Progress on women's health—lessons and opportunities for global cancer control
Authors: Felicia M Knaul, Natalia M Rodriguez, Afsan Bhadelia, Patricia Garcia, Rifat Atun
Journal: The Lancet Global Health (2018)

Impressive gains in the health of women, particularly the substantial reductions in maternal mortality, have been achieved since the launch of the Millennium Development Goals,1United NationsMillennium development goals.http://www.un.org/millenniumgoals/Google Scholar yet the focus on reducing deaths associated with pregnancy, childbirth, and the post-partum period has undervalued the multiple roles women have in all societies beyond that of childbearing, including their many contributions to their families, communities, health systems, and economies.2Langer A Meleis A Knaul FM et al.Women and health: the key for sustainable development.Lancet. 2015; 386: 1165-1210Summary Full Text Full Text PDF PubMed Scopus (218) Google Scholar Maternal deaths also represent a decreasing fraction of women's overall disease burden, and the traditionally narrow interpretation of maternal health has led to a restrictive view of women's needs across their life cycle.3Knaul FM Langer A Atun R Rodin D Frenk J Bonita R Rethinking maternal health.Lancet Glob Health. 2016; 4: e227-e228Summary Full Text Full Text PDF PubMed Scopus (19) Google Scholar Non-communicable chronic diseases (or NCDs, aligned with the nomenclature put forward by Knaul and colleagues4Knaul FM Gómez-Dantés O Bhadelia A Frenk J Beyond divisive dichotomies in disease classification.Lancet Glob Health. 2017; 5: e1073-e1074Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar), exemplify new and often ignored challenges that increasingly affect women's health worldwide. Mortality associated with women's cancers (breast and cervical cancer) now far outnumber maternal mortality.5Global Burden of Disease Cancer CollaborationGlobal, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life years for 32 cancer groups, 1990 to 2015: a systematic analysis for the Global Burden of Disease study.JAMA Oncology. 2017; 3: 524-548Crossref PubMed Scopus (2728) Google Scholar, 6WHOMaternal mortality factsheet.http://www.who.int/mediacentre/factsheets/fs348/en/Date: November, 2016Google Scholar Global health investment and global advocacy movements in women's health continue to focus on maternal and child health and ignore women's cancers that are becoming of increasingly higher priority. Additionally, women have specific challenges associated with stigma and gender discrimination that exacerbate their risks of dying and suffering from cancer and other NCDs. Addressing the emerging challenges of NCDs in women's health necessitates an integrative lifecycle approach that maintains a focus on reproductive and maternal health while extending the reach of programmes and policies beyond reproduction to encompass the health challenges that women face during their entire lifespan and throughout the care continuum.7Knaul FM Bhadelia A Arreola-Ornelas H et al.Women's reproductive health in transition: the overlapping challenge of breast and cervical cancer.Cancer Control. 2014; 11: 50-59Google Scholar, 8Knaul FM Bhadelia A Gralow J Arreola-Ornelas H Langer A Frenk J Meeting the emerging challenge of breast and cervical cancer in low-and middle-income countries.Int J Gynaecol Obstet. 2012; 119: S85-S88Crossref PubMed Scopus (34) Google Scholar, 9Bustreo F Knaul FM Bhadelia A Beard J Araujo de Carvalho I Women's health beyond reproduction: meeting the challenges.Bull World Health Organ. 2012; 90 (78A): 478Crossref PubMed Scopus (14) Google Scholar Effective health systems can and should encompass the overlapping components of cancer care and control by developing integrated programmes that target and meet disease-specific priorities and systemic challenges synergistically, as envisioned in a diagonal approach to health-systems strengthening.10Sepúlveda J Bustreo F Tapia R et al.Improvement of child survival in Mexico: the diagonal approach.Lancet. 2006; 368: 2017-2027Summary Full Text Full Text PDF PubMed Scopus (144) Google Scholar This approach can help link cancer care and control with many services associated with a broad range of health promotion and treatment activities and will enable optimal use of existing health programmes or platforms, including those in other sectors such as education and social welfare, to address multiple health priorities. Countries across different income levels have shown examples of successfully integrating women's cancers into women's public health programmes and have demonstrated how social welfare, women's empowerment, maternal and child health, sexual and reproductive health, and antipoverty programmes can serve as platforms to expand access to cancer control and care. For example, the Mexican human development and poverty alleviation programme Oportunidades (now called Prospera) is a social welfare scheme that offers conditional cash transfers to the women of more than 90% of poor, urban, and rural families for the purpose of promoting education, nutrition, and health (including breast and cervical cancer education and screenings).11Knaul FM Bhadelia A Atun R Frenk J Achieving effective universal health coverage and diagonal approaches to care for chronic illnesses.Health Aff (Millwood). 2015; 34: 1514-1522Crossref PubMed Scopus (41) Google Scholar Examples of community health and primary health promoter programmes in Mexico and Peru have provided health education for women in their own communities and have ensured a properly trained primary health-care workforce. These national programmes can serve as models to integrate awareness-building, stigma-reduction, early detection, treatment, survivorship care, and palliation for NCDs within population-wide and primary care platforms. Drawing on these examples and from work of the Lancet Commission on women and health,2Langer A Meleis A Knaul FM et al.Women and health: the key for sustainable development.Lancet. 2015; 386: 1165-1210Summary Full Text Full Text PDF PubMed Scopus (218) Google Scholar we will use the occasion of the Toronto Global Cancer Conference, March 1–3, 2018, to: (1) take account of the global successes and future challenges to the health of women; (2) consider what global cancer control can learn from these successes; and (3) taking a diagonal approach, discuss how efforts to reduce the burden of women's cancers can be imbedded into and take advantage of women's health and empowerment platforms. FMK declares grants from Pfizer, Mayday Fund, American Cancer Society, Roche, CRDF Global, JM Foundation, Grunenthal, and GDS; grants, personal fees, and non-financial support from Roche and Merck/EMD Serono; grants from Pfizer, Novartis, GlaxoSmithKline, Sanofi, Chinoin, and NADRO; and grants and non-financial support from Asociacion Mexicana de Industrias de Investigacion Farmaceutica, outside the submitted work. AB declares unrestricted gifts from Pfizer and grants from Roche. All other authors declare no competing interests.