Zach Ward, Assistant Professor of Health Decision Science, chats about current and future research and finding solutions to real-world public health challenges. 

Q: What’s a real-world problem that your current research is trying to solve, and how would you explain it to someone outside of public health?
A: One project I have been working on is the forthcoming Lancet Oncology Commission on the global cancer workforce.  We know in general that there are shortages of healthcare workers, and that these will likely worsen in the future. But there is a lot that we don’t know, including how many people in each country actually develop cancer, get diagnosed, and receive effective treatment. Or how shortages of specific workforce personnel (e.g., community health workers, oncologists, nurses, pathologists, surgeons, imaging specialists, etc.) impact different aspects of cancer diagnosis and care. My research uses large-scale computer simulations to synthesize all of the data that are available to estimate a more comprehensive picture of the global cancer burden – including people who die without ever being diagnosed – and to project what investments countries should prioritize in the coming decades to have the largest impact on cancer mortality.

Q: Why does this work matter now, and how could it change the way we think about health policy, and/or your specific area of work, in our daily lives?
A: Cancer cases are projected to increase as populations grow and age, and most of that growth will be in low  and middle income countries that already have acute workforce shortages. Our analyses show that cancer survival among diagnosed patients is generally poorer in these settings, and furthermore, many people who develop cancer die without ever being diagnosed.  Where you live, more than what type of cancer you have, is often the key factor that determines your outcomes. By quantifying undiagnosed cancers, survival gaps, and workforce shortages, we give policymakers a way to see cancer not just as a biological disease but as a health systems problem.  Beyond estimating the gaps, we also provide actionable policy guidance on what specific personnel types and pathways to scale-up would have the largest health impact and economic return on investment in each setting. This work highlights cancer as a universal health burden and helps to shift the focus from high tech treatments in rich countries to a global question of how we can ensure that people everywhere can receive timely diagnosis and quality care.

Q: Looking ahead, what change or impact do you hope your research will lead to in the next five to ten years?
A: We will be launching the commission at the end of May at ASCO, and over the next few years I hope that policymakers will use this research for evidence-based planning and priority setting.  For example, these analyses can guide workforce capacity planning as governments develop and update national cancer control plans. This work also underscores the need for major investment in cancer and workforce registries and digital health solutions to provide timely data on cancer incidence, stage at diagnosis, and survival, and how these vary both across and within countries.  Our research on the large hidden burden of undiagnosed cancer can help shift attention to upstream health system factors that are critical barriers to diagnosis and care. Finally, I hope this research catalyzes new financing and partnership models that recognize that investments in health system strengthening and workforce capacity building are not just costs, but yield large economic and societal benefits.