​​​​​​As part of the inaugural Princess Margaret Global Partners' Consultation, (L to R), André Picard, health reporter and columnist with the Globe and Mail, moderated a panel discussion about policy, economics, and the health care delivery sector featuring Drs. Bob Bell, Brad Wouters, Richard Sullivan, Elena Garralda, Felicia Knaul, Thierry Philip and, on the left in the screen above, C.S. Pramesh. (Photo: UHN)​

As conflict, climate change and economic recession ravage the health care sector in many countries around the world, experts at a recent global event hosted at UHN say now is the time to think differently about health equity and the political approach to global cancer control.

With cancer being the number one or two cause of death in most of the world today, they say there is a dire need to prioritize cancer control on the global development agenda.

However, this will require the help of economists and policymakers to build the case, according to leaders of cancer centres from nine different countries who gathered at Princess Margaret Cancer Centre for the inaugural Princess Margaret Global Partners' Consultation, hosted by the PM's Global Cancer Program.

"Fundamental research creates new discoveries that can transform the world," said Dr. Brad Wouters, Executive Vice President of Science and Research at UHN.

"A commitment to change the future means a commitment to invest in research in all countries, but right now, the argument is not well articulated at all," said Dr. Wouters, emphasizing that economists and policymakers must advocate for cancer as a priority on the world stage, in the same way the eradication of infectious diseases has been championed, with clearly outlined challenges and goals.

The event marked the first time PM's Global Partners had a chance to meet one another in person and launch a critical dialogue about how to best address inequities in access to cancer care both within certain populations in high-income countries, as well as in lower- and middle-income countries.

The participants included eminent medical leaders from: A.C. Camargo Cancer Centre (Brazil); Aga Khan University (Kenya); Deutsches Krebsforschungszentrum (Germany); Institute Curie (France); King Hussein Cancer Centre (Jordan); Peter MacCallum Cancer Centre (Australia); Tate Memorial Centre (India); Vall d'Hebron Institute of Oncology (Spain): Clinical Research Malaysia (Malaysia); the Global Cancer Program's International Advisory; and members of the PM's Cancer Care Network.

"These partnerships have blossomed into rich exchanges in the realms of research, education, clinical care and knowledge mobilization," event co-hosts, Dr. Keith Stewart, VP Cancer UHN and Director, Princess Margaret Cancer Centre, and Dr. Danielle Rodin, Director, Global Cancer Program, noted in a joint statement. "Together we can effect transformative change in the global landscape of cancer control."

'It also requires political choices'

Dr. Mary Gospodarowicz, interim Director of the PM's Global Cancer Program, and her team engaged PM Global Partners and members of the International Advisory Committee to the Global Cancer Program in developing the agenda for the two-day consultation, Oct. 26 and 27.

Among the topics debated: patient engagement in global cancer control; the role of cancer centres in cancer prevention, early detection, policy development and public health; patient support and palliative care, cancer research; education and global knowledge translation; and philanthropy and global cancer control.

"Many Jordanians who trained in Canada at the Princess Margaret Cancer Centre are now cancer leaders in Jordan," said Dr. Jamal Khader from King Hussein Cancer Centre, "​and we are transferring our technology and expertise beyond our borders to help countries like Uganda, Romania and Ukraine develop capacity."

Dr. Felicia Marie Knaul, a full member at Sylvester Comprehensive Cancer Center, Director of the Institute for Advanced Study of the Americas at the University of Miami and member of the PM Global Cancer International Advisory, argued cancer is not on the global development agenda because it is seen as too costly.

While there are cost-effective interventions that could be saving lives around the world, such as vaccines, chemotherapy, and promoting healthy lifestyles, she says, many of those don't materialize because of the intense focus on high-cost of cancer care in high-income countries.

"Otherwise, global cancer conferences would be talking about far less expensive interventions that would save a lot of people's lives, rather than something that could extend someone's life for a few months for those who might not even want those few extra months," she said.

Dr. Richard Sullivan, Professor of Cancer and Global Health at King's College in London and member of the PM Global Cancer International Advisory, agreed there should be more advocacy and money allocated for cancer, but to different domains of cancer.

"Right now, the health care system is very focused on Olympic medicine for Olympic athletes," he said, emphasizing that the Western health care model prioritizes innovation while failing to consider other important aspects of health, including social justice, equity, and affordability.

"We need more money, yes, but it also requires political choices to be made about prioritization and how that money should be allocated," said Dr. Sullivan, Director of the Institute of Cancer Policy, and the Director of the Centre for Conflict and Health Research at King's College.

"And we're not doing a good enough job making that case with the national cancer control programs," he says.

Advocacy should focus on improving everyone's health everywhere

With the current political climate pulling industry funding in many directions, Dr. Knaul said the ask for more investment in cancer needs to be crafted differently.

"Health ministers are tired of every disease knocking at the door saying, 'my disease is bigger than your disease,'" she says.

The advocacy should focus on improving everyone's health everywhere, as opposed to certain groups of people in certain areas of the world, which will also address other forms of inequity, including education and gender, Dr. Knaul said.

She called this the “the economics of hope" – the spillover effect and externalities that arise from taking action against cancer – and, in contrast, the cost of inaction.

"We need to walk into the health minister's office and make the argument that if you do more for cancer, we'll achieve more for a lot of other diseases, as well," Dr. Knaul said.

While there have been major advancements in cancer research in recent years, Dr. Knaul said part of the problem is that money for health care has traditionally been invested as if the future is going to be the same as the present.

"We built systems as if there wouldn't be a vaccine, as if we wouldn't find the cause of cervical cancer – and now we're trying to catch up," Dr. Knaul said.

"I think the goal is to be much bolder than we've been in the past when it comes to investing in the future of health care, investing in prevention, and creating real change that can save people's lives."

Dr. Miyo Yamashita, CEO and President of the Princess Margaret Cancer Foundation, led the panel discussion on "Philanthropy in Global Cancer Control." Guest speakers included: Professor Tim Evans, Director and Associate Dean of the School of Population and Global Health at McGill University, who gave an inspiring address on "Global Health – Mobilizing Solidarity, Science, and Systems;" and Professor Avi Goldfarb, Rotman Chair in Artificial Intelligence and Healthcare at University of Toronto, who gave a provocative address on "The Disruptive Economics of Artificial Intelligence in Healthcare." Andre Picard, the Globe and Mail health reporter and columnist, served as moderator.

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