METHODS: Cancer experts in lower-resource health care systems (as defined by the World Bank as low- and middle-income countries; N = 151) were contacted to participate in a modified consensus-seeking Delphi survey, comprising two rounds. In round 1, participants (n = 69) rated predetermined areas of potential research priority (ARPs) for importance and suggested missing ARPs. In round 2, the same participants (n = 49) rated an integrated list of predetermined and suggested ARPs from round 1, then undertook a forced choice priority ranking exercise. Composite voting scores (T-scores) were used to rank the ARPs. Importance ratings were summarized descriptively. Findings were discussed with international patient advocacy organization representatives.
RESULTS: The top ARP was research into strategies adapting guidelines or treatment strategies in line with available resources (particularly systemic therapy) (T = 83). Others included cancer registries (T = 62); prevention (T = 52); end-of-life care (T = 53); and value-based and affordable care (T = 51). The top COVID-19/cancer ARP was strategies to incorporate what has been learned during the pandemic that can be maintained posteriorly (T = 36). Others included treatment schedule interruption (T = 24); cost-effective reduction of COVID-19 morbidity/mortality (T = 19); and pandemic preparedness (T = 18).
CONCLUSION: Areas of strategic priority favored by cancer researchers in RCRs are related to adaptive treatment guidelines; sustainable implementation of cancer registries; prevention strategies; value-based and affordable cancer care; investments in research capacity building; epidemiologic work on local risk factors for cancer; and combatting inequities of prevention and care access.
METHODS: We used a case-study approach-a desktop analysis based on journal articles, country reports, newspaper articles, and other sources from the past 10 years-to analyse and compare the green education disparities among pace-setter, maturing, and emerging ASEAN countries.
FINDINGS: As a pace-setter ASEAN country, Singapore has made impressive progress in promoting green education through the effective implementation of pragmatic policies and impactful green education initiatives. Furthermore, the country has established extensive formal and informal green education programmes that closely align with the Singapore Green Plan 2030. By contrast, maturing ASEAN countries are making incremental progress in incorporating green education into their formal education systems. However, challenges faced by these countries include a shortage of well-trained teachers, the lack of specific green education subjects in school syllabuses, and financial constraints. Despite these challenges, innovative approaches-such as partnerships with non-governmental organisations (eg, the World Wide Fund for Nature)-have emerged as promising strategies to promote green education within these maturing nations. Emerging ASEAN countries face the biggest challenges in promoting green education. Competing national priorities, political instability, limited funding and resources, inadequate infrastructure, and a lack of qualified educators pose challenging barriers to advancing green education within emerging ASEAN nations.
INTERPRETATION: This study provides insights into the best practices and challenges surrounding green education within pace-setter, maturing, and emerging ASEAN countries. To address the disparities in green education among these countries, there is a need to adopt a holistic ecosystem framework characterised by the so-called 8i enablers, namely infrastructure (eg, well-equipped laboratories and learning spaces), infostructure (eg, advanced teaching technologies), intellectual capital (eg, well-trained educators), integrity systems (eg, efficient green education governance systems), incentives (eg, public and private funding for green education initiatives), institutions (ie, strong institutional leaders), interaction (ie, cooperation and collaboration among relevant stakeholders), and internationalisation (eg, leveraging regional and international partnerships to access expertise and resources).
FUNDING: None.