Implementing and monitoring the right to health in breast cancer: selection of indicators using a Delphi process

Lisa Montel; Michel P Coleman; Therese Murphy; Dina Balabanova; Raffaele Ciula; Dabney P Evans; Claire Lougarre; Didier Verhoeven; Claudia Allemani

doi:10.1186/s12939-023-01964-w

Implementing and monitoring the right to health in breast cancer: selection of indicators using a Delphi process

Int J Equity Health. 2023 Jul 29;22(1):142. doi: 10.1186/s12939-023-01964-w.

Authors

Lisa Montel¹, Michel P Coleman², Therese Murphy^{3

4}, Dina Balabanova⁵, Raffaele Ciula⁶, Dabney P Evans⁷, Claire Lougarre⁸, Didier Verhoeven⁹, Claudia Allemani²

Affiliations

¹ London School of Hygiene and Tropical Medicine, Cancer Survival Group, Faculty of Epidemiology and Population Health, Keppel Street, London, WC1E 7HT, UK. lisa.montel@lshtm.ac.uk.
² London School of Hygiene and Tropical Medicine, Cancer Survival Group, Faculty of Epidemiology and Population Health, Keppel Street, London, WC1E 7HT, UK.
³ Queen's University Belfast, Belfast, UK.
⁴ Raoul Wallenberg Visiting Chair, Lund University, Lund, Sweden.
⁵ London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK.
⁶ Sapienza University of Rome, Rome, Italy.
⁷ Hubert Department of Global Health, Emory University, Atlanta, GA, USA.
⁸ Ulster University, Belfast, UK.
⁹ University of Antwerp, Antwerp, Belgium.

Abstract

Background: Women with breast cancer have different chances of surviving their disease, depending on where they live. Variations in survival may stem from unequal access to prompt diagnosis, treatment and care. Implementation of the right to health may help remedy such inequalities. The right to health is enshrined in international human rights law, notably Article 12 of the International Covenant on Economic, Social and Cultural Rights. A human rights-based approach to health requires a robust, just and efficient health system, with access to adequate health services and medicines on a non-discriminatory basis. However, it may prove challenging for health policymakers and cancer management specialists to implement and monitor this right in national health systems.

Method: This article presents the results of a Delphi study designed to select indicators of implementation of the right to health to inform breast cancer care and management. In a systematic process, 13 experts examined an initial list of 151 indicators.

Results: After two rounds, 54 indicators were selected by consensus, three were rejected, three were added, and 97 remained open for debate. For breast cancer, right-to-health features selected as worth implementing and monitoring included the formal recognition of the right to health in breast cancer strategies; a population-based screening programme, prompt diagnosis, strong referral systems and limited waiting times; the provision of palliative, survivorship and end-of-life care; the availability, accessibility, acceptability and quality (AAAQ) of breast cancer services and medicines; the provision of a system of accountability; and the collection of anonymised individual data to target patterns of discrimination.

Conclusion: We propose a set of indicators as a guide for health policy experts seeking to design national cancer plans that are based on a human rights-based approach to health, and for cancer specialists aiming to implement principles of the right to health in their practice. The 54 indicators selected may be used in High-Income Countries, or member states of the OECD who also have signed the International Covenant on Economic, Social and Cultural Rights to monitor progress towards implementation of the right to health for women with breast cancer.

Keywords: Breast cancer; Cancer control; Human rights-based approach to health; Monitoring; People-centred health system; Right to health.

MeSH terms

Breast Neoplasms* / diagnosis
Breast Neoplasms* / therapy
Female
Human Rights
Humans
Right to Health*