Like any woman in her predicament, when health economist Felicia Knaul was diagnosed with breast cancer two years ago while living in Mexico, her world turned upside down. Yet during treatment, the realization that many women in developing countries lack access to the high quality of care that she received spurred her to action.
An HMS associate professor of social medicine in the Department of Global Health and Social Medicine, Knaul is director of the Harvard Global Equity Initiative. Collaborating with leaders from HMS, HSPH and Dana-Farber, she has convened a global task force that seeks to do for cancer in the developing world what has been done successfully with some infectious diseases like AIDS. Creation of the task force was announced on Nov. 4 at an international conference, “Breast Cancer in the Developing World,” which was led by Knaul and held in the Longwood Medical Area.
She shared with Focus her views on cancer as a global health problem.
Focus: Talk about why breast cancer is a global issue, not just an issue of the developed world.
Felicia Knaul: Breast cancer is today a global public health priority. Years ago, this was seen—correctly at the time—as a disease concentrated in women in the developed world. Today, the statistics tell us something different: 55 percent of cases and an even higher proportion of deaths occur in the developing world. As communicable diseases become less of a burden, women live longer and are exposed to other health threats. In a way, we are victims of our own success.
A key point to keep in mind is that there is really no way to prevent breast cancer. We rely on early detection and effective treatment. Since both are often lacking in the developing world, case fatality rates are much higher than in developed countries.
Right now the vast majority of research is done in developed-world populations. So we don’t know enough about how and why these tumors express themselves in the developing world.
Tell me about the Harvard Global Equity Initiative.
It is a University-wide initiative designed to work on issues of social and economic development related to promoting global equity. HGEI has just been relaunched, and I am very pleased to have been invited to be the director. We have decided to focus substantially on health issues, which is why our first major initiative was an international seminar on breast cancer.
The goal for the new task force is to do for breast and other cancers globally what we’ve done for diseases like AIDS. What are the challenges?
The Global Task Force for Expanded Cancer Care and Control in the Developing World—announced at the recent international conference—is going to design and implement innovative strategies to bring cancer control and treatment to patients in these countries. We are going to build on some of the global success stories with conditions like AIDS in which global negotiation and lobbying made much-needed drugs available to the poorest populations. Innovative delivery means making better use of the primary and secondary levels of care, including primary care doctors, nurses and midwives. Luckily, some important elements of cancer care can today be delivered in settings other than specialty hospitals, especially with appropriate training and supervision.
As someone who is living with cancer, what have your experiences taught you?
I brought myself to face chemotherapy when it hit me that the only thing worse than having it was not being able to have it because of a lack of resources to pay for it. I realized, having worked in the developing world, that this is the reality faced by the vast majority. What enabled me to face the treatment that I had to face was the conviction that I could use the experience to be able to help other women. Before my diagnosis, I talked about the statistics of health in developing countries; now I live these statistics.
Students may contact Felicia Knaul at felicia_knaul@harvard.edu for more information.
