Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries

Harvard Global Equity Initiative, Boston, MA, November 2011

286 Pages Posted: 10 May 2012 Last revised: 28 May 2012

See all articles by Felicia Knaul

Felicia Knaul

Harvard Global Equity Initiative; Mexican Health Foundation

Julio Frenk

Bill and Melinda Gates Foundation

Lawrence Shulman


Date Written: November 1, 2011


Low and middle income countries (LMICs) share a common, emerging, and largely unrecognized challenge: the burden of increasingly prevalent chronic and non-communicable diseases. This emerging challenge compounds the difficulty of responding to the backlog of disease and illness associated with poverty and “underdevelopment” often associated with preventable infections and reproductive health problems. Cancer – itself a complex set of devastating diseases – epitomizes the complexities and inequities of the epidemiological challenge faced by LMICs.

Cancer is also a challenge to economic and human development, as it is both a cause and an effect of poverty. The long-term disability and ongoing health care costs of cancer impoverish families and health systems, and contribute to social exclusion. At the same time, poverty, lack of access to education and health care, and discrimination expose populations to additional risks for presenting and dying from many cancers.

There are glaring disparities between rich and poor in incidence and death from preventable cancers and death from treatable cancers, as well as in the pain, suffering, and stigma associated with the disease. These disparities constitute a cancer divide and demonstrate that increasing access to cancer care and control is also an issue of equity.

Yet, many believe – and these myths persist – that meeting the challenge of cancer in LMICs – with the exception of some basic prevention – is unnecessary, unaffordable, unattainable, and – perhaps the most pernicious – inappropriate because such an effort would take away resources from other high burden, communicable diseases.

These four myths plague and undermine the work of the global community in cancer care and control (CCC), as well as on other non-communicable disease (NCD) and chronic illness.

Keywords: non-communicable diseases, Cancer, health systems, Low and middle income countries

Suggested Citation

Knaul, Felicia and Knaul, Felicia and Frenk, Julio and Shulman, Lawrence, Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries (November 1, 2011). Harvard Global Equity Initiative, Boston, MA, November 2011, Available at SSRN:

Felicia Knaul (Contact Author)

Mexican Health Foundation ( email )

Periférico sur 4809, El Arenal Tepepan, Tlalpan
El Arenal Tepepan, Tlalpan
Mexico, D.F., 14610
(52) 55 56559011 (Phone)
(52) 55 56559082 (Fax)

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Harvard Global Equity Initiative ( email )

FXB Building, Room 632
651 Huntington Avenue
Boston, MA 02115
United States
(617) 4327938 (Phone)


Julio Frenk

Bill and Melinda Gates Foundation ( email )

P.O. Box 23350
Seattle, WA 98102
United States

Lawrence Shulman

Independent ( email )

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