We’ve got to talk about… the C-word
Prioritizing cancer at a time when it is not a priority
Cancer, once an enigma, is now the second leading cause of death worldwide, after cardiovascular disease. It is also increasingly on the rise in the developing world, where it is rising at a faster rate than population growth. In the Middle East, in particular, cancer cases will outpace population growth by a rate of almost two to one.1 It is an issue that not only cannot be ignored but should be prioritized.
While the rise in cancer rates outstrips population growth, there are very few cancer treatment centers in the Middle East. Healthcare systems in the region currently do not have, either the capacity to absorb this increase in the number of cancer patients, or the proper medical facilities and expertise to provide them with the treatment they need. One of the leading comprehensive cancer centers in the region has, in recent years, been forced to turn patients away due to lack of space.2 If this is the situation today, one can only shudder at how it will develop over the years. Governments must prioritize health and take urgent action to prepare the region to shoulder the cancer burden of the next generation.
Unfortunately, maintaining healthcare on policy makers’ list of priorities has become a challenge in itself as governments in the region grapple with unprecedented political and economic challenges. The situation varies from one Middle Eastern country to another, thus the response to this impending health crisis will have to be tailored to fit the varying needs, both locally and regionally. For instance, some countries in the region might have the financial resources and economic growth rates to build the infrastructure needed to absorb the rising number of cancer patients, but neither the human resources nor the expertise to provide these patients with life-saving cancer treatment. Other countries in the region might be equipped with the skilled labor force, but lack the financial resources to build the infrastructure necessary to absorb all cancer patients.
These varying needs call for regional cooperation to ensure that solutions are crafted to make optimal use of limited available resources, both in terms of human capital and financial assets. The most effective solution may not necessarily require the construction of a comprehensive cancer treatment center in each and every Arab country. It may be more efficient to consolidate expertise in a select number of cancer centers in the region and ensure that they receive sufficient funds to become hubs for cancer patients from across the region. Medical partnerships and research must be encouraged and promoted in order to exchange expertise and enhance the capacity of healthcare providers. These efforts should all be channeled towards increasing the availability of quality life-saving treatment.
As cancer care becomes more available, the issue becomes how to ensure that patients have access to such care. It is no longer feasible to expect governments to shoulder, alone, the burden of proving healthcare to their populations. The global financial crisis has forced many governments to slash their public expenditures, sacrificing much of their budgets allocated for healthcare. This is particularly the case with tertiary level care, which is expensive and often requires a commitment of time due to the complexity of the disease being treated. Given that public healthcare is increasingly being strained by financial limitations, it is imperative that all segments of society take responsibility in order to ensure that patients have access to quality medical care.
Private sector and non-profit organizations should step in to alleviate the government’s burden of providing healthcare. In the case of the private sector, this can be achieved by investing in the health sector and supporting medical centers and projects through corporate social responsibility (CSR) programs. Nonprofit organizations on the other hand can become alternative providers of medical services. In Jordan, for instance, the United Relief Works Agency for Palestine Refugees (UNRWA) is the main provider of primary healthcare for Palestinian refugees registered with the agency. Another non-profit organization that provides healthcare services is the King Hussein Cancer Foundation (KHCF) and Center (KHCC). KHCC is the primary provider of cancer treatment in Jordan, while KHCF has various goodwill funds which cover either partially or fully the cost of treatment for underprivileged patients.
Insurance programs can also be effective in providing coverage for patients who require treatment and cannot afford it. KHCF’s Cancer Care Program is an example of an insurance program that offers subscribers limited coverage to be treated exclusively at KHCC, upon being diagnosed with cancer, in return for a minimal annual subscription fee.
Governments must also concentrate their efforts on prevention and early detection. Research has revealed that a large proportion of non-communicable diseases (NCDs) are preventable. According to the World Health Organization (WHO), “NCDs share modifiable behavioral risk factors like tobacco use, unhealthy diet, lack of physical activity and the harmful use of alcohol, which, in turn, lead to overweight and obesity, raised blood pressure, and raised cholesterol […] Feasible and costeffective interventions exist to reduce the burden and impact of NCDs and sustained action to prevent risk factors and improve healthcare can avert millions of preventable premature deaths”.3 For these interventions to be effective, stakeholders must cooperate to ensure that regulations are promulgated and enforced to reduce exposure to risk factors. This can be achieved through bans on smoking in public places, for example, or constraints on advertisements for so-called junk food. Together, these efforts will create an enabling environment that will encourage individuals to adopt a healthy lifestyle, thus reducing their chances of getting NCDs.
Governments must join forces with other stakeholders to devise and build the proper framework to curb the rise in NCDs in the region and to ensure that quality cancer treatment continues to be available and accessible to all patients. Building infrastructure and developing skills and expertise to provide quality medical treatment to patients in the region require advance planning and a solid investment of funds and time. It is therefore incumbent on all stakeholders to confront the rise of NCDs head-on and reprioritize healthcare in their policies and budgets. It is only by consolidating efforts today that we will be able to avert a health crisis in the near future.
by Zaid A. Bitar, Deputy Director General and Head of International Development, King Hussein Cancer Foundation, Amman, Jordan and Dr. Lena El-Malak, Senior International Development Manager, King Hussein Cancer Foundation, Amman, Jordan.
- Economist intelligence Unit, comp. “Breakaway: The Global Burden of Cancer Challenges and Opportunities.” (2009): 41-42. Print and CIA Online World Fact Book, All Country Background Data.
- The King Hussein Cancer Center is the only center in the region accredited by the Joint Commission International as a Disease Specific Cancer Center.
- World Health Organization (WHO) Discussion Paper, A Comprehensive Global Monitoring Framework and Voluntary Global Targets for the Prevention and Control of NCDs, 21 Dec. 2011 [available online at www.who.org].