the post-2015 agenda - there are still notable weaknesses
and omissions in the way that NCDs are defined and
addressed. For example, the HLP Report frames cancer and
other NCDs as an issue for high-income countries only, failing
to recognize that NCDs are a universal issue, with a
disproportionate impact on low- and middle-income
countries and vulnerable populations. While the HLP Report
gives little focus to the common NCD risk factors (tobacco
use, harmful use of alcohol, physical inactivity and unhealthy
diet), the recommendations of the Sustainable Development
Solutions Network7 do not address the need for a health
systems response to NCDs, including the critical need for
improving access to essential cancer medicines and
technologies.8 These omissions serve as a stark reminder that
the cancer community still has some way to go to ensure that
the full continuum of care for cancer is firmly positioned in
the post-2015 agenda.
Making the case for cancer in the post-2015 agenda
A strong political mandate
Since the development of the MDGs, the cancer and NCD
community has made history by securing a UN High-Level
Meeting which adopted the UN Political Declaration on NCDs
in 2011. This Declaration recognizes that "the global burden
of and threat of non-communicable diseases constitutes one
of the major challenges for development in the twenty-first
century, which undermines social and economic development
throughout the world, and threatens the achievement of
internationally agreed development goals".9
In May 2012, a global target to reduce premature deaths
from NCDs by 25% by 2025 was adopted by Member States
at the World Health Assembly. In 2013, the foundations of a
new global NCD architecture were put in place with the
adoption of a Global Monitoring Framework for NCDs
(GMF), a Global NCD Action Plan 2013-2020 (GAP) and a
Global Coordination Mechanism for NCDs. UICC, its
members and partners, welcomed the inclusion in the GMF
and GAP of cancer-specific targets, indicators and actions
including in the areas of cancer planning and surveillance,
vaccination for HPV and HBV against cervical and liver
cancers, early detection and screening for breast, cervical,
oral and colorectal cancers linked to timely treatment,
access to essential medicines and technologies, and
palliative care policies. These new and ambitious
commitments to the prevention and control of cancer,
particularly in low- and middle-income countries, signal the
readiness of governments to prioritize cancer in the global
health agenda, and recognition of the intrinsic links between
cancer and development.
The economics of cancer
The 13.3 million new cases of cancer in 2010 were estimated
to cost US$ 290 billion, and medical costs accounting for the
greatest share (US$ 154 billion), with non-medical costs and
income losses accounting for US$ 67 billion and US$ 69
billion respectively. The total costs are expected to rise by
US$ 458 billion in the year 2030.
10 Given that 47% of cancer
cases and 55% of cancer deaths occur in low- and middleincome countries, with this percentage set to rise
11, a large
proportion of these costs will hit the countries that are least
equipped to address this challenge. Even so, the staggering
risk that cancer poses to economic growth and development
is still only just starting to receive recognition through
investment in national cancer control plans, despite the fact
that we know that this risk can be managed effectively and
that a return on investment in health is possible. The World
Health Organization estimates that a basic package of costeffective
strategies to address the common cancer risk
factors in low- and middle- income countries would require
an investment of only US$ 2 billion a year
12
, and yet less than
3% of overseas development assistance for health is
invested in cancer and other NCDs.13
Cancer and the environment
Challenges to sustainable development such as rapid
urbanization, climate change and shifting agricultural and
resource use patterns impact on nutritional security, and are
linked with greater exposure to cancer risk factors including
smoking, poor diet and low physical activity.
Additionally, a wide range of environmental causes of
cancer, encompassing environmental contaminants or
pollutants in air and water, occupation-related exposures
such as asbestos and UV-radiation as well as exposure to
excessive sunlight and cancer-causing infections, together
make a significant contribution to the cancer burden.
"Better health outcomes from NCDs
[including cancer] is a precondition for, an
outcome of, and an indicator of all three
dimensions of sustainable development:
economic development, environmental
sustainability and social inclusion"
WHO Global NCD Action Plan 2013-2020
CANCER CONTROL PLANNING
CANCER CONTROL 2014 27