Africa: Smoking Threatens Africa With Cancer Epidemic

Mauritius leads Africa in carrying graphic notices on cigarette packs, warning for example of the dangers smoking holds for children.
2 September 2009
interview

Tobacco use in Africa is growing faster than in other continents, says Dr. John Seffrin, who has been on the frontlines in the war against cancer for several years and now serves as the chief executive officer of the American Cancer Society. Taking part in the recent LIVESTRONG Global Cancer Summit in Dublin, Ireland, he hailed the global unity shown in reducing the stigma of cancer and working harder at prevention, early diagnosis and treatment. He spoke with allAfrica.com.

How did the cancer summit come about?

Lance Armstrong [the American professional road racing cyclist who has survived cancer] and the Lance Armstrong Foundation decided that it was important to have not just another meeting on cancer, but a special summit that would bring together people from all over the world and a diverse group of people that would include scientists, public health professionals, survivors and advocates. The foundation raised money and worked with other organizations like the American Cancer Society to put this summit on. It was a smashing success and we hope it will be a launch pad for people to work better together to solve the cancer problem.

What were some of the summit's achievements?

There were a number of achievements. First of all there's no question there was a lot of dialogue about the importance of de-stigmatizing cancer. It's stigmatized in different ways in different parts of the world. In many places there's a stigma that it's always a fatal disease.

The hopeful side of cancer has never been more hopeful. We were able to document that here [at the summit] and these activists will be able to communicate that within their organizations and in their communities and in their nations. Sixty-four countries were represented from every continent.

The second positive thing was that there was unity and a declaration to work together and to do certain specific things, like to develop a national cancer plan in every nation and to collaborate with one another and to emphasize the importance of how to prevent the disease.

There are a number of things that I think were accomplished here that have not been accomplished in other meetings that have been held around the world on cancer over the past number of years.

Have you set a date or a goal for when countries should come up with their national cancer plans?

We did not put a date on it because we felt that would be too stringent in the sense that some countries may be able to do it this very year, others may take three years. But the key was that it's a starting point.

Each country needs to develop a cancer plan. We have shown, very substantially in various parts of the world, that if you develop a plan and if you work your plan it can make a difference.

How might developing countries need to craft their plans to fit in specifically with their challenges, which are so great when it comes to dealing with cancer?

In developing countries the first thing is for the policymakers and the citizens to appreciate that even if they're fighting other communicable diseases - HIV/Aids, and tuberculosis and malaria - cancer is a growing public health problem. Cancer will become the number one cause of death in the world next year. They first need to recognize that they have a problem because they may be so busy working on these other problems that they don't realize that the cancer problem is getting worse.

Because they are low-resourced countries, they need to look at the most effective things that they can afford to do. Cancer prevention is often very affordable. The best way to save a life from cancer is to not get it in the first place. So doing certain things like implementing the Framework Convention on Tobacco Control, the protocols show that if you raise the tax on tobacco, fewer people smoke, especially children.

Those are things that don't cost the government but actually increase revenue for the government. So for developing countries it's important for them to know what policies they can put in place that are a win-win - it helps solve the problem but it also helps the public coffers.

How does Africa fit in when it comes to global tobacco use?

Africa has relatively low tobacco use prevalence rates. But it has the fastest increasing prevalence rates. They're low compared to China, where 60 percent of the men smoke, but they're going up faster than anywhere in the world. We at the American Cancer Society are committed to doing tobacco control in Africa because here's a chance to prevent an epidemic of disease that otherwise will happen.

The tobacco industry is rapaciously promoting its product in all areas of the world where prevalence rates are low. So we're targeting Africa and we need to get on the ground with prevention programs before it's too late. It's a lot easier to prevent people from starting ever to smoke than it is to get them to quit because it's so addictive. Here's an opportunity to get dramatic results and that is to prevent what has become the single largest cause of preventable death in the world: addiction to tobacco.

How might you go about doing that in Africa?

The number one thing that can be done in any part of Africa is to change current public policies. If every country in Africa would implement the protocols of the Framework Convention on Tobacco Control they could get dramatic results.

What can be done, irrespective of the infrastructure [challenges], is they can insist on smoke-free areas, where no one has to be exposed to second-hand smoke, where they work and in public places. Number two - a ban on advertizing, especially to children. Number three - raising the tax on tobacco products so they are less affordable. This intervention is particularly good at keeping children from getting addicted.

These are things that can be done irrespective of economic development.

It doesn't take a million dollars to implement these [policies]. It takes the courage to change existing practices and existing policies.

What kind of role have the foundations of Lance Armstrong, New York Mayor Michael Bloomberg and Bill and Melinda Gates played in fighting cancer in the developing world?

Extraordinary. The Bloomberg Initiative, and now the Gates Initiative and the Lance Armstrong Initiative are going to save a lot of lives. We at the American Cancer Society did a study a number of years ago and pointed out that, taking out North America and Australia, less than 100 million dollars was being spent on all of the efforts for tobacco control in the entire world. Based on the size of the problem it is no investment whatsoever.

For the first time now we have high visibility, which Lance Armstrong brings to the issue. He's the first world champion to come out of retirement and return to competitive sport not for profit but for a cause. He shows that the hopeful side of cancer has never been more hopeful. He brings visibility to the problem and shows that you can survive the disease.

The investment of the Gates Foundation and the Bloomberg Foundation will allow us then to develop capacity on the ground in continents like Africa. We've proven in other parts of the world that if you get activists involved at the ground level you can change public policy and you can change human behavior. It will save a lot of lives and prevent a huge amount of suffering.

Remember, in the world, tobacco is the leading cause of preventable illness and premature death and that has a huge economic burden, not to mention what it means in terms of individual and family suffering.

What comes next, after the summit?

There were 500 delegates from 64 countries and what comes next I believe is for people who were here to collaborate better together, to join hands. What comes next is the beginning of a movement that coalesces people, gets people together to develop a kind of solidarity. We all have other things to do back home but we're all going to join together, put this on the list and make something happen.

Cancer has become potentially the most preventable and most curable of the major life-threatening diseases facing humans around the world. What we want to do is change that potentiality into a reality for all people.

It's a very important point because many people think cancer is a death sentence but it doesn't have to be. But we do have to take action or it can be a death sentence.

The next thing is to move forward from this summit saying we're going to have a broader base of activity and we're going to try to attack this problem in every major region in the world. We need to do that because the cancer death rates are increasing in every major region. That's not well known because there's so much publicity about other important diseases, like HIV/Aids, tuberculosis and malaria. They're all on the G8 health agenda, they're all part of the Millennium Development Goals of the World Health Organization, but cancer is not on the agenda. Cancer this year will kill more people in the world than all three of those diseases combined.

Cancer hasn't been given the attention that it needs and certainly deserves to have because it's no longer hopeless. In America alone we've shown that we've saved 650,000 lives since 1991.

Is that through a combination of prevention and medical care?

Yes. We've proven that the cancer death rates in 1991 in America started to go down and they've gone down every year since then and they're going down faster. So we're saving 273 more lives per day than we were in 1991. That's partly because we're preventing a lot of it because the tobacco use rates are going down, particularly among men, but it's also because of improved therapy. We have better and more targeted therapies to treat cancer. It's also happening because we're detecting more cancers early when they're less likely to be lethal and you're more likely to have an effective cure.

Are there plans for another summit?

I'll be very surprised if there isn't another one but I don't think a decision has been made on when or where that will be.

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