Bridging Divides: The diagonal optimalist approach

Felicia Marie Knaul

Tuesday, June 14, 2011 Global Health Council Washington, DC

July, 2007

January, 2008

The Cancer Divide: disparities in

outcomes between poor and rich directly related to inequities in access and differences in underlying socio-economic and health conditions.

The divide is the result of concentrating risk factors, preventable disease, suffering, impoverishment from ill health and death among poor populations.
fueled by progress in cutting-edge science and medicine in high-income countries.

The opportunity to survive (M/I) should not be defined by income. Yet it is.
100%

Children

Adults

Survival inequality gap

Leukaemia
Cervix Prostate HL N HL

All cancers

Breast Testis

LOW INCOME

HIGH INCOME

LOW INCOME

HIGH INCOME

Source: Knaul, Arreola, Mendez. estimates based on IARC, Globocan, 2010.

Avoidable cancer deaths

Income Region Low income Lower middle income Upper middle income High income % of deaths considered avoidable

65 53 46 29

LMICs: 83% of avoidable

The cancer divide: an equity imperative

Cancer is a disease of rich and poor yet, it is increasingly the poor who suffer:
Exposure to risk factors Cancers of infectious origin Death from treatable cancer Stigma and discrimination Avoidable pain and suffering Impoverishment

Challenge and disprove the minimalists: myths about cancer& NCD

M1. Unnecessary: Not a health priority for the poor M2. Impossible: Nothing we can do about it M3. Unaffordable: .for the poor M4: Inappropriate: Challenging cancer implies taking resources away from other diseases of the poor

The diagonal approach to health system strengthening

Rather than focusing on disease-specific vertical programs or only horizontally on system constraints, harness synergies that provide opportunity to tackle disease-specific priorities while addressing systemic gaps. Optimize available resources so that the whole is more than the sum of the parts Bridge the divides as patients suffer diseases over a lifetime, most of it chronic

Diagonal strategies
1. Harness platforms: Integrate disease prevention, screening and survivorship into MCH, SRH, HIV/AIDs, social welfare/anti-poverty programs 2. Delivery: Catalyze, employ and deploy community health workers and expert patients 3. Financing: social protection strategies that include horizontal and vertical coverage 4. Stewardship: Improve regulatory frameworks to remove non-price barriers to pain control

Juanita:
Her cancer was detected late -- a series of missed opportunities to apply the diagonal approach

Be an optimist optimalist: apply the economics of hope

Restructuring health systems in the face of chronicity: The diagonal optimalist approach
Felicia Marie Knaul
Tuesday, June 14, 2011 Global Health Council Washington, DC