Need to Increase Awareness of NCDs in MICs on the Edge of the Syrian Refugee Crisis

Introduction

Noncommunicable diseases (NCDs), one of today's biggest health challenges, are emerging as one of the leading causes of death worldwide (WHO, 2018). However, the availability of data on diseases and deaths worldwide also reveals disparities between countries in efforts to combat NCDs (Ezzati et al., 2018). Undoubtedly, low- and middle-income countries (MICs) and their health systems face major challenges in efforts to combat NCDs (Niessen et al., 2018; Islam et al., 2019). NCD deaths remain a major public health problem in all countries, including low- and middle-income countries, with more than three-quarters of these deaths occurring in these countries (WHO, 2022). Learning from the experiences of high-income countries is crucial for MICs to gain insights and develop effective policies and interventions for NCDs (Hearn et al., 2019). Monitoring these interventions at the national level is crucial to reduce the burden and impact of NCDs through feasible and cost-effective interventions and to track global progress and identify challenges (WHO, 2022). The increasing evidence of NCDs' global health significance has prompted WHO member countries to initiate efforts to reduce premature deaths caused by the four major NCDs (cancers, cardiovascular and chronic respiratory diseases, and diabetes in people in the age range 30–69 years) by 25% by 2025 compared to 2010 levels (Ezzati et al., 2018).

While the term NCDs encompasses cardiovascular diseases, diabetes, chronic respiratory diseases, mental illnesses, and injuries, there is a noticeable gap in knowledge and experience regarding cancer (Schrecker, 2020). Cancer types such as breast cancer are among the important non-communicable diseases are the leading causes of death worldwide, and are the most common cancer type among women, especially in developed and developing countries (WHO, 2021). Low and middle-income countries face challenges in dealing with cancer, especially breast cancer, and their health ministries encounter limitations in improving breast cancer outcomes (Elghazawy et al., 2020; Prodhan et al., 2023). Multiple barriers hinder efforts to enhance cancer care outcomes in MICs. These barriers include a lack of scientific and epidemiological data, insufficient information on resource planning for breast cancer control, limited availability of experts and resources, inadequate quality of health statistics data, politicized decision-making processes, and socio-cultural factors that impede effective healthcare delivery (Dankó, 2014; Ginsburg et al., 2018).

Aside from the challenges related to cancer care outcomes, middle-income countries confront significant financial constraints in their efforts to combat cancer effectively (Carrera et al., 2018). Families in MICs often experience significant out-of-pocket (OOP) health expenditures to meet the healthcare needs related to cancer (Ginsburg et al., 2018; O'Neill et al., 2015). Despite breast cancer being a major concern among women in MICs, there has been limited attention given to the OOP costs associated with breast cancer for women and their families (Mustacchi, 2021). OOP payments refer to direct payments made by patients when insurance coverage does not fully cover the cost of healthcare goods and services (Hernández-Vásquez et al., 2020). While the information on OOP health expenditures has been collected in many high-income countries (OECD, 2021), there is a lack of data on OOP expenditures for cancer in MICs like Turkey. Turkey, classified as an upper MIC by the World Bank (World Bank, 2022), has an emerging economy and has witnessed significant improvements in the health status of its population in recent years, thanks to healthcare reform policies such as the Health Transformation Program (HTP) implemented since 2003. The Turkish government has been committed to enhancing the governance and quality of healthcare services and has implemented successful policies for early diagnosis of cancer and other non-communicable diseases (NCDs) such as cardiovascular diseases and diabetes (WHO, 2013; WHO, 2018). However, there is limited information in the literature regarding the current situation and costs of breast cancer in Turkey, especially in the context of the ongoing Syrian refugee crisis.