How odd that a major report of today has to reach into the public health traditions developed in the horse-and-buggy age of a century ago to find solutions.
[rssbreak]
But that’s where the formidable Policy And Action For Cancer Prevention report, released last month, places its hopes. Its issue? Here is a disease that kills 11 million a year globally, and no government has acted as forcefully as many public health agencies did ages back against the equivalent plagues of their era.
The document, backed by the World Cancer Research Fund and the American Institute for Cancer Research and chaired by Michael Marmot, prof of epidemiology at University College London, expresses the consensus of the world’s most authoritative medical experts. It’s a panel with the same scientific and consensual manner and with similar stature to the international panel on climate change that settled the key scientific debates around global warming.
And here’s the punchline: cancer is a largely preventable disease. The report points to overwhelming evidence that a third of cancers are caused by cigarette smoking and another third by a combo of poor diet and insufficient exercise.
Without even counting the cancers caused by carcinogens in pollutants, these findings reframe cancer as an “environmental disease” – one that comes from the world external to the patient’s body and genes.
But what institution will take responsibility for this epidemic? The authors have an answer: cancer must be treated with what they call “the classic public health approach.”
It was public health programs, after all, that generated the laws, regulations and infrastructure producing major gains in quality and length of life in industrialized countries over the last hundred years. In the late 19th and the 20th centuries, the big killers in the global North, as is still the case in the global South, were infectious and contagious diseases.
Public health officials were mandated to wipe out the causes of disease: overcrowded tenements and factory sweatshops, polluted water supplies and open sewers. Over time, for example, governments replaced substandard water suppliers with public utilities that went to the enormous expense of cleaning and sterilizing water and delivering it virtually free to all.
The analogy between water utilities and diet or exercise is repeated several times in the report. If people have a right to health, then government has a duty to protect health, whether by providing and ensuring an uncontaminated water supply or enacting pricing legislation to discourage junk food.
The government doesn’t merely provide information on the importance of drinking clean water, nor does it cut back because bottled water is available. Neither absolves the state “from the obligation to ensure the provision of a safe supply of water.” And no one accuses governments of acting like a nanny state when they do this.
When safer and better food, water, air and work led to healthier lives for the entire population, the old germ-transferred diseases were replaced by chronic ones like heart disease and cancer. These weren’t infectious and didn’t spread from poor to wealthy areas.
The framing of chronic illnesses as “diseases of affluence” cast them as private matters, implying the need for more willpower and moral strength to counter the effects of too much salt, fat, sugar and starch and sloth. It was believed governments have little role to play in this scenario, except to encourage individuals to opt for healthier lifestyles and perhaps ask companies to voluntarily cut back on harmful ingredients.
Tobacco and alcohol addictions are exceptions to this perspective, perhaps because they cause problems for innocent others through second-hand smoke and drunk driving. These products have been regulated to make them less affordable and accessible.
By contrast, calorie-rich but nutrient-poor foods – aside from monitoring for adulteration or contamination – have largely escaped forceful government regulation.
The new report upbraids this hands-off tradition. The standard “check-up and a check” recommended by old-style cancer societies gets short shrift, dismissed as “primary prevention.” The new science puts the emphasis on what is called “primordial prevention,” getting to the causes of the causes.
This means, the report says, proposals to end agricultural subsidies that make harmful foods artificially cheap, like corn for livestock or for the sugar in soft drinks, or trade practices that keep countries from banning unhealthy imports of processed and junk foods. It also means requiring street designs that make walking and biking more pleasant, efficient and safer than driving. Suburbs are cancer causers, and will have to get exercised in the new order.
What’s good for the food companies is also good for farming. “Air, soil and water need to be regarded as public goods, and their preservation and protection as essential to the health, welfare and survival of the human species and the natural world,” the report says.
A force higher than the market, the authors say, has to prevail.
Read this report and call me in the morning.
ANTI-CANCER CURES
From Policy And Action For Cancer Prevention and Food, Nutrition, And Physical Activity And The Prevention Of Cancer: A Global Perspective.
GOVERNMENTS SHOULD:
• revise all legislation so it protects against cancer
• set up dedicated walking and cycling facilities
• use legislation, including pricing, to discourage unhealthy food
• restrict advertising of fast food to children
• ensure international food trade generates health
news@nowtoronto.com
