Cancer control in small island nations: from local challenges to global action.


Diana Sarfati, Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
Rachel Dyer, Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
Paula Vivili, Public Health Division, Pacific Community, Noumea, New Caledonia
Josephine Herman, Ministry of Health, Rarotonga, Cook Islands
Dingle Spence, Hope Institute Hospital, Kingston, Jamaica
Richard Sullivan, School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
David Weller, James Mackenzie Professor of General Practice, Usher Institute of Population Health, Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
Freddie Bray, Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
Sarah Hill, Global Health Policy Unit, University of Edinburgh, Edinburgh, UK
Christopher Bates, Nossal Institute for Global Health, Melbourne School of Population and Global Health, Melbourne, VIC, Australia
Sunia Foliaki, Centre for Public Health Research, Massey University-Wellington Campus, Wellington, New Zealand
Neal Palafox, Pacific Regional Cancer Programs, Department of Family Medicine and Community Health, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA; Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA
Silvana Luciani, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
Alec Ekeroma, Department of Obstetrics and Gynaecology, University of Otago, Wellington, Wellington, New Zealand; National University of Samoa, Le Papaigalagala Campus, To’omatagi, Samoa
James Hospedales, Caribbean Public Health Agency, Kingston, Jamaica

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Cancer is a leading cause of death in small island nations and is forecast to increase substantially over the coming years. Governments, regional agencies, and health services of these nations face daunting challenges, including small and fragile economies, unequal distribution of resources, weak or fragmented health services, small population sizes that make sustainable workforce and service development problematic, and the unavailability of specialised cancer services to large parts of the population. Action is required to prevent large human and economic costs relating to cancer. This final Series paper highlights the challenges and opportunities for small island nations, and identifies ways in which the international community can support efforts to improve cancer control in these settings. Our recommendations focus on funding and investment opportunities to strengthen cancer-related health systems to improve sharing of technical assistance for research, surveillance, workforce, and service development, and to support small island nations with policy changes to reduce the consumption of commodities (eg, tobacco and unhealthy food products) that increase cancer risk.