I have a role with Cancer Research UK as their cancer prevention champion. Most of my own studies are trials or observational studies of smoking cessation interventions or population level interventions to reduce tobacco use. I also do work on alcohol policy so it’s trying to look at studying often natural experiments where we have policy changes to see what happens in practice. Those are the types of studies I still do.
Could you talk to us about cancer prevention?
When we talk about cancer prevention often clinicians and others think about how they can intervene with individuals for primary prevention which might be around addressing health behaviours, things like diet, physical activity, weight, alcohol or tobacco. Those are all important things to do, brief advice, treatment, but actually, what we know from decades of evidence is that the biggest impact is when you change things at the population level so you change policies or environments that make it easier for people to make healthy choices. And that’s what we discussed in today’s symposium - population level interventions to reduce cancer.
How can you combat the lack of attention and awareness to cancer prevention?
The research funding, for example, for prevention is tiny compared to the funding on treatment optimisation and new drugs, so that’s a big challenge. The other thing is that we kind of accept in Western societies, in particular, that people make their own choices and therefore recommending things like policy change can be controversial. I think one of the challenges with prevention is clinicians, professionals, others, they don’t necessarily know what to do and they think that it’s not their role to be advocates for that type of change. They would rather focus, for example, on the individual patient. But certainly, in my experience, if we want to reduce preventable cancers we actually need more of us in the community to be advocates for that kind of change. I think conveying the evidence about what works at the population level helps people to understand why that type of change is important.
Could you talk to us about the role of third sector when it comes to prevention?
I think charities and other NGOs are really important, particularly if they’re not reliant on government for funding. What they can do is they can commission studies or they can look at the evidence, they can communicate clearly what they think works or doesn’t based on the evidence that we have and then they are able to be a voice, not necessarily alone but with other partners to advocate for policy change. So they can push government to make tricky decisions.
The other thing they can do, of course, is they can work with the public so they can change public opinion by identifying what the public don’t know or what they might want information about. Just to give you an example, we found in two recent surveys we did that people who were more aware of the links between obesity and cancer and alcohol and cancer were more likely to be supportive of policy changes to reduce harmful alcohol consumption or to support people to maintain a healthy weight. That’s an important finding and I think what it means is that we actually need to increase people’s understanding of these preventable cancer risks before we can make the case for some of the policy changes that we need.
Could you discuss your talk at NCRI?
Essentially we talked about what I describe as the four Ps so that’s product, place, price and promotion. I think if we want to reduce alcohol consumption or we want obesity rates to be lowered because they are so high, not just in the UK but in many countries, then the things that we need to change in our environment are things like the price of products, things that are reasonably cheap or very cheap, easily affordable and not necessarily the right things for people to consume. We need to address things like marketing, that’s the promotion of these products, particularly to children, because we know that really affects consumption of things like foods that are high salt and sugar and fat. For alcohol, for example, we might want to look at the place of sale or the times of sale so that’s the P in place.
Also the product themselves, so we know that we can have reformulation of some foods to make them healthier and that involves working with industry or for alcohol, for example, we could be trying to have price measures that would actually make the products that are lower alcohol more attractive to consumers. So, those are the four Ps, those are things we can change in the environment. I think communicating that clearly and giving people the evidence to understand why those types of changes are important alongside treatment or support for individuals is quite c
