ESMO, the leading professional organisation for medical oncology, counting more than 30,000 members worldwide, welcomes the 2023 UN Political Declaration on Universal Health Coverage (UHC) as it represents an extraordinary opportunity to accelerate action on cancer prevention and control globally.
The declaration, delivered at the UN High-Level meeting on UHC, is a commitment from the 193 UN member states to move forward with the global non-communicable disease agenda, which includes cancer. The commitment needs to be put into action now to ensure that millions of cancer patients are not left behind.
“With 1 in 5 people expected to develop cancer during their lifetime, ESMO urges the UN member states to guarantee Universal Health Coverage benefit packages to their entire population,” said ESMO President Andrés Cervantes.
UHC benefit packages should include a core set of comprehensive, safe, affordable, effective, and high-quality services for prevention, screening, diagnosis, treatment according to guidelines, palliative care, and rehabilitative services for cancer. “These packages must be well funded and delivered by an adequate number of well-trained and well-resourced health workforce,” stressed Cervantes. “These services should be considered essential and should not result in financial hardship for patients or lead to catastrophic and generational impoverishment.”
Cancer services included in national health benefit packages are not always proportional to the size of the cancer burden. The widest discrepancy in the inclusion of cancer care in the packages is between lower-middle-income countries (LMIC) and the upper-middle-income countries (UMIC), and for palliative care it is between the UMIC and high-income countries (HIC) (1). “This highlights the urgent need to optimize resources to achieve equity in cancer care,” said Cervantes.
“ESMO acknowledges the diversity of countries and the need to tailor national cancer control plans to individual needs,” emphasized Jean-Yves Blay, ESMO Director of Public Policy. “For this reason, ESMO has put efforts into supporting the development of the WHO Cancer Module within their Integrated Health Tool (IHT) (2) by expanding it with data from two to 20 cancers, and by supporting its implementation so far in five countries - Kenya, Mozambique, Kyrgyzstan, Senegal, and Palestine.”
“It is only by uniting our efforts that we will be able to provide a comprehensive set of affordable essential health services to everyone who needs them,” Blay said.
The world committed to the basic human right to health with the WHO Constitution and the 1948 UN Universal Declaration of Human Rights. Since then, the world has experienced innumerable health emergencies. The 2019 global pandemic was a wake-up call to remind us that 75 years later we are still unprepared to safeguard the health of the world’s population. The ESMO President concluded: “As physicians we are deeply concerned that so many countries are not on track to deliver on the 2017 World Health Assembly Cancer Resolution and the 2030 Sustainable Development Goals. ESMO, on behalf of the entire oncology community, urges countries to fully implement the actions they have committed to over the years and the ones in this second UN Political Declaration on Universal Health Coverage: only by doing that will we be able to create a healthy future for ourselves, for our planet and the future generations.”
To translate the commitment into tangible achievements, the member states are encouraged to:
- Strengthen and develop robust referral systems across the continuum of care to ensure timely and affordable access from primary, to secondary and tertiary care levels where cancer patients are predominantly treated
- Ensure access to cancer medicines, including opioids for pain relief
- Ensure strengthening of primary, secondary and tertiary care with a view to increase preparedness and response to health emergencies and pandemics
- Ensure that essential cancer services include supportive and palliative care that addresses quality of life, side-effects, and all aspects of toxicity
- Ensure adequate funding of, and access to, clinical trials, including academic clinical trials to ensure that the specificities of rare cancers are properly taken into account
- Make population-based disease registries mandatory, and ensure they include the comprehensive incidence, relapse, and mortality data required for evidence-based healthcare planning; in order to measure national health policy effectiveness, and demonstrate the number of lives saved
With its official statement, ESMO stands ready to support the member states in their efforts to reduce the burden of cancer with the Society’s cancer resources that can assist in each of the three dimensions of Universal Health Coverage:
- Global Curriculum in Medical Oncology to support training the necessary workforce to increase population coverage.
- Evidence-based ESMO Clinical Practice Guidelines and Pan-Asian Adapted Guidelines to support decisions to optimally expand essential health services.
- ESMO-Magnitude of Clinical Benefit Scale and ESMO Scale of Clinical Actionability of Molecular Targets (ESCAT) to prioritize the use of cancer medicines, improve health outcomes and reduce the financial burden of health services.
References
- Cancer Care Inclusion in Health Benefit Packages: Findings from a WHO Global Survey in 2020-2021, forthcoming.
- The IHT is an interactive tool that can support national strategic health planning in low- and middle-income countries, through assessment of resource needs for cancer prevention and control based on national data, objectives, and resources.