Achieving cervical cancer elimination: an ecological assessment of global determinants using a policy determinant model.

Abstract

BACKGROUND Countries must implement and scale up effective programmes to achieve the WHO 2030 cervical cancer elimination targets; however, systemic challenges exist. This study aimed to determine key economic, political, sociocultural, and health-system determinants associated with achieving target coverage of human papillomavirus vaccination and screening, cancer treatment, and areas of opportunity for policy reform and health system strengthening. METHODS In this ecological study, we developed a policy determinant model (PDM) to assess key policy determinants of interest using the following conceptual frameworks: social determinants of health, WHO building blocks, and universal health coverage. Core framework domains were operationalised within the PDM through identification of direct or proxy variables located in publicly available global datasets. The PDM was applied with cervical cancer as the disease focus, using an ecological approach. Kendall's and Pearson's correlation coefficients measured the strength of associations between policy indicators and indicators measuring WHO elimination target coverage for vaccination, screening, and treatment. FINDINGS Data from 155 countries across 39 policy determinant indicators were analysed. Indicators measuring equity-focused economic, social, and public policies had large positive associations, with higher values reported for country-level screening and treatment coverage, per WHO targets. Assessment of indicators measuring health system performance likewise showed core health system capability and availability to be associated with progress in cervical cancer elimination. National cancer control planning had low or no associations with achieving target coverage, indicating ineffective implementation. INTERPRETATION Social, economic, cultural, and environmental policies, in conjunction with health system performance and equitable access to care play integral roles in country capacity to achieve the 2030 elimination targets. In harnessing the cervical cancer elimination agenda, nations have the opportunity to leverage global momentum and funding to drive broader health system strengthening, investment, and policy reform. FUNDING Australian National Health and Medical Research Centre.