Social Perspective of Cancer: The 10/90 Gap

A big problem in the distribution of cancer care is the so-called 10/90 gap. The 10/90 gap refers to the finding that 90% of the research investments is targeted to only 10% of the world’s population. This is because there is a big difference in the types of cancer per country that people are more at risk for, as explained in the World Cancer Report. For example, in developing countries people are most at risk for lung; breast; stomach; colorectal; and liver cancer, while developed countries often have much more cases of breast and prostate cancer. Furthermore, in developing countries 1 in 4 cancers are due to infections, while in developed countries this is only 1 in 10. All these differences make it harder to find a treatment of cancer that will work globally.

Miranda is a physician trained as clinical epidemiologist in Peru and the UK with interest in public health and policy, Zaman has studied at the department of Epidemiology and Public Health at University College in London; they are both experts in this field and therefor their article is a reliable source. Chinnock is a communicator in health and medicine, specialising mainly in global public health. He is qualified in Applied Biology and Human Nutrition. Is a Chief Specialist Scientist, who works at the Medical Research Council of South Africa, and is an associate Professor at the Faculty of Health Sciences, University of Cape Town. Clarke has studied at the School of Medicine, Dentistry and Biomedical Sciences. Their article is also very reliable as they are all experts in their field, and come from different parts of the world, therefor can make a good article about the developed and the developing world.

The World Health Organization (WHO) and the World Cancer Research Fund (WCRF) are both internationally recognised organisations with a trustworthy reputation. Lastly, Kavanos is not an expert in any medical field, he has studied at the London School of Economics, but all his sources are very reliable, therefor his source is trustworthy too. So the 10/90 gap is for a great part due to the differences in cancers globally. However, there is more to it. Many developing countries struggle to provide basic health care. Globalisation may be a factor in this, according to Kavanos. He explains that while it may improve economic growth in developing countries, it may also compromise investments in health care in individual countries.

Another effect that globalisation has on cancer care, is that many developing countries can expect a rise in cancer cases due to globalisation. This is because people get older, and because urbanization leads many to a less healthy lifestyle, with less exercise, more unhealthy food, and more industrial exposures. Accompanying this increased risk of getting cancer, is the often late diagnosis and inadequate treatment. According to Kavanos 80% of patients in developing countries already have an incurable form of cancer when they get diagnosed. Not only do developing countries have different risks concerning cancer, they also have poorer access to epidemiological date and research. Not to mention the unused potential of many researchers in developing countries. As there is often no good system to fund researchers, it is harder to contribute their work to the national and international medicine, further keeping the 10/90 gap intact.

Moon S. Chen, nationally renowned cancer health disparities expert with a Ph. D. from the department of Public Health Sciences, calls the cancer burden unique, unusual, and unnecessary. It is unnecessary because to reduce the burden, only very basic changes would have to be implemented. Cancer screening would have to be more accessible, to ensure earlier diagnosis, resistance to physician visits needs to be overcome, and lastly culturally competent interventions need to be instituted that promote a healthier lifestyle, especially with less smoking, as 30% of cancers are caused by smoking.

There is a solution possible, according to Annie J. Sasco’s Cancer and globalization: The World Trade Organization (WTO) can facilitate the introduction of products in any country, no matter how impoverished it may be. The WTO can do this trough trade agreements. Sasco has studied at the French Institute of Health and Medical Research, and is currently the Director of Research at the Université Victor Segalen, this source is thus very reliable.

The 10/90 gap is thus partly caused by the differences in cancer types globally, and partly by the wealth differences globally. But even in one country the results of randomised trials may not be applicable to everyone. This is because a lot of these researches only study a highly selected group of people, and therefor the results are not applicable to such a broad population as hoped for. This results in a conflict between proof of concept and generalisability. For example, the elderly are often extremely underrepresented in cancer clinical trials relative to their disease burden, because they’re often ineligible for clinical trials. This is because of their oftentimes more eleborate medical history. Protocol then requires them to be excluded, not only for their safety, but also because it might compromise the results. Miranda and Zaman further explain that many health differentials between social groups are not necessarily generated solely by medical causes. To solve this problem solutions are required at a different level than solely clinical research as it is now.