Colombian perspectives in cancer control

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Published: 12 Dec 2016
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Dr Carlos José Castro Espinosa - Liga Colombiana contra el Cancer, Bogota, Colombia

Dr Castro speaks with ecancertv at the 2016 World Cancer Congress about successes and challenges in cancer control in Colombia.

He describes lobbying efforts to bring tobacco taxation to a level equal to surrounding nations, and a survey which found the counterpoint argument of tobacco companies, that higher taxes would spur an illegal trade of tobacco companies, was not borne out.

Dr Castro goes on to call for wider involvement in political and policy processes, and introduces topics to be discussed at the upcoming ecancer conference in Colombia

I was invited to speak with the people of the UK Cancer Research team and the American Cancer Society regarding the increase of taxation in tobacco products in Columbia. There’s no doubt, especially after the UK experience, that increasing the taxes for tobacco decreases the amount of smokers. In Columbia and in most developing countries the tobacco industry has the argument that if you increase taxation on tobacco products what you will do is to increase smuggling and illegal trade of tobacco and that’s basically the big argument that the tobacco industry is spreading the word away.

So we decided, with the Columbian League Against Cancer and other foundations, to make a survey and investigation, some kind of social research, to see whether that was true or not. The tobacco industry is always saying that maybe 20% of tobacco illegal trade will increase if we increase taxation. What we found out is that that’s absolutely nonsense, it’s very, very small the amount of illegal trade of tobacco if you increase taxation, it’s only about 3%. So that was a big argument and we went to the government, especially to the Ministry of Finances, and we told them, ‘Listen, you want money?’ and he always said, ‘Yes, we need money.’ ‘Increase tobacco taxation.’ In just one minute he just signed a whatever they call it increasing the tobacco products by more than 50% of what they were already being charged.

That was very important because you saw the taxation that Columbia had for tobacco was very low if you compare it to Venezuela, Ecuador, Peru, Panama. So, as of this year, just a couple of weeks ago, we decided to increase the taxation so that tobacco products from Columbia are almost the same as in Venezuela and the neighbouring countries. That was a big step and obviously the tobacco industry is quite upset. No wonder, that’s OK. So that was something. I thought it was going to be very difficult because you know that the tobacco industry has a lot of power, money, lobbying, but we found out that for the government taxation money is very important and they really opened their eyes – ‘Oh yes, let’s do it.’ So that was a good thing.

Another thing that is worthwhile mentioning is that we are also behind the project of increasing, or at least putting some taxation, to sugar products. We are well aware that they have nasty complications with health so we are also trying to put some taxation to sweetened products and we hope that that law is going to pass because all of these efforts are directed to have healthy living habits. So I guess that the Columbian League is doing [?? 3:37] and it’s also trying to find out… I always say that doctor society needs to get involved into politics, not become politicians, which I hate, but politics in the broad sense of the word. Unless you get into politics you won’t be able to change really things that are of great importance in any country. You have to get into politics, again not mix politics with politicians, politics, health policy. It’s important to all of the organisations that in some way are involved with cancer management and cancer prevention to get involved with politics. Talk to the politicians, convince them with facts. This is the thing that you need to do, that’s why we elected you guys to go to Congress and whatever. These are facts, you have to represent us and we are going to demand you do your job. So that’s what we are doing and so far I’m happy but you can never be absolutely sure that things are going to turn out the way you think.

Could you tell us more about the tobacco consumption?

We interviewed something like 1,500 people that were smokers of five different big cities – Bogotá, Medellín, Cali and two cities from the frontier. Amazingly, the cities that had the largest amount of illegal tobacco products were the cities of the frontier, especially the one with Venezuela. So I cannot say that we interviewed people from Venezuela, they were buying cigarettes, they were interviewed. But it’s interesting that cities from the frontier, 20% of the tobacco that was being consumed in that city was illegal.

Could you discuss the upcoming Bogotá conference?

Yes, that’s important and I’m very excited about it because for the first time ecancer, in a joint venture with the Columbian League Against Cancer, is organising an oncology meeting in Columbia with the participation of at least fifteen very well-known physicians from Europe and Latin America and North America, and some Columbians also, and we are going to be talking about different topics of oncology that are of great importance for our country – cervical cancer, breast cancer, prostate cancer, childhood cancer and also palliative care. Palliative care is a big issue that hasn’t been given the importance that is needed, and especially in Columbia. Although we already have a Columbian Palliative Care Society we need to give them more space and convince government and also physicians of the importance of palliative care, palliative care and pain control. We have a lot of work to do and I hope that this type of activity, academic activity as an oncology meeting, it’s going to be held on 17th and 18th November in Bogotá, is going to be the first step of many more to come in the future. I’m delighted to be working with ecancer, they have a great organisation, Professor McVie and all of the team, they have done extraordinary work and they are very enthusiastic, very well organised and I’m happy. I just hope that all of the effort that they have done and that we have done is going to be rewarded by a great success that I hope is going to be that meeting. We’re expecting about three hundred attendees so we look forward to having that event and hopefully if it’s OK the following years keep on working with ecancer. A great tool to educate people, community, and education is, for me, the most important tool to break down the neck of cancer.