CANCER CONTROL PLANNING
32 CANCER CONTROL 2015
global health matter. The Task Force was co-chaired
by Mitchell E Daniels Jr, former governor of Indiana
and Thomas E Donilon, former national security
adviser to President Barack Obama. The bipartisan
Task Force was composed of a distinguished group of
experts that included former government officials,
scholars, and practitioners.
The charge of this Task Force was to assess the case
for greater United States engagement on the NCD
crisis in developing countries and recommend a
practical strategy for intervention. In doing so, the
Task Force considered four questions: (i) the effect of
NCDs in low- and middle-income countries now; (ii)
existing efforts to address them; (iii) United States
and international interests in doing more; and (iv)
possible cost-effective interventions to address the
epidemic. This article summarizes those findings, paying
particular attention to the burden and interventions related
to the prevention, management and treatment of cancer in
low- and middle-income countries.
The effect of NCDs in developing countries
NCDs are rising faster, affecting younger populations and
having worse health and economic outcomes than seen in
developed countries. Cancer, cardiovascular disease and
chronic respiratory illnesses cause 80% of the deaths and
two-thirds of the disability from NCDs in these countries.
Cancer and these other NCDs long ago became a challenge
for developed countries as well, but the epidemiological
transition happening in developing countries differs in
speed, scale, and consequence (Fig. 2).
NCDs are affecting people at younger ages in low- and
middle-income countries than they are in wealthy states.
Most of the death and disability from NCDs in emerging
countries occurs in working-age people (those under the age
of 60). In many low-income countries, particularly in Africa,
that proportion rises to 90% or higher.
Cancers and other NCDs are also yielding worse outcomes.
Cancers that are preventable or treatable in developed
countries are often death sentences in developing countries
(2). Whereas cervical cancer can largely be prevented in
developed countries thanks to the human papillomavirus
(HPV) vaccine, in sub-Saharan Africa and South Asia it is the
leading cause of death from cancer among women (1). Ninety
percent of children with leukemia in high-income countries
can be cured, but 90% of those with that disease in the
world's 25 poorest countries die from it (3).
The rise of NCDs in low- and middle-income countries is
not merely a byproduct of success - reductions in infectious
diseases or increasing incomes (4). Death and disability from
NCDs in low- and lower-middle-income countries is
increasing faster than the rate of decline from
communicable diseases. Premature death and disability
from cancer and other NCDs is increasingly associated with
poverty in emerging countries, just as they are in wealthier
nations. The trajectories of many NCDs depend on the
wealth of the country where one lives. The death and
disability wrought by breast, lung, and cervical cancer,
(measured in Table 1 as disability-adjusted life years, or
DALYs) are subsiding in developed countries but increasing
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18 1990 1995 2000 2005 2010
Year
Millions of deaths
Figure 2: Deaths caused by NCDs in low- and middle-income countries
Data source: Institute for Health Metrics and Evaluation, Global Burden of Disease Study 2013
Table 1: Percentage change in DALYs: 1990-2010
Data source: Institute for Health Metrics and Evaluation, Global Burden of Disease Study 2010
Low income Lower-middle income Upper-middle income High income
All communicable diseases -14% -27% -47% -23%
All NCDs 42% 38% 18% 9%
Lung cancer 78% 56% 52% 7%
Breast cancer 124% 58% 55% 1%
Cervical cancer 28% 19% 18% -16%
Leukaemia 54% 30% -7% 1%