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Maddox R, Bovill M, Waa A, Gifford H, Tautolo ES, Nez Henderson P, Martinez S, Clark H, Bradbrook S, Calma T. Reflections on Indigenous commercial tobacco control: 'The dolphins will always take us home'. Tob Control 2022; 31:348-351. [PMID: 35241610 DOI: 10.1136/tobaccocontrol-2021-056571] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Raglan Maddox
- Modewa Clan, Milne Bay, Papua New Guinea
- Aboriginal and Torres Strait Islander Health Group, National Centre for Epidemiology and Public Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michelle Bovill
- Wiradjuri, New South Wales, New South Wales, Australia
- School of Health and Medicine, Hunter Medical Research Institute, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Andrew Waa
- Ngāti Hine/Ngāpuhi, Aotearoa, New Zealand
- Eru Pomare Māori Health Research Unit, University of Otago, Wellington, New Zealand
| | - Heather Gifford
- Ngāti Hauiti, Aotearoa, New Zealand
- Research for Māori Health and Development, Whakauae Research Services, Whanganui, New Zealand
| | - El-Shadan Tautolo
- Samoa/Ngāti Tapuniu, Samoa, Samoa
- AUT Pacific Health Research Centre, Auckland University of Technology, Auckland, New Zealand
| | - Patricia Nez Henderson
- Navajo Nation (Diné), Turtle Island, Arizona, USA
- Black Hills Center for American Indian Health, Rapid City, South Dakota, USA
| | - Sydney Martinez
- Cherokee Nation Citizen, Tahlequah, Oklahoma, USA
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Hershel Clark
- Navajo Nation (Diné), Turtle Island, Arizona, USA
- Black Hills Center for American Indian Health, Rapid City, South Dakota, USA
| | - Shane Bradbrook
- Ngāi Tāmanuhiri, Rongowhakaata, Ngāti Kahungunu, Aotearoa, New Zealand
| | - Tom Calma
- Elder from the Kungarakan tribal group and a member of the Iwaidja tribal group, Northern Territory, South Australia, Australia
- Office of the National Coordinator, Tackling Indigenous Smoking, Canberra, Australian Capital Territory, Australia
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Nez Henderson P, Lee JP, Soto C, O′Leary R, Rutan E, D′Silva J, Waa A, Henderson ZP, Nez SS, Maddox R. Decolonization of Tobacco in Indigenous Communities of Turtle Island (North America). Nicotine Tob Res 2022; 24:289-291. [PMID: 34516637 PMCID: PMC8807169 DOI: 10.1093/ntr/ntab180] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/12/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Patricia Nez Henderson
- Navajo Nation (Diné), Rapid City, SD, USA
- Black Hills Center for American Indian Health, Rapid City, SD, USA
| | - Juliet P Lee
- Pacific Institute for Research and Evaluation-California, Prevention Research Center, Berkeley, CA, USA
| | - Claradina Soto
- Navajo Nation (Diné)/ Jemez Pueblo, Los Angeles, CA, USA
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Rae O′Leary
- Turtle Mountain Band of Chippewa, Timber Lake, SD, USA
- Missouri Breaks Research Industries, Inc., Timber Lake, SD, USA
| | - Emma Rutan
- Black Hills Center for American Indian Health, Rapid City, SD, USA
| | | | - Andrew Waa
- Ngāti Hine/Ngāpuhi, Wellington, New Zealand
- Eru Pomare Māori Health Research Unit, University of Otago, Wellington, New Zealand
| | - Zahlanii P Henderson
- Navajo Nation (Diné), Rapid City, SD, USA
- Black Hills Center for American Indian Health, Rapid City, SD, USA
| | - Shanoa S Nez
- Navajo Nation (Diné), Rapid City, SD, USA
- Black Hills Center for American Indian Health, Rapid City, SD, USA
| | - Raglan Maddox
- Modewa Clan, Papua New Guinea, Canberra, Australian Capital Territory, Australia
- Aboriginal and Torres Strait Islander Health, National Centre for Epidemiology and Population Health, Australian Nation University, Canberra, Australian Capital Territory, Australia
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3
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Cartujano-Barrera F, Rodríguez-Bolaños R, Arana-Chicas E, Allaham F, Sandoval L, Rubado M, Gallegos-Carrillo K, Colugnati FAB, Galil AG, Mejia RM, Cupertino AP. Smoking Cessation Mobile Interventions in Latin America: A Systematic Review. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:122-132. [PMID: 34263686 DOI: 10.1177/15404153211020410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To systematically review published articles reporting the use of smoking cessation mobile health (mHealth) interventions in Latin America. METHODS Five different databases were searched from database inception to 2020. Criteria: (1) the research was a smoking cessation randomized controlled trial (RCT), quasi-experimental research, or single-arm study; (2) the intervention used at least one type of mHealth intervention; (3) the research was conducted in Latin American; and (4) the research reported the cessation rate. RESULTS Of the seven selected studies, four were conducted in Brazil, two in Mexico, and one in Peru. Only one study was an adequately powered RCT. Interventions relied on text messages (n = 3), web-based tools (n = 2), and telephone calls (n = 3). Some studies (n = 4) provided pharmacotherapy support. Smoking cessation outcomes included self-reported (n = 5) and biochemically verified (n = 2) abstinence. Follow-ups were conducted at Month 6 (n = 2), Week 12 (n = 4), and Day 30 (n = 1). Cessation rates varied from 9.4% at Week 12 to 55.5% at Day 30. CONCLUSION Despite the promising cessation rates of mHealth interventions in Brazil, Mexico, and Peru, there is a need to rigorously evaluate these interventions in different Latin American countries with RCTs that are long-term, adequately powered, and use biochemical verification of cessation.
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Affiliation(s)
| | - Rosibel Rodríguez-Bolaños
- Departamento de Investigación sobre Tabaco, 37764Instituto Nacional de Salud Pública. Cuernavaca, Morelos, Mexico
| | - Evelyn Arana-Chicas
- James P. Wilmot Cancer Institute, 6923University of Rochester Medical Center, Rochester, NY, USA
| | - Fatema Allaham
- James P. Wilmot Cancer Institute, 6923University of Rochester Medical Center, Rochester, NY, USA
| | - Lizbeth Sandoval
- James P. Wilmot Cancer Institute, 6923University of Rochester Medical Center, Rochester, NY, USA
| | - Michelle Rubado
- James P. Wilmot Cancer Institute, 6923University of Rochester Medical Center, Rochester, NY, USA
| | - Katia Gallegos-Carrillo
- Unidad de Investigación Epidemiológica y en Servicios de Salud Delegación Morelos, 37767Instituto Mexicano del Seguro Social. Cuernavaca, Morelos, Mexico
| | | | - Arise G Galil
- Faculdade de Medicina, Universidade Federal de Juiz de Fora. Juiz de Fora, Minas Gerais, Brazil
| | - Raul M Mejia
- Programa de Medicina Interna General, 28196Universidad de Buenos Aires. Buenos Aires, Argentina
| | - Ana Paula Cupertino
- James P. Wilmot Cancer Institute, 6923University of Rochester Medical Center, Rochester, NY, USA
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Bhatt G, Goel S, Shergill G. One size doesn't fit all: contouring and addressing social vitals in reversing tobacco epidemic in Punjab, India. BMJ Case Rep 2020; 13:e231890. [PMID: 32139447 PMCID: PMC7059514 DOI: 10.1136/bcr-2019-231890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/03/2022] Open
Abstract
There are many tobacco users who wish to quit. In some cases, ostracism related to religious proscriptions serves as a barrier and prevents them from revealing their addiction status. Religion as an institution has an immense influence on human behaviour. It contributes to the cultural identity of individuals, moderating uniformity in their behaviour and social life. We describe a case from a province in Punjab in North India, where tobacco use is a 'taboo' due to the widely practised faith of Sikhism. The case illustrates how a doctoral thesis student, along with the healthcare providers at a non-communicable disease clinic, overcame the concealment of tobacco use of a patient with hypertension due to fear of social exclusion. The student assisted him in quitting tobacco use through a culturally specific, patient-centric, individualised, behavioural intervention using religion as a backdrop. This case study highlights the importance of recognising and appreciating the dynamics of sociocultural factors to develop a suitable and successful deaddiction strategy. This case elaborates how a simple 'nudge' of religious tenets-based counselling helps the tobacco addict transgress or tide over such barriers.
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Affiliation(s)
- Garima Bhatt
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sonu Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Tane MP, Hefler M, Thomas DP. Smokefree leadership among the Yolŋu peoples of East Arnhem Land, Northern Territory: a qualitative study. Glob Health Promot 2019; 27:100-108. [PMID: 31232171 DOI: 10.1177/1757975919829405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This qualitative study examined smokefree leadership among the Yolŋu people, Indigenous landowners of East Arnhem Land. Despite disproportionately high smoking prevalence, the study found that most people enacted smokefree leadership within families and communities. While there was broad concern about not impinging on the autonomy of others, Indigenous health workers regularly advised clients, family and community members to quit smoking. This followed a general belief that the issue of smoking was best raised by health workers, rather than traditional leaders. Protecting children from second-hand smoke and preventing smoking initiation was important to all participants irrespective of their smoking status. An enduring and highly valued cultural connection to ŋarali' (tobacco) remains an essential part of the sacred practices of the funeral ceremony, an important and unique social utility. The study found consensus among participants that this would not change. Navigating traditional connections to ŋarali' in a context where most people are still addicted to commercial tobacco is challenging and requires respectful and culturally compelling approaches. Tobacco control initiatives with the Yolŋu should therefore utilise existing smokefree leaders within the social context in which ŋarali' is valued and used, an approach that may resonate with other Indigenous Australian nations and communities.
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Affiliation(s)
- Moana Pera Tane
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - Marita Hefler
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - David P Thomas
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
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6
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Waldstein A. Smoking as Communication in Rastafari: Reasonings with ‘Professional’ Smokers and ‘Plant Teachers’. ETHNOS 2019. [DOI: 10.1080/00141844.2019.1627385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Strasser-Weippl K, Chavarri-Guerra Y, Villarreal-Garza C, Bychkovsky BL, Debiasi M, Liedke PER, Soto-Perez-de-Celis E, Dizon D, Cazap E, de Lima Lopes G, Touya D, Nunes JS, St Louis J, Vail C, Bukowski A, Ramos-Elias P, Unger-Saldaña K, Brandao DF, Ferreyra ME, Luciani S, Nogueira-Rodrigues A, de Carvalho Calabrich AF, Del Carmen MG, Rauh-Hain JA, Schmeler K, Sala R, Goss PE. Progress and remaining challenges for cancer control in Latin America and the Caribbean. Lancet Oncol 2016; 16:1405-38. [PMID: 26522157 DOI: 10.1016/s1470-2045(15)00218-1] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 12/22/2022]
Abstract
Cancer is one of the leading causes of mortality worldwide, and an increasing threat in low-income and middle-income countries. Our findings in the 2013 Commission in The Lancet Oncology showed several discrepancies between the cancer landscape in Latin America and more developed countries. We reported that funding for health care was a small percentage of national gross domestic product and the percentage of health-care funds diverted to cancer care was even lower. Funds, insurance coverage, doctors, health-care workers, resources, and equipment were also very inequitably distributed between and within countries. We reported that a scarcity of cancer registries hampered the design of credible cancer plans, including initiatives for primary prevention. When we were commissioned by The Lancet Oncology to write an update to our report, we were sceptical that we would uncover much change. To our surprise and gratification much progress has been made in this short time. We are pleased to highlight structural reforms in health-care systems, new programmes for disenfranchised populations, expansion of cancer registries and cancer plans, and implementation of policies to improve primary cancer prevention.
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Affiliation(s)
- Kathrin Strasser-Weippl
- Centre for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria; The Global Cancer Institute, Boston, MA, USA
| | - Yanin Chavarri-Guerra
- The Global Cancer Institute, Boston, MA, USA; Hemato-Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Cynthia Villarreal-Garza
- Instituto de Cancerología, Centro de Cáncer de Mama, Tecnologico de Monterrey, Monterrey, Nuevo León, Mexico; Departmento de Investigación y de Tumores Mamarios, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Brittany L Bychkovsky
- Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Marcio Debiasi
- Hospital Mae de Deus, Porto Alegre, Rio Grande do Sul, Brazil; Hospital Sao Lucas da PUCRS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro E R Liedke
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Instituto do Câncer Mãe de Deus, Porto Alegre, Rio Grande do Sul, Brazil
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Cancer Care in the Elderly Clinic, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | - Don Dizon
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Eduardo Cazap
- Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina
| | - Gilberto de Lima Lopes
- Medical Oncology, Centro Paulista de Oncologia and Oncoclinicas do Brasil Group, São Paulo, Brazil; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Diego Touya
- Department of Oncology, University of the Republic, Montevideo, Uruguay
| | | | - Jessica St Louis
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Caroline Vail
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Alexandra Bukowski
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Pier Ramos-Elias
- Instituto de Cancerología, Centro de Cáncer de Mama, Tecnologico de Monterrey, Monterrey, Nuevo León, Mexico
| | - Karla Unger-Saldaña
- Cátedra CONACYT, Unidad de Epidemiología, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | | | - Mayra E Ferreyra
- Oncology Department, Maria Curie Hospital, Buenos Aires, Argentina
| | - Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Angelica Nogueira-Rodrigues
- Federal University, Minas Gerais, Brazil; EVA-Group Brasileiro de Tumores Ginecológicos, Brazilian Gynecologic Oncology Group, Bahia, Brazil
| | | | - Marcela G Del Carmen
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jose Alejandro Rauh-Hain
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Raúl Sala
- Grupo Argentino de Investigación Clínica en Oncología-GAICO, Rosario, Santa Fe, Argentina
| | - Paul E Goss
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Egbe CO, Petersen I, Meyer-Weitz A, Oppong Asante K. An exploratory study of the socio-cultural risk influences for cigarette smoking among Southern Nigerian youth. BMC Public Health 2014; 14:1204. [PMID: 25416846 PMCID: PMC4247683 DOI: 10.1186/1471-2458-14-1204] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 11/12/2014] [Indexed: 11/19/2022] Open
Abstract
Background The increase in smoking prevalence in developing countries including Nigeria has been mainly blamed on the aggressive marketing strategies of big tobacco companies. There is a paucity of research on other socio-cultural risk factors for smoking among the youth. The main objective of this study is to explore and describe socio-cultural risk factors influencing cigarette smoking among the youth in Southern Nigeria. Methods A total of 27 respondents (5 community leaders, 4 political analysts and 18 young cigarette smokers) were interviewed using a semi-structured interview guide. Interpretative Phenomenological Analysis (IPA) was used to analyse the data. Results Social-cultural practices fuelling early usage and exposure of children to cigarettes and the promotional activities of tobacco companies were identified as possible factors influencing youth’s smoking behaviour in Southern Nigeria. Conclusion Tobacco control policies should include cultural interventions to modify current traditional practices and social norms which fuel the use of tobacco in the society. Such interventions must target specific groups, subpopulations and subcultures more exposed to the cultural risk influences for smoking.
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Affiliation(s)
- Catherine O Egbe
- Discipline of Psychology, School of Applied Human Sciences, College of Humanities, University of KwaZulu-Natal, King George V Avenue, Durban 4041, South Africa.
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Moore SP, Forman D, Piñeros M, Fernández SM, de Oliveira Santos M, Bray F. Cancer in indigenous people in Latin America and the Caribbean: a review. Cancer Med 2014; 3:70-80. [PMID: 24403278 PMCID: PMC3930391 DOI: 10.1002/cam4.134] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 07/20/2013] [Accepted: 08/17/2013] [Indexed: 12/29/2022] Open
Abstract
Cancer is a leading cause of death in Latin America but there have been few assessments of the cancer burden for the 10% of the population who are indigenous. Evidence from other world regions suggests cancer survival is poorer for indigenous people than for others due to a greater incidence of case-fatal cancers, later stage at diagnosis, and less cancer treatment. A status report on the cancer profile of indigenous people in Latin America and the Caribbean (LAC) is therefore clearly warranted. We undertook a systematic review of the peer-reviewed literature in academic databases, and considered evidence from cancer registries from 1980, to assess cancer epidemiology among indigenous people in LAC. We identified 35 peer-reviewed articles pertaining to cancer in indigenous people. Rates of cervical cancer in parts of Brazil, Ecuador, and Guyana, stomach cancer rates in regions of Chile and gallbladder rates in Chile and Bolivia, were higher for indigenous compared to others. Breast cancer rates were lower in Ecuador, Brazil, and Chile. Six cancer registries in Brazil provided incidence data but no other reports of incidence, mortality, or survival were identified. There was a paucity of data surrounding the cancer burden of indigenous people in LAC. In view of predicted increases in cancer rates in ensuing decades, and the disparities in burden already experienced by indigenous people in the region, it is imperative that cancer profiles are obtained and cancer control measures identified and prioritized.
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Goss PE, Lee BL, Badovinac-Crnjevic T, Strasser-Weippl K, Chavarri-Guerra Y, St Louis J, Villarreal-Garza C, Unger-Saldaña K, Ferreyra M, Debiasi M, Liedke PER, Touya D, Werutsky G, Higgins M, Fan L, Vasconcelos C, Cazap E, Vallejos C, Mohar A, Knaul F, Arreola H, Batura R, Luciani S, Sullivan R, Finkelstein D, Simon S, Barrios C, Kightlinger R, Gelrud A, Bychkovsky V, Lopes G, Stefani S, Blaya M, Souza FH, Santos FS, Kaemmerer A, de Azambuja E, Zorilla AFC, Murillo R, Jeronimo J, Tsu V, Carvalho A, Gil CF, Sternberg C, Dueñas-Gonzalez A, Sgroi D, Cuello M, Fresco R, Reis RM, Masera G, Gabús R, Ribeiro R, Knust R, Ismael G, Rosenblatt E, Roth B, Villa L, Solares AL, Leon MX, Torres-Vigil I, Covarrubias-Gomez A, Hernández A, Bertolino M, Schwartsmann G, Santillana S, Esteva F, Fein L, Mano M, Gomez H, Hurlbert M, Durstine A, Azenha G. Planning cancer control in Latin America and the Caribbean. Lancet Oncol 2013; 14:391-436. [PMID: 23628188 DOI: 10.1016/s1470-2045(13)70048-2] [Citation(s) in RCA: 316] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Non-communicable diseases, including cancer, are overtaking infectious disease as the leading health-care threat in middle-income and low-income countries. Latin American and Caribbean countries are struggling to respond to increasing morbidity and death from advanced disease. Health ministries and health-care systems in these countries face many challenges caring for patients with advanced cancer: inadequate funding; inequitable distribution of resources and services; inadequate numbers, training, and distribution of health-care personnel and equipment; lack of adequate care for many populations based on socioeconomic, geographic, ethnic, and other factors; and current systems geared toward the needs of wealthy, urban minorities at a cost to the entire population. This burgeoning cancer problem threatens to cause widespread suffering and economic peril to the countries of Latin America. Prompt and deliberate actions must be taken to avoid this scenario. Increasing efforts towards prevention of cancer and avoidance of advanced, stage IV disease will reduce suffering and mortality and will make overall cancer care more affordable. We hope the findings of our Commission and our recommendations will inspire Latin American stakeholders to redouble their efforts to address this increasing cancer burden and to prevent it from worsening and threatening their societies.
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Affiliation(s)
- Paul E Goss
- Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA 02114, USA.
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