Southeast Asia is home to over 680 million people with rich histories and cultures. Despite the ongoing dynamic growth in this region, the care gap for people with cancer persists as a challenge. This includes disparities in cancer risk, screening, access to care, and survivorship. Then, what are some of the factors causing the cancer care gap in Southeast Asia?
Cancer in Southeast Asia
Cancer is the second leading cause of death after cardiovascular diseases. Cancer occurs when abnormal cells grow uncontrollably in any organ or body tissue, invading other parts of the organ or body. In 2020, the WHO South-East Asia Region estimated 1.4 million cancer-related deaths and 2.2 million new cases in the region.
A study has shown how individuals’ identities impact their access to cancer care. These identities are intersectional, involving race/ethnicity, religion, sex, and gender identity, as well as geography, language, and ancestry. This complex interrelationship study underscores that social determinants of health are interconnected.
The Intersectional Cancer Care Gap
The geographic and socio-economic disparities in Southeast Asia play a pivotal role in shaping the alarming cancer gap within the region. Developing nations in this region face limited access to healthcare, especially in rural areas. There are only a number of professionals and medical equipment specializing in cancer treatment, such as in the Philippines, where there are 0.71 oncologists for every 100,000 Filipinos. Often, cancer patients have to seek treatments abroad due to the lack of proper facilities in their home countries.
Additionally, gender, beliefs, and ethnicity are some of the socio-cultural aspects affecting cancer care. In 2018, there was over 60% mortality for women with cervical cancer among the 90% of global deaths within low-to-middle-income countries in this region. Women still have difficulties in accessing cancer care due to many forms of gender discrimination, such as misogyny, stereotypes, and gender role expectations.
Moreover, the prevalence of traditional Asian values among people in Southeast Asia, characterized by conservatism and collectivism, also contributes to the cancer care gap by acting as barriers to accessing healthcare and receiving social or state support.
Different religious groups often experience disparities in cancer care, as religion, culture, ethnicity, and geography are closely connected. For instance, a study found that in 2007, only 30% of Muslim women were reported utilizing the government’s breast self-examination (BSE) program, compared to 41% of Buddhist women in Southern Thailand. This gap is influenced by factors such as limited awareness of screening methods, fatalistic beliefs, and varying health literacy. Some groups may prefer faith healers over modern cancer therapy.
Furthermore, different ethnic backgrounds can also hinder cancer care. In Singapore, for instance, a study found that the Malay community has a lower likelihood of cancer screening compared to the ethnic Chinese population, while the migrant workers in the city-state face barriers to accessing general healthcare, hindering their access to cancer care.
Addressing the cancer care gap is crucial in achieving inclusive healthcare coverage for all. Several practices have been implemented by countries in this region to address the challenge, like Singapore, Philippines, Myanmar, Malaysia, and Thailand.
In 2023, Singapore mandated employers to provide medical insurance for migrant workers, reflecting extensive cross-sectoral efforts to promote health equity. Through the National Integrated Cancer Control Act of 2019, the Philippines established a nation-scale comprehensive cancer center through public-private partnerships, aiming to redistribute access to specialist care.
Meanwhile, Myanmar actively participated in the global initiative City Cancer Challenge, aiming to strengthen cancer care in low-to-middle-income countries through locally developed solutions. Malaysia implemented projects, including the Beat Prostate Cancer campaign, to educate the public, while Thailand launched the Cancer Anywhere campaign to raise awareness.
All in all, the efforts to close the cancer care gap in Southeast Asia still have a long way to go. They are complex matters requiring participation from all stakeholders. Recognizing and uplifting the voices of diverse groups in research, clinical practice, and health policy is important to acknowledge and address the socio-economic disparities in the region. Additionally, understanding the region’s religious and cultural beliefs, addressing inequities, enhancing health literacy, and reducing care costs are essential. Considering each population’s unique identity and background is crucial to creating healthcare systems that leave no one behind.
Editor: Nazalea Kusuma