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The topic for the essay is:
According to the Journal of Global Health (2014), cancer kills more people low-and middle-income countries than HIV, malaria and tuberculosis combined. Discuss some of the possible reasons for this high incidence of cancer deaths in such countries, and the possible effects.
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Cancer is one of the most expensive and important non-communicable diseases. About 80% of the global cancer related deaths occur in Low and Middle-Income Countries (LMIC)(Lopes et.al, 2013). This shows that LMIC’s are not as efficient in meeting the needs of cancer patients as opposed to richer and developed countries. The mortality rate due to cancer is increasing irrespective of its potential to be treated and prevented. This essay discusses on the causes and effects of cancer in Low and Middle Income Countries (LMIC).
The causative role for high rates of cancer in LMIC’s can be attributed to two factors including lack of adequate public health services and lack of personal care from the public. Only 5-10% of the cancer deaths are related to genetic defects where as the 90-95% is associated to lifestyle factors (Anand et. al, 2008). This includes smoking cigarettes, diets (red meat, fried food items), alcohol, sun exposure, infections, stress, radiations, environmental pollutants, physical inactivity and obesity (Anand et. al, 2008). People in low socioeconomic groups tend to consumer more tobacco and are less active physically and consume energy dense food. Globalisation and urbanisation impact their lives both positively and negatively and has led to change in their lifestyle. 25% of the cancers in developing countries occur due to infections. There are higher incidences of lung cancer and oral cancer due to abundant indoor air pollution and increased betel nut and tobacco usage (Kanavos, 2006). The out of pocket expense related to treatment for cancer is very high including admissions, out patient
visits and drug expenses and hence patients fail to yield quality health care when inflicted by cancer (Chalkidou et.al, 2014)
Public health care system plays an important role in determining the health of the population. The higher rates of cancer related deaths reflect poor access to oncology therapies to the afflicted. Cancer was not recognised as a high priority health problem in LMIC countries as opposed to malaria, other infectious diseases, malnutrition, and
death of women during childbirth. Slow death and silent suffering of cancer patients attracted lesser attention in comparison to more visible health issues like the ones mentioned above. But now an increase of 73% in cancer cases is predicted in developing countries (Kanavos, 2006).
Most of the trends that result in cancer can be addressed through policies. Lack of effective surveillance and control, adequate health care, funding and coverage, as well as the lack of preventive health care policies plays equal roles in increasing cancer mortality cases in the LMICs. Also, most feasible and economic methods of controlling cancer in developed countries like early detection of cancer and foundational and feasible cancer control strategy fails when translated to LMICs. This is because of contextual reasons like lower educational and understanding of the population, their ignorance and lack of accessibility to medical provisions (Anderson et. al, 2015).
Cancer should be identified in an early stage. In most cases Cancer is detected in later stages when the disease in incurable and hence decreasing the chances of survival and increasing costs for medication (Anderson et.al, 2014). LMICs lack early detection programs that are cost effective. This early intervention is efficient and cost effective, but still requires an adequate medium to be effectively implemented, as it requires both awareness education and screening (Anderson et.al, 2015). Lack of access to medical provisions and financial support in terms of medical insurance remains a major impediment when it comes to health care. Advanced diagnostic modalities and
cancer therapies are required for controlling mortality in the incidence of cancer and it is not accessible for all cancer patients in lesser-developed countries (Lopes et.al, 2013).
The impact of cancer on LMICs is very high. Cancer was once considered a problem that was exclusive only to the developed world and hence the health systems in LMICs were ill prepared in facing challenges from cancer. LMICs now face a dual challenge on addressing long-term health issues. This includes health education programmes and preventive care for cancer, which are characteristic challenges when it comes to underdeveloped countries. Financing and providing the afflicted population with expensive cancer therapies is yet another challenges that is faced by the public health care system. LMICs now have to work towards universal medical coverage and ensuring coverage for medical issues to everyone also means increased expenditure for the country. This also means increase in taxation & increase in bureaucratic as well as administrative demands (Lopes et.al, 2013). Most LMIC’s are included in low resource settings and hence medical institutions tend to be weaker leading to issues in relation to management and accountability. There are high chances for corruption and hence higher chances for underfunding and
misallocation of expenditures. Hence LMIC’s face the challenge of ensuring that the funds are beneficial to the truly deserving patients. The economic demands of cancer on LMICs are also very high. Productivity loss due to cancer accounts up to one quarter of the total cost that is spend on treatment. Though LMICs only contribute for
6.2% of the amount spent on cancer globally, there is 89% of global cancer expenditure gap which is the cost incurred on terms of what is incurred and what would have been incurred (Lopes et.al, 2013). Individual families are also getting impacted because of the lack of adequate health care. In India, people borrow money and sell assets during hospitalization. The economic burden of illness on families is very high.
To conclude, responsibility for increasing cancer rates in LMICs can be attributed to both the public whose lifestyle increases the chances for occurrence of cancer and the public health care system that fails to take adequate steps towards prevention and control of cancer and related diseases. LMICs are striving hard to reciprocate and confront the new health challenge (cancer) that has trembled their nation. Preventive care for cancer has more potential than aftercare for cancer. But awareness education and screening of national population is yet a hard target to be achieved by LMICs that are still under the threat of communicable diseases.
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