The keynote address: Balancing healthcare needs in a changing context
Professor Meinir Krishnasamy gets EONS-10 off to an impressive start. Report by Jim Boumelha.
Professor Krishnasamy, chair in Cancer Nursing at the University of Melbourne and president of the Clinical Oncology Society of Australia, delivered the keynote speech at EONS’ 10th Congress, entitled “Balancing healthcare needs in a changing context”. Her presentation took a spellbound audience of 500 nurses by storm and was a formidable curtain raiser for what has been described as one of the best EONS congresses to date.
Professor Meinir Krishnasamy delivers her keynote conference speech to the EONS-10 audience
Meinir started her lecture by setting out the global context with facts and figures, which she said presented to the largest workforce across the globe “the opportunity to make a difference to these challenges given the rapidity and the unpredictability with which cancer care is changing.”
She alluded to the advances in technology, the rapidity of change, the potential for precision medicine but critically to the fact that the distinction between the ‘haves and have nots’ has never been greater. She then moved on to talk more broadly about how to deal with “balancing or meeting healthcare needs in a context that is changing almost daily around us.”
For her, the war on cancer cannot be won if a tiny percentage of the world has better outcomes and the vast majority of the world does not. Using tables and graphs from a wide variety of sources, academia, research and NGOs, Meinir set out to demonstrate with mathematical precision the context within which she argued for balancing healthcare needs in cancer.
Our mission to address the imbalance
Her starting point was the staggering statistics from Oxfam showing the richest 1% in the world now has as much wealth as the rest of the world combined. It is in this context that she called on nurses to begin to understand that “our mission to address the imbalance of cancer should be within a much larger context of what’s happening in the world, otherwise we keep chipping away at the Nixons and at the Moonshots, investing more energy into our fight against cancer, when actually the problem is much broader.” She gave shocking examples, such as 15% of the world population having access to 70% of the world radiotherapy facilities, while many low and middle income countries have fewer than 20 physicians and 100 nurses per 100,000 people, which is the minimum standard set by WHO.
Professor Meinir Krishnasamy takes questions from the audience
She made a wake-up call in particular to “those of us who are blessed enough to live in a country that is well resourced, and watch the others, the people in the low and middle income countries who die inevitably from cancer and other non-communicable diseases unnecessarily.
“We live in an environment where we know we are increasingly at risk of becoming singular and isolated and 'othering' the groups that may be a challenge to our resources and capabilities,” she said.
Meinir cited staggering statistics in particular on humanitarian and unmet healthcare needs which have grown exponentially in the last 30 years. She gave the example of Australia where if they continue to spend in GDP on health as they do now, “in the next 15 years there will be nothing left for education, for roads, or for anything else.” Questioning the cost of the reforms of the NHS in the UK, “it’s about getting that balance between quality and cost containment,” she said, “it does not matter how many amazing top quality cancer nurses you get rid off and replace with junior staff, you will not fix the problem of cancer through an inward looking environment, doing a bit of lean thinking, a bit of tweaking around the system to get the processes to run more smoothly.” She concluded, “If we need to redress the balance of healthcare need, we need people who can think, who can see the bigger picture and that’s you.”
Finally, addressing the huge variation in healthcare expenditure per capita across the European region, Meinir affirmed that “with as little as 0 or 3% being spent on public health, we cannot win the war on cancer, we cannot redress the balance of unmet healthcare need if we continue to focus on the system in isolation.”
How to get a balance
She then set up the agenda against which healthcare need can be balanced, referring to confounding variables around geography, ageing, sex, race, ethnicity, diagnosis. Again she called on her audience to think carefully how to get balance for themselves as people working in the system, and how to redress the balance across the system for equity for their patients and their families, and confront issues in terms of meeting healthcare need around differentiation of sex and issues of ageing population.
Meinir pointed to the 65 years and over population in the European region, projected to rise from 129 million in 2010 to 224 million in 2050. “There are more and more of us… More and more of us are getting cancer and may or may not be having the problem alongside many of the co-morbidities as we age.” she said. “We are at risk of demonising older people. They are becoming a drain on the system. They are becoming a problem. They are becoming ‘the other’.”
The elephant in the room
While some people see the problem from the spectrum of the huge economic impact for death and disability from cancer which was $825 billion in 2008, (1.5% of the world’s GDP), the elephant in the room, she said, is that this is not acknowledged: inequality in early years, where you were born, how you were born, who you were born to, shapes the rest of your life; levels of education, whether you get an opportunity to have an education depending on your sex, depending on the resources in your country, depending on values, depending on culture; critically, how do you develop health literacy?
In conclusion, how should we take an overwhelmingly depressing dataset and carry on thinking about nurses’ contribution? For a start, the good news is that a third of all cancer diagnosis are preventable. And let’s not forget the incredible possibilities: precision medicine, the advances in technology on radiation delivery and others, although the strong question asked by Meinir remains about how much the developed world continue to embrace advancements without asking: what about the others?
Make our voice heard
The other issue is about public expectations. Meinir referred to what can be done starting using our collective muscle. “All of us live in environmental societies where we know what is available, we want it, we demand it, we are asking for it. We have huge power with government and we make our voice heard,” she said.
She also listed all the global campaigns such as “We can. I Can” launched last year by the Union for International Cancer Control (UICC) saying “actually the way we’ll win this year, the way we’ll redress the imbalance on healthcare needs is by coming together globally, working locally, working nationally, coming together globally to really advocate for thinking about where we are spending the money and where is the greatest capacity for people to benefit.”
EONS President Daniel Kelly thanks Professor Meinir Krishnasamy for her excellent contribution to the EONS-10 Congress
Her final call was for everyone “to be vigilant to inequity, to every person that comes in front of them day by day: is this person disadvantaged in terms of their cancer healthcare needs? Are they older, are they black, are they a woman, are they a man? So many things that they can look for in the day-to-day environment.”