BREATHING IN A NEW ERA
A COMPARATIVE ANALYSIS OF LUNG CANCER POLICIES ACROSS EUROPE
“healthy ” life; the higher the DALY, the greater the burden. DALYs take into consideration the years of
life lost due to a) premature mortality and b) morbidity (that is, disability and ill health). Although lung
cancer has a significantly higher burden in Europe than colorectal cancer, breast cancer, pancreatic
cancer and prostate cancer, its burden has dropped more than the other four cancers over the last
couple of decades—partly owing to a fall in rates of smoking over the same period (Figure 2).^3Poverty and ignorance: twin drivers of lung cancer
Growing and aging populations, urbanisation and lifestyle changes have resulted in an increasing global
burden from cancers as a whole. And although socioeconomic status is linked to cancer generally, it
plays a particularly strong role in lung cancer.
Socioeconomic status is the social standing or class of an individual or group—often measured as
a combination of education, income and occupation. People with low socioeconomic status are more
likely to engage in unhealthy behaviours, such as smoking: in the UK, 23% of people in the lowest
income band smoke, versus 11% of those with incomes over £40,000.^4
This high incidence of unhealthy behaviours is often compounded by poor treatment. The UK’s
National Lung Cancer Audit documents significant inequalities in treatment due to regional variations
between England and Wales.^5 People with low socioeconomic status also on average have lower health
literacy (that is, the capacity to obtain, process, and understand basic health information and services
needed to make appropriate health decisions).^6 And low health literacy means that people are likely to
be particularly immune to public health messages and awareness campaigns. Indeed, the existence of
low health literacy is a challenge throughout Europe.^7 There is, therefore, a need for public health and
health promotion activities that target specific hard-to-reach populations.
The association between low socioeconomic status and lung cancer emerges clearly in national
statistics. In England and Scotland there is a nearly threefold greater incidence among the most
deprived versus the least deprived populations.8, 9 The Independent Cancer Task Force in England
concluded that if socioeconomically disadvantaged populations in the country had the same incidence
rates as the least deprived, there would be 11,700 fewer cases of lung cancer each year.^10 Similar
inequities have been documented in Norway and a number of other European countries.^11Lung cancer is responsible for 15% of all cancer costs in
Europe
Cancer is estimated to cost Europe about €126 billion (US$140 billion) per year—with €52 billion due to
lost productivity.^12 As advances in healthcare extend life expectancy and as populations grow and age,
this cost will continue to grow.^13 Lung cancer has a larger economic burden (calculated as the sum of
direct healthcare costs and indirect costs such as lost productivity) than breast, colorectal and prostate
cancer combined.^12 In 2009 lung cancer consumed 15% of overall cancer costs in Europe, at a price tag
of US$18.8 billion.^14
Although the cost of treating lung cancer comes with a hefty price tag, it is still arguably relatively
under-resourced. The proportion of government health expenditure allocated to each individual
cancer is not proportionate to its burden.^15 While on average approximately 5% of all health
expenditure is for cancer, there is a significant difference between what is spent on different types of