Inequality in access to care undermines cancer-control efforts in Latin America

In July 2017 a study I edited was released: a major report on cancer control in Latin America, with a focus on inequality in access to care. The report is based on the Latin America Cancer Control Scorecard (LACCS), which assesses cancer-control policies and programmes in 12 Latin American countries. 

Limited resources dedicated to cancer care are not the only problem in Latin America. Our study shows that the fundamental problem is an inefficient distribution of cancer-control assets. This arises from three overlapping issues: fragmentation within Latin American health systems; disparities in provision based on ability to pay; and geographical differences in provision. Policymakers will need to tackle these inequalities in order to ensure continued progress in cancer control.

Highlights from the research:

  • Cancer is the second-biggest killer in Latin America, accounting for 19% of all deaths on average. The International Agency for Research on Cancer projects the number of cancer deaths in Latin America to more than double by 2035.
  • In recent years the region has made important steps forward, such as widespread human papillomavirus (HPV) vaccination, increasingly stringent anti-tobacco laws and growing access to cancer care for the previously uninsured.
  • However, problems persist, especially the accelerating obesity epidemic, “medical apartheid” that is restricting poorer citizens to less well-resourced care, and a widespread lack of palliative care.
  • Cancer-control efforts in Uruguay and Costa Rica receive the best average scores in The EIU’s Latin America Cancer Control Scorecard (LACCS), while the room for improvement is largest in Paraguay and Bolivia.

More people in Latin America are getting cancer care than ever before. Too often, though, the poor, those in the countryside, and uninsured people experience insufficient cancer care, according to a new report published today (July 5th) by The Economist Intelligence Unit (EIU), Cancer control, access and inequality in Latin America: A tale of light and shadow, commissioned by Roche.

The report is based on the Latin America Cancer Control Scorecard (LACCS), which assesses cancer-control policies and programmes in 12 Latin American countries. One-half of countries have put in place cancer-control plans. However, around one-third of these plans are not up-to-date (as they do not cover the current year), and one-half of them do not include specific provisions to address inequalities.

Progress has been made in rolling out population-based cancer registries, but issues with data quality and coverage persist. Other areas with room for improvement include high rates of late-stage diagnosis, insufficient resources for current and future cancer-care needs and fragmented healthcare systems.

Inequalities in access to cancer care are a particular problem. Access is worse for those unable to afford private insurance or to obtain social security-based insurance through their employment. Moreover, cancer control in rural areas remains a concern. Specialist human resources and equipment are concentrated in urban areas, making diagnosis less likely and adding travel expenses to effective treatment costs.

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