Better cancer control for worldwide populations at the margins of healthcare: Direct big-issues talk and due diligence

While there is increasing attention to cancer among underserved populations globally, recent publications have suggested that discussions often ignore the broad but critical issues and lack due diligence. This communication considers these subjects. We all seek honest governments, recognition of women's and other human rights, protection of minorities, the fostering of education for all, and the rendering of fair justice. Absence of these overwhelms efforts in cancer care. Massive rural-urban migration and the majority of cancer burdens globally occurring among the huge populations of poor Asians are also dominating realities. In-depth understanding of how people actually live must ground our efforts. Weak governments, weak health systems, and widespread corruption adversely impact work to improve cancer outcomes. Some implications of these painful circumstances are first that cancer-specific, top-down approaches may be less suitable and less effective than locally defined efforts sensitive to particular broad issues. Second, that widespread drug availability may be less an economic issue than a social systems issue. Third, patient education about cancer signs and symptoms may be less useful than direct efforts targeting broad human rights issues to give patients real choices to seek care. We suggest that addressing cancer control for underserved populations needs to be more of an exercise in addressing the major societal issues, living noble values, investigating to see things as they really are, and acting from a model of intervention suitable to the broad complex challenges.