Encouraging governments to develop effective policies that reduce risk factors in the population and strengthen health systems
Copenhagen, Denmark, 12-16 September 2016
ESMO welcomes the World Health Organization (WHO) Regional Office for Europe’s Action Plan for the Implementation of the European Strategy for the Prevention and Control of Non-Communicable Diseases (NCDs) 2012-2016 (PDF), together with the ‘Annexes’ adopted by the WHO Regional Committee for Europe at their meeting on 12-16 September 2016.
ESMO, represented by Fatima Cardoso, Portugal, and Rosa Giuliani, Italy, participated in preparatory meetings of the Action Plan. Drs. Cardoso and Giuliani highlighted that while they agree prevention is essential, the Action Plan cannot focus only on prevention as while 40% of cancers may be preventable, the other 60% are not. They also emphasised that the decline of mortality observed for many cancers is the result of screening and early diagnosis. They noted that screening and early detection programs are meaningful only if there are also timely treatment options available. Many of their comments are included in the Action Plan which will influence national cancer plans for the next 10 years, 2016-2025.
The NCD Alliance and the Union for International Cancer Control (UICC) submitted statements to the WHO Regional Committee on what they welcomed and felt needed to be improved within the WHO Europe NCD Action Plan before the final version was approved.
The aims behind the Action Plan
WHO’s aspirational vision of the Action Plan aims to achieve a health-promoting Europe, free of preventable non-communicable disease, premature death and avoidable disability. The Action Plan encourages governments to work across all sectors to develop effective policies that reduce risk factors in the population and that strengthen health systems. WHO recommends promoting prevention programmes, targeting high-risk individuals, and maximising health coverage for a country’s population with effective treatment and care.
The Action Plan supports the achievement of global and European targets to reduce premature mortality from cancer, cardiovascular disease, diabetes and chronic respiratory diseases as set forth in the WHO Health 2020 plan (1% annually by 2020), the Global NCD Monitoring Framework (25% by 2025) and the Sustainable Development Goals (one-third by 2030), using the year 2010 as a baseline.
WHO encourages countries to raise awareness of early signs and symptoms of cancer and the need for early detection. Many conditions fail to be detected early enough for effective treatment. Thirty to forty percent of cancer in eastern Europe is metastatic at diagnosis. Better education of the general public and professionals should lead to prompt referral for diagnosis. To minimize harm and increase effectiveness, cancer screening should take place where evidence of effectiveness exists, and within population-based, organized screening programmes with strong quality assurance mechanisms. However, WHO adds that there is no real value in screening and early detection if diagnostic or treatment options are unavailable.
Regarding access to medicines, WHO calls for at least 80% access to essential medicines by 2025 and concrete actions are needed, such as national diagnostic and treatment guidelines that are tailored to country resources and ensure equity of access to the highest national standards for all citizens.
Monitoring and surveillance of health outcomes should take place through population-based disease registries.
Proposed national actions
- Raise awareness of the risk factors, early signs and symptoms of cancer and other major NCDs among health professionals and the general public;
- Increase clinical competencies in early diagnosis and management, and have in place effective and rapid referral, diagnostic and treatment pathways for management of those detected;
- Implement, where appropriate and evidence-based, population-based, organized and quality-assured screening programmes for cervical, breast and colorectal cancers according to the country context and where health systems can support effective outcomes;
- Assess public and private facilities within primary care systems and, where necessary, improve the availability of affordable basic technologies and essential medicines, including generics, required to treat major NCDs;
- Support the implementation of at least a minimum set of essential NCD interventions in primary care to increase coverage and equitability of basic care;
Regarding vaccines, some vaccine-preventable conditions are associated with the development of NCDs: the primary cause of cervical cancer is persistent or chronic infection with one or more of the high-risk (or oncogenic) types of human papilloma virus (HPV), a sexually transmitted infection; and, in some people, chronic infection with hepatitis B virus leads to cirrhosis and liver cancer. Vaccination is an effective public health intervention and, in recent years, significant progress has been achieved in protecting young children against hepatitis B through their life-course by implementing universal newborn or infant hepatitis B vaccination.
ESMO projects in collaboration with WHO
- Alexandru Eniu, Romania participated on behalf of ESMO in the update of cancer medicines in the WHO Model List of Essential Medicines. The list was updated in April 2015, and an article describing the new cancer medicines added to the list can be found in ESMO Open.
- Nathan Cherny, Israel, led the ESMO European Consortium Study on the Availability of Anti-Neoplastic Medicines in Europe which was recently published in Annals of Oncology.
- ESMO has been closely collaborating with the WHO for almost 15 years on cancer control. A summary of our collaborative projects and how they led to ESMO receiving ‘official relations status’ with the WHO can be found in ESMO Open.