The cancer burden in the European Union and the European Region: a way forward: address to the Informal Meeting of Health Ministers, Brussels, Belgium

Address to the Informal Meeting of Health Ministers, Brussels, Belgium

Ms Zsuzsanna Jakab, WHO Regional Director for Europe

05 July 2010

Thank you for welcoming me to this event in the first week of Belgium’s Presidency of the European Union (EU). On behalf of the WHO Regional Office for Europe, let me extend our best wishes for the next six months. We look forward to working with you on the priorities you have set for health issues in the EU and beyond.

Cancer has been a prominent issue in many European health initiatives that WHO has supported and contributed to. Most recently, important work was carried out under Slovenia’s leadership, during its EU Presidency, and in 2009 the European Commission launched the European Partnership for Action Against Cancer. WHO applauds these efforts, which recognize that cancer is one of the biggest health threats that European citizens face today; the Regional Office plans to strengthen its technical capacity and role in this field.

Indeed, cancer is a leading cause of mortality in the WHO European Region, second only to cardiovascular diseases (CVD). Moreover, incidence rates are rising as the population ages and as control over other diseases, including CVD, gradually improves. Overall, cancer accounts for 20% of all deaths in the European Region, with 2.5 million new cases diagnosed each year in the EU alone. WHO data reveal just how unnecessary this is. Lung cancer is the leading cause of cancer mortality by far; in the EU-12 (countries belonging to the EU before May 2004), it caused nearly twice as many deaths as breast, colorectal or stomach cancer.

On the one hand, unacceptable inequalities, particularly for preventable cancers, are found throughout the Region, as public health interventions reach some – but not all – vulnerable populations. On the other hand, these inequalities also point the way to action, showing that progress is possible if policy-makers, health professionals and communities work together to improve health.

The complexity of cancer control presents unique challenges for policy-making, requiring an integrated approach with both vertical and horizontal elements. Holistic national cancer policies, spanning from prevention to palliative care, are cropping up throughout the Region, and WHO is wholly committed to these efforts. At present, we are working closely with eight Member States on reviewing or developing national cancer control programmes, but we hope that the number will grow as experience with them and evidence on their effectiveness accumulate.

Primary prevention, particularly tobacco control, is a key plank in this public-health-based strategy, as we work to make healthy choices easier for citizens across the Region. Cancer shares common risk factors with other noncommunicable diseases (NCDs), including heart disease, stroke and diabetes. The WHO Regional Office for Europe promotes an integrated approach to prevention and health promotion through the European Strategy for the Prevention and Control of Noncommunicable Diseases. It provides an umbrella for WHO strategies, frameworks and action plans on individual risk factors, such as tobacco, alcohol, unsafe food and poor nutrition, obesity, physical inactivity and unhealthy environments.

Early detection is a second plank. While population-based programmes screening for breast and cervical cancer are in place in most countries, screening for colorectal cancer is just beginning to appear. Further, all these recommended screening programmes for three types of cancer vary considerably in target populations and recommended frequency. In the past three years, the WHO Regional Office for Europe has worked with policy-makers from over 40 countries to strengthen cervical cancer prevention and develop screening programmes. This work is underpinned by the Office’s broader work to strengthen health systems and particularly to improve quality assurance systems.

These efforts will improve screening, but will also help to improve treatment through integrated care, including palliative care. This field is growing throughout the Region; and as it does so, countries will need technical support from experienced professionals. In 2008, the Regional Office organized a meeting with WHO’s European collaborating centres on palliative care. The goal was to establish a close partnership between them and the Regional Office and to develop a coordinated and systematic approach to technical and country work in this area.

In addition, research – particularly translational research, including study of the interaction between genes, lifestyle and the environment – must be stimulated and supported to ensure services for the population follow best practices. In this regard, the Regional Office plans to work more closely with the International Agency for Research on Cancer (IARC), which is part of WHO. Today, two priorities are especially pressing: the needs for coordinated and comprehensive cancer registries across the Region and for a thorough review of European directives on research and data protection. Moreover, behavioural research is needed to address the question as to why action is not taken to prevent conditions known to be preventable.

In this case, as in others, regional leadership will be a significant determinant of success. WHO envisions for itself a strong role in political leadership and technical guidance, and we look forward to working closely with the EU and WHO Member States, to provide the political leadership necessary to carry this out on the country level.

Joint strategies – including the exchange of best practices, coordinated research and policy formulation, and coherent and transparent collaboration among all stakeholders – add value to countries’ efforts. Developing synergies, fora and other channels for concerted action will be a priority for WHO throughout this biennium and beyond, and we look forward to working with Member States (those of WHO and those of both WHO and the EU) to improve cancer outcomes and population health throughout the European Region.

Thank you.