World Cancer Leaders’ Summit 2015
The importance of international collaboration in cancer care policies
Prof Knut-Inge Klepp - The Norwegian Institute of Public Health, Oslo, Norway
Norway is a very well organised country but you’re here to talk about international collaboration and looking at policies for getting cancer care implemented. What have you got to say about international collaboration? What are the key points?
Particularly in the policy area it’s so important with international collaboration because policies are often implemented at a national level so in order to gain experience with the impact and how acceptable they are it’s really important to be able to share across countries.
What sorts of policies concerning cancer have proved to be winners?
There are a number of ones in the area of nutrition. We have a framework called the Nourishing Platform and just now 255 actions reported in 100 countries across the globe. For instance in Mexico they implemented a tax on soft drinks, showing that it is possible to reduce the consumption of soft drinks based on increasing cost, a similar experience from Norway.
So you’ve got some evidence already that you really can implement changes in diet?
Right, and there are other examples. For example in Europe there’s a big network set up how to reduce the impact of marketing of unhealthy food and drinks to children. So there are 25 countries involved now in how to best implement different regulations.
There’s a lot of resistance to that because you’re talking about large global corporations and weight of public opinion says we don’t want to be told what to eat.
Right, but when it comes to children parents and others say it is acceptable. But it is true, it is resistance from the industry and it’s important to be very clear what should the policies be. Also it is an international issue because the corporate industries are multinational, they can move to another country, broadcast their advertising across borders. So it has to be agreement across countries.
So how can you implement such policies in countries outside Scandinavia, do you think?
We had a meeting in Turkey two years ago, they brought in a lot of their neighbouring countries and they were able then to see, just to define the issue, to assess how big a problem is it in their country. Then there’s a wide variety of how they can actually go ahead addressing it: looking at the school setting as one setting, for example, that should be commercial free; looking at TV advertising or other forms of advertising targeting children.
Presumably you have to approach it in a multifaceted way. On the one hand you can go for codes of conduct, on the other hand you can go for advertising and you can, of course, have legislation. How do you strike the balance?
That’s why it’s so important to do evaluation and, again, that’s why it’s important with international collaboration. So I don’t think the word gets out yet on what is the best balance but there is some indication that statutory action, legislation, is more effective than voluntary action. But there are different models being used and it is really important to evaluate them further.
We’ve been hearing at this meeting here in Istanbul, though, that sometimes there are conflicts of interest so you might even make statutory changes and they still don’t work.
Right. Again, it is important with evaluation to see what is the reason then why they don’t work. Is it because they are not really being followed up, they are not being implemented? Or is it that they are being perceived as unacceptable. In Denmark they introduced a tax on fat content in food, it has been evaluated, proven to be very effective, but it was withdrawn after about one year because of resistance from the food industry that it was too complicated for them and had too much hassle for the food industry.
What about a sugar tax?
Sugar tax has been implemented in different places. In Mexico we see that it is now being implemented and there’s a nice international collaboration between the Public Health Institute in Mexico and the Food Science Group at North Carolina University in the US and also an international advisory board in Norway. We do have sugar tax that has been implemented on soft drinks, we see that their consumption has gone down substantially since it got introduced.
If you’re going to implement changes you need to be able to prove that they work so how do you get evidence of effectiveness?
There you need the research evidence and that’s why it is so important with this international collaborative work and being able to contrast the different experiences because these kinds of policies it’s difficult to implement in a randomised way like you often want to do when you get evidence from biomedical research. Then you also need the experience of people, people who know the context, know what is acceptable and know what’s feasible, how do they value and judge the different policy measures.
How would you sum all of this up in recommending concerned people all over the world how to go about the problem of reducing the cancer burden by implementing dietary changes?
You need to know what’s out there and that’s why a framework like the nourishing platform is such a very useful tool where you can go in and see what has been done in Peru, what has been done in Romania, other parts of the world, and what are their experiences. So that’s number one, information about the different options. Second, it’s important to see that some of these measures have to be on an international basis because the issue is international. So it’s important then to have the framework and agreement between countries like you had, for example, on the strategies for non-communicable diseases promoted by the WHO.
