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CANCER CONTROL INTERVIEW

8 CANCER CONTROL 2021

of health. The general public often does not prioritize health

in political dialogues, instead focusing on income and wealth,

security, infrastructure. Our task is to make health seen as a

communal good.

The promotion of health is further constrained by what

people expect from governments in regulations to reduce risk

exposure - that is, a 'nanny state' dialogue. And with cancer, we

are further tasked with communicating the difference between

risk and hazard.

Within the health agenda, cancer can feature prominently,

particularly in high-income countries. It has featured in recent

US elections as an example through political commitments.

But, in the vast majority of countries, investments are not

concomitant to the broader health, social and economic

burden of the disease.

And, political commitments are only one step towards

practical actions. After the UN High Level Meeting on NCDs

in 2011, after all this energy went into preparation and

into political engagement, progress has been sporadic and

insufficient. There were 34 Heads of State at that Meeting

and over 50 Health and Foreign Ministers. But, if we look at

impact from available data, there has not been concomitant

improvements in general government expenditure on NCDs

before and after that 2011 event.

But we all felt better afterwards?

Yes, we did feel better. It was not a failure per se. But, it begs the

question of what constitutes success? And, for whom? Similar

to 'shooting for the stars for cancer cure', are we also 'shooting

for the stars' that every government is only prioritizing cancer?

Would that be well situated in the reality of where cancer fits

in a broader health agenda?

Once you start saying cancer is the most important issue…. I've

always felt very uncomfortable with that. There's a woman

in a field somewhere struggling with a breech birth, are you

really telling me that your five-year randomized control trial

getting an extra six weeks of life is more important? One

wants to say: "Guys, where's your humanity?"

That was perfectly said. For all of us in the cancer community,

it is the a driving purpose for our lives, how we spend our time

and energy. At the same time, there's a lot of unrelated poor

health and suffering in the world.

We can start by shifting away from heavily focused

investments on curative therapy at all costs. Yes, it is absolutely

important that we innovate, that we drive progress. But, we

can also see how supporting the broader health agenda will

also benefit cancer community and save millions of lives each

year while doing it. Investments in primary healthcare and

universal health coverage improve cancer care. That is a fact

to provide more holistic care is, in some ways, a moral failure.

And when we ask people with cancer four questions "Do

you know what your prognosis is? Do you know why you're

receiving treatment? Do you know what are some of the

complications of your treatment? Do you know what the

financial implications of the treatment you're receiving? …

Ask these four questions anywhere in the world, and the vast

majority of cancer patients won't be able to know? Now, please

tell me isn't that an absolute failure in creating a system that

empowers cancer patients?

How do you regard the current COVID-19 pandemic?

It has been devastating in health impact, but also devastating

in its social impact. Health has become increasingly viewed in

a political context, and trade-offs are positioned through a lens

of tribalism rather than solidarity. We are losing an opportunity

to show that health should promote social cohesion rather

than exacerbate it.

These days carry the weight of history. It is a global gut

check. The past year (2020-2021) has been so challenging

because solidarity is being lost in so many communities. Going

back to your question on what are some of the challenges

for us in the cancer community. We are experiencing similar

phenomena now with COVID-19 - divisions in priorities,

motivation and objectives. And, it is triggering burnout and

radical individualism that will harm the health agenda. We still

have opportunities to emerge stronger and with new ways of

working. But, we must acknowledge the massive human and

economic costs of the pandemic.

We should all be thinking more about the political philosophy

of cancer. What's so instructive about cancer is that it makes

you look afresh at Society and how we regard one another. If

we only think about the medicine, and the scientific/clinical

side of cancer we're missing a large part of the story.

I totally agree. We all applaud the advances in cancer survival.

But, at the same time, the social narrative and what cancer

means to individuals and to communities has been lost on

the focus on increasing survival at all costs. That's where I

agree with what you what you've said. The failure to create a

philosophy of cancer results in a complete void of a coherent

narrative behind it. Misinformation is rampant, creating

situations in which the gut response to the word 'cancer', for

too many people, is fear and misery not empowerment. And

that is current predominant 'the philosophy of cancer'.

If everyone's so afraid of cancer, why haven't we done better

in terms getting it onto political agendas? If cancer is so

commonplace why isn't it a leading issue?

It is multi-factorial and is linked to the broader political context

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