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The need to build on recent progressTo Mr Merino it is time for the region to
put “promotion even before prevention”.
Even though promotion and prevention are
commonly mentioned in cancer plans, there
are concerns that these are no more than
good intentions. To Dr Vargas “the results
of prevention can be seen ten years later.
It, therefore, has few political returns.” Such
efforts need to be supported with resources
as much as other more visible and immediate
cancer actions. According to Dr Sarria,
resources spent on cancer prevention are
about only 12% of Peru’s cancer budget. As
a striking example, Dr Ruales estimates that
the budget for promotion and prevention in
Ecuador equates to the cost of two to three
treatments with novel drugs obtained through
judicial processes.For Dr Sarria “changing behaviours is key.
Education is needed with all the relevant
stakeholders.” Uruguay is taking steps in this
direction, by introducing prevention as a
subject in medicine faculties, according to Dr
Ubillos. “This has been instituted as a policy of
the Ministry of Health, ” he adds.In order to assess progress in risk factor
control, the ICP examined key policies
addressing tobacco regulation, as well as the
promotion of healthy lifestyles and diets. All
countries address tobacco through a policy,
strategy or action plan. However, compliance
varies. All countries require warning labels
on tobacco packages, for instance. Brazil
has the highest score for tobacco control,
followed by Chile, Costa Rica and Ecuador.
Peru and Paraguay show gaps in areas such
as advertising bans. Brazil’s actions have
translated into results: “Between 2008 and
2013 the reduction [of smokers] was 20%. In2018 only 10% of the population 18 years and
older is addicted to smoking,” says Mr Medici.
In half of the 12 countries, cigarettes have
become more affordable from 2008 to 2016
(Argentina, Colombia, Panama, Paraguay, Peru
and Uruguay)—which weakens the ICP scores
for these countries in the tobacco control
category.Uruguay has become a world leader in
tobacco control policy. In 2006 it became
the first South American country to fully ban
smoking in public places.^50 More recently,
Uruguay has become the first Latin American
country to require plain packaging on tobacco
packs, in addition to enforcing a requirement
of “single presentation” (restricting selling of
only one variant per brand). Although the rate
of smoking and incidence in lung cancer is
still relatively high in Uruguay, these policies
resulted in a massive decline in smoking from
40% of adults in 2006 to 22% by 2017.^51Lastly, the ICP examined the establishment
of policies promoting healthy lifestyles,
healthy diets, physical activity and action
against alcohol use. Most countries have
made progress in this area. However, Bolivia
is still lacking a policy for healthy diet and
physical activity. According to experts,
creating this change of attitude will need more
than policymaking and a full cross-sectoral
commitment. Argentina is the only country
that lacks an operational policy, strategy
or action plan to reduce the harmful use of
alcohol. But positively, “more measures for
prevention are being considered, such as taxes
on sweetened drinks”, says Dr Ismael. “This will
involve multiple stakeholders, including the
industry. But the challenge is not only in the
legislative aspects but in creating awareness.”(^50) H Wipfli and JM Samet, “One Hundred Years in the Making: The Global Tobacco Epidemic”, Annual Review of Public Health, 2016.
(^51) The Union, “Uruguay becomes the first country to require plain packaging of tobacco products in Latin America”, 2018.