Not Beyond Us. This is the theme of World Cancer Day 2015 [8]. But how will we achieve it? Cancer can seem insurmountable. The global cancer burden is great. In 2012, 8.2 million people died from cancer-related causes—most of them in Africa, Asia, and Central and South America, which experiences more cases and more deaths than anywhere else: 60 percent of the 14 million new cancer cases annually and 70 percent of all cancer-related deaths occur in the developing world [9]. The same countries bearing the brunt of the cancer burden have the fewest resources to tackle it [10].

Still we know and remind one another today, the 4th of February: We can and must stop vaccine-preventable cancers and reduce preventable cancer deaths. We must reduce the cancer inequities.

Cancer, you are not beyond us.  

Among women, cervical cancer is one of the deadliest -- and most easily preventable -- cancers.  Women in the developing world account for 85 percent of the 270,000 deaths every year.  Yet we know that effective prevention, treatment and care are possible.

This post originally appeared on Devex [13].

Cancer is gaining ground in the developing world.

People in poor countries are more likely to die from cancer, and die far younger, than people in rich countries. Today, on World Cancer Day, this  [14]cancer divide [14] continues to worsen. Even as misconceptions have receded, the reality hasn’t.

There’s been political progress at the global level, including the 2011 U.N. resolution on noncommunicable diseases like cancer. Yet the traditional mode of global assistance for developing countries — aid funding — hasn’t been forthcoming. Without it, the NCD agenda has gained little traction in those countries.

Perhaps the answer isn’t countries at all.

Addressing NCDs is critical for global public health, but it will also be good for the economy; for the environment; for the global public good in the broadest sense… If we come together to tackle NCDs, we can do more than heal individuals–we can safeguard our very future.

- UN Secretary General Ban Ki-Moon in his remarks to the UN General Assembly in 2011

Management Sciences for Health (MSH) and the LIVESTRONG Foundation [18] (LIVESTRONG) are proud to sponsor a Congressional staff study tour to Uganda and Rwanda [19] examining the key elements of the countries' health systems with a particular focus on how the countries are addressing non-communicable diseases (NCDs), also known as chronic diseases.

Strong health systems are the most sustainable way of improving health and saving lives at large scale. For a health system to address the needs of its people it must:

In the beginning of my medical career during the early 1990’s, I witnessed the devastating effects of HIV & AIDS.  Nearly 60 percent of the hospital beds I attended were filled with AIDS patients, many of them my close friends and colleagues. At the time, little was known about the AIDS epidemic; no effective treatments were available; and as a physician, I watched helplessly as day after day those closest to me suffered until their death.  

Today, almost three decades later, thanks to increased prevention and access to care and treatment for HIV, most of these hospital beds have emptied of HIV & AIDS patients.  Now, these same beds are filled by those suffering from preventable chronic diseases, including vaccine-preventable cancers [23].

Today, February 4, we commemorate World Cancer Day [24], joining the global community to raise awareness about the global cancer epidemic, and renew our commitment to address cancer in low-and middle-income countries (LMICs).

Millions of girls in developing nations will avoid getting a deadly form of cancer---cervical cancer---due to a major drop in costs for two vaccines against cervical cancer. Merck and GlaxoSmithKline announced May 9 that costs for the vaccines against human papillomavirus (HPV) would be cut [28] to below $5 per dose.

Over 275,000 women die from cervical cancer per year in poor countries.

Merck’s Gardasil vaccine will cost $4.50 per dose and GlaxoSmithKline’s Cervarix will cost $4.60 per dose. The costs were negotiated through the GAVI Alliance [29] (see infographic [30]).

This is welcome news, with cancers and other chronic diseases becoming one of global health’s biggest challenges, moving towards the post-Millennium Development Goals era.

With less than 1000 days until the Millennium Development Goals expire, the process for setting post-2015 goals [34] continues to ramp up.  We take this opportunity to reflect on the current state of community health systems in low- and middle-income countries and consider how the post-2015 agenda could reshape them—perhaps dramatically.

Community health systems today

Integration moves ahead

Poor and rural communities in low- and middle-income countries are leaving behind the “one clinic, one service” approach. So-called vertical programs, which organized resources according to single health conditions, created a patchwork of health services at the community level. You could get HIV care from one provider, but would have to go down the hall, down the street, or often much farther to get maternal health care or malaria care.

Eugénie [38], a widow in Rwanda, farms to provide for her children. In January 2012, she had surgery to remove a tumor, a procedure that would have devastated her family economically if she did not have insurance. Rwanda’s health insurance program is the most successful of its kind in sub-Saharan Africa: it supports the health of more than 90 percent of the population, including the most vulnerable, like Eugénie.

Chronic diseases --- notably cancers, cardiovascular diseases, chronic lung diseases, and diabetes --- now account for nearly 35 million deaths annually. The human and economic burden of chronic diseases are staggering, especially in developing countries [41]. Left unchecked, by 2030 the epidemic will kill twice as many people in low- and middle-income countries as it does today.

One year ago, the world came together to address this emerging global epidemic. Country representatives, policy makers, and civil society convened in New York for the United Nations (UN) High-Level Meeting on Non-Communicable Diseases (NCDs) [42], and the UN General Assembly adopted a declaration [43], promising to strengthen and accelerate the response.

Using a basic household item like vinegar to screen for a deadly disease is one of those "Aha!" solutions that will save lives. I had never imagined that I’d get to see the procedure in action.

Cervical cancer kills some 250,000 women every year -- over 80 percent from low-income countries, according to the World Health Organization [47] (WHO). Early diagnosis can save lives, but many health facilities in developing countries struggle to find a way to screen women in remote, overcrowded settings. Last year, The New York Times [48] talked about the success of using vinegar as a cervical cancer diagnostic method in Thailand, and yesterday SHOTS, NPR's health blog [49] documented its life-saving use in Botswana.

(Cross-posted on MSH at AIDS 2012 conference blog [52])

On Sunday, July 22, 2012, Management Sciences for Health (MSH) hosted a satellite session, Beyond MDG 6: HIV and Chronic NCDs: Integrating Health Systems Towards Universal Health Coverage [53] at the XIX International AIDS Conference (AIDS 2012). The session panelists were (left to right): Dr Ayoub Magimba, Till Baernighausen, Dr Jemima Kamano, John Donnelly (moderator), Sir George Alleyne, Dr Doyin Oluwole, and Dr Jonathan D. Quick.