Cancer inequalities Cancer inequalities in Europein Europe

Kielce, Polish conference on cancer, 13/15 June 2011Kielce, Polish conference on cancer, 13/15 June 2011

Dr. Andrea MicheliDirector

Descriptive Study and Health Planning UnitFondazione IRCCS “Istituto Nazionale dei Tumori”

Milan

EUROCHIP-1..3EUROCHIP-1..3Cancer is an element of our societies Cancer is an element of our societies

Why?Why? ToTo fight inequalities fight inequalities What?What? Translational research projectTranslational research project

How?How? Economy of scale: EUEconomy of scale: EU

From actions to common actionsFrom actions to common actionsTanks to Magdalena Tanks to Magdalena

Macro-economic approach - background

European vision

Cancer - inequalities - EuropeCancer - inequalities - Europe

LIFE EXPECTANCY IN EU-27, ICE, N, and CHLIFE EXPECTANCY IN EU-27, ICE, N, and CH2005-20092005-2009

Source: United Nations Population Division

LIFE LIFE EXPECTANCY EXPECTANCY

TRENDS IN TRENDS IN EUROPEEUROPE

InequalitiesInequalitiesin healthin health

increasedincreased

Source: United Nations Population Division

Life expectancy at birthLife expectancy at birth $PPP$PPP yrs

I) GDPI) GDP << = 20,000 = 20,000 73.373.3 II) II) 20,000 20,000 << GDPGDP << = 30,000 = 30,000 79.179.1III) III) 30,000 30,000 << GDPGDP << = 336,0006,000 79.679.6IV) GDPIV) GDP >> 336,0006,000 8080.0.0

GDP AND LIFE EXPECTANCY AT BIRTHGDP AND LIFE EXPECTANCY AT BIRTH

I, Bulgaria, Romania, Latvia, I, Bulgaria, Romania, Latvia, POLANDPOLAND, Lithuania, Hungary, Estonia, Slovakia, Lithuania, Hungary, Estonia, SlovakiaII, Portugal, Malta, Czech Republic, Slovenia, Cyprus, Greece, Spain, ItalyII, Portugal, Malta, Czech Republic, Slovenia, Cyprus, Greece, Spain, ItalyIII, France, Germany, Finland, United Kingdom, Belgium, Sweden, DenmarkIII, France, Germany, Finland, United Kingdom, Belgium, Sweden, DenmarkIV, Austria, Iceland, The Netherlands, Switzerland, Ireland, Norway, LuxembourgIV, Austria, Iceland, The Netherlands, Switzerland, Ireland, Norway, Luxembourg

Sources: United Nations Population Division. For GDP International Monetary Fund Sources: United Nations Population Division. For GDP International Monetary Fund

GROSS DOMESTIC PRODUCT (GDP) ANDGROSS DOMESTIC PRODUCT (GDP) ANDCANCER INCIDENCECANCER INCIDENCE

Source: GLOBOCAN 2002, IARC & United Nations (UN)

Age-standardized incidence rates, World Standard Population per 100,000, GDP: at current prices US $, 2006.

GROSS DOMESTIC PRODUCT (GDP) ANDGROSS DOMESTIC PRODUCT (GDP) ANDCANCER MORTALITYCANCER MORTALITY

Age-Standardized incidence rates, World Standard Population per 100,000, GDP: at current prices US $, 2006.

Source: GLOBOCAN 2002, IARC & United Nations (UN)

GDP and age-standardized incidence rates for all cancers. Men

Sources: Human Development Report 2009; Ferlay et al. 2008

GDP and age-standardized mortality rates for all cancers. Men

Disks are proportional to the public health expenditure ($ PPP) Sources: Human Development Report 2009; Ferlay et al. 2008

Source: Verdecchia A. et al.

EUROPE

Gross Domestic Product (GDP), Total National Health Expenditure (TNHE) and Public Health Expenditure (PHE)

GDP ($PPP)

0 10000 20000 30000

EstoniaPoland

SlovakiaCzech Rep

SloveniaScotland

SpainWales

FinlandEngland

ItalyFrance

SwedenGermany

NetherlandsDenmark

AustriaNorway

Switzerland

TNEH ($PPP)

0 1000 2000 3000

EstoniaPoland

SlovakiaCzech Rep

SloveniaScotland

SpainWales

FinlandEngland

ItalyFrance

SwedenGermany

NetherlandsDenmark

AustriaNorway

Switzerland

PHE ($PPP)

0 500 1000 1500 2000

EstoniaPoland

SlovakiaCzech Rep

SloveniaScotland

SpainWales

FinlandEngland

ItalyFrance

SwedenGermany

NetherlandsDenmark

AustriaNorway

Switzerland

Countries are ranked by GDP in 1995

EUROCARE-45-year relative survival, all cancers

countries are ordered by Total Health Expenditure

PolandEurope

Berrino F. et al, The Lancet Oncology, 2007

5 YEARS RELATIVE SURVIVAL FOR ALL CANCERS5 YEARS RELATIVE SURVIVAL FOR ALL CANCERSEUROCARE 3 EUROCARE 3

Ranked by 1995 TNEHRanked by 1995 TNEH

Source: Verdecchia A. et al. European Journal of Public Health, 2008

GDP AND EPIDEMIOLOGICAL CANCER DATA GDP AND EPIDEMIOLOGICAL CANCER DATA

All cancers M & FAll cancers M & FCOUNTRIES BY QUARTILE of GDP per capita ($PPP)

Incidenceper 100,000

Mortalityper 100,000

Survival%

LOWEST GDP < 20,000(BG, RO, LV, PL, LT, HU, EE, SK)

336 209 -

20,000 < GDP < = 30,000(PT, MT, CZ, SI, CY, EL, ES, IT) 363 172 5030,000 < GDP < = 36,000(FR, DE, FI, UK, BE, SE, DK)

411 171 49

HIGHEST GDP > 36,000(AT, IS, NL, CH, IE, NO, LU)

405 176 53

Sources: Ferlay et al. EJC, 2010. EUROCARE-4. For GDP International Monetary Fund Sources: Ferlay et al. EJC, 2010. EUROCARE-4. For GDP International Monetary Fund

• Produce cancer plans (and follow them)• Promote cancer information, i.e. cancer

registration • Organize screening programs for cancer

of cervix, breast and colorectum

• And invest in primary prevention actions

Against cancer inequalities: Against cancer inequalities: indications from Europeindications from Europe

Health Strategies in Europe. Lisbon, 12-13 July 2006. Coleman M., modified

Health Strategies in Europe. Lisbon, 12-13 July 2006. Coleman M. Health Strategies in Europe. Lisbon, 12-13 July 2006. Coleman M.

L. von Karsa et al. Cancer Screening in the European Union. First Report.

L. von Karsa et al. Cancer Screening in the European Union. First Report.

L. von Karsa et al. Cancer Screening in the European Union. First Report.

Lung cancer in Poland and EU-27, malesLung cancer in Poland and EU-27, males

Source: GLOBOCAN 2008, WHO. For Survival: EUROCARE-4. Sant et al. EJC 2009. WORLD Standard Population, per 100.000

Rate per 100,000Rate per 100,000

per 100

Smoking trends in European countries Smoking trends in European countries (M+F)(M+F)

Source: WHO, Health For All Europe, 2011

NO smokingEat better, five portion per dayReduce alcohol consumptionIncrease physical activity, 30’ of walking per day

Cancer inequalities: Cancer inequalities: promote healthpromote health