Cancer prevention

Main points

• To achieve a life-style change, in addition to knowledge and concrete advice an individual needs motivation, skills and resources to carry out the change, and trust in their own possibilities.
• Healthcare includes particular preventive services which promote health and prevent deceases. Health should also be enhanced alongside treating illnesses. Preventive measures have, however, been overshadowed by treating illnesses during past years.
• An individual’s living environment, as well as decisions made and actions taken in different sectors of society essentially impact how easy it is for a person to maintain or improve their health.

A great deal is known about factors causing cancer. Actions that each individual can take to influence their own cancer risk are summarized in the European Cancer Recommendations (Table 1) .

From the population’s point of view, the most crucial issue in decreasing cancer risk would be eliminating the use of all tobacco products. Healthier nutrition and exercising habits and noticeably lower alcohol consumption would lower the risk of many cancers. Most melanomas could be prevented if everyone would protect themselves from the sun properly. Screening is important for early cancer detection.

In cancer prevention it is useful to focus especially on children and young people. The developing of cancer typically takes a long time and living habits are formed at an early age, e.g. smoking is usually picked up already as a minor.

In this article I am examining how to proceed from risk factor knowledge to changes that reduce risk factors. What makes people change their lifestyles? How can cancer prevention be strengthened in health care? How does our living environment enable a healthy life and even make it easy and appealing? And what kind of impact do regulations, the actions of different sectors of society or economic and tax policies have?

The framework of this article is based on the five strategies for promoting health by WHO: 1) developing of personal skills, 2) redirecting of health services, 3) strengthening community actions, 4) creating of healthy environments and 5) healthy public policy [1].

Knowledge, skills and motivation

Health care, public health institutions, schools and media are essential sources of health information. Healthy living habits have been promoted for example with national recommendations on nutrition and exercise.

One challenge has been commercial advertising and other commercial information, which often utilizes health claims and has superior resources. This challenges the public to improve their health literacy.

Nowadays, disease prevention it is often spoken of from the perspective of choices–especially lifestyle choices–commonly referring to the active and conscious decisions of individuals. Simple and solution-oriented knowledge and concrete advice especially helps individuals who are motivated and have resources to change their living habits and become healthier. Mere knowledge, however, is not enough. Change also requires both motivation and belief in one’s possibilities, in addition to skills and necessary resources. Goals should not be set too high.

We usually draw too strong a division between physical and mental wellbeing, even though they are closely connected: It takes a great deal of mental resources to make a lifestyle change. Vice versa, healthy living habits such as exercise and healthy nutrition have a positive effect on for instance depression symptoms [2, 3]. Hurry, stress or feeling dejected or an acute life-crisis can reduce our resources and make active lifestyle changes more difficult. On the other hand, falling ill may motivate us to make alterations and a lifestyle change can increase the sensation of being in control of the disease.

In cancer prevention the motivation for lifestyle changes can e.g. stem from having a cancer patient in one’s close circle. Usually a person considering a lifestyle change does not think of avoiding one particular disease group, but more likely is focusing on their current welfare and the prospect of staying as healthy as possible in the future, too. Hence, it is of great value that the same principals of healthy living habits also apply to preventing most other diseases. Good lifestyle choices linked to healthy living habits are beneficial in preventing cardiovascular diseases, diabetes and cancer alike.

The lifestyles of people close to us and associated values crucially affect our own habits. For an individual young person, the example of people close to them is still often decisive–for example, whether tobacco products are used at home or by friends.

Preventive health services

In healthcare health is promoted and diseases prevented as a part of the service in general, and also in special preventive services. As the possibilities of health care have improved, resources have been increased particularly in specialized health care. At the same time relative amount of private health services used has grown. Due to these changes, health promoting and disease preventing work has been increasingly overshadowed by treating diseases.

One of the publicly declared targets of the social and health services reform in Finland has been cost savings, which are to be created with increased prevention of the common diseases in the population. It is, however, yet unclear how the prevention of these common diseases will be secured within the new structures.

Health services should include advice on nutrition and physical activity, mini-interventions (tobacco related products, alcohol), special tobacco withdrawal and substance abuse services, and high quality preventive services. Preventive services include maternity and child welfare clinics, school and student health services, occupational health and safety, and sexual and reproductive health services, as well as relevant screenings.

It is important that geographical distance or the costs relating to services, medicines, medical devices or distances do not hinder access to services.

Health as a goal of societal policies

Health is not constructed primarily through individual efforts, supported by healthcare, or even through the example set by a person’s close circles. Health is also always affected by the living environment, as well as decisions made and actions taken in different sectors of society. To enable health perspectives to be taken into consideration in such decisions and actions, it is important to indentify the most important processes affecting health and the points in decision making and implementation that affect every day living conditions, the environment, or societal policies. The health effects of the decisions made across sectors should be assessed in advance, and should include assessing health impact on different population groups. At the same time solutions that are acceptable also from the health point of view whole serving their original purpose should be found [4–6].

According to section 11 in the Health Care Act municipalities and health care districts must assess and take into consideration any health effects in their planning and decision making. Municipalities have important tasks that impact health, relating e.g. to zoning, industrial policy and education and youth work. Municipalities may promote health for example by building surroundings to enhance safe physical activity or by ensuring healthy mass catering in childcare and educational facilities.

The social and health services reform weakens the close connection between municipalities and social and welfare services. This change has awakened concerns of how it will affect the ability and interest of municipalities to take into consideration the health impact of their decisions.

A prerequisite of the successful execution of laws and other social policy decisions is that they are accepted amongst the people. The cultural change of lifestyles take time and thus changes are often made gradually. For example, the salt content of mass catering and processed food has been lowered slowly, allowing people’s eating habits to adjust accordingly. Also, changes in smoking have been slow. For example, smoking in work places and restaurants became unaccepted behavior only after decades of consistent tobacco policies.

Most straightforwardly, regulations and norms define what is permitted. For example, it is not allowed to sell alcohol or tobacco related products to minors. The advertising of tobacco and alcohol is also limited. There are also exact regulations on foodstuff quality and information regarding them that must be provided.

Tax policies can be utilized to affect the prices of products. Prices especially impact consumption habits of young people. Tobacco tax is a good example of this.

Finland was one of the first countries to legislate a health based tax on sugar. This tax was later dismissed after the sugar industry appealed to European Commission on the issue. Many countries, including Great Britain and Australia are considering taxes with similar aims in spring 2016.

In addition to health based taxes for hazardous substances, the arsenal could include favoring products and services essential to health with lower VAT or directly by subsidized prices.

The alcohol policy has not been as consistent as the tobacco policy, when examining availability or price. The changes are clear. Alcohol consumption has increased strongly when availability has been improved and when the taxes have been lowered. After 2008 the raising consumption, and increasing alcohol problems and mortality has been curbed by successive tax raises. This has resulted in a slight decrease in the growth of use [7]. At the moment, in spring 2016, the reform of alcohol policy is being discussed. These discussions include several changes that increase the availability of alcohol.

Living habits vary between demographic groups. Socioeconomic differences in health in Finland are remarkable, even on an international scale. People with low income and education have on average the unhealthiest lifestyles, the most diseases and the shortest life expectancy. The unemployed, poor and those with bad living conditions usually also have the poorest health [8].

Different population groups and the variances in their health should be taken into consideration when planning and implementing policies actions to promote health and prevent diseases. We should know whether unhealthy life styles are primarily a question of lack of knowledge, skills, motivation or opportunity? Is focusing on the individual enough? How does the living environment promote health?

 

Literature

[1] WHO. Ottawa charter for health promotion. An International Conference on Health Promotion 17.–21.11.1986.

[2] Seppälä J, Kauppinen A, Kautiainen H, Vanhala M, Koponen H. Masennus ja ruokavalio. Duodecim 2014; 130(9): 902–9.

[3] Liikunta. Current Care Guidelines. The working group established by the Finnish Medical Society Duodecim and the Current Care Guideline Management. Helsinki: The Finnish Medical Society Duodecim 2016 [updated 13.1.2016]. www.kaypahoito.fi.

[4] Ollila E. Health in All Policies: from rhetoric to action. Scan J Publ Health 2011; 39 (Suppl 6): 11–8.

[5] Leppo K, Ollila E, Peña S, Wismar M, Cook S. Health in all policies. Seizing opportunities, implementing policies. Helsinki: Ministry of Social Affairs and Health 2013.

[6] Melkas T. Terveys kaikissa politiikoissa -periaate Suomen terveyspolitiikassa. Yhteiskuntapolitiikka 2013; 78 (Suppl 2).

[7] Karlsson T, Kotovirta E, Tigerstedt C, Warpenius K. Alkoholi Suomessa – Kulutus, haitat ja politiikkatoimet. Report 13/2013. Helsinki: THL 2013.

[8] Palosuo H, Koskinen T, Lahelma E et al., edit. Terveyden eriarvoisuus Suomessa. Sosioekonomisten terveyserojen muutokset 1985–2005. Helsinki: Ministry of Social Affairs and Health 2007.

 

Captions

Table 1. European Code Against Cancer. The table can also be found from http://cancer-code-europe.iarc.fr/index.php/fi/ .