The study is actually about looking at the correlation between governance and cancer control generally. Studies have been done in the past to look at the impact or the relationship between governance and health outcomes, other health outcomes, like under-five mortality, immunisation coverage, nutrition, and so forth and so forth. Our own study is trying to look at is there any kind of correlation actually between governance and cancer control in general? We tried to look at cervical cancer as our own [cancer of index], because cervical cancer is the first cancer targeted to be eliminated worldwide. We felt that it’s the most potential cancer to be eliminated, and we have seen that in other [??] progress has been made in controlling this cancer.
We’re trying to look at are there governance issues that affect cancer control generally? As you are aware, many studies or many scientists have worked on biological reasons why we have disparities in outcomes, or in cancer outcomes generally. Maybe they’re genetic or biological, generally, but there are some factors that are non-biological, probably, that are responsible for disparities in outcomes. So, essentially, that’s why we tried to look at whether governance is one of those non-biological factors that causes these wide disparities in outcomes of cancer, and particularly cervical cancer.
What was the study design?
The design is a cross-sectional study looking at publicly available data on governance and cancer control metrics. We look at the worldwide governance indicators that were published, that is published or is being hosted by the World Bank. They are publicly available. Then we look at the mortality-incidence ratio of cervical cancer. The mortality-incidence ratio is a metric that is being used generally to look at control of cancer generally, because if the number of mortality is more, is equal to the number of new cases they are having, then it’s an index of how well that cancer is being controlled in that country. So, basically, that’s what we look at, and then we did a regression analysis to look at whether there’s any correlation between governance indicators and the mortality-incidence ratio.
What were the results of this study?
So, like I said earlier, we looked at the governance indicators, six of them, six governance indicators, as proposed by the World Bank. The six governance indicators are indicators that indicate the wellness of governance in any country. The World Bank keeps this data which is publicly available. Then we also look at data on cervical cancers, the incidence and mortality data from the GLOBOCAN 2000 reports. We analysed 179 countries. More than half of those countries have cervical cancer as one of the top three cancers in those countries.
We found that there’s a strong correlation between all the different components of governance, the six components of governance. The correlation is such that it’s negative for countries that have good governance systems: usually they have a low mortality-incidence ratio, which shows that there’s good cervical cancer control in those countries. For countries that have poor governance, or low governance indicators, usually they have a very high mortality-incidence ratio, which connotes that cancer control is very poor in those countries. When we run the regression analysis on those data, we found out that the strongest predictor, actually, of the mortality-incidence ratio is government effectiveness. That means that how governments are run, how policies are formulated, how policies are implemented, how government is constituted, and how governments are transitioned, all those things affect the outcomes of cancer treatment.
Like I said earlier, we used cervical cancer because it’s the first cancer that is targeted for elimination worldwide, and it has such a wide disparity between countries that have good governance and countries that have poor governance. What that shows to us is that apart from the fact that there are biological differences that cause differences or disparities in outcomes, we also saw from our own study that the kind of governance, or the way countries are governed, also affects the outcome of cancer treatments, or it affects cancer control in general.
What is the significance of these results in influencing changes to public policies in LMICs?
Actually that’s the essence of this study, really, to show that, apart from the fact that we have biological differences, that consists [?? 06:58] cervical cancer, there are governance issues that are responsible. A lot of effort is being put in the biological aspects. We know about HPV, for instance – how do we do HPV testing? How do we do cancer treatment? How do we do radiotherapy for cervical cancer? How do we do brachytherapy? Those are technical components of this disease, but there are governance issues that are often overlooked.
So what this study means, or what this study is going to do to change policy, is that people that are looking towards eliminating cervical cancer, for instance, whatever support, whatever resources that we’re trying to bring to this effort, we need to look at governance of countries, regions, states, or provinces, because that also has implication on how cancers are controlled or how cervical cancer is controlled. Particularly, we’re interested because cervical cancer is targeted for elimination and the whole world is putting its efforts to look at getting resources, getting all the tools, which is pretty available.
If you look at, for instance, HPV vaccination, we have the vaccines. If you look at pap smear, we have effective screening methods, but why is it that they are not available in some countries, and they are very available in some countries? That is basically sometimes about governance. Sometimes it’s not even about income, it’s about how that country is governed. What is the priority of the government, or what are the priorities of the government?
This study is going to change policy in the sense that people that are pushing for better cancer control, particularly in low- and middle-income countries, we have to look at governance as a very critical component of that effort. If the world is looking toward eliminating cervical cancer, I think one of the things the world needs to look at is how countries, how states and provinces, are governed, because that affects cancer control based on our own study.
Is there anything else you would like to add?
Generally, I have been working on cancer disparities, looking at what are the non-biological factors that cause disparities in cancer outcomes. Several studies have looked at biological factors like aggressive cancers in some populations compared to other populations, some genetic factors in some populations rather than other populations. But from this study, we have seen that a significant cause of disparity is actually caused by governance, and this is something that people are not talking about. Most times, if you look at community professionals, cancer professionals, and all that, they are basically focused on the biological factors, genetic factors – what are those differences between races, and all that? But, fundamentally, if you look at it also, the governance, how governance of those states, or countries is being run, affects that. One of my own messages is that we need to look at that.
The second thing I want to say is that, apart from that, people have looked at some of these things may not necessarily be within the health sector itself. Because, like we said, it’s not the Minister of Health that decides solely whether they are going to vaccinate their population. It is an executive decision. It’s going to be the government that would decide whether they want to commence or not. The Minister of Health in a country, for instance, knows that vaccines are effective, screenings are effective. But he is not the one that takes that decision, so sometimes some of those governance or government decisions are not really done within the traditional health sector, and they are outside of the health sector, but they have significant impact on the health outcomes of populations.
