Cricketer Yuvraj Singh's cancer diagnosis is distressing, and he will hopefully bounce back with the help of the best treatment available. But this is also a moment for India to consider how its public health policy is dealing with the long and dark shadow of cancer. An estimated 800,000 new cancer cases occur in India annually, imposing huge costs on state and society in providing tertiary care for advanced chronic cases. Mortality due to the scourge is projected to go up from 730,000 in 2004 to 1.5 million in 2030. The evidence on the causes clearly points to the need to strengthen key policy goals — preventing new cases, offering low or no-cost treatment, improving quality of life or palliation. Arguably, the single biggest intervention that public policy can make is to tighten curbs on the use of tobacco, given that major cancers in Indian men are linked to it. It is worth pointing out that India has the world's highest number of oral cancers, linked to the tobacco chewing habit. In general, screening and early diagnosis for cancer will benefit both men and women. The unfortunate reality is that India cannot quickly scale up screening in a cost-effective manner, and must therefore focus on early detection to enhance survival rates.
Seeking out the best treatment — especially in expensive domestic corporate hospitals or facilities abroad — is an option open to a minority of Indians. The imperative is to improve access to diagnosis within the country, and subsidise costly medication. The High Level Expert Group of the Planning Commission on Universal Health Coverage has suggested a sound approach to improve access to cancer treatment. The Centre should unhesitatingly accept its recommendations and devote the funds necessary to equip health sub-centres in all areas to screen and refer patients to Primary Health Centres for detailed examination, laboratory sampling, breast and cervical examination. District hospitals and higher institutions in the public system should be equipped to offer surgery, therapy and palliative care. Equally vital is the suggestion that essential medicines be made available free to all patients, and paid for through enhanced public procurement. It is relevant to point out that effective prevention programmes, detection and advances in treatment have reduced cancer death rates significantly in America. The US policy has translated into prevention of more than a million deaths in two decades, as the American Cancer Society points out in its annual report for 2012. India needs more ultrasound machines, endoscopes and training for doctors in district hospitals, to drive down death rates. If Yuvraj Singh were to be the ambassador for such an agenda, speedy progress is possible.
