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CANCER CONTROL 2015 33
fast in developing countries.
The factors fueling the soaring rates of NCDs are dramatic
changes in urbanization, global consumer markets, and
longevity that occurred in wealthy nations over decades, but
are happening simultaneously and much faster in still-poor
countries. Urbanization, trade and the global integration of
consumer markets have done much good in developing
countries: improved sanitation, lifted millions from poverty
and increased food production.
Yet these trends have also helped fuel a rise of NCDs and
associated risk factors that is faster than developing
countries have been able to establish the health and
regulatory systems necessary to adjust. Health spending by
low- and middle-income country governments has tripled
over the past 20 years but remains low relative to higherincome
countries (5). Health spending by all developing
country governments, representing 5.7 billion people, is less
than is spent by the governments of Canada, France,
Germany and the United Kingdom, which have a combined
population of 245 million (6).
The United States and international response to
United States' response
Despite the growing urgency, the United States and
international community response has been modest. The
United States currently has no dedicated programmes or
budget to address cancers and other NCDs in low- and
lower-middle-income countries (7), but has worked with
international partners to incorporate cancer prevention and
treatment into larger existing United States global health
initiatives. The following list illustrates a few of these
‰ The United States Centers for Disease Control and
Prevention (CDC) has advised developing-country
governments on cervical cancer screening, surveillance,
and prevention programmes (8).
‰ The United States Department of State and the CDC
Foundation support the Pink Ribbon Red Ribbon
initiative, which leverages the President's Emergency
Plan for AIDS Relief (PEPFAR) programme to promote
breast cancer education and expand cervical cancer
screening and treatment (9).
‰ The United States National Institutes of Health's (NIH)
National Cancer Institute (NCI) has provided training on
establishing cancer registries in low- and middle-income
countries and contributed limited support to several
sub-Saharan African countries to do so.
‰ The NCI promotes United States research collaborations
with China and five Latin American countries,
participates in the Middle East Cancer Consortium,
provides a four-week training course in cancer
prevention, and offers a small number of grants to South
African and Indian researchers working on low-cost,
cancer-related technology (10).
‰ The United States Agency for International
Development (USAID) has provided support for the
Global Alliance for Clean Cookstoves and the Uganda
Cancer Institute (11).
Though promising, these initiatives are small-scale.
According to the Institute for Health Metrics and Evaluation
(IHME), the United States government only dedicated US$
10.8 million of its more than US$ 8 billion global health aid
budget to NCDs in 2010 (5).
International community response
In the absence of strong United States leadership, the
international response to cancers and other NCDs has
struggled. The United Nations (UN) General Assembly's
2011 high-level meeting on NCDs helped broaden public
recognition of the human and economic toll of NCDs and
inspired several important country-led initiatives (12, 13). In
May 2012, the World Health Organization (WHO) set a
voluntary global target for reducing premature NCD
mortality by 25% by 2025, reached agreement with its
member states on an international monitoring framework,
and released another global action plan on NCDs.
Yet donor aid, in-country resources, and a practical, wellprioritized
agenda for collective action on NCDs remain
elusive (5). In 2010, the international development
assistance for health dedicated for each DALY lost to
HIV/AIDS was US$ 69.38, US$ 16.27 per DALY lost to
malaria, and US$ 5.42 per DALY lost to poor maternal,
newborn, and child health, but only US$ 0.09 per DALY lost
to NCDs (14, 5). Cancer research, treatment and prevention
programmes targeting low- and middle-income countries
receive only a fraction of the international aid devoted to
The case for increased United States and
United States and international interests will be affected by
the rise of NCDs in low- and middle-income countries
because of their human, economic and strategic
consequences. The international community has four
compelling interests to increase its engagement on cancers
and other NCDs.