The Global Fight Against Cancer

New Tobacco Atlas Underlines World No Tobacco Day Focus on Industry's Undue Influence

The newly released Tobacco Atlas, Fourth Edition graphically details the scale of the tobacco epidemic, progress that has been made in tobacco control, and the latest products and tactics being deployed by the highly profitable tobacco industry. Lead Atlas author Michael Eriksen penned the chapter entitled "Undue Influence." The theme of tomorrow's World No Tobacco Day bears the same name. Dr. Eriksen's research drives home the need to expose and counter the tobacco industry's brazen and increasingly aggressive attempts to undermine global tobacco control efforts.

By Michael Eriksen, ScD

Tobacco companies spend untold millions of dollars annually to influence public policy and legislation. Reporting of tobacco industry political contributions is not required in most countries, so the complete picture of the tobacco industry’sinvestment is not fully understood. In 2010, nineteen companies with tobacco interests spent $16.6 million and employed 168 lobbyists in an effort to directly influence political decisions in the US.

In addition to political influence, tobacco companies make charitable contributions under the guise of corporate social responsibility (CSR). Often these donations and efforts do more to benefit the image of tobacco companies than to benefit humanitarian efforts. In 2010 Philip Morris International contributed a fraction of a percent of the company’s net profits in global charitable donations ($25 million in donations and $7.5 billion in profits). Parties or nations to the WHO FCTC are warned to “be alert to any efforts by the tobacco industry to under-mine or subvert tobacco control efforts” and are obligated to protect their public health policies from commercial and other vested interests of the tobacco industry.

The influence of the tobacco industry is monumental, and tobacco companies’ contributions to socially responsible causes are of great concern. Not only are CSR contributions a form of tobacco advertising and promotion, but such contributions allow tobacco companies to legitimize themselves with policymakers and the public and counter the negative attention surrounding their deadly products.The tobacco industry exerts undue influence through partnerships with other organizations, such as convenience stores, advertising, and farmers’ associations, and the hospitality industry. Tobacco companies fund front groups and think tanks to promote tobacco or oppose tobacco legislation. While these organizations appear to be independent, governments must be wary of their involvement with Big Tobacco.

The China National Tobacco Corporation has sponsored at least 69 elementary schools,and thousands of students daily are exposed to pro-tobacco propaganda, names and messages.  Schools signs read, "Genius comes from hard work.  Tobacco keeps you sucessful."

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About the Author

Michael Eriksen is a professor in and the founding dean of the Institute of Public Health at Georgia State University. He is also director of Georgia State University’s Partnership for Urban Health Research and Center of Excellence in Health Disparities Research. Prior to his current positions, Eriksen served as a senior advisor to the World Health Organization in Geneva and was the longest-serving director of the Centers for Disease Control and Prevention’s Office on Smoking and Health (1992–2000). Previously, Eriksen was director of behavioral research at the M.D. Anderson Cancer Center. He has recently served as an advisor to the Bill and Melinda Gates Foundation, the Robert Wood Johnson Foundation, the American Legacy Foundation, and the CDC Foundation.Eriksen has published extensively on tobacco prevention and control and has served as an expert witness of behalf of the US Department of Justice and the Federal Trade Commission in litigation against the tobacco industry. He is editor-in-chief of Health Education Research and has been designated as a Distinguished Cancer Scholar by the Georgia Cancer Coalition. He is a recipient of the WHO Commemorative Medal on Tobacco or Health and a Presidential Citation for Meritorious Service, awarded by President Bill Clinton. Eriksen is a past president and Distinguished Fellow of the Society for Public Health Education, and has been a member of the American Public Health Association for 
over 35 years.

About the Fourth Edition

The Fourth Edition of The Tobacco Atlas launched on March 21, 2012, at the World Conference on Tobacco OR Health in Singapore, a decade after the publication of the first edition. The Atlas presents the most up-to-date information on tobacco and tobacco control available in a highly graphic, easily understandable format. 

Access to essential pain medicines an important goal in the fight against NCDS

By Meg O’Brien, PhD, Director, Global Access to Pain Relief Initiative

As we head into the World Health Assembly later this month, there will be a good deal of energy focused on translating the commitments to addressing non-communicable diseases made at last year’s UN High-level Meeting into concrete outcomes for people living and dying with these diseases.
There is one group of people anxiously waiting for us to close our Power Point presentations, wrap up our conference calls, and focus our efforts on securing the essential medicines that are out of their reach. They are the 3.3 million people who die each year of cancer or HIV in moderate or severe pain without treatment and the millions of caregivers who must watch them suffer so unnecessarily.
Opioid analgesics, including morphine, are considered essential medicines by the World Health Organization and are recommended for the treatment of moderate to severe pain. Opioids are also on almost all national essential medicines lists, but access to them is severely limited in most low- and middle-income countries, where 85% of the world’s population consumes just 7% of the medicinal opioids.
There is no more striking example of the global disparity in access to health care than cancer. Cancer patients in low- and middle-income countries lack access to basic diagnostic services and cancer awareness is low, so about 80% of cancer cases are in advanced stages of disease when they are diagnosed. Treatment options are severely limited and where treatment is available, it is less effective in such advanced cases. With a prevalence of about 80% among people with advanced cancer, untreated moderate to severe pain that grows worse each day is a consistent feature of cancer care in resource-limited settings.
Improved access to essential pain medicines is not the only thing that cancer patients in low- and middle-income countries need, but it is arguably the easiest and least expensive need to meet, would do the most to relieve suffering, and recent data suggest may also extend survival. With treatment costs in many programs as low as 1.6 USD per week, the cost of providing 12 weeks of treatment to the 4.3 million people who die of cancer in pain in low and middle-income countries each year is just 83 million USD.
The need for pain relief is not limited to people with cancer. Those with HIV, myocardial infarctions, and people recovering from surgery need it, too. So improving access to essential pain medicines offers an opportunity to move beyond disease-specific silos and build initiatives to address non-communicable diseases that are integrated with – and build on – existing communicable disease programs.
As we look for practical, meaningful, and attainable objectives in the fight to improve care for non-communicable diseases, securing access to essential pain medicines is a no-brainer. The policy framework and clinical guidance are in place; the medicines are plentiful, inexpensive, and effective; the need is great; and the impact will be immediate.

The Global Access to Pain Relief Initiative (GAPRI) is a joint programme of the American Cancer Society (ACS) and the Union for International Cancer Control (UICC) to make effective pain control measures universally available to cancer patients in pain by 2020, in line with Target 8 of the World Cancer Declaration.

Marking Mother's Day by Raising Awareness of Cervical Cancer

Atlanta, Georgia, U.S.A. — On Mother's Day, May 13, the American Cancer Society Global Health Programs is asking women everywhere to consider a critical issue that affects mothers all over the world.

More than 20,000 people die from cancer each day worldwide, and almost half of them are women. This is especially true in developing countries, where the rising cancer burden among women results in needless pain and suffering and ultimately the devastating loss of young mothers, wives, sisters and daughters.

To address this women's health challenge, the American Cancer Society stands with our global partners in calling for an urgent, comprehensive response that promotes lifesaving information and resources for cancer prevention, early detection, treatment and pain control. 

Developing coutnries bear the brunt of this disease.  Fortunately, there is promising news. Learn more about the global burden of cervical cancer from ACS Chief Medical Officer, Dr. Otis Brawley. http://tinyurl.com/6t2otsg

Cancer Control in Africa: ACS Recognizes International Nurses Day with Frontline Report on Zambia Nurses Treating Tens of Thousands With Cervical Cancer

On Saturday, May 12, International Nurses Day is celebrated around the world to mark the contributions nurses make to society.  In honor of this year's theme “Closing the Gap from Evidence to Action” — ACS invites you to read about cervical cancer screenings and life-saving follow-up services underway in Zambia's capital. 

Lusaka, Zambia — Down a dirt road in Lusaka that snakes through makeshift hawker stalls lies the Zambia Ministry of Health George Clinic. Patients crowd waiting areas, sitting on thin benches sometimes for several hours waiting to be seen by a nurse. What makes this clinic unique is that it is one of only a handful of places in a city of 1.7 million where women are screened for cervical cancer. It is at full capacity every day, as it serves a neighborhood of more than 30,000 women.

The clinic uses the VIA (visual inspection using acetic acid) method to screen for cancer of the cervix. If suspicious lesions are found and can be removed by the nurse by cryotherapy, this is done immediately. Once a patient leaves, clinic staff may never see her again, as most patients do not have a formal address. More than 80 percent of the women agree to be treated on the spot. The nurses’ role as a counselor is crucial, as most patients have never had a simple pelvic exam.

Cervical cancer is the leading cause of cancer death among women in sub-Saharan Africa, due to a high prevalence of human papillomavirus (HPV) infection, which causes cervical cancer, coupled with a lack of screening services and early detection. In Zambia, the impact of the disease is catastrophic, as it accounts for up to half of all female cancer cases. Eight out of 10 patients die from the disease. Health authorities in countries like the US recommend women get their first screening in their 30s. Yet, in Zambia large numbers of women in their early 20s already have signs of the disease, and many suffer from advanced-stage cervical cancer.

Women are the backbone of Zambia; besides being the mothers, family managers, and caretakers, they are breadwinners as well. The death of even one woman is devastating to a community, as they must now take in the children from her family with the few economic resources that they have available, further straining an already fragile situation.

As bleak as the situation seems, progress is being made in the fight against the disease. The Centre for Infectious Disease Research in Zambia, in association with the Ministry of Health, began the first program to screen for cancer of the cervix in 2003. From a shoebox of a room in the University Teaching Hospital, the program has grown and has rolled out to a handful of places that includes the George Clinic. The program has successfully screened more than 72,000 women in nearly a decade. Still, in pilot stage the program will expand nationally if funding becomes available.

Expanding cervical cancer screening to all the districts in Zambia is easier said than done. Roads are ruined in the rainy season. Communications and infrastructure are addled year round. Myths about illness abound. Many believe cervical cancer is a "curse" or a "hexe." Many women seek treatment from traditional healers rather than going to a local health post. There is a strong role for awareness, education, and advocacy in this fight.

In the end, this battle will be won by two people — women entering the clinic and the nurses performing the screening. Their 20-minute interaction is what will bring more women into screening clinics. If patients feel that they are in a secure environment where they are respected and valued, they will spread the word in their communities and more women will come to be screened. Our role as NGOs, donors, researchers, and administrators is to make sure that nurses and their patients have the resources and support they need.

 — Jay Evans, Director of Business Planning, ACS Global Health Programs 

Global Cervical Cancer Headline Facts

• Cervical cancer was the fourth leading cause of cancer death in women worldwide, and the leading cause of cancer death among women in sub-Saharan Africa and South Central Asia in 2008. That year, cervical cancer caused an estimated 275,100 deaths.Ninety percent of these deaths occurred in developing parts of the world, where access to screening and treatment are often non-existent and adolescent girls are not receiving vaccination for the human papilloma virus (HPV), the primary risk factor for cervical cancer.
• The HPV vaccine can prevent up to 70 percent of cervical cancer cases, and cost-effective procedures are available to detect and treat cervical pre-cancer.
• To redress the rise in cervical cancer, the Society has spearheaded programs in India, Latin America, Southeast Asia, and sub-Saharan Africa. We aim to promote public awareness about cervical cancer, educate health professionals, and improve access to screening. We collaborate with PATH and the Cervical Cancer Action Coalition with a shared goal of preventing cancer globally.

Source:  Global Cancer Facts & Figures, 2nd edition

Benin Workshop Highlights Taxation as a Highly Effective Tobacco Control Policy

Written by Tosin Orogun, Africa Tobacco Control Regional Initiative

Porto Novo, Benin — Experts have called on the Benin government to implement an effective taxation policy on tobacco products in the country as a strategic tool for controlling tobacco sales and consumption.

Providing overview of tobacco consequence in the region, Dr. Judith Segnon-Agueh, Tobacco Control Focal point in the Benin Ministry of Health, noted that although tobacco products are very harmful, prices of the products are too low thereby increasing its consumption rate in the country. She said "we must take conscious steps to ensure that we raise price of tobacco products in the country through taxes, so that tobacco products become expensive such that is not easily accessible in Benin. By doing this, we can drastically reduce the demand for the products. The good thing is that we can achieve this by putting in place a strong tobacco taxation policy based on the expert recommendations and global best practices.

"Speaking on tobacco taxation in the ECOWAS region, the Taxation Campaign Coordinator for the Africa Tobacco Control Consortium, Mr. Noureiny TCHA KONDOR, submitted that "the government must take seriously the issue of the loopholes of present tobacco excise tax regulations by supporting a FCTC compliant tobacco tax policy implementation while being involved in anti illicit tobacco trade initiatives at regional level, without any interference of the industry".

Dr. Evan Blecher, Director of International Tobacco Control Research at the American Cancer Society noted that when taxes on tobacco products are too low, it results in low prices of tobacco products and consequently increase consumption of the products, because they become cheaper to buy. He added that smuggled tobacco products are potentially more harmful because the content are not regulated, noting that this scenario not only affect the health of the citizens it also "undermines the tax system of the country".

According to Augustin Faton, President of Initiative for Tobacco Control Education in the Republic of Benin, all West African countries are economic stakeholders for cross-border trade in the region, and ”and putting in place an effective tobacco taxation policy in Benin and corresponding policies across the region will help reduce cases of smuggling of tobacco products and ensure compliance with existing trade protocols among these countries that are sharing borders in the ECOWAS region” he added.

Speaking to journalists after the opening session of the workshop, the Regional Coordinator of the Framework Convention Alliance – Afro (FCA) Mr. Tih A. Ntiabang said, "countries in the ECOWAS region must make deliberate efforts to agree on the modalities for implementing effective laws that will raise taxes on tobacco products and discourage tobacco industries' strategy of smuggling products from one country to another." While encouraging countries of the region to continuously increase taxes on tobacco products, he pointed out that one of the key recommendations of the WHO MPOWER to arrest tobacco use, is to raise taxes.

Mr. Tosin Orogun, the Media Advocacy and Communications Coordinator for Africa Tobacco Control Consortium, emphasized on the fact all stakeholders must recognize that effective control of illicit trade and tobacco tax evasion control begins with implementing the provisions of the WHO FrameworkConvention on Tobacco Control (FCTC) by enacting the effective domestic tobacco control laws. According to him, "countries within the region that have demonstrated commitment to implementing the FCTC must be supported and encouraged to get to the finish-line".

Benin is working towards entrenching tobacco control regulations into their national laws.

The workshop was organized by Initiative for Tobacco Control Education as part of the activities supported by the Africa Tobacco Control Consortium. Among participants at the meeting are representatives of different government ministries concerned with health and taxation issues in Benin, the media and Civil Society Organizations working in Tobacco Control.

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