Opinion: To achieve UHC, we can’t forget about cancer prevention

This month, on Dec. 12, the global health and development community marked international Universal Health Coverage Day, and highlighted its important theme of a healthy future for all. A look at the #UHCDay Twitter hashtag provides an indication of the wide range of views from across civil society, national governments, and multilateral organizations on how to best achieve UHC. It’s clear there are varying routes that countries can take to shape healthier societies where all people can access quality health services without financial hardship.

While there is no “one-size fits all” solution, the next political declaration on UHC, to be approved at the second United Nations high-level meeting on UHC in September 2023, is a critical milestone for the global health community. It will be a norm-setting document with application to all countries around the world that sets the tone for how governments can improve their health systems in the coming years. Consequently, the next few months will be crucial for civil society organizations to influence the zero draft of the political declaration.

As organizations working to lower the global cancer burden, we support other groups across the health sector advocating for a resolution that builds on the outcomes of the 2019 U.N. high-level meeting, acknowledges lessons from the COVID-19 pandemic, and promotes more resilient health systems. And we believe that it’s critical that a key building block of healthier societies is not neglected: prevention.

Lack of prevention drives inequity

Three quarters of the 13 million annual cancer deaths projected worldwide by 2030 are estimated to take place in lower- and middle-income countries, with almost half caused by preventable factors. The statistics become even more shocking when looking closely at these preventable cancers. Nearly 90% of cervical cancer deaths, which is almost entirely preventable through human papillomavirus, or HPV, vaccination, occurs in LMICs which have far lower rates of vaccination and screening than high-income countries. Over 80% of the 1.3 billion tobacco users worldwide live in LMICs, and smoking-related deaths are rising in LMICs while they fall in HICs.

These inequalities are why Cancer Research UK supports work that combats HPV in LMICs, and works with partners including the Union for International Cancer Control to promote tobacco control globally.

We are also seeing similar trends with alcohol consumption, and subsequent alcohol-related cancers and other noncommunicable diseases, with rates starting to decline in high-income countries and increase in LMICs. Of greater concern is the proactive move by the alcohol industry to increase marketing and sales in LMICs, with particular focus on marketing to women. Given the close association between light to moderate drinking and breast cancer incidence, together with the link to other NCDs, domestic violence, and a suite of other harms, this trend has the potential to exacerbate health, social, and economic inequities.  

Embedding prevention within UHC

Much of the UHC debate is rightly focused on the services and treatment that should be covered in essential packages, how these are financed, and how better service integration and improved Primary Care, or PHC, are key tools in expanding coverage. We believe that for UHC plans to properly address the threat of cancer and other NCDs, the diagnostic and treatment services that are the pillars of cancer care must be underpinned by effective prevention.

This is vital for the global cancer community’s efforts in closing the care gap that currently exists across the world. People’s chances of survival from cancer are still heavily determined by who they are, and where they live. We have seen that the lopsided burden of preventable cancers that certain populations and countries continue to bear is a major driver of health inequity. The progressive realization of UHC will falter if societies don’t address cancer and NCD prevention, which we believe is an essential foundation for a healthy future.

We already know what these preventive measures look like, and that they are both high impact and cost effective. The updates to Appendix 3 of the World Health Organization’s Global NCD Action Plan provide a valuable blueprint of the policies countries can enact. These range from population level interventions that combat unhealthy diets, physical inactivity, and alcohol and tobacco-related harms, to PHC-level prevention such as vaccination against HPV and hepatitis B.

Most of these preventive measures go beyond combating cancer, and are also reducing the burden of NCDs more broadly. As such, they’re aligned with a core principle of UHC, which is effective integration of health care services and interventions. Similar integration at a national policy level, between cancer control strategies and broader UHC plans, is also essential. These should complement each other, laying out clear pathways towards better cancer control specifically, and UHC more generally, with national cancer strategies informing UHC plans.

Looking ahead to 2023

The first few months of the new year will be pivotal for civil society across global health as we advocate for a strong UHC Political Declaration next September. UHC2030 is again playing a vital role in developing “key asks” for this, with a multi-stakeholder consultation running from January to March. We believe that integrating cancer and NCD prevention, and health promotion measures in these key asks is a necessity.

For a road map towards UHC to have true credibility, it must combat the drivers of the wide inequities in health that we currently see between different countries. In targeting the causes of disease that disproportionately affect LMICs, prevention policies are an innately pro-equity intervention.

As the second leading cause of death worldwide, the global burden of cancer is already huge, and it is growing. Access to treatment and care remains hugely inequitable, and catastrophic out-of-pocket health spending has increased in LMICs since the pandemic. The inclusion of cost-effective cancer and NCD prevention in UHC plans, along with screening and treatment, is vital in helping turn the tide.

As a cancer community we need to make the case in the coming months for the broad benefits of these interventions, and how well they can integrate into UHC packages. And we need to join forces with the wider global health community, advocating to governments for a bold and progressive UHC political declaration, and then holding them to account for implementing it.