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Addressing the Global Challenge of Cancer
The global burden of cancer is large and projected to grow larger. Each year
there are approximately 10 million new cancer cases and more than 6 million
deaths worldwide. In many developed countries, including the United States,
cancer accounts for more than 20 percent of all deaths. In less developed
countries, all-site cancer rates are generally lower and cancer accounts for a
lower percentage of deaths. However, it is within developing countries that
cancer is projected to increase most rapidly over the next few decades. Unless
current trends change, cancer in developing countries is expected to represent
70 percent of the global cancer burden by the year 2030, a statistic driven by
demographic shifts toward more elderly populations and the movement toward more
Western lifestyles, most notably increased per capita tobacco consumption and
higher fat/lower fiber diets.
In developing countries, up to 25 percent of cancers are currently linked to infectious agents, including hepatitis viruses and human papillomavirus
(HPV), the leading cause of cervical cancer. Approximately 80 percent of the women who die from cervical cancer live in developing countries. Cancer prevention activities in these countries are scant, and screening and early detection programs are rare. Compounding this problem are limited financial resources available for cancer treatment and fewer highly trained and skilled providers of cancer care.
Read
more
Middle East Cancer Consortium Expanding in Size and Influence
With the addition of Turkey earlier this year, the Middle East Cancer
Consortium (MECC) continues to grow and influence cancer prevention and care in
its member countries. In June, Turkey, with a population of about 70 million,
officially joined MECC at a signing ceremony in Ankara, Turkey. Other member
countries include Cyprus, Egypt, Israel, Jordan, and the Palestinian Authority.
Turkey's addition brings the population represented by MECC to more than 160
million.
"Even in a part of the world where strife and violence are a regular
part of life, cancer is a reality that we must do our best to address," said
National Cancer Institute (NCI) Director Dr. Andrew C. von Eschenbach. "After
more than 8 years, MECC has proven that despite political and social
differences, people can come together and do the work of trying to improve other people's lives." Read
more
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The NCI Cancer Bulletin is produced by the National Cancer Institute
(NCI). NCI, which was established in 1937, leads the national effort to
eliminate the suffering and death due to cancer. Through basic, clinical, and
population-based biomedical research and training, NCI conducts and supports
research that will lead to a future in which we can identify the environmental
and genetic causes of cancer, prevent cancer before it starts, identify cancers
that do develop at the earliest stage, eliminate cancers through innovative
treatment interventions, and biologically control those cancers that we cannot
eliminate so they become manageable, chronic diseases.
For more information on cancer, call 1-800-4-CANCER or visit
http://www.cancer.gov.
NCI Cancer Bulletin staff can be reached at
ncicancerbulletin@mail.nih.gov.
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Addressing the Global Challenge of Cancer
The global burden of cancer is large and projected to grow larger. Each year
there are approximately 10 million new cancer cases and more than 6 million
deaths worldwide. In many developed countries, including the United States,
cancer accounts for more than 20 percent of all deaths. In less developed
countries, all-site cancer rates are generally lower and cancer accounts for a
lower percentage of deaths. However, it is within developing countries that
cancer is projected to increase most rapidly over the next few decades. Unless
current trends change, cancer in developing countries is expected to represent
70 percent of the global cancer burden by the year 2030, a statistic driven by
demographic shifts toward more elderly populations and the movement toward more
Western lifestyles, most notably increased per capita tobacco consumption and
higher fat/lower fiber diets.
In developing countries, up to 25 percent of cancers are currently linked to infectious agents, including hepatitis viruses and human papillomavirus
(HPV), the leading cause of cervical cancer. Approximately 80 percent of the women who die from cervical cancer live in developing countries. Cancer prevention activities in these countries are scant, and screening and early detection programs are rare. Compounding this problem are limited financial resources available for cancer treatment and fewer highly trained and skilled providers of cancer care.
As an institution with an international mandate, NCI's challenge is not just to eliminate suffering and death due to cancer in the United States, but to do so worldwide. And although advanced communications technology
and air travel have made the world much "smaller," from the perspective of addressing the worldwide cancer burden, it is still a very big world and a very big task. The challenge is indeed daunting, but it is one from which we cannot shrink. More has been learned about cancer over the last two decades than in all of previous human history combined. Over the next two decades, we must begin to broadly apply what we have learned and continue to learn.
As this special issue of the NCI Cancer Bulletin demonstrates, NCI's international activities are both broad and deep. These activities recognize the diversity of the environments and genes that characterize the earth's population, offering invaluable opportunities to investigate these interactions. They also take advantage of molecular epidemiology
to substantially increase what we know about and can do about cancer. The mission to train both Americans and foreign nationals to battle cancer is one that we take very seriously. Each year more than 1,000 international researchers work in NCI laboratories. These researchers make significant contributions
to NCI's research program while acquiring the knowledge, skills, and abilities to enhance the research environment of their home countries.
NCI's Office of International Affairs (OIA) is charged with monitoring the institute's international activities, many of which are managed within NCI's intramural and extramural divisions. In addition, OIA manages a range of activities that are intended to catalyze research advances through individual and group training, and through facilitation of interactions between cancer researchers in the United States and the international research community.
The articles in this issue of the Bulletin cover just a small sampling of the kinds of activities in which NCI is engaged. More importantly, they also offer some context for the global burden
that cancer represents - a burden that NCI is committed to eliminating with the help of members of the cancer
community from the United States and around the world.
Dr. Joe Harford
Director, NCI Office of International Affairs
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Middle East Cancer Consortium Expanding in Size and Influence
With the addition of Turkey earlier this year, the Middle East Cancer
Consortium (MECC) continues to grow and influence cancer prevention and care in
its member countries. In June, Turkey, with a population of about 70 million,
officially joined MECC at a signing ceremony in Ankara, Turkey. Other member
countries include Cyprus, Egypt, Israel, Jordan, and the Palestinian Authority.
Turkey's addition brings the population represented by MECC to more than 160
million.
"Even in a part of the world where strife and violence are a regular
part of life, cancer is a reality that we must do our best to address," said
National Cancer Institute (NCI) Director Dr. Andrew C. von Eschenbach. "After
more than 8 years, MECC has proven that despite political and social
differences, people can come together and do the work of trying to improve
other people's lives." Much of MECC's focus has been on establishing and
supporting population-based cancer registries in member countries. With its
entry into MECC, Turkey will establish its own registry, based in the city of
Izmir. Beginning early next year with NCI funding, Dr. John Young of Emory
University will conduct a training course for Turkish cancer registrars. To
facilitate registry training, MECC has established course material and a
standards manual, which in this case will be translated into Turkish. The
standards manual has already been translated into English and Greek; Arabic and
Hebrew versions are anticipated. Staff from NCI's Surveillance, Epidemiology,
and End Results (SEER) program also have assisted MECC registries with
training, technical support, and quality control. The first-ever comparison of
cancer incidence rates in Israel and one of its Arab neighbors, Jordan, was
published in the European Journal of Cancer Prevention in 2003. The paper had
Israeli, Jordanian, and American authors, including three from NCI. This will
likely be the first of many publications based on data from MECC-affiliated
registries, explains Dr. Joe Harford, head of NCI's OIA and the primary liaison
between MECC and NCI. Plans also are underway for an NCI monograph that will
provide a more detailed analysis and commentary on cancer incidence in the
Middle East using data derived from selected MECC-affiliated registries. MECC is
also engaged in activities beyond the registries, including educational
workshops for health care professionals from MECC member countries. Earlier
this year, for example, MECC held a workshop on palliative care, with experts
from the U.S., Europe, and the Middle East serving as faculty.
"Palliative care
has been identified by the World Health Organization as one of the highest
cancer priorities for countries with the most severely limited resources,"
explains Dr. Harford. "Throughout the developing world, cancer patients often
present with more advanced, less curable cancer, making building capacity in
palliative care and symptom management all the more pressing." MECC has also
begun to expand its influence in the region beyond cancer, holding a workshop
earlier this year on disease prevention and health promotion. More about MECC
can be found on its Web site, www.mecc.cancer.gov.
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IARC Monograph on Risks of Tobacco Smoke
In May 2004, the International Agency for Research on Cancer (IARC), part of
the World Health Organization, published Volume 83 of the IARC Monographs on
the Evaluation of Carcinogenic Risks to Humans. Totaling nearly 1,500 pages,
"Tobacco Smoke and Involuntary Smoking" summarized the evidence for the
carcinogenicity of tobacco smoke. While the conclusions confirm the
cancer-causing effects of active smoking, this volume also concludes its
evaluation of the risks associated with second-hand smoking and classifies
second-hand smoke as carcinogenic to humans.
The IARC Monographs Program publishes independent assessments of carcinogenic risks by a variety of agents,
mixtures, and/or exposures. Each assessment is carried out by a working group
of international experts who review all published evidence relating to the
particular agent. The working group is also charged with indicating where
additional research efforts are needed. Since its inception in 1969, the
program has reviewed more than 880 agents, and the monographs have become
widely used around the world, owing to their thoroughness and accuracy. Since
its beginning, the IARC Monographs Program has been supported by NCI; the
National Institute of Environmental Health Sciences has provided additional
support since 1993.
Cancer Researchers Receive Awards at International Conference in
Cairo
At its fifth annual meeting, held October 2-5 in Cairo, Egypt, the
International Network for Cancer Treatment and Research (INCTR) recognized two
researchers - one from a developing nation and the other from a resource-rich
nation - for their contributions to cancer control.
The Nazli Gad el-Mawla Award, named for a pioneering female Egyptian oncologist, was presented to Dr.
Mahmoud M. Mahfouz of Egypt, who served as chairman of the Kasr Al-Ainy Center
of Radiation Oncology and Nuclear Medicine at Cairo University, where he was
involved in the training and supervision of more than 185 postgraduates for
their master's and medical degrees. The second award - named for Paul Carbone,
a groundbreaking American oncologist who, as the associate director for
clinical oncology at NCI, played a critical role in the development of cancer
chemotherapy - was given to Dr. Franco Cavalli, who has headed the Division of
Oncology at the Ospedale San Giovanni in Bellinzona, Switzerland since 1978 and
has made notable contributions to cancer care in Central America. Hundreds of
health care providers and researchers from more than 50 countries attended the
meeting, including a delegation of 25 physicians from Iraq. In addition to oral
and poster presentations given by individual researchers, representatives from
the World Health Organization, the International Agency for Research on Cancer,
the African Organization on Research and Training in Cancer, the International
Union Against Cancer, the International Atomic Energy Agency, and NCI also
participated in the event. Next year's meeting is scheduled for December in
Chennai, India. INCTR is a nonprofit organization, headquartered in Brussels,
Belgium, that provides cancer prevention and treatment strategies to developing
countries, helps those countries build a research and clinical infrastructure,
and facilitates international collaboration between physicians and scientists.
NCI's OIA provides support to INCTR, and NCI's Dr. Ian Magrath serves as its
president. More information about INCTR can be found at http://www.inctr.org.
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All-Ireland Consortium:
Health Diplomacy at Its Best
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The principle objective of the Consortium is to enhance the capacity of our cancer services to improve the lives of
cancer patients on the island. I look forward to Ireland's continued participation in the relationships with our colleagues in
Northern Ireland and NCI.
- Ivor Callely TD, Minister of State
Department of Health and Children, Dublin
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Over the last several years, NCI's OIA, under the leadership of Dr. Joe
Harford, has been at the forefront of NCI's efforts to contribute to the global
fight against cancer. One of the OIA's crowning achievements has been the
Ireland-Northern Ireland-NCI Cancer Consortium. Preparations are now underway
to celebrate the 5-year anniversary of the signing of this historic memorandum
of understanding and to plan for continued success in the coming years.
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There is no doubt that the NCI-All-Ireland Consortium has become a powerful force for
good for cancer patients on the island of Ireland, and we look forward to further success and
increasing collaboration as part of this unique international partnership.
- Dr. Patrick Johnston of Queens University Belfast
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Since 1999, the All-Ireland Cancer Consortium has sought to enhance the
infrastructure for cancer research and cancer care on the island of Ireland. In
addition to facilitating interactions among the three research communities
represented, the Consortium has developed a number of joint programs across the
continuum of cancer.
The most recent milestone is the newly established Centre
for Cancer Research and Cell Biology (CCRCB), officially announced last month
during a ceremony at Queen's University in Belfast, Northern Ireland. The CCRCB
has been established as an interdisciplinary research center bringing together
researchers from the Schools of Medicine, Chemistry, Biology & Biochemistry,
Pharmacy, and Mathematics & Physics. The new Centre will be led by Dr. Patrick
Johnston of Queens University Belfast and will work closely with local
institutions that conduct cancer clinical trials.
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The NCI-All-Ireland agreement has already begun to speed up the process of cancer research development
on the island of Ireland and has been a major milestone agreement for cancer care in this country.
- Micéal Martin TD, former Minister for Health
and Children in Ireland and current Minister of
Enterprise, Trade and Employment
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While the CCRCB hopes to one
day elevate Belfast to one of the world's leading locations for translational
cancer research, the All-Ireland Consortium has spent the last 5 years setting
the gold standard for health-related international partnerships. The scope of
the Consortium's activities can also be gauged by the breadth of its Working
Groups: Scholar Exchange, Clinical Trials, Cancer Registries, Nursing,
Information Technology/Telecommunications, and Prevention.
Scholar exchanges thus far have included three Irish scholars given 3-year fellowships in
epidemiology that include 1 year working with NCI's SEER program in Bethesda,
Md. and more than a dozen nurses who have trained in oncology nursing and
clinical trials for 3 months at the NIH Clinical Center. The collaboration
between the cancer registries covering the Republic of Ireland and Northern
Ireland under the auspices of the Consortium has resulted in the first-ever
comparison of cancer incidence rates between the North and South. The
Prevention Working Group, chaired by Dr. Doug Weed of NCI's Division of Cancer
Prevention, has been particularly active within the Consortium. In addition to
participating in workshops in Ireland on topics such as "Cancer Prevention and
Tobacco Control" and "Obesity and Cancer," the working group has dedicated
itself to building a community of prevention-oriented scientists and cancer
caregivers on the island of Ireland. Perhaps the most tangible manifestation of
this commitment is to be found in the fact that over 80 researchers and health
care providers from the island have participated in the NCI's Summer Curriculum
in Cancer Prevention (see http://cancer.gov/prevention/pob). This program
includes a 4-week course, "Principles and Practice of Cancer Prevention and
Control" and a 1-week course, "Molecular Prevention." The faculty for these
courses consists of approximately 85 experts from NCI, NIH, and academic
institutions. Over the past 5 years, the courses have drawn approximately 140
international participants. In addition to the activities related to cancer
prevention, the Cancer Consortium has been engaged in the formation of an
All-Ireland Cooperative Group for conducting island-wide clinical trials in
cancer. The headquarters function of the Cooperative Group is located in Dublin
with a center for data management and statistics in Belfast.
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The All-Ireland Consortium promotes partnerships at both clinical and research levels - at both cross-border and international levels.
- Dr. Mark Lawler of St. James Hospital, Dublin
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Yet another
important benchmark achieved under the Consortium has been the ongoing
implementation of the Telesynergy® system. This integrated telecommunications
system of computers, microscopes, cameras, and other equipment can transmit
X-rays and other medical images or a live exam of a patient to distant sites
where clinicians can discuss the case as if they were in the same room.
To date,
three Telesynergy suites have been installed at Belfast City Hospital and at
both St. Luke's Hospital and St. James' Hospital in Dublin under the auspices
of the All-Ireland Cancer Consortium.
Later this month, the Implementation Group
of the Consortium, chaired by Dr. Harford, will assemble in Dublin within the
context of the World Congress of Cancer Organizations meeting. There, the group
will mark the 5-year anniversary of the Consortium and discuss plans for the
next 5 years of this very successful collaboration.
More information regarding
the All-Ireland Cancer Consortium can be found at
http://www.allirelandnci.org.
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Special Announcement |
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Hawk Takes Over NCI's Office of Centers, Training, and Resources
Dr. Ernest Hawk, chief of NCI's Gastrointestinal and Other Cancers Research
Group in the Division of Cancer Prevention, will assume a new role as the
director of NCI's Office of Centers, Training and Resources (OCTR), effective
November 14. Dr. Hawk, who first came to NCI in 1993 as a cancer prevention
fellow, replaces acting director Dr. Linda Weiss in this role, which she
assumed upon retirement of OCTR's previous director last January. Dr. Hawk
brings extensive peer review and grants oversight experience to his new
appointment, where he will oversee OCTR's four branches and be responsible for
scientific, fiscal, and administrative management. Dr. Weiss will resume her
previous position as chief of the Cancer Centers Branch and Dr. Jaye Viner will
serve as acting chief of the Gastrointestinal and Other Cancers Research Group.
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Bridging the International Divide
NCI is advancing the cancer fight globally through a series of partnerships
with foreign cancer counterparts, extending from Asia to the Middle East to
Europe. These bilateral agreements involve sharing research information and
researchers across international borders.
NCI's longest such relationship is
the 30-year-old U.S.-Japan Cooperative Cancer Research Program. Under this
agreement, the two nations have sponsored more than 250 seminars and
collaborated on more than 500 researcher exchanges.
The current focus of the
exchange program is to provide junior scientists from both countries with
mentoring, training, and research experience while working on research projects
of mutual interest to the host laboratories.
NCI also is working with the
National Translational Cancer Research Network of the United Kingdom to
establish translational research fellowships in cancer, to train future
generations of translational cancer researchers and build working relationships
between these researchers on both sides of the Atlantic. Under this initiative,
a shared Fellow would receive 3 years of support for working on a translational
research project of mutual interest to the U.S. and the UK, splitting that
fellowship period equally in both countries. It is expected that two
fellowships will be awarded in 2005 and two fellowships every year
thereafter.
Additionally, NCI is expanding a bilateral cancer relationship with
Italy's Istituto Superiore di Sanità (ISS) beyond the area of
pharmacogenomics. Under the existing partnership, several joint research
projects have been identified and collaborative research is ongoing. NCI and
ISS also cosponsored a workshop on cancer vaccines in Rome last April.
Reaching Out to Russia
NCI and its Russian counterparts in the cancer fight moved closer to a formal
alliance last June after NCI Director Dr. Andrew C. von Eschenbach and NCI's
OIA Director Dr. Joe Harford joined Health and Human Services (HHS) Secretary
Tommy G. Thompson on a delegation trip to meet with Russian health officials on
their soil.
A significant component of that trip involved the visit to the N.N.
Blokhin National Cancer Research Center in Moscow, the largest cancer treatment
center in Russia. While in Moscow, Secretary Thompson and members of the HHS
delegation also met with the leaders of the American-Russian Cancer Alliance
(ARCA), which was started nearly 3 years ago, with participants from the
University of Maryland Greenebaum Cancer Center in Baltimore; the Fox Chase
Cancer Center in Philadelphia; the Blokhin Center; and the Kurchatov Institute,
the premier Russian nuclear research center.
ARCA's goal is to develop a
partnership among American and Russian scientists engaged in cancer prevention
and therapy. Its mission is to pool the intellectual and scientific resources
of both countries, which will lead to positive results in cancer control more
quickly and efficiently than if done in each country independently. Among the
ARCA projects is a groundbreaking project funded by the U.S. to use Russia's
expertise and nuclear facilities to produce research radioisotopes for
diagnostic and therapeutic applications in oncology.
Another outcome from the
HHS delegation was the creation of a joint cancer communications activity that
will allow personnel from both countries' institutions to interact. In addition
to NCI, the activity will involve communications personnel from the Centers for
Disease Control and Prevention, the two academic institutions currently
involved with ARCA, and several U.S. nongovernmental entities. Plans are also
on the table to organize a Russia-U.S. activity centered on cancer prevention.
NCI's International Research Contributions
NCI, in addition to conducting a national research program, also supports
cancer-related research around the world. For instance, recruitment for a phase
III trial is underway in Guanacaste, Costa Rica to evaluate the efficacy of a
vaccine to protect women against two oncogenic strains of human papillomavirus
(HPV). NCI researchers, in collaboration with the Foundation for the Costa
Rican Institute for Research and Training in Nutrition and Health (Fundación
INCIENSA) and the Costa Rican Ministry of Health, plan to test a virus-like
particle (VLP) vaccine originally developed at NCI. Costa Rica was chosen for
the phase III trial due to its high rate of cervical cancer.
Led by Dr. Allan
Hildesheim of NCI's Division of Cancer Epidemiology and Genetics (DCEG) and Dr.
Rolando Herrero of Fundación INCIENSA, the 8-year study will randomize 12,000
to 15,000 women aged 18 to 25 years to receive either the VLP or a control
vaccine. Enrollees will receive three vaccinations over a period of 6 months
and will participate in follow-up screening for several more years. Preclinical
studies in the United States and elsewhere have repeatedly suggested the
potential usefulness of VLP HPV vaccines. Other trials have also suggested that
this type of vaccine shows adequate short-term protection from persistent HPV
infections in women.
Other studies in which DCEG has been involved include
research collaborations with China, Japan, Africa, Russia, Australia, and
Europe, some dating back as far as the early 1970s. For example, NCI and the
Shanghai Cancer Institute of China have been collaborating on numerous
projects, including a prospective study to evaluate
causes of cancer among women in China. In Africa, NCI has teamed up with the Ugandan Virus Research Institute to study AIDS-related cancers
such as Kaposi's sarcoma. DCEG has also played an important role in a partnership between investigators in Australia, Europe, and the U.S. to map novel melanoma susceptibility genes and better understand the risk factors for melanoma.
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Health Diplomacy: A Situation Where Everyone Wins
In today's global economy, no nation lives in a vacuum, and that is particularly
true when it comes to health. The process of globalization has led to improvements in social, economic, and political conditions worldwide, but the movement of more than two million people each day across national borders
and the growth of international commerce also contribute to health risks ranging from infectious disease in travelers to contaminated foods.
Despite these risks, health poses the best opportunity for U.S. diplomacy. The desire for good health is a motivating
factor and leading political issue around the world. Therefore, what better way to break down the barriers and open constructive dialogue among countries than by contributing to the improvement of their people's health? Integrating health policy into national security and broader foreign policy can further our nation's causes abroad and serve as a bridge to peace and stability around the world.
Politicians may question whether the American people are ready to provide further assistance to improve health in other nations, but a recent survey taken by the Gallup Organization for the Department of Health and Human Services (HHS) clearly indicates that Americans recognize and support the responsibilities of the United States in this area. Specifically, most respondents indicated that the United States should play an active role to combat world hunger (74 percent), fight the spread of infectious diseases (80 percent), and find a cure for cancer and other diseases (91 percent) on a global scale.
The Bush Administration is well aware of the importance of global health and the valuable contribution it can make to the economy and security of countries. The President has personally spearheaded
a number of major new global health initiatives and participated in, or sent his Cabinet officials to, key international
meetings for addressing global health priorities.
HHS plays an important role in supporting the President's initiatives
and leading many of America's global health efforts through its various agencies. Through NCI, for example, we participate in the Ireland-Northern Ireland-NCI Cancer Consortium to facilitate cooperative research and training between our country and our partners on the island of Ireland. We are also partnering, through NCI, in the establishment
of the King Hussein Cancer Center in Jordan as a regional cancer treatment facility that is now saving the lives of young cancer patients from Iraq. And through NCI, we helped establish the Middle East Cancer Consortium among the countries of Jordan, Cyprus, Egypt, Israel, the Palestinian Authority, and Turkey. When we cooperate internationally through initiatives such as these to address shared health problems, we can find solutions more efficiently, help improve the health of the world's people, and learn from one another in doing so. In other words, everyone wins.
Americans are a generous and caring people. For humanitarian reasons, they want to help improve the health of those in other countries as well as their own. But altruistic motives notwithstanding, it is in the best interest of the United States to increase its role in global health and to elevate health as one important aspect of diplomacy. A thorough analysis of issues in, as well as new approaches to, global health can significantly aid the nation in developing an effective
approach for such work. For this reason, I am asking the U.S. Surgeon General to develop a report on the state of global health, with recommendations
for action. I am also in the process of transforming the long-admired Public Health Service Commissioned Corps, led by the Surgeon General, to meet the future demands of our country and the world community. My goal and passion is to influence America's foreign policy such that we put even more investments into developing countries, especially with respect to improving their health and education. If we cooperate with a wide range of domestic and international partners, the United States can help create a world in which the citizens of every country enjoy good health.
Tommy G. Thompson
Secretary of Health and Human Services
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