The role of government and regulation in cancer prevention
Series paper: Cancer prevention
The world population is ageing and increasing in size. As a result, the numbers of people diagnosed with and dying of cancer are increasing. Cancer is also a growing problem in developing countries.
Government, be it local, state, provincial, national, or even a union of nations, has clear roles in the control of cancer. It is widely appreciated that much of the research that has defined the causes and treatment of cancer was, and is, government funded. Less appreciated, the body of work about how to control cancer shows the importance of an environment that encourages individuals to adopt healthy behaviours, and government has a vitally important role.
Through regulation, education, and support programmes, governments can create an environment in which alcohol and tobacco use is reduced and citizens maintain good levels of physical activity, healthy bodyweight, and good nutrition. Cancer prevention and the creation of a culture of health is an essential mission of government, beyond that of the traditional health-focused departments such as health ministries; it is in the domain of governmental agencies involved in environmental protection, occupational safety, and transportation.
Cancer prevention and health promotion are also in the realm of the zoning board, the board of education, and the board of health.
Lowering alcohol consumption
Alcohol consumption is linked to numerous cancers. One study of a European cohort estimated that alcohol is associated with 10% of all cancers in men and 3% of all cancers in women, including cancers of the head and neck, oesophagus, liver, breast, and colon. The combination of alcohol and tobacco use is an especially potent cause of cancers of the aerodigestive tract (cancers of the mouth, throat, and oesophagus). Results from a European cohort study suggest that alcohol and tobacco use were associated with nearly 45% of head and neck cancers in men, and 25% of these cancers in women.
As is the case with tobacco use, alcohol consumption is an unnecessary habit. Although there is no safe level of alcohol use, several developed governments have published guidelines with recommended upper levels of alcohol consumption in an educational effort that aims to encourage moderation.
There is no agreement about what constitutes harmful or excessive alcohol consumption across the world. As of January, 2016, the UK Government recommends that men and women consume no more than 14 units of alcohol per week. A unit in the UK is equivalent to 8g of alcohol. The 14-unit recommendation equates to no more than five pints of beer with 5% alcohol by volume per week. Compared with the British definition of unit and recommended consumption per week, the US Government recommends that men consume no more than 25 units; Ireland, 21.2 units; Denmark, 21 units; New Zealand, 19 units; and Spain, 35 units. The 14-unit limit for women in the UK is similar to the recommended 12.3 units in the USA and 10.5 units in Denmark, and is on a par with Ireland.
In virtually every society, the affordability, availability, and promotion of alcohol are controlled, to varying degrees, by laws and regulation. Some governments attempt absolute prohibition because of cultural or religious reasons. Most of these countries have a black market for illegal alcohol. Other countries implement regulations, largely intended to prevent intoxication and promote traffic safety. The prevention of chronic disease is secondary and the prevention of cancer is clearly not the primary purpose of most alcohol control efforts in these countries.
Programmes promoting moderate and responsible alcohol consumption might involve laws, but more commonly involve public service announcements and education through television, radio, and print advertisements. Educational efforts sometimes focus on the alcohol user, but often also on the user’s friends and associates in an effort to create social pressure supportive of moderation or abstinence.
The CDC Community Preventive Services Task Force has suggested strategies that state and local governments can use to create social and physical environments that reduce alcohol use. These strategies are garnered from systematic reviews of the scientific literature, and are similar to those of tobacco control.
Strategies include introducing labelling regarding the harms associated with alcohol consumption, taxing alcohol (the more expensive alcohol is, the less excessive the use and related harms), regulating the density of retailers, limiting the days and hours that alcohol can be sold, enforcing laws that prohibit sales to minors, and enacting laws that hold retailers liable or at fault for harm caused by illegal sales to intoxicated or under-aged customers.
Regulation is disadvantageous to the alcohol industry. Alcohol manufacturers have tried to counter the threat of regulation by contesting the association between advertising and the levels of consumption; by supporting voluntary, industry-controlled educational initiatives; and by focusing on individual rather than corporate responsibility.
The key to cancer prevention is for the individual to engage in and adopt healthy lifestyle habits. Behavioural activities, such as eating a proper diet, both in types and amounts of food, engaging in appropriate exercise and physical activity, and receiving appropriate clinical interventions to prevent cancer, are important.
Being healthy also involves avoiding known causes of cancer, including tobacco and alcohol, and careful management of exposure to other carcinogens.
When discussing healthy habits, phrases such as individual choice or personal responsibility are often a focus. Tobacco, alcohol, and food manufacturers use marketing to promote use of their products and create an environment of consumption. This Series paper gives examples of many agencies and departments of governments that use advertising, social marketing, education, regulation, and law to create an environment more conducive to people making healthy choices and adopting healthy habits.