Future of education in closing the equity gap in global cancer control
Authors: Meredith Giuliani, Julio Frenk
Journal: The Lancet Global Health (2018)

Substantial disparities exist in cancer control worldwide. A rapid increase in the incidence of cancer and a growing crisis in access to care co-exist with a gap in human resources for health, with little promise of a timely solution. Cancer services must expand on a large scale to address equity gaps, and implicit in that is the need to train new cancer professionals. WHO has projected a shortage of 18 million health-care workers by 2030.1World Health AssemblyHuman resources for health and implementation of the outcomes of the United Nations' high-level commission on health employment and economic growth. World Health Organization, Geneva2017Google Scholar Gaps exist in most areas. For example, in cancer, the Global Task Force on Radiotherapy for Cancer Control (GTFRCC) has projected a need for 215 000 new health-care professionals by 2035 to meet the demands for radiotherapy services.2Atun R Jaffray DA Barton MB et al.Expanding global access to radiotherapy.Lancet Oncol. 2015; 16: 1153-1186Summary Full Text Full Text PDF PubMed Scopus (516) Google Scholar The Lancet Commission on surgery3Meara JG Leather AJ Hagander L et al.Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development.Lancet. 2015; 386: 569-624Summary Full Text Full Text PDF PubMed Scopus (1818) Google Scholar estimated a need for 2·28 million specialist surgical, anaesthetic, and obstetric providers by 2030. This is a doubling of the existing surgical workforce. High-income countries also expect these projected gaps and have concerns about inadequate numbers of medical and radiation oncologists.4Yang W Williams JH Hogan PF et al.Projected supply of and demand for oncologists and radiation oncologists through 2025: an aging, better-insured population will result in shortage.J Oncol Pract. 2014; 10: 39-45Crossref PubMed Scopus (146) Google Scholar Traditional efforts to increase the availability of health-care professionals have led to only a minimal increase in human resources for health. These efforts are hampered by attrition of trained individuals from areas of highest need, a lack of sustainability in new initiatives, and the fact that graduates are often poorly equipped to address the needs of patients and the public.5Frenk J Chen L Bhutta ZA et al.Health professionals for a new century: transforming education to strengthen health systems in an interdependent world.Lancet. 2010; 376: 1923-1958Summary Full Text Full Text PDF PubMed Scopus (3000) Google Scholar, 6WHOGlobal strategy on human resources for health: workforce 2030. World Health Organization, Geneva2016Google Scholar WHO has articulated a global strategy on human resources for health, with recommendations for sustainability, local retention, and training reform to better equip health-care teams and facilitate task shifting activities. The Lancet Commission on global surgery clearly articulated the misdistribution of the surgical workforce.3Meara JG Leather AJ Hagander L et al.Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development.Lancet. 2015; 386: 569-624Summary Full Text Full Text PDF PubMed Scopus (1818) Google Scholar The 2010 Lancet Commission on education of health professionals for the 21st century5Frenk J Chen L Bhutta ZA et al.Health professionals for a new century: transforming education to strengthen health systems in an interdependent world.Lancet. 2010; 376: 1923-1958Summary Full Text Full Text PDF PubMed Scopus (3000) Google Scholar defined the urgent need for health professions curricular reform and highlighted that "a slow-burning crisis is emerging in the mismatch of professional competencies to patient and population priorities because of fragmentary, outdated, and static curricula producing ill-equipped graduates from underfinanced institutions". In the past, the duration of professional training has been extended across health professions. With the rapid progress in science and new technologies, all health professionals clearly need lifelong learning skills. Upfront education that leads to initial credentialing is insufficient in the long term. The expert group to the high-level commission on health employment and economic growth7Horton R Bhorat H Bruysten S et al.High level commission on health employment and economic growth. World health Organization, Geneva2016Google Scholar made ten recommendations to transform the health workforce so as to promote high-quality education and life-long learning, to harness information and communication technologies, and to advance the international recognition of health workers' qualifications. At the Toronto Global Cancer Control Conference, March 1–3, 2018, we will discuss initiatives for health professions education reform that have developed from the Lancet Commission on education of health professionals for the 21st century. We will explore the opportunities afforded by new information and communication technologies and innovations in pedagogy. We will also discuss the potential next steps to address the gaps in health human resources for cancer care, the actors that need to be engaged, and the opportunities afforded by global partnerships. Finally, we will explore how the strategies and recommendations from the Lancet Commission on education of health professionals for the 21st century affect the health-care system and how greater synergies between educational institutions and the health-care system can be exploited to improve care. We declare no competing interests.