Background

ith more than 1.5 million new cases estimated in 2020, skin cancers are the most commonly diagnosed group of cancers worldwide. Malignant melanomas (hereafter melanoma) account for approximately 1 in 5 of these cancers, with approximately 325 000 cases estimated globally in 2020. Historically a rare disease, melanoma incidence rates have been increasing during the last 50 years in fair-skinned populations of European ancestry. 1,2 Much of this increase is likely due to increased exposure of vulnerable populations to UV radiation, a strong and ubiquitous risk factor for melanoma, emitted naturally by the sun but also from artificial sources. 3,4 According to recent global estimates, more than three-quarters of all newly diagnosed melanoma cases can be attributed to UV radiation. 5 Although the risk of melanoma generally increases with age and incidence is greater among older populations, melanoma is among the most common cancers in young adults. 6 Incidence rates have stabilized or decreased among recent birth cohorts in a few countries, such as Australia and the US. 1,7 The reasons for these decreases in incidence are still debated and are likely associated with a combination of changes in lifestyle and social behavior, ethnic heterogeneity, and population admixture (ie, in which previously diverged or isolated genetic lineages mix). Yet with generational increases in melanoma incidence reported in most other high-risk populations and uniform increases observed in older age groups, the rates and number of melanoma diagnoses are projected to increase in the coming decades, 8,9 emphasizing the urgent need IMPORTANCE Despite many cases being preventable, cutaneous melanoma remains the most serious skin cancer worldwide. Understanding the scale and profile of the disease is vital to concentrate and reinforce global prevention efforts.OBJECTIVE To examine global patterns of cutaneous melanoma in 2020 and to provide projected estimates of cases and deaths by 2040. DESIGN, SETTING, AND PARTICIPANTSThis population-based study used the GLOBOCAN 2020 database for global epidemiological assessment of new cases and deaths due to invasive melanoma.MAIN OUTCOMES AND MEASURES Age-standardized incidence and mortality rates were calculated per 100 000 person-years by country, world region, and 4-tier level of human development. Estimated numbers of cases and deaths were calculated for the year 2040.RESULTS A worldwide total of 325 000 new melanoma cases (174 000 males, 151 000 females) and 57 000 deaths (32 000 males, 25 000 females) was estimated for 2020. Large geographic variations existed across countries and world regions, with the highest incidence rates among males (42 per 100 000 person-years) and females (31 per 100 000 person-years) observed in Australia/New Zealand, followed by Western Europe (19 per 100 000 person-years for males and females), North America (18 per 100 000 person-years for males, 14 per 100 000 person-years for females), and Northern Europe (17 per 100 000 person-years for males, 18 per 100 000 perso...

The World Health Assembly of 2005 called for all health systems to move towards universal coverage, defined as "access to adequate health care for all at an affordable price". A crucial aspect in achieving universal coverage is the extent to which there are income and risk cross-subsidies in health systems. Yet this aspect appears to be ignored in many of the policy prescriptions directed at low-and middle-income countries, often resulting in high degrees of health system fragmentation. The aim of this paper is to explore the extent of fragmentation within the health systems of three African countries (Ghana, South Africa and the United Republic of Tanzania). Using a framework for analysing health-care financing in terms of its key functions, we describe how fragmentation has developed, how each country has attempted to address the arising equity challenges and what remains to be done to promote universal coverage.The analysis suggests that South Africa has made the least progress in addressing fragmentation, while Ghana appears to be pursuing a universal coverage policy in a more coherent way. To achieve universal coverage, health systems must reduce their reliance on out-of-pocket payments, maximize the size of risk pools, and resource allocation mechanisms must be put in place to either equalize risks between individual insurance schemes or equitably allocate general tax (and donor) funds. Ultimately, there needs to be greater integration of financing mechanisms to promote universal cover with strong income and risk cross-subsidies in the overall health system.

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