the best investments in women’s health: family planning.
In Bangladesh, just last month, a national survey showed a 40 percent drop in maternal deaths during the last decade. One of the contributing factors? Family planning. That is an unprecedented step forward.
Tanzania achieved a 21.5 percent drop in maternal deaths during the last five years, precipitated in part by increased access to and enthusiastic use of modern contraception. Another step forward.
In places like Ghana and Ethiopia, women every day have access to more contraceptive options — another step forward — as they endeavor to plan their families and define their futures. Women like Ayera Kabele, an ambitious 30-year old in Addis Ababa. She married in her early 20s and had a child soon thereafter. But she was also a student who wanted to finish college — a dream achieved because she was able to delay having another child by using an IUD. Four years later, degree in hand, Ayera and her husband were ready for their second child — another dream achieved. Yet another step forward.
This scenario between couples plays out every day around the world — including here in the United States. These are universal conversations about when to start a family and how many children to have. Anyone who has been a party to one can appreciate how vital they are to the health and well-being not only of women, but also of their families as well.
Why is that? In addition to saving women from death and injury during pregnancy or childbirth, saving mothers’ lives saves babies’ lives. Family planning also boosts women’s economic empowerment and creates an environment where children have a better chance not only to survive, but also to thrive. Strong and healthy families lead to stronger and more stable communities, in a virtuous cycle toward prosperity for nations.
We know that up to one-third of maternal deaths could be prevented if every woman who wanted to use contraception to limit or space her births was able to do so. In part, this is due to fewer unwanted pregnancies — especially when women have no other options — and thus to fewer women seeking abortion to end them. Mostly, though, it’s because every pregnancy and childbirth poses risks, especially where medical care is inadequate, if it exists at all. This is how family planning saves lives — and more.
Yet flying in the face of mounting evidence, there is a real risk that the United States foreign assistance budget will include drastic cuts to international family planning — the catalyst to so much good in countless communities worldwide. Indeed, at a moment when every budget dollar must be used as efficiently and effectively as possible, few investments pay better long-term dividends than family planning.
Just four years remain until the deadline for achieving the Millennium Development Goals (MDGs) set by the United Nations. A report released last year rated access to reproductive health care as low or moderate in 70 percent of the regions surveyed. This is not acceptable.
There have been strong policy and funding commitments made in the United States’ Global Health Initiative as well as at the United Nations (U.N.) to bolster access to and support for family planning as vital investments to improve the lives of women and families worldwide. The year 2010 also saw the launch of the first-ever U.N.’s Global Strategy for Women’s and Children’s Health and ongoing efforts by the State Department’s Office on Global Women’s Issues to link foreign policy with women’s rights. There is much reason for optimism.
As we mark the centennial of International Women’s Day, supporters of women’s health worldwide must continue to advocate for family planning and reproductive health services, which have done so much for women and girls in the U.S. and in so many countries around the world.
See the Global Health Council position paper on Maternal, Newborn, Child and Reproductive Health.
![CT (A) of 78-year-old male who was status post–left lobe lobectomy and left upper lobe wedge resection shows recurrent nodule at the surgical resection site. Fused PET/CT (B) demonstrates increased [18F]FDG uptake in the corresponding nodule at the surgical resection site consistent with recurrent tumor.](https://i0.wp.com/pharmaceuticalintelligence.com/wp-content/uploads/2013/01/fig-10-lung.jpg)
![CT (A) demonstrates new left upper lobe mass representing new primary NSCLC in a patient who had a status post–right pneumonectomy for a prior NSCLC. CT (B) obtained in the same patient 2 weeks after radiofrequency ablation (RFA) demonstrates the postablation density in the left upper lobe. Fused PET/CT (C) obtained 4 months after RFA demonstrates mild [18F]FDG uptake at RFA site in the left upper lobe consistent with posttreatment inflammation. Fused PET/CT (D) obtained 7 months after RFA demonstrates new focal [18F]FDG uptake at post-RFA-opacity consistent with recurrent tumor.](https://i0.wp.com/pharmaceuticalintelligence.com/wp-content/uploads/2013/01/fig-11-lung.jpg)
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