These are the countries best prepared for the fight against cancer

Last year, 18.1 million people developed cancer – and 9.6 million died from it. Cancer causes one in six deaths globally. In fact, it is the leading cause of premature death in more than half of all nations, while the countries predicted to see the biggest increase in cases are the least prepared, according to new research.

The Economist Intelligence Unit’s new Index of Cancer Preparedness investigated the state of readiness in 28 countries for what it terms “the global epidemic of cancer”. Although high-income countries have the most cases of cancer, it warns that low- and middle-income nations will see the fastest spread of the disease.

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The top five

Australia leads the index. Although it suffers high levels of certain cancers, notably skin, prostate, breast, bowel and lung cancers, its cancer mortality rate is among the world’s lowest. The index gives Australia top scores in most areas, but identifies weaknesses in the availability of some cancer services and infrastructure.

The Netherlands, Germany, France and the UK complete the top five nations in the index. However, although Australia is rated best for policy and planning, Japan has the highest score for care delivery and Sweden is rated best for health system and governance.

Egypt does least well of the nations surveyed. Liver cancer rates are rising in Egypt, according to the latest available World Health Organisation figures, which also show that almost half of Egyptian men smoke, nearly a quarter are physically inactive and a fifth are overweight.

Although Egypt scores very highly for its cancer research activities, the index highlights a shortage of trained cancer treatment staff and low levels of political will, infrastructure and cross-sectoral action to tackle cancer.

Wealth vs health

Research for the index, which was supported by pharmaceutical companies Novartis, Pfizer and Roche, found that as people in the developing world live longer and grow richer the number of cancer cases will increase. Types of cancer historically more prevalent in the rich world will in future afflict people in developing nations.

Healthcare systems of countries already struggling to cope with cancer risk being overwhelmed as their populations become more affluent, says the index. Although 59% of cancer cases globally are currently in low or middle-income nations, the index predicts these countries will see 71% of global cancer deaths in the future.

The index says increased investment in healthcare will be needed together with improved organisation and resources. Each country needs a national cancer control plan but this must be actionable and supported by data to monitor success in treating and preventing the disease.

Big isn’t always better

A good plan, well implemented across the whole national healthcare sector, can enable countries with fewer resources to do as well as better-resourced nations. According to the report, planning helps to explain why Thailand has a cancer mortality rate (67%) which is very close to better-resourced Romania (61%).

Controlling cancer can't be isolated but should be part of a health system that's accessible to all. The authors say countries with the strongest health systems and governance have the lowest cancer mortality rates.

Even the best-resourced health systems have weaknesses. “Generally, in wealthier countries accessible care exists but links between oncology and other parts of the health system, notably primary care, frequently require improvement,” say the report’s authors.

In lower-income countries, the bigger issue is access to healthcare in the first place. Cancer control needs to be developed simultaneously with improved general healthcare. The authors, cite Rwanda, where cancer prevention was integral to the rebuilding of health services after the civil war in the 1990s. Today, 95% of Rwandans have access to free healthcare through government and insurance, they note.