Overview

Key messages:

• Governments and health systems are committed to preventing and tackling cancer but inequality is a real obstacle to progress.
• Wider determinants of health have a major impact but health systems (and access to them) make a significant difference.
• A broad health systems approach will help policy-makers to improve early detection, diagnosis and treatment and translate scientific advances into equitable change.
• Aligning action on the core health system functions is key so that governance, financing, service delivery and resource generation act collectively on the challenges cancer poses.
• There is a wealth of practical experience in countries that can help policy-makers implement changes that work.
• Strengthening governance can reduce cancer inequalities and offset the pressures associated with growing budget constraints and complex regulation. Steps that have made a difference include:
  • Setting out a clear policy and vision rooted in evidence.
  • Embedding stakeholders in policy and governance, integrating public and patient organisations.
  • Making legislation and regulation explicitly address equity.
  • Aligning national and European Union cancer plans.
• Sustainable financing is critical to sustained improvement. Countries have done well where they have addressed progressive revenue raising, including earmarked investments, equitable coverage and effective purchasing of care and high-cost innovative medicines.
• Service delivery should be providing equal and timely access for all across the entire cancer continuum. Countries have made improvements by focusing on enhanced effectiveness and the safety of care for patients.
• Resource generation – particularly creating an appropriate health workforce – is critical. Staff shortages challenge equitable cancer care but measures that have proved effective include:
  • Enhanced training and new skill-mixes
  • Encouraging integrated multidisciplinary teams that value care coordination
  • Collaborating with stakeholders and engaging with informal caregivers.
• Digitalisation offers opportunities but risks deepening inequalities. Policy-makers need to be aware of the risk of excluding the vulnerable and marginalised.
• Effective cross-sector and multidisciplinary collaboration is a critical enabler of innovation and of implementation that reduces the equity gap.
• Integrating top-down and bottom-up initiatives is central to success. Political will is critical, but public awareness and advocacy support robust engagement and encourage social participation in policy-making.