Humanosphere

Tom Paulson

No doctor, no medicine at clinic in rural Nigeria

There’s a big push going on right now to expand the scope of the global health agenda, to include many non-communicable diseases (NCDs) like cancer.

The American Society of Clinical Oncology (cancer docs) this week called upon President Barack Obama to push the United Nations to add cancer to the list of priority diseases in global health. The UN, which is holding a special high-level meeting on NCDs in September, seems likely to do so. The UN’s World Health Organization already resolved to do this last year.

Preventing cancer should definitely be on the agenda, as much of that is a matter of behavior change. But should cancer treatment be on the agenda?

My KPLU colleague Keith Seinfeld covered a March conference that addressed this question in his report Cancer joins AIDS, malaria as global health issue.

Keith quoted one Seattle doc claiming that treatment for breast cancer is cheap enough to be feasible in poor countries. But as NPR’s Scott Hensley recently noted, Even Many Americans Can’t Afford Cancer Care.

The AP reports that even up-and-coming countries like India already are being overwhelmed by health costs.

I’ve written about this issue before — mostly from the perspective of those who are advocating to get their cause on the global health agenda, whether it is cancer or mental illness or some other “neglected disease.” I missed another discussion about cancer in the global context yesterday, put on in Seattle by the World Affairs Council and featuring some leading cancer experts advocating, of course, for their area of expertise.

Maybe some of those who attended the WAC event will have something to add here.

The big question that often seems to go unanswered or glossed over is this:

Given that the international community is already having trouble meeting the demand for simpler and cheaper health interventions (children’s vaccines, basic antibiotics, malaria drugs) is much of cancer care too expensive for the global health agenda?

On the battlefield, medics developed the concept of triage — of deciding who to try to save and who to let die. It’s a brutal calculus, but one we make every day in global health by virtue of what gets funded and what doesn’t. Does global health, which was once a neglected field but now seems to be everybody’s best friend, need triage?

Jake Marcus, a fellow at the UW Institute for Health Metrics and Evaluation, recently wrote this article for The Atlantic expressing his doubts about whether the NCD movement in general will be able to gain much momentum.

Perhaps someone should be raising more doubts about the converse, about the risk of actually making the global health agenda too inclusive. Cancer docs want to fight cancer and they want to help even the poorest people. That’s great and some forms of cancer care will be applicable in low-resource communities.

But without some kind of prioritized global health strategy — some kind of triage that takes cost, poor country resources and complexity into account — it’s quite possible that Western health care industry interests will be advancing causes that are unlikely to be feasible for most poor countries.

A blue-ribbon bunch of think-tankers called the (somewhat grandiose-sounding) Commission on Smart Global Health Policy recently put out a report — “Smart Global Health” — that does offer some level of prioritization.The group also has a nifty quick video presentation on NCDs.

Cancer and the other NCDs need to be on the global health agenda. But it looks like we’re at the stage of maturation in global health where some triage is also needed – making the tough decisions about what not to do in order to concentrate on where you can help the most.