President Couchepin, President Vazquez, your Royal Highnesses, Dr Cavalli, excellencies, honourable ministers, distinguished delegates, ladies and gentlemen,
First and foremost, let me thank you for this opportunity to address such a distinguished audience. As Dr Cavalli has noted, you represent a large number of countries and a broad spectrum of disciplines, including not only the biomedical sciences, but also the social and behavioural sciences, health economics, networks for patient support, and the voices of civil society.
This is entirely appropriate. A complex disease like cancer must be tackled on multiple fronts, by multiple partners. The five-track programme for this congress admirably captures the broad sweep of actions needed for cancer control.
For public health, the complexity of cancer control has increased enormously following the shift of the disease burden from wealthy to less affluent countries. According to the latest WHO statistics, cancer causes around 7.9 million deaths worldwide each year. Of these deaths, more than 72% are now occurring in low- and middle-income countries.
This is a shocking statistic, with huge implications for human suffering, health systems, health budgets, and the drive to reduce poverty. It is also a strong call to action.
We have known for some time that cancer incidence and survival are closely linked to socioeconomic factors. In low- and middle-income countries, cancer overwhelmingly affects the poor.
In these populations, opportunities for early detection, treatment, and cure are severely limited. Cancer tends to be detected at an advanced stage, when palliative care, including pain relief, is the only possible intervention.
Even this intervention fails to reach an estimated 4 million cancer patients in any given year. This is unacceptable.
Low-cost drugs, administered correctly, can relieve pain in nearly all cases. As stated in a recent World Health Assembly resolution, palliative care for all in need is an urgent humanitarian responsibility.
Ladies and gentlemen,
In wealthy countries, cancer has long been a greatly feared disease that touches lives in deeply personal ways. Today, cancer touches every country in the world, sometimes in deeply disturbing ways.
This is especially true when we look at national differences in the cancer burden, differences in access to treatment and care, and above all differences in outcomes and survival rates.
This congress will be considering a draft World Cancer Declaration. This is an outstanding document. Its recommended actions respond to a bleak situation. And I fully agree: the rise of cancer in less affluent countries is an impending disaster. The Declaration notes the failure of the international community to pay adequate attention to cancer, with efforts and resources traditionally focused on infectious diseases.
But let us look at this Declaration in the context of several recent trends in public health. I believe these trends make the international community especially receptive to the Declaration’s arguments, and responsive to its call to action.
The time is right to make cancer control a development priority.
This is the first priority action set out in the Declaration: place cancer on the development agenda. As we all know, chronic diseases, including cancer, were not on the agenda when the Millennium Declaration was signed and its goals and targets were set.
This is my first point. Cancer contributes to poverty and impedes development. The world can understand this now. The response to AIDS vividly demonstrated what chronic care means in terms of the demands on health systems, the health workforce, and financial resources, at the international, national, and household level.
Diseases like cancer are a leading cause of so-called catastrophic health expenditure. This is especially true in low- and middle-income countries, where most people rely on out-of-pocket payments for health care. WHO estimates that catastrophic payments for health care push an estimated 100 million people below the poverty line each year.
For cancer, out-of-pocket payment is a double-edged sword. It discourages people from seeking treatment early, when the chances of cure are greatest. And it deepens household and community poverty.
Health systems in developing countries can usually cope with the intermittent emergencies caused by infectious diseases. The patient either survives or dies. In contrast, the demands of chronic care can push a fragile health system to the breaking point.
This brings me to my second point: capacity building – one of the five tracks in the congress programme. The Declaration sets out specific capacity needs for cancer control, especially in low- and middle-income countries. These recommendations will fall on receptive ears.
In just the past few years, the international community has come face-to-face with the consequences of decades of failure to invest adequately in basic health systems. This is the biggest obstacle to health development.
First-rate interventions – and the money to buy them – will have little impact in the absence of systems for their delivery. Fortunately, the major funding agencies and health partnerships are now investing in basic health infrastructures and delivery systems. This trend, too, will benefit cancer control
For cancer control in low- and middle-income countries, breakthroughs do not come in the form of spectacular new drugs for cure. True breakthroughs come when research shows how existing tools can be adapted to work well in resource-poor settings. In this regard, let me applaud the work of partnerships like the Alliance for Cervical Cancer Prevention.
Like cervical cancer, liver cancer is far more prevalent in the developing world than in wealthy countries. With support from the GAVI Alliance, more and more countries with limited resources are introducing hepatitis B vaccine into routine immunization programmes. Globally, the number of countries with such programmes has grown from 31 in 1992 to nearly 170 today. This is progress.
If we can bring down the burden of cervical and liver cancers, we will give developing countries a head start as they confront the complex challenges of cancer control.
Unfortunately, virtually no country in the world is doing enough to prevent cancer. This is my third point. Tobacco control, which is also on your programme, is the world’s best opportunity to prevent cancer on a grand scale.
Let me assure you: public health is after the tobacco industry as never before. The Framework Convention on Tobacco Control has rapidly become one of the most widely endorsed treaties in the history of the United Nations.
Earlier this year, WHO introduced a package of six interventions that have proven their ability to reduce tobacco use – in any resource setting. Also this year, new funds in the millions of dollars have been made available for tobacco control, specifically in the developing world. This is one fight we must win.
Ladies and gentlemen,
I have one final observation. Developing countries are now face-to-face with problems that affluent countries confronted decades ago. Policies were devised. Lessons were learned. Incidence rates for some cancers dropped, while cure and survival rates improved.
These experiences need to be shared as urgently as possible. We are indeed on the brink of a disaster. As populations age, we must anticipate a continuing rise in cancer incidence. But what we cannot accept is the huge gaps in prospects for cure, survival, and a dignified death that divide the world according to wealth.
This is where the true breakthroughs are needed – in the interest of health development, in a spirit of social justice and solidarity, and for the sake of fairness in the prevention of human suffering.
Thank you.