The diagonal optimalist approach 130611

8/2/2019 The diagonal optimalist approach 130611

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Bridging Divides:

The diagonaloptimalist approach

Felicia Marie Knaul

Tuesday, June 14, 2011

Global Health Council

Washington, DC


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January, 2008

July, 2007


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The Cancer Divide: disparities inoutcomes between poor and rich directlyrelated to inequities in access anddifferences in underlying socio-economicand health conditions.

The divide is the result of concentratingrisk factors, preventable disease,suffering, impoverishment from ill healthand death among poor populations.

fueled by progress in cutting-edgescience and medicine in high-income

countries.


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Adults

Breast

Cervix Prostate

Testis

HL

N HL

Leukaemia

All cancers

Source: Knaul, Arreola, Mendez. estimates based on IARC, Globocan, 2010.

Children

LOW

INCOME

HIGH

INCOME

Survival

inequalityga

p

LOW

INCOME

HIGH

INCOME

100%

The opportunity to survive (M/I)

should not be defined by income.

Yet it is.


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LMICs: 83% of avoidable

Avoidable cancer deaths

Income Region % of deaths considered

avoidable

Low income 65Lower middle income 53

Upper middle income 46

High income 29


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Cancer is a disease of rich and poor yet,

it is increasingly the poor who suffer:

Exposure to risk factors

Cancers of infectious origin

Death from treatable cancer

Stigma and discrimination

Avoidable pain and suffering

Impoverishment

The cancer divide:

an equity imperative


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Challenge and disprove the

minimalists:

myths about cancer& NCD

M1. Unnecessary: Not a health priority for the poor

M2. Impossible: Nothing we can do about it

M3. Unaffordable: .for the poor

M4: Inappropriate:Challenging cancer implies taking resources

away from other diseases of the poor


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Rather than focusing on disease-specific

vertical programs or only horizontally on

system constraints, harness synergies that

provide opportunity to tackle disease-specific

priorities while addressing systemic gaps.

Optimize available resources so that thewhole is more than the sum of the parts

Bridge the divides as patients suffer diseases

over a lifetime, most of it chronic

The diagonal approach

to health system strengthening


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1. Harness platforms: Integrate disease prevention,screening and survivorship into MCH, SRH,

HIV/AIDs, social welfare/anti-poverty programs

2. Delivery: Catalyze, employ and deploycommunity health workers and expert patients

3. Financing: social protection strategies that

include horizontal and vertical coverage

4. Stewardship: Improve regulatory frameworks to

remove non-price barriers to pain control

Diagonal strategies


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Juanita:Her cancer was detected late -- a

series of missed opportunities toapply the diagonal approach


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Be an

optimist

optimalist:

apply the

economicsof hope


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Restructuring health

systems in the face of

chronicity:The diagonal

optimalist approach

Felicia Marie Knaul

Tuesday, June 14, 2011

Global Health Council

Washington, DC

The diagonal optimalist approach 130611

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