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CANCER In 2012, the worldwide incidence of cancer rose to an estimated 14 million new cases per year, with an estimated 8.2 million cancer deaths. Globally, in 2012 the most common cancers diagnosed were those of the lung (1.8 million cases, 13% of the total), breast (1.7 million, 11.9%) and colon (1.4 million, 9.7%). The most common causes of cancer death were cancers of the lung (1.6 million, 19.4% of total cancer deaths), liver (0.7 million, 9.1%) and stomach (0.7 million, 8.8%). 51 For some cancer types such as lung cancer, incidence rates are similar to death rates, indicating that most diagnosed cases end in death, while other cancer types, such as breast or cervical cancer, are less likely to be fatal and can be diagnosed early and effectively treated. TRENDS Worldwide age-standardized cancer mortality improved modestly between 2000 and 2012, with a 6% decline overall (Figure 6.9). But that number masks significant regional, gender and disease type variations. The largest regional improvement in cancer mortality during 2000–2012 was in the high-income OECD region, mainly due to improvements in men’s lung cancer mortality, stomach cancer and colorectal cancer mortality in both sexes, and women’s breast cancer mortality. Age-standardized cancer death rates increased in the South-East Asia Region and the Western Pacific Region, excluding high-income OECD countries. Among the leading cancers, the largest decline in mortality rates was observed in stomach cancer, which has declined around 20% globally since 2000 (Table 6.1). Cervical cancer was the only other major cancer with a mortality decline since 2000 exceeding 10%. Lung cancer mortality has fallen 4% for men, but increased for women. There is evidence of considerable regional variability, with an estimated 19% decrease in lung cancer mortality for men in the high-income OECD countries, compared to increases of greater than 10% for men in the South-East Asia Region and both men and women in the Western Pacific Region, excluding high-income OECD countries. Unlike CVD, total cancer mortality rates are not lowest in the highincome OECD countries. Cancer totals mask diverse patterns in specific cancer types, some of which have higher incidence in wealthier countries (e.g. colorectal and breast cancer), while others have a lower incidence in such settings (e.g. stomach cancer and cervical cancer). Still others vary according to their main cause (e.g. lung cancer is mainly determined by tobacco use, which does not have a linear relationship with wealth). Nearly one third of cancer deaths are caused by five leading behavioural and dietary risks: high body mass index; low fruit and vegetable intake; lack of physical activity; tobacco use; and alcohol use. 53 Chronic infections, mainly Helicobacter pylori, human papillomavirus, and HBV/HCV are estimated to be associated with around 16% of cancers worldwide (with a larger role in sub- Saharan Africa). 54 POSITIVE DEVELOPMENTS Improved prevention: Reductions in tobacco use, as the single most important risk factor for cancer causing about 20% of global cancer deaths, have contributed to declines in cancer mortality, especially lung cancer. 7 Several other changes in exposures and lifestyles have likely contributed to declines in incidence and mortality from stomach cancer, including reductions in salt intake coupled with increases in fresh fruits and vegetable consumption and improvements in hygiene leading to reduced infection with Helicobacter pylori. 55 Early detection, diagnosis and treatment: In high-income countries, declines in mortality in the face of increasing cancer incidence are likely a result of advanced quality health care. 56,57 However, low-tech approaches to early detection of cancer have proven their efficacy in developing countries too. A prime example is cervical cancer screening using visual inspection with acetic acid and cryotherapy or cold coagulation treatment of precancerous lesions. This type of “screenand-treat” programme has been successfully implemented in India. 58 Legislation to reduce exposure and risk behaviours: Lessons from cancer control measures in high-income countries show that prevention works, but that health promotion needs to be supported by appropriate legislation. For instance, the first international treaty sponsored by WHO, the FCTC, has been critical in reducing tobacco consumption through legislative actions, including those that increase tobacco taxes, which is one of the most effective tobacco control interventions to reduce consumption. Similar approaches need to be evaluated with regard to the consumption of alcohol, and in limiting exposure to occupational and environmental carcinogenic risks, including air pollution. Figure 6.9 Cancer death rates, by region and globally, 2000 and 2012 1,8 Age-standardized death rate per 100 000 population 160 140 120 100 80 60 40 20 0 2000 2012 AFR 2000 2012 AMR 2000 2012 SEAR 2000 2012 EUR 2000 2012 EMR 2000 2012 WPR 2000 2012 Highincome OECD 2000 2012 Global 142 HEALTH IN 2015: FROM MDGs TO SDGs
CHALLENGES Lack of access to effective, timely diagnosis and treatment: In the absence of effective early detection programmes such as cancer awareness or screening, patients are diagnosed at very late stages when curative treatment is no longer an option. Population-based screening methods have been implemented for cancer of the cervix, breast and colon-rectum in some high-income countries. Screening, however, is not widely implemented as the necessary resources are not available in most regions. Furthermore, diagnostic services including histopathology and treatment access are poor in many low- and lower-middle-income countries, resulting in high cancerrelated mortality. Immediate investment in human resources, health services and sustainable supply chains are needed to provide timely diagnosis and treatment. Profit-driven disease: Many of the product consumption risks associated with the development of cancers are found in high-sodium processed foods and alcoholic beverages, both of which make companies money. 59 The sale of tobacco is also extremely profitable. Challenging the production and distribution of profit-generating carcinogens is a major challenge for all countries. Sedentary lifestyles: Physical inactivity increases the risk of several cancers, both directly 60 and as a result of increased body mass index (BMI). 61 Spiralling costs: The financial cost of dealing with the growing cancer burden is damaging the economies of even the richest countries. In 2010, the total annual economic cost of cancer was estimated to reach approximately US$ 1.16 trillion. 56 The costs of treatment for individuals can be prohibitive, resulting in forgoing treatment or catastrophic medical expenses. At the country level, failing to invest in basic cancer management can result in billions of dollars of economic loss. 62 STRATEGIC PRIORITIES Cancer prevention and control efforts programmes are a critical component for the achievement of the SDG target reduction in premature mortality due to NCDs. The SDG also includes several other targets that aim to reduce the exposure of people to carcinogens by creating a healthier environment with less pollution and contamination of air, water and soil (for example, Target 3.9). As this brief outline indicates, any cancer response will need to be carried forward on multiple fronts. WHO and the International Agency for Research on Cancer (IARC) are collaborating with other UN agencies on the UN Noncommunicable Diseases Interagency Taskforce (2014) to increase political commitment for cancer prevention and control. Efforts are focusing on coordinating and conducting research on the causes of human cancer and the mechanisms of carcinogenesis, as well as on the monitoring of the cancer burden (as part of the work of the Global Initiative on Cancer Registries). Going forward, it will be imperative to develop proven strategies for cancer prevention and control, and to generate new knowledge, and disseminate existing knowledge to facilitate the delivery of evidencebased approaches. It will also be essential to develop standards and tools to guide the planning and implementation of interventions for prevention, early detection, treatment and care, and to provide technical assistance for rapid, effective transfer of best practice interventions to developing countries. Implementation of WHO toolkits, such as the WHO Package of Essential Noncommunicable Diseases Interventions, will improve service delivery throughout the health sector by promoting early detection and effective management. 23 Finally, countries themselves need to increase efforts to strengthen health systems at national and local levels to ensure early diagnosis and deliver care for cancer patients. Lack of palliative care: Moderate to severe cancer pain is suffered by over 80% of cancer patients in the terminal phase. 63 Effective public health strategies, comprising community- and home-based care, and including improved access to oral morphine are thus essential. Table 6.1 Six leading cancer causes of death globally, by sex, 2012, and trends in the death rates globally and by region, 2000–2012 1,52 Global 2012 rank Cancer type Global AFR AMR SEAR EUR EMR WPR Females 1 Breast cancer -8 2 Trachea, bronchus, lung cancers 9 3 Colon and rectum cancers -8 4 Cervix uteri cancer -12 5 Stomach cancer -21 6 Liver cancer 7 Males 1 Trachea, bronchus, lung cancers -4 2 Liver cancer -2 3 Stomach cancer -20 4 Colon and rectum cancers -7 5 Prostate cancer -8 6 Oesophagus cancer -8 ASDR decreased by more than 5% ASDR increased by more than 5% Between -5% and 5% change in ASDR Highincome OECD NONCOMMUNICABLE DISEASES 143
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from M I L L E N N I U M DEVELOPMEN
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WHO Library Cataloguing-in-Publicat
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CONTENTS vii Abbreviations 1 1 From
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7 153 Mental health and substance u
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IHR IPCC ITN LLIN MCV MDG MDR TB mh
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SUMMARY This report aims to describ
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sourced development finance. 11 The
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Despite their overall success, the
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The 13 targets that underpin the br
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Box 1.1 Life expectancy improvement
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40 Advanced research on European he
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SUMMARY The SDGs position health as
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Figure 2.2 Trends in fertility by r
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Ageing Populations around the world
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The recent influx of refugees into
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and implementing policies and progr
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that dialogue is to demonstrate an
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One of the challenges we face as we
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Most recently, the right to health
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2100 Figure 2.15 Global average sur
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Figure 2.17 Proportion of health fa
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42 World development report 2014: r
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3 UNIVERSAL HEALTH COVERAGE
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UHC is coverage that provides peopl
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Figure 3.4 Per capita government he
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living in poverty, are pushed furth
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integration of all SDG health targe
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GOVERNANCE Governance in the health
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HEALTH FINANCING A country’s heal
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HEALTH WORKFORCE Health systems and
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MEDICAL PRODUCTS Access to quality
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HEALTH INFORMATION Health informati
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SERVICE DELIVERY In order to achiev
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RESEARCH FOR UHC Research evidence
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NOTES AND REFERENCES 1 World health
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89 Implementing the Commission on I
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173 Labrique A, Vasudevan L, Chang
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SUMMARY Deaths among pregnant women
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Figure 4.3 MDG and SDG targets rela
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have declined from 25% to 14% betwe
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Chapter 5). As noted above, there h
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Figure 4.8 Wealth-related inequalit
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young children. 61 Specific indicat
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CHALLENGES Access to skilled care a
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CHALLENGES Scaling up effective int
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CHALLENGES Leaving no country behin
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CHALLENGES Endemic countries: Polio
Page 101 and 102: Figure 4.22 Prevalence of stunting
Page 103 and 104: CHALLENGES Spurring action in count
Page 105 and 106: CHALLENGES Ending child marriage: D
Page 107 and 108: 43 Financing global health 2014: sh
Page 109: 5 INFECTIOUS DISEASES
Page 112 and 113: Infectious and parasitic diseases a
Page 114 and 115: Figure 5.4 Global number of deaths
Page 116 and 117: International TB funding increased
Page 118 and 119: Improving quality of care: The qual
Page 120 and 121: Table 5.1 Summary of specific targe
Page 122 and 123: HIV/AIDS More than 30 years since t
Page 124 and 125: TUBERCULOSIS TB is a treatable and
Page 126 and 127: MALARIA Almost half the world’s p
Page 128 and 129: NEGLECTED TROPICAL DISEASES NTDs 89
Page 130 and 131: HEPATITIS Viral hepatitis is caused
Page 132 and 133: WATERBORNE DISEASES Waterborne dise
Page 134 and 135: CHOLERA Cholera is an acute diarrho
Page 136 and 137: SEXUALLY TRANSMITTED INFECTIONS STI
Page 138 and 139: NOTES AND REFERENCES 1 Global Healt
Page 140 and 141: 84 Dye C, Maher D, Weil D, Espinal
Page 143 and 144: SUMMARY NCDs are included as a spec
Page 145 and 146: Figure 6.2 Probability of death fro
Page 147 and 148: as task sharing using community hea
Page 149 and 150: The stated aim of the strategy is p
Page 151: CHALLENGES Despite declines in mort
Page 155 and 156: CHALLENGES Diabetes is an increasin
Page 157 and 158: CHALLENGES Increasing use in some r
Page 159 and 160: CHALLENGES Air pollution remains a
Page 161 and 162: 40 From burden to “best buys”:
Page 163: 7 MENTAL HEALTH AND SUBSTANCE USE
Page 166 and 167: Mental disorders, including dementi
Page 168 and 169: the effectiveness of task sharing b
Page 170 and 171: • To provide comprehensive, integ
Page 172 and 173: DEPRESSION AND SUICIDE Mental disor
Page 174 and 175: DEMENTIA The world’s population i
Page 176 and 177: SUBSTANCE USE AND SUBSTANCE USE DIS
Page 178 and 179: NOTES AND REFERENCES 1 Global Healt
Page 181: 8 INJURIES AND VIOLENCE
Page 184 and 185: Injuries, whether sustained acciden
Page 186 and 187: due to limited data. However, the s
Page 188 and 189: aiming to stop the predicted increa
Page 190 and 191: ROAD TRAFFIC INJURIES Every year, a
Page 192 and 193: VIOLENCE AND HOMICIDE There were an
Page 194 and 195: WAR AND CONFLICT In 2012, an estima
Page 196 and 197: DISASTERS Disasters are often assoc
Page 198 and 199: NOTES AND REFERENCES 1 Global repor
Page 201 and 202: SUMMARY In September 2015, heads of
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A 10-page declaration precedes the
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THE PLACE OF HEALTH IN THE SDGs 1 H
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that health systems providing integ
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FOLLOW-UP AND REVIEW 9 Monitoring t
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NOTES AND REFERENCES 1 Transforming
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WHO South-East Asia Region: Banglad
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ISBN 978 92 4 156511 0
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