Position statement: structural change for cancer prevention
The problem
In the UK, around 40% of cancer cases are preventable.[1] There is therefore considerable scope for positive change. But at present, many people are becoming ill and dying who would otherwise have enjoyed many more years of life and good health.
The things that make these cancers preventable are to do with lifestyle. The main factors are:
- Smoking tobacco
- Diet, in relation to obesity, processed and red meat, and lack of fibre
- Drinking alcohol.
The most preventable cancers are of the lung, bowel, skin (melanoma), breast, oesophageal, bladder, kidney, stomach and pancreas.
Nature of the problem
The tempting narrative of personal responsibility, which argues that individuals simply need to make better decisions for themselves, is inadequate to tackle preventable cancers.
People engage in unhealthy behaviours for complex reasons that cannot be simply addressed by encouraging different choices. For many people, unhealthy choices are the easy and therefore rational choices to make, while healthy choices are difficult or impractical. Changes to our economy, society and environment are essential for reducing preventable cancer.
Unhealthy behaviours can be encouraged by many situations:
- Buying cheap processed food from a convenience store may be much easier than travelling further to a supermarket to buy healthy food, particularly for someone without access to a car
- Joining in with the smoking and drinking of family members may be much easier than resisting pressure and social cues to conform
- For many people, making ends meet financially and coping with challenges in their personal life may be much higher priorities than quitting smoking or paying close attention to their diet
- It is often easier to satisfy a craving or yield to temptation than to spend a prolonged period resisting it – whether that is for a cigarette, a drink, or a slice of cake at work.
- For someone who is tired after working a long day, buying an unhealthy takeaway from a nearby outlet may be easier than cooking a healthy meal from scratch.
Recommendations
Structural change is required to reduce the incidence of preventable cancer.
This should not be principally a matter of restricting personal freedoms. Some measures of this sort, such as some tightening of where and when smoking is permitted, may be useful. But the necessary policy changes relate far more to improving our society and economy.
Some measures may involve incentivising different commercial behaviours. The Soft Drinks Industry Levy (“sugar tax”) prompted many companies to reformulate their products so that they contain less sugar. Further measures of this sort are desirable.
Elsewhere, regulatory interventions to make healthier choices easier and unhealthy choices harder are required. This may be through the planning system, for instance to ensure that new housing developments come with ready access to healthy food at affordable prices (usually meaning access to a large supermarket), or to limit proliferations of takeaways. Restrictions on how tobacco, food and alcohol are marketed and sold will also be required.
In all aspects of future reform, the root causes of health inequalities must be recognised. Many of the greatest inequalities in health outcomes arise directly from to higher rates of preventable cancers. Policy-makers must understand why different groups can or can’t afford to make different choices, or prioritise different things.
Information and encouragement to equip people to make healthy individual choices must continue to be part of the mix. However, reliance solely on this approach will be inadequate, and will guarantee many premature deaths, as well as high demand on healthcare services to treat preventable illness.
Finally, strong public education and messaging about public health is needed. Research shows that people are supportive of measures that they expect will work, but that understanding of the true nature of how structural factors drive unhealthy behaviours is low.[2] However, it also shows that people can readily grasp these issues if they are presented with the necessary information: policy-makers and political leaders need to make this a higher priority.
About CancerWatch
CancerWatch is an organisation made up of people whose lives have been affected by cancer, who are passionate about eliminating preventable cancers in the future.
June 2023
[1] https://www.cancerresearchuk.org/health-professional/cancer-statistics/risk/preventable-cancers
[2] https://www.nesta.org.uk/report/changing-minds-about-changing-behaviours-obesity-focus/