Keynote speaker Felicia Marie Knaul, PhD, calls for end to global health disparities through more equitable access to cancer care

Felicia Marie Knaul, PhD

By Lisa Braverman

The first Keynote speaker at this year’s Annual Meeting, Felicia Marie Knaul, PhD, presented a thoughtful and optimistic plan for reducing global disparities in both cancer care and health care more broadly.

Dr. Knaul, director of the Institute for Advanced Study of the Americas and professor at the Department of Public Health Sciences at the Miller School of Medicine at the University of Miami, was introduced by Mary Gospodarowicz, MD, FASTRO. Dr. Gospodarowicz described Dr. Knaul’s many impressive credentials and accomplishments, including serving as the senior health economist for the Mexican health department, authoring books about global health and chairing several Lancet commissions.

Beginning with a personal story, Dr. Knaul spoke about how she was diagnosed with invasive breast cancer at her first mammogram. Both she and her husband, Julio Frenk, MD, MPH, PhD, were working in Mexico’s Ministry of Health. “We had studied health systems, but had never lived a health system,” she said.

Learning more about health systems by visiting hospitals, Dr. Knaul spoke with patients who were undergoing cancer treatment – including women who, like her, were being treated for breast cancer. She found patients whose tumors should have been readily detected but were not. How can tumors go undetected for so long in good health systems, she wondered.

Through wide-ranging, rigorous analysis, Dr. Knaul argued that we can close the cancer divide by harnessing global health systems. She aimed to dispel the pervasive myths that often characterize discussions about cancer care in low- and middle-income countries (LMICs). Access to cancer care is a priority for LMICs; cancer disproportionately affects the poor, and the opportunity to survive is, heartbreakingly, defined by income. For example, 90% of children with leukemia survive in Canada, but only 10% survive in the world’s poorest countries. In terms of palliative care, the wealthiest 10% of countries have 90% of distributed opioid morphine-equivalent, while the poorest 50% of countries have 1%.

The costs of inaction for cancer care, Dr. Knaul argued, are tremendous. From an economic perspective, avoidable premature deaths rob individuals and their economies of productive working years. The costs involved in fighting the cancer divide are also lower than many might anticipate. Prices for vaccines may be brought down for LMICs, and aggregate platforms bringing the public and private sectors together may be leveraged to reduce costs as well.

Praising a diagonal approach, Dr. Knaul discussed what makes for an effective universal coverage plan. To be effective, universal coverage must invest in both prevention and treatment. The diagonal approach harnesses synergies to address disease specifics and systemic issues in tandem. For example, promoting healthy lifestyles is beneficial for much more than cancer care alone. Increasing access to cancer care and control can strengthen health systems in return.

Dr. Knaul spoke in depth about the Seguro Popular, a national, at-scale expansion of coverage and beneficiaries in Mexico. The program expanded coverage by disease, including an effective package of interventions. The program was discontinued this year, but Dr. Knaul remains optimistic about the future of global cancer care. She believes health initiatives should be guided by patient voices.

Optimism continues to shape Dr. Knaul’s philosophy of cancer care. She stressed the importance of being an optimist and an optimalist. As her Keynote address began, it ended with a personal story. During her last chemotherapy infusion, she developed septicemia. While at the time she realized she may not survive, she recovered and was able to enjoy activities with her children again. She took her daughters to a butterfly garden, where she was the most popular visitor thanks to the bright blue hat covering her hairless head. At that moment, her youngest daughter, who had had such a difficult time with her mother’s baldness, became comfortable with it.

“I realized you can turn some of the most devastating, painful situations into lessons about how the future can be better than the present,” she said. The address ended with a call to take that sentiment to heart, to leverage optimism – even if it was refashioned from pain – to expand access to cancer care.

Published on: October 27, 2020

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