At last week’s World Cancer Leaders’ Summit, we had the opportunity to focus on and celebrate the C/Can2025: City Cancer Challenge initiative, which is designed to improve cancer treatment and care services in cities with a population of greater than 1 million. Cities are critically important in the fight against cancer and other non-communicable diseases (NCDs) as half the world’s population lives in cities and nearly two-thirds of the world’s population will be city dwellers by 2050. As such, health provision in cities has a proportionate impact on both national and global health.
Of course, city residents typically benefit from better access to health services than their counterparts in rural areas, as cities are usually where the facilities and resources (including doctors) to diagnose and treat cancer are located. However, we must also recognise that all cities or countries face resources constraints when dealing with the growing cancer burden. From a population perspective, and in terms of exposure to the risk factors of preventable cancers, cities are encountering a heavy strain on their cancer services. Global population growth and increased urbanisation make it even more critical that local governments and health providers adopt a strategic approach to ensure that health services – including cancer services - are fit for purpose today and can keep up with future demand. In this respect, C/Can 2025 is a vital tool to increase the number of people with access to quality cancer treatment and services in cities around the world.
Creating a healthy city is as much about diagnosing and treating illness in a timely and effective way as it is about preventing disease and injury to reduce the human and economic cost. This is something we’ve long advocated in the global cancer community - prevention plays a crucial role in cancer control. To date, much of the focus has been on engagement with national governments with the objective of ensuring that cancer prevention strategies are one of the central pillars of an effective national cancer control policy.
Yet many cities can implement a wide range of policies independent of national decisions – offering the opportunity to put in place local strategies where there is no national strategy, or to implement a more effective version of the national strategy.
In addition to local implementation of cancer prevention strategies, potentially setting an example to other cities and to national government, city leaders often have significant political capital at the national level. With encouragement and support, they could also better use their power and influence to advocate for cancer prevention strategies at the national level. This is an opportunity we must take. It’s time for the cancer community to think of city leaders as stakeholders in cancer prevention efforts, and to engage with mayors and city administrators on this critical issue.
There are plenty of cancer prevention policies that can be implemented at the city level – and perhaps the greatest opportunity lies in tobacco control. As highlighted by our colleagues in Prevent 20, 20 percent of global cancer deaths are related to tobacco use – so tobacco control policies are cancer prevention tools. Known, proven policies outlined in WHO’s Framework Convention on Tobacco Control (FCTC) and MPOWER package have helped reduce the prevalence of tobacco use, but global population growth means the actual burden remains stubbornly and unsustainably high.
In many countries, cities are making a difference, implementing and enforcing strong tobacco control policies at the city level in the absence of national laws, or where national laws are weaker than WHO recommended best practice.
This isn’t just about smokers – although smoking is linked to at least 14 cancers – there also is a cancer burden associated with second-hand smoke exposure. Strong smoke-free laws help to reduce that burden while also encouraging smokers to cut down and quit, and are an excellent example of where many cities have moved ahead of national policy. China is a particularly salient example: smoke-free policies across some of China’s largest cities are now protecting more than 60 million people.
High tobacco taxes and prices that reduce affordability are proven to be the single most effective way of reducing tobacco use - encouraging current smokers to cut down and quit, and deterring youth from initiating smoking - but are the least well implemented.
An effective cancer prevention strategy should include advocacy for high tobacco taxes and prices as a cancer prevention tool at the city and national levels. Countries like the Philippines have shown that the funds raised from increasing tobacco taxes can be used to help pay for health care, including cancer services – a clear “win-win” from a health perspective.
Some cities will have the latitude to increase tobacco taxes within the municipal area and this could have a significant impact – especially if local government is able to allocate some of the funds raised to local health provision. The most effective results – from a health and economic perspective - will of course be delivered if high tobacco taxes are consistent across the entire country and all tobacco products. For example, when consumers can simply drive out of the city to purchase cheaper cigarettes, the impact is reduced. Even so, we should encourage mayors and city leaders to adopt high tobacco taxes where possible, and to express strong and vocal support for this policy at the national level. The importance of leadership and champions for high tobacco taxes simply can’t be underestimated.
I encourage all cancer organisations to advocate for increased tobacco taxes. As cancer organisations, we must recognise the significant role tobacco plays in the increasing global burden of cancer, and that tobacco-related cancers can be prevented. Our collective experience is invaluable and should be broadly shared within our community of practice. Let us use our relationships with mayors and other city leaders to advocate for tobacco taxes as a cancer prevention tool at the city and national level – encouraging them to be stakeholders in this important work. With our support, it’s one of the ways in which cities really can drive positive change.
Read more on the benefits of tobacco taxes at wecanprevent20.org.