CANCER CONTROL PLANNING
34 CANCER CONTROL 2015
disability as a means of supporting
economic development and
promoting United States exports.
Developing countries have
represented roughly half of global
growth since the 2008 financial
crisis (17). United States privatesector
investments in sub-Saharan
Africa over the past decade have
yielded among the highest rates of
return of any region in the world,
but low-income countries cannot
sustain economic growth unless
their middle-class and workingage
people survive (18). In
addressing the rising burden of
cancer in these countries, the
United States advances its own
interests in international trade,
United States exports and American jobs.
Fourth, the international community has interests in
enhancing the credibility of global health programmes and
building fruitful partnerships with capable allies and rising
powers. The discrepancies in international global health
spending will grow in the coming years as the NCD crisis
expands in low- and middle-income countries and continues
to afflict young people disproportionately. Cancers and their
associated health-care costs are a pressing concern for the
economies and governments of countries of United States
strategic interest and an untapped opportunity for
collaboration. As the cancer epidemic expands, the economic
costs of these diseases on working-age people and
households could escalate into population dissatisfaction
with the governments in countries and regions where United
States interests lie.
The international community has strong interests to
increase engagement now. While the costs of child health
are declining in low- and lower-middle-income countries, the
opposite is true for adults (Fig. 3) (19). The economic growth
that developing countries must sustain just to achieve the
adult health performance that existed in developed
countries more than 60 years ago has risen sharply since the
mid-1990s. This trend is independent of the HIV/AIDS
epidemic. Three conclusions emerge from this analysis. First,
effectively addressing cancer and other NCDs in developing
countries will become more difficult with each year of
inaction. Second, economic growth alone is unlikely to solve
the NCD crisis in most of these countries. Third, effective,
low-cost international initiatives can make a difference, as
First, cancer undermines the effectiveness of existing
global health investments. Cancers (and NCDs in general)
are increasing in the same countries and populations that
United States and international initiatives target for other
global health concerns. The Task Force undertook case
studies of the 49 countries in which the United States
devoted US$ 5 million or more in aid for health in 2013.
NCDs accounted for 1.6 times as many premature deaths as
malaria, tuberculosis, and HIV/AIDS combined.
Second, cancers represent an opportunity for the United
States government and international partners to build on
existing global health platforms to achieve sustainable
reductions in premature death and disability that
disproportionately affect the poor. Cancer prevention and
treatment strategies incorporate similar elements of
management of HIV/AIDS: promotion of healthy behaviours,
long-term adherence to prescribed treatment, consistent
monitoring of treatment outcomes and patient engagement
in care and treatment decisions (15). The same approaches
that the global health community uses to ensure safe,
reliable supplies of AIDS and malaria treatment, childhood
vaccines and contraceptives could be leveraged to improve
access to the essential medicines needed to address cancer
in developing countries. A successful low-technology
screen-and-treat programme for cervical cancer in women
with HIV was piloted through PEPFAR in Zambia, and is a
good example of this opportunity (16).
Third, the United States has an important interest in
fostering the long-term capacity of developing countries to
prevent and reduce premature cancer-related death and
3000
2500
2000
1500 1985 1990 1995 2000 2005 2010
Year
GDP per person
Adult female
(15-59 years)
Adult male
(15-59 years)
Child
(Under 5 years)
Figure 3: GDP per capita associated with low- and lower-middle-income countries achieving the median
mortality rates that existed in high-income countries in 1950
Data source: Institute for Health Metrics and Evaluation, Global Burden of Disease Study 2013