Elsevier

European Journal of Cancer

Volume 46, Issue 14, September 2010, Pages 2525-2533
European Journal of Cancer

The effects of the financial crisis on primary prevention of cancer

https://doi.org/10.1016/j.ejca.2010.07.048Get rights and content

Abstract

The present financial crisis will affect primary cancer prevention through several avenues: personal lifestyle choices, exposure to environmental risk factors, decisions made in the private sector and public policy on cancer prevention. Whilst it is clearly problematic to reach solid conclusions on a direct connection between economic crises and cancer mortality, we can identify trends that provide guidance for further action. For some lifestyle choices such as smoking or diet, we argue that public policy may channel existing tendencies during times of crisis for clear added value. In other areas, including research and health system investments, we will make the case that the resources not used now for cancer prevention efforts will lead to increased costs (both financial and human) down the road. Policy makers face a clear choice: they can follow a cost contention strategy, which may reduce expenditure in the short-term only to increase it in the long-term, or they can use the financial crisis as an opportunity to make difficult choices in terms of health service rationalisation, whilst at the same time strengthening evidence-based prevention policies. In short, we argue that despite the scarcity of funds and the governmental priorities on economic recovery, cancer prevention is more relevant now than ever.

Introduction

Enduring political, economical and social changes will doubtless arise from the worldwide financial crisis that erupted in 2008. In all arenas, including the field of public health and cancer prevention, individual and policy decisions can be characterised by a damage control mentality or, alternatively, as an opportunity to correct mistakes and build a more solid foundation for the future. In this paper, we will briefly review the existing literature for clues on how the present crisis will affect cancer prevention with regard to personal lifestyle choices, exposure to environmental risk factors, decisions made in the private sector and public policy.

There are inherent difficulties in this type of analysis. First of all, it is clearly problematic to reach solid conclusions on the connection between economic crises and cancer mortality given the amount of time needed to account for the required induction period and the complexities involved in establishing causal links. Whilst much has been written on the causal mechanisms between unemployment and overall mortality (see Box 1), most of these studies have taken place in the United States (US) (with different social protection schemes) and have usually found clearer (and cyclical) links in the short-term. Because cancer can take decades to develop, different study models may be required to explore potential correlations. The heterogeneous array of pathologies encompassed under the umbrella term ‘cancer’ also poses challenges because recession can affect different cancers through different pathways. Finally, the financial crisis is affecting countries very differently; in Europe, the Netherlands and Norway have maintained stable unemployment rates near or below 4% whilst Spain, Ireland and Latvia have seen significant decreases in their working population (Fig. 1).

Causal links between mortality and financial crisis.

The causal mechanisms between financial crisis and mortality are multi-faceted, potentially influenced by multiple factors:

  • the strength of the social safety net,1 generally robust in European countries

  • demographics, with specific groups (socially disadvantaged, the young2) being harder hit by crises

  • liberalisation of employment laws, with subsequent decreases in the number of permanent contracts and job security in general

Regions such as the former Soviet states reacted to economic troubles with dramatic reductions in life expectancy. However, recent evidence points out that wealthy countries experience short-term improvements3, 4, 5, 6, 7 owing to less exposure to occupational risks and traffic accidents, as well as decreased opportunity cost of healthy leisure time activities.8 These findings overturn those of past studies,9, 10 which reached different conclusions by using simpler time series models.

In this article, we examine specific elements in isolation (for example, tobacco smoking or public investment in research) in order to identify general trends that provide policy makers with guidance for further action (Table 1). In some cases, such as for some lifestyle choices, we find that public policy may channel existing tendencies for clear added value. In others, including research and health system investments, we make the case that the resources not used now will lead to increased costs (both financial and human) down the road. In all cases, we argue that despite the scarcity of funds and the governmental priorities on economic recovery, cancer prevention is more relevant now than ever.

Section snippets

Lifestyle risk factors during an economic downturn: never let a crisis go to waste

Cancer prevention research estimates that approximately a third of all cancers can be avoided, most of these by modifications in lifestyle choices. A well established body of evidence points to smoking and excessive alcohol intake as serious risk factors for cancer, whilst growing evidence suggests that poor diet, physical inactivity and obesity also play a major role in the development of malignant neoplasia.1

Any lifestyle modification requires a great effort on the part of individuals, but a

Environmental risk factors

Different factors play a role in human exposure to environmental carcinogens. Some depend on the health of the environment as a whole (i.e. the state of the ozone layer), whilst others change according to highly specific industries and activities. In turn, human efforts that reduce exposure to contaminants can be intentional (i.e. environmental or labour protection laws) or not (i.e. fluctuating levels of industrial production). In this section we will examine how the current financial crisis

Concerns in the private sector

Does financial crisis threaten efficient and sufficient allocation of private funds for preventing cancer? In this section we specifically consider pharmaceutical research programmes for cancer prevention and behavioural changes related to private insurance.

Public policy for cancer prevention

As European cancer control strategies become increasingly integrated and interdependent, the boundaries separating primary prevention, secondary prevention and treatment (or tertiary prevention) are blurring. Innovative health technology and changing carcinogenesis factors in the community also play a role; the identification of the BCRA gene can lead to the option of a preventive mastectomy, whilst individualised cancer vaccines (Oncophage) are formulated from patients’ tumours and used as

Conclusions and recommendations

Cancer prevention—like cancer itself—encompasses a great number of diverse factors, including lifestyle choices, genetics, environment, occupation, infections and access to preventive healthcare. It is no surprise, then, that cancer control efforts can overlap with everything from the control of hypertension to the reduction of greenhouse gases. Indeed, the depth and breadth of these concerns almost make it a valid proxy to judge the overall investment that individuals, public institutions and

Conflict of interest statement

None declared.

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