Action needed on NCDs – now

Much work needs to happen between now and the HLM in September. We’re attending the Multi-stakeholder Hearing in New York this week to engage Member States and share our priorities. Our advocacy will continue through our annual participation at the 78th WHO World Health Assembly this month, as we promote the benefits of cancer prevention policy.

We’ll participate in advocacy activities and side-events, promoting our HLM policy brief, which outlines our key messages. Civil society must continue its vital role in pushing for change and shaping an impactful Political Declaration.

We’ll collaborate with our longstanding partners such as NCD Alliance, UICC, World Obesity Federation and Movendi International to support the cancer and NCD prevention policy agenda. In the lead-up to the HLM in September, we’ll continue this series doing a deeper dive into each of these policy asks, and share our reflections as progress develops.

If you would be interested in supporting these advocacy asks, please reach out to policy@wcrf.org.

We’ve come across many examples of human rights being used to advance cancer prevention at the McCabe Centre – whether through public interest litigation by civil society in south Asia to introduce smoke-free public places, or through incorporating non-communicable disease (NCD) prevention and healthy diets into regional human rights strategies and reporting to UN human rights bodies in the Pacific.

We were therefore pleased to see World Cancer Research Fund International’s recently launched Policy Blueprint recognise the co-benefits of cancer prevention and the fulfilment of human rights.

This blog aims to explain what these co-benefits are, and how those working in cancer prevention can make the most of them.

Cancer prevention is part of our human rights

The International Covenant on Economic, Social and Cultural Rights establishes that people have a right, and countries have a duty, to prevention, treatment and control of disease as part of the right to health. The Committee on Economic, Social and Cultural Rights, which is established under the Covenant to assist in its interpretation, outlines that in order to protect, promote and fulfil the right to health, countries need to regulate health-harming products and make preventive health services and health information available, accessible, acceptable and good quality. The UN Special Rapporteur on the Right to Health, an independent expert on human rights whose mandate is established under the UN Human Rights Council, has endorsed a number of cancer prevention measures as a means of fulfilling this right, most specifically in relation to front-of-pack food labelling and promoting and supporting breastfeeding.

Likewise, the Committee on the Rights of the Child states that children’s right to health in the Convention on the Rights of the Child includes government obligations to address childhood obesity. This includes limiting children’s exposure to fast foods that are high in fat, sugar and salt or energy dense and nutrient poor, and regulating their marketing and availability in schools and other public places.

Grounding prevention policies in human rights

In many countries, human rights law can provide a valuable framing for engagement with ministries outside of health. In Argentina, civil society organisations successfully advocated for front-of-pack food labelling in parliament using a campaign strongly grounded in human rights. This included emphasising consumers’ right to information on whether foods had levels of sugar, fat and sodium that would harm health, and the right to healthier food environments as a component of the rights to food and health.

In Norway, the WHO’s guideline on policies to protect children from the harmful impact of food marketing, which is aligned with obligations under the Convention on the Rights of the Child, has been important to the Ministry of Health’s recent announcement of its plans to ban the marketing of junk foods to children.

The Committee on the Rights of the Child has raised concerns about commercial marketing in digital environments, including the profiling of children’s personal data for targeted marketing and the use of manipulative advertising techniques. The Committee has made recommendations that have been incorporated into UNICEF/WHO tools to support Member States to address the marketing of unhealthy foods to children. These connections between the marketing of unhealthy foods to children and a broader range of problematic digital commercial practices provide an opportunity to connect cancer prevention challenges to broader issues of online privacy, digital surveillance, and the rights of children in online spaces, and build alliances on these issues.

Cancer places an unequal burden on already marginalised or under-served communities, who are also more exposed to many cancer risk factors. A human rights approach, with its emphasis on ensuring that no one is left behind, and community participation and accountability, is a way of making sure that we have an equitable response that respects, protects and fulfils the rights of each individual to health. In her report on food, nutrition, and the right to health, the UN Special Rapporteur, Tlaleng Mofokeng, describes how disadvantaged groups are targeted in food marketing, and calls for more attention to be given to the relationship between NCDs, racial discrimination and gender.

Challenging the co-option of human rights by unhealthy industries

Despite human rights bodies’ recommendations to prevent cancer and regulate third parties’ impact on health, commercial interests such as the tobacco, alcohol or food industries are often more adept and better resourced at using this body of law than cancer prevention advocates. Unhealthy industries often invoke rights in litigation against public health laws, as part of a trend to launch legal challenges under trade, investment and constitutional law as a means of blocking public health policy. In Mexico, food companies launched a constitutional challenge to front-of-pack food labelling, arguing that it discriminated against food companies and restricted their right to trade.

Courts consistently reject these arguments, recognising that the rights of commercial actors must be balanced against other societal interests, including the rights of people to health, and that it does not enhance rights if we leave the marketing of harmful products by powerful commercial entities unchecked. The Supreme Court of Mexico upheld the front-of-pack labelling law, finding that the labels furthered the right to health and did not present a barrier to commerce. These challenges demonstrate the importance of proactively engaging with human rights and the law as part of a broader strategy on cancer prevention, so that lawyers representing commercial entities are less able to co-opt human rights to block public health policy.

A need for strategic alliances

Human rights are ultimately allies in implementing evidence-based laws to fulfil people’s right to health, with legal principles that emphasise equity, the right of consumers to be informed, and government obligations to regulate commercial actors that may harm human rights all fitting in well with public health objectives. Recalling these principles and building strategic alliances with human rights groups means we can better realise the potential of cancer prevention policies to promote and fulfil human rights for all.

The author would like to acknowledge Hayley Jones and Clare Slattery for comments on an earlier draft of this article.

In almost every region of the world, overweight and obesity among children and adolescents is a public health problem. There has been no progress in stemming the rate of overweight and obesity in children under 5 years in nearly 20 years, according to the World Health Organization (WHO).

This is a problem, because we know that when people live with overweight or obesity near the start of their lives, it often becomes a challenge throughout their adult lives.

What’s the problem with being inactive?

Young people may not be thinking very much about their risk of developing cancer. But the habits laid down in youth can last a lifetime. Our evidence shows that being active reduces the risk of colon (part of the bowel), post-menopausal breast and womb cancers.

Perhaps more importantly, being physically active also helps reduce our risk of living with overweight and obesity – a cause of at least 13 different types of cancer. Put simply, excess weight results from an imbalance between the energy we take in through our diet, and the energy we expend through being active (and other bodily functions). While we need to consider wider issues related to our ability to access a healthy diet, and managing stress and sleep levels, part of the solution involves being more active.

Are screens a particular problem?

Screens, and particularly mobile phones, have been blamed for a range of social and health problems among young people, including:

• short-sightedness
• mental ill health
• bullying
• poor sleep

Evidence from our 2018 Diet and Cancer Report revealed convincing evidence that more screen time for children (from mobile phones but also using computers at school and watching devices during leisure time) makes weight gain more likely, as well as overweight and obesity.

The reasons for this are mixed. We tend to watch screens while sitting down, which uses less energy. Watching screens can also encourage us to eat more than is needed, not least because of exposure to adverts for unhealthy food and drinks, which young people may be particularly susceptible to.

The WHO lists limiting screen time as one of the ways to prevent and manage overweight and obesity in young people – but it’s only one.

What are the barriers to getting more active?

Young people’s experiences differ but, looking at the evidence and talking to parents and teenagers in the UK, a few common problems are highlighted:

• Underfunded / poor-quality equipment in public spaces (that may also feel unsafe to use).
• Cost – young people often don’t have a steady income, and gyms/clubs/sports can be expensive. Young people need access to parks and sports fields in their neighbourhoods.
• Travel – young people are often dependent on others for travel, which makes active travel – including safe routes to walk or cycle to school – and good public transport infrastructure so important (see below).
• Lack of options – children and young people in the UK are often offered activities such as football, netball and cross-country, but many want to try out less conventional sports such as yoga, dodgeball or trampolining.
• Gender – there is a significant decline in young girls taking part in sport, and parents of girls highlighted particular barriers to participation around body image, concerns about sweating and clothing, and lack of private changing spaces.

Elsewhere, a 2022 study looking at Botswana, Ethiopia, South Africa and Zimbabwe identified barriers around funding, but also highlighted community safety and a general lack of infrastructure as challenges.

What solutions are working around the world?

When developing ideas and designing policies to tackle overweight and obesity among children and young people, one voice is often unheard – that of young people themselves. From 2018–23, World Cancer Research Fund was involved in an innovative EU-funded project called CO-CREATE, which aimed to change that by putting young people at the forefront of tackling the obesity epidemic in Europe. The youth representatives on the project came up with 4 demands to policymakers, including “Offer all children and adolescents free, organized physical activities at least once every week.”

Using what they learned as part of the CO-CREATE project, our Policy team have devised a policy factsheet on physical activity, outlining the best ways to meet our Cancer Prevention Recommendation to be physically active.

Of all the information in the factsheet, some policy recommendations would specifically benefit children and young people, if acted on by governments around the world. These include:

• Initiatives that optimise opportunities for physical activity (including walking and cycling to and from school).
• Active play before and after school, as well as during recess and lunch breaks.
• Reduce sitting during classes.
• Policies to priorities active urban design, like ensuring access to open/green space or walking and cycling infrastructure where people live.

To keep people informed about both the need to be active, and the opportunities available to them, we also recommend:

• High quality physical education in school curricula.
• Enhanced physical activity training for all teachers.

And some of these innovative policies are already being undertaken in parts of the world. There are many policies recorded in our MOVING database mandating physical activity in schools, broadly ranging from 2–4 hours per week, depending on age and country.

And it’s not just dedicated PE sessions. Italy’s Scuola attiva kids aims to promote a culture of wellbeing and movement among not only students but teachers and families as well. In Finland, the Students on the Move programme encourages young people to sit less and move between breaks. Belgium’s Adventurous Activity initiative offers young people the chance to try out high and low ropes, tree climbing, rowing, BMX, skiing and orienteering.

Yet parents we spoke to suggested that there also needs to be a reframing of how PE is seen in school. One parent in Surrey, UK, said: “If you’re really good, you tend to do loads as part of a club, but there seems to be very little for those who aren’t any good.”

“There’s different aspects of sports. There’s one where you’re trying to create lifelong fitness for young people to engage in sport as part of a healthy lifestyle. And there’s another part where you need competitive sport to provide appropriate challenge” – Jennifer Cole, teacher and parent of 3, Brunei

“Emphasise fun so everyone can join in. Let people compete and win something but focus on beating personal bests rather than being top of the class so it’s not exclusive. Why not offer points or vouchers for those who increase their steps the most, not the ones with the overall highest numbers, so you’re encouraging people who don’t do anything?” – Mike, parent of 3 including 2 teenage girls, UK

Active travel was another key concern for parents – and is also one of our policy recommendations, including:

• Transport policies, systems and infrastructure that prioritise walking, cycling and use of public transport.
• Road safety actions for pedestrians and cyclists.

Active travel, which has the additional benefit of helping countries meet climate commitments, is already being promoted in many European countries. Austria’s Kindergarten Mobility Box aims to make walking and cycling the norm from a young age, and Belgium has similar scheme.

Perhaps, rather than just focusing on crisis-driven solutions to an increasingly inactive world, we need to listen more to young people about the changes they want to see in their world, alongside implementing policies that make it easier for everyone – especially young people – to move more and sit less as part of their everyday lives.

National Cancer Control Plans (NCCPs) are overarching strategic frameworks developed by governments to establish priorities for cancer, including:

• Prevention
• Diagnosis
• Treatment
• Survivorship
• Palliative care

Crucially, their potential to drive meaningful improvements in cancer outcomes has been proven.

Prevention is a glaring omission

The International Cancer Control Partnership’s most recent global review of NCCPs found that only 30% of all cancer plans address prevention. This is a glaring omission, especially given that the cancer burden is already unsustainable – placing increasing pressure on over-stretched health systems and economies. Nearly half (40%) of all cancer cases are preventable by addressing modifiable risk factors including diet, weight, activity, alcohol, smoking and sun exposures, underscoring the fact that prevention is the sustainable way forward.

World Cancer Research Fund are on a mission to wave the flag for primary prevention. First off, Rachael Gormley, acting president of World Cancer Research Fund International, took part in a roundtable event about NCCPs at the recent World Economic Forum in Davos, Switzerland. Rachael took full advantage of this important platform to emphasise why prevention must be central to all cancer strategies.

We also welcomed the UK government’s call for evidence on the National Cancer Plan for England. Our primary goal is to ensure that the new plan places prevention and survivorship at its heart. We’ll be sharing our written submission in due course and look forward to collaborating with organisations across sectors to amplify our calls.

Plans can be force for positive change

The International Cancer Benchmarking Partnership has examined the relationship between cancer policies and survival rates. It found significant potential for NCCPs to improve cancer diagnosis, treatment, and outcomes when applied strategically and successively.

Countries that adopt this approach have experienced the greatest improvements in cancer survival. For example, Denmark, which implemented 4 consecutive plans between 2000 and 2020, has significantly improved the survival rates for multiple cancers, including an 19% increase in the 1-year survival rate for lung cancer over 15 years.

Prevention is crucial to the success of NCCPs as it offers the most effective and affordable long-term method of cancer control. Prevention policies range from interventions aimed at reducing risk factors, such as helping smokers quit, and policies to reduce overweight and obesity, to actions that tackle cancer-causing infections, such as human papilloma virus vaccination programmes.

While NCCPs are not a silver bullet, they present a unique opportunity to implement targeted, context-specific actions on a national scale. This is particularly important for prevention, where wide-ranging strategies can benefit from the streamlined and coordinated structure of NCCPs, which can set out a roadmap of action across the entire prevention continuum.

Bottom line is rising cancer burden

The growing global cancer burden is why NCCPs focused on prevention are needed.

The WHO estimates that nearly 1 in 6 deaths globally are caused by cancer each year, meaning that annually around 10 million people lose their lives to cancer. The latest statistics on global cancer rates also show that in 2022, there were 20 million new cancer diagnoses, and 53.5 million people living with or beyond cancer.

The enormity of these figures can make it difficult to remember that they represent real people who have had their lives turned upside down by cancer.

It isn’t only the human cost of cancer that is immense. The social and economic costs are also undeniable, making it particularly concerning that globally new cases are expected to skyrocket to 35 million annually by 2050. This increase will be felt most acutely in low- and middle-income countries, which are expected to experience a more rapid rise in cancer rates in the coming decades.

Fortunately, this worrying trajectory is not inevitable. A focus on cancer prevention in NCCPs would allow millions more people to live cancer free. It is also the most cost-effective way to tackle cancer and, crucially, reduces the need for expensive later stage treatments that are often inaccessible to many. In addition, it could lead to an array of co-benefits such as the prevention of other non-communicable diseases and a reduction in health inequalities.

While this shift to prevention requires systemic change coupled with sustained investment, the challenge is not insurmountable. Ultimately investment in prevention will have the highest pay off for governments and the good news is that we already know the integrated policy approach needed to make this a reality.

NCCPs are a meaningful tool to prevent cancer and improve survivorship, support health systems, and promote economic growth. We will continue making the case for prevention to ensure that NCCPs fulfil their potential to reduce the cancer burden. Alongside working to ensure the National Cancer Plan for England prioritises prevention, we will be calling for all countries to develop NCCPs that include meaningful prevention measures at the UN High-Level Meeting on non-communicable diseases in September.

The International Agency for Research on Cancer estimates that, by 2050, the world will see 35 million new cancer cases each year, up by 15 million annual cases in 2022. Yet with the right policies to prevent cancer, 14 million of those people could avoid their diagnosis. These policies would need to address a variety of factors, including tobacco, alcohol, overweight and obesity, breastfeeding and unhealthy diet.

Cancer places increasing burden on society

As the cancer burden increases, the strain on our health systems, economies and families becomes harder to meet. Unhealthy weight – just one risk factor – is projected to cost the global economy more than $4 trillion a year by 2035. Our food systems make eating a healthier diet harder. High production and consumption of red and processed meat, and low consumption of wholegrains, vegetables, fruit and beans, plays a role in increased cancer risk and the risk of other diseases such as diabetes. This misalignment also contributes to unhealthy natural environments, as diet-related greenhouse gas emissions are significant contributors to global warming. Most of these are related to production of animal-based foods. This is why prevention is the only sustainable way forward – with resilient populations and food systems working together for public health.

Prevention the sustainable way forward

We believe that prevention must be prioritised and is the only sustainable way forward. We also need to better explain:

1. The science around cancer risk and diets, weight, breastfeeding, physical activity, and alcohol – as summarised in our Cancer Prevention Recommendations.
2. Which policies should be prioritised to shape healthier environments that minimise these cancer risks for populations.
3. How cancer prevention policy can have positive cascading effects for our health, but also for our health systems, our societies and our shared natural environment.

Cancer prevention policies can have ripple effect

We also know that cancer prevention policies can touch on and improve other areas beyond health. For example, diets high in red and processed meat increase people’s risk of colorectal cancer, and that healthier diets made up of more wholegrains, fruit and vegetables can protect people from the same type of cancer. This is why our Cancer Prevention Recommendations say people should limit red and processed meat, and eat a diet rich in wholegrains, vegetables, fruit and beansAt the same time, if our food systems produced less red and processed meat, and animal- food in general, and instead moved towards producing plant-based foods, this would have a significant impact in lowering diet-related CO2 emissions. Policymakers need to make sense of these connections, and our guidance shows what they need to do to promote such positive cycles – or co-benefits.

Why we created the Blueprint

Our well-established Cancer Prevention Recommendations cover 10 ways in which individuals can minimise their risk of preventable cancers. A growing body of evidence is showing that adherence to these Recommendations is associated with lower risk of developing cancer and other NCDs, but also lower risk of dying from cancer.

However, the Recommendations have not – until now – been presented alongside population-level policy advice. We need to promote an integrated approach to preventing cancer, otherwise policymakers may risk formulating repetitive but disconnected policy strategies across these areas that do not speak to or build on each other. For example, marketing restrictions can be a useful tool to encourage healthy diets but are also relevant for promoting breastfeeding and limiting alcohol consumption. Even though the targeted products are different, there are lessons to be learned from policy efforts across different cancer risk factors.

By joining the dots in these different areas, we can create greater awareness of how different policy approaches can contribute to cancer prevention. Our new blueprint makes a compelling case for action, especially for prevention to be included in national cancer plans. The blueprint also reinforces the need for a whole-of-government approach that puts public health goals before commercial interests.

What’s inside the Blueprint?

The Blueprint is accompanied by factsheets on specific cancer risk factors.

Our policy blueprint makes the case for population-level policy action and focuses on 5 factors: diet, weight, breastfeeding, physical activity and alcohol – in line with our Cancer Prevention Recommendations. We also look at how these factors can support people living with and beyond cancer

Our blueprint is an essential, evidence-based guide for policymakers and advocates, pulling together tools and resources to provide a comprehensive resource on cancer prevention. It pulls together existing tools and resources to support efforts on cancer prevention, including key guidance for World Health Organization, but also our existing NOURISHING nutrition and MOVING physical activity policy frameworks. All this information is distilled in a package of resources:

• An outline of 8 policy areas – including marketing restrictions, fiscal and legal, procurement, planning and incentives in communities– and how they apply to diet, weight, breastfeeding and physical activity.
• 10 factsheets with in-depth technical detail on how to roll out each Recommendation at population level.
• An exploration of the co-benefits of cancer prevention policy: addressing health inequities; meeting climate and sustainability targets; addressing commercial determinants of health; and fulfilling human rights.
• 7 strategies to help policymakers take action.

The goal of these resources is to strengthen understanding of how environment shapes cancer risk, and what policymakers can do about it.

How it was developed

To develop these resources, we built on our policy work, we reviewed existing key policy documents, and asked experts in the science and policy of cancer prevention, as well as lawyers, advocates for non-communicable disease prevention or breastfeeding what is most important in their respective areas. We then brought all the main elements together.

What’s next?

The Policy blueprint for cancer prevention will now be a centrepiece of our conversations with policymakers going forward – from Member States at the World Health Organization to the UN High-Level Meeting on Non-communicable diseases.

We invite you all to get involved: download the blueprint, share it, and use it in your work.

> Download it now

> Download our factsheets and other policy tools in our resource library

> To give us feedback and share how you want to use the blueprint, write to policy@wcrf.org

Upon entering the conference, I was greeted by a large amount of media and cameras, although, thankfully, none were for me! The conference was much bigger than I had anticipated and unlike anything I had attended in the past – I’ve presented at conferences such as the European Congress on Obesity and the Health Enhancing Physical Activity conference.

There were different halls and arenas where exhibitions, meetings and fringe events were held. The National Farmers’ Union of England and Wales had a large tractor in the exhibition hall, and another organisation had a double decker bus. There was a great atmosphere with each exhibitor eager to share their priorities for the new government.

In the evening, we attended a talk by The Vegan Society, with strong debates on what constitutes a healthy and sustainable diet. We met our first MP, Dr Simon Opher, and gave him our Policy priorities to prevent cancer.

The costs of prevention

Bright and early on Monday morning, I headed back to the conference arena in anticipation of a busy day ahead and had a 45-minute wait in the rain to clear security.

First on our agenda were sessions hosted by IPPR (Institute for Public Policy Research) and the Health Foundation on the government’s plans for health and care with Wes Streeting, Secretary of State for Health and Social Care. Due to the delay in getting into the conference hall, I headed to this event 45 minutes early, which was a blessing. Shortly after I arrived, all seats were taken, meaning many people had to stand at the back, with most spectators standing outside with the hope of listening to the event.

Wes Streeting at the Labour Party Conference 2024

One key message from Streeting’s talk was the economic cost of ill health, particularly unemployment due to ill health, with the government needing to take a whole of society approach to tackle this.

How can we improve health?

The next event was hosted by Nesta, a UK innovation agency for social good, on: Shift to prevention and solutions to improve health. A key message for me was the need for political bravery. Nesta presented a range of policy innovations which, it estimated, could reduce obesity by 23% through creating targets for retailers. But that would require taming industry! Is there enough political will?

Governments know what they should be doing but, often, it’s not the most favourable option due to a whole host of reasons – including financial cost. We need a “health in all policies” approach if we’re going to truly tackle the economic aspects of ill health.

The evening ended on a high when Kate and I attended a reception hosted by the Children’s Charities Coalition with speakers including Andrew Gwynne MP, Parliamentary Under-Secretary of State at the Department of Health and Social Care, and Janet Daby MP, Minister for Children and Families. Once the speeches ended, Kate and I headed in Gwynne’s direction with the hope of giving him our Policy priorities to prevent cancer, as his ministerial portfolio covers many of the policy areas we work under such as obesity, alcohol and physical activity. The stars aligned and we were able to talk to Gwynne and share our briefing. He agreed to meet us after the conference back in London.

Andrew Gwynne MP and Kate Oldridge-Turner

Closing remarks

The final day saw less rain and Keir Starmer, the UK Prime Minister, deliver his speech.

The final fringe event I attended was hosted by the Recipe for Change Campaign and Diabetes UK on how Labour can achieve its ambition to raise the healthiest generation of children. The main takeaway was ensuring prevention is embedded into all aspects of policy outside of health, so, including prevention in housing and children services, for example.

Overall, the conference was very eye-opening and certainly a great way to make connections with key organisations and people. I believe it’s been a worthwhile visit and helped to raise the profile of World Cancer Research Fund and the work we do to prevent cancer. And it was great to hear about the new government’s commitment to prevention. However, we will have to work together to ensure the words turn into action!

> Read our Policy priorities to prevent cancer