Breaking the cycle: health inequity’s hidden economic impact

With Breast Cancer Awareness Month (BCAM) around the corner, I’ve been thinking about how different the experience can be for people living with breast cancer, depending on where they live in the world. We all know about the stark disparities in care and outcomes depending on your geographical location, but I’d like to shine a light on another factor – the economic impact of a breast cancer diagnosis and the cost of inequity.??

Just imagine being in a position where the choice between treatment and bankruptcy is a very real threat. How much does that add to the incredible emotional toll of a breast cancer diagnosis? In India for example, some people with cancer are required to pay for more than half the total cost of their care, meaning they could be faced with unthinkable decisions that could rip through entire families.[1] And let’s not ignore the fact that limited access to screening services causes more late diagnoses, leading to worse outcomes, higher healthcare costs and lower productivity.[2]

We need a collaborative and holistic approach to tackle the far-reaching and devastating impact of health inequities on individuals, families, societies and economies. We need to involve policymakers, local governments, pharma companies and the healthcare community – that's how we can truly create a movement that strives to do better for every person facing a breast cancer diagnosis no matter where they live. This is the essence of the World Health Organization’s (WHO) Global Breast Cancer Initiative, which aims to reduce breast cancer mortality by 2.5% per year.[3] I’m proud to work for an organization like @Roche that’s making every effort to contribute to this goal and address the health inequities that people with breast cancer face. But we can’t do it alone, we need to work alongside people and organizations with expertise in how health systems operate on the ground and how they can work best for their local communities. Last BCAM, @Jacqueline Wambua and I discussed one way we’re doing this through the incredible EMPOWER program, but we haven’t stopped there.???

Recently, we partnered on the development of a report on the case for investing in women’s cancers in the Asia Pacific (APAC) region, which was developed by @Economist Impact and commissioned by the @APAC Women’s Cancer Coalition . Covering countries ranging from Australia to the Philippines and representing around 60% of the world’s population, the burden of breast cancer, as well as cervical cancer, is expected to rise faster in APAC than anywhere else.[2,4] This report aimed to dig into the health, societal and economic impact of women’s cancers and the policy environment around them, to highlight the opportunity to invest for impact, to address these cancers and to determine the steps we can take to improve outcomes for the region.?

These are some of the recommendations from the report that most stood out to me because they clearly show the need for collaboration across the healthcare ecosystem to address women’s cancers from every angle:?

• Governments should prioritize women’s cancers as key policy areas to achieve national targets for immunization, screening and treatment.
• Governments and global funding bodies should devise and implement effective and sustainable funding models.
• Services and programs should be patient-centric and tailored to the needs of affected populations in different settings.
• Integrated, holistic approaches should be taken to tackle resource and capacity challenges.?

The final recommendation is one that our Ivory Coast team has already brought forward in its work to tackle some of the resource and capacity challenges in the country. On the Ivory Coast, there’s limited access to healthcare professionals (only 0.2 doctors per 1,000 patients, compared with 2.6 per 1,000 in the US) and few screening, diagnosis and treatment centers.[5] This drove our Ivory Coast team to work with the government, the national cancer control program and other stakeholders across the healthcare ecosystem to create the @Innov’Keneya program with Impact Hub Abidjan . Part of the work involved setting up AI-powered technologies to aid the limited capacity of healthcare professionals, including:

• pre-screening, risk evaluation and stratification tools for healthcare community workers.?
• telepathology platform to support decision-making, training capacity and to optimize coordination.?

For this amazing work, the Innov’Keneya program received an award for digital and innovation from @SANTE EN ENTREPRISE , one of the largest corporate social responsibility health-focused networks in Africa.?

To reach even more people, we’ve collaborated with @City Cancer Challenge , along with other private-sector partners, with the aim to support cities in low- and middle-income countries with populations of over 1 million to improve equitable access to quality cancer care. Take Rwanda, we worked together with Rwanda’s Biomedical Centre to set up a patient navigation program to improve care for women with breast and cervical cancer. The digital platform allows specialists from hospitals in the country’s three main cities to share information to ensure systematic multidisciplinary clinical decision-making. Check out this article , if you want to find out more about this initiative.?

Clearly, all of these individual partnerships and initiatives are moving us in a positive direction on the long road to health equity for all people with breast cancer, but how can we learn from them more quickly and scale them at pace? How can we make sure that this great work isn’t restricted to that community or city alone? Because, while the specifics might be different, the overall challenges that might be faced in, say, the Ivory Coast may not be all that different from somewhere like Vietnam, as highlighted in some of the examples shared. I’ve heard firsthand from stakeholders around the world that they are eager to collaborate in order to accelerate learnings and advance health equity, via our XProject initiative . By partnering and applying our learnings elsewhere, we can create a virtuous circle of positive change for individuals, families, societies and economies.?

References?

[1] Maurya P, et al. Economic Burden of Cancer Treatment in a Region in South India: A Cross Sectional Analytical Study. Asian Pac J Cancer Prev.?2021;22(12):3755–62.

[2] Economist Impact. Impact and opportunity: the case for investing in women’s cancers in Asia Pacific [Internet; cited 2023 September]. Available from: https://impact.economist.com/perspectives/sites/default/files/ei249_-_womens_cancer_in_apac_v10.pdf .

[3] World Health Organization. The Global Breast Cancer Initiative [Internet; cited 2023 September]. Available from: https://www.who.int/initiatives/global-breast-cancer-initiative .?

[4] United Nations Economic and Social Commission for Asia and the Pacific. Population trends in Asia and the Pacific [Internet; cited 2023 September]. Available from: https://www.unescap.org/sites/default/files/SPPS-Factsheet-Population-Trends-v3.pdf .?

[5] The World Bank. Physicians (per 1,000 people) [Internet; cited 2023 September]. Available from: https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?end=2019&locations=CI&start=2012 .