National Model of Cancer Prevention; NACC, 2001

National Model of Cancer Prevention

Conception

Actual Social Problem!

Cancer occurance in Georgia exceeds 30000, incidence is more than 7000 and mortality - more than 5500.
It should be mentioned that person gets cancer in the optimal age (45-65 years) of professional and personal development, when one's activity brings the maximal benefit. That's way the cancer significantly hazards the world economically and obstacles the rhythm of its development.
It's been a long time, that the problem of cancer finally passed the borders of health care and acquired the significance of world's global social importance. This is the reason, that at the present time cancer control activity already represents the prioritized direction of social field.

Carcinogenic Agents Exposure

Cummulative Risk for each person to get cancer straightly correlates with level of one's occupation, living and resting place environment pollution by carcinogenic agents.
As it known, carcinogenic agents are divided in 3 groups:

Physical carcinogenic agents (ionizing radiation, sun ultraviolet rays, electric- magnetic fields);

Chemical carcinogenic agents (anthropogenic chemical substances);

Biological carcinogenic agents (viruses and bacteria).
Carcinogenic agents exposure on population is possible due to following ways:

Air (occupational place, out door, building);

Drinking and irrigating water;

Atmospheric precipitations (direct exposure of radioactive rains, pollution of soil and consequently agricultural products by radioactive and chemical carcinogenic agents, and etc.);

Meals and non-alcoholic drinks;

Widely used everyday products (chewing gums, soap, detergents, medications, perfumery and etc.).
Carcinogenic agent's exposure on population could be realized by the following ways, concerned with life style:

Active and passive (environmental) tobacco smoking;

Alcoholic drinks;

Drug addiction;

Non-controlled sexual life;

Natural and artificial tan;

Other individual hygienic features concerned with social-economic conditions.

Cancer Primary Prevention

Avoidance of carcinogenic agents exposure, concerned with life style and consequently, the reduction of cancer risk is possible due to healthy life style.
As it known, 70% of cancer incidence and mortality could be avoided by healthy life style.
At the same time, Georgian population is at least inadequately informed concerning the carcinogenic agent's exposure and possibilities to reduce the cancer risk due to healthy life style and adoption of health habits.
In order of population sanitary education, NACC started the edition of package of recommendations: How Can You Prevent Cancer.
Sanitary education is generally stressed on raise of oncological vigilance and knowledge of oncology, population support to pay attention on their health status, their assurance in necessity and effectiveness of periodical preventive examinations.
The lack of appropriate legislative basis, which can ensure the law- based conduction of population social defense, is also very important issue. The necessity of adoption of Bills, amendments and new laws in Georgian legislation in the aim of population social defense is well argumented and highly motivated. This will promote the protection of population from carcinogenic agent's exposure, support to maintain their health status and/or make them healthier, consequently increase the mean life time and faster the country social -economical development.

Main Idea of Conception

Numerous cancer etiologic factors are already identified at the present time and cancer primary prevention is possible due to avoiding their exposure on humans.
Intellectual potential in Georgia is necessary enough to dissolve mentioned problems. Also it should be taken in to account that the significant fall of cancer incidence and it's mortality will be possible only 30-50 years after the starting the action of newly adopted appropriate laws and amendments. Consequently, if not carry out the management of activities toward this direction right now, country will be unable to avoid the significant loss of population and huge economic damage in the first half of XXI-Th century, because of wasted time. Unfortunately, only the issues, concerning the chances of extenuation of population loss and economic damage could be discussed at the present time. Those chances improvement will be possible only due to emergent and active joint intersectional co-operation.
The main point of National Model of Cancer Prevention consists the avoidance of exposure of all already identified cancer etiologic factors due to all available at the presents time measures, or at least their reglamentation by adoption of legislation basis with conductive intersectional economic mechanisms. Effective conduction of carcinogenic agent's exposure reglamentation could be ensured by economic management (adoption of fines and taxes on cancer risk).
Due to adoption of Cancer Control legislation, and consequently by the acceptance of fines and taxes on cancer risk, population social defense in oncological sphere will be possible, particularly,

Diseases primary prevention, and cancer among of them, will be treated in rank of State Strategic Policy;

Due to conduction of complex measures, cancer primary prevention will be performed by reglamentation of carcinogenic agents exposure;

Taxes and fines on cancer risk will become the extra profit source of state and received funds will be directed for realization of secondary preventive programs (main localization cancer screening programs);

Due to development of cancer primary and secondary prevention directions, the cancer incidence and mortality rates will significantly fall, population life time indicators will raise and their social defense will be ensured. State Policy and Legislation
Process of starting of primary prevention will be started by dissolving the following tasks:

Diseases primary prevention should be treated in rank of State Strategic Policy and health promotion and diseases prevention should be declared as prioritized direction of health care system;

It's necessary to conduct activities aimed at creating of favorable environment for security, which means the protection of environment (Eco-systems of Georgia and borderline regions, atmospheric and working place air, soul, water, Black Sea, flora, dietary products and etc.) from pollution by chemical, radioactive and biologic (viruses, bacteria and etc) carcinogenic agents; Due to this, the limitation of carcinogenic agents exposure, health promotion and cancer prevention will be reached and consequently, the mean life time will be raised, giving high economic effect,

Popularization of healthy life style to public at large,

Adoption of legislative projects by parliament which will prohibit:

1. Tobacco smoking at state and non-state organizations and places of public meeting;

2. Advertisement of tobacco products (as one of the type of health hazardous narcotic means) and strong alcoholic drinks;

3. Advertisement of non-alcoholic drinks and other dietary products without the testing on carcinogenic agents and appropriate certification;

4. Manufacture, export and import of dietary products, non-alcoholic and alcoholic drinks and other consuming products without obligating testing on carcinogenic agents and certification.

Ways of Cancer Prevention

Popularization and implementation of healthy life style in population, improvement of living standard levels;

Improvement of population hygienic education, management of activities for population information concerning the oncological vigilance, raise their knowledge of oncology, population support to pay attention on their health status, their assurance in necessity and effectiveness of periodical preventive examinations, population supporting measures for their active participation in state conducted monitoring control of sanitary-hygienic standards;

Complex activity against tobacco smoking and it's exposure on population (especially adults and children);

Acceptance of state sanitary-hygienic standards on nicotine and tar concentration in tobacco, followed by observing control;

Establishment of obligating testing control of exported and imported dietary products, non-alcoholic and alcoholic drinks and other consuming products on carcinogenic agents (control of concentrations and admitted border doses for each carcinogenic agent), definition of ways for industrial licensing and

product's certification, implementation of taxes on product's cancer risk testing, adoption of fines on violation of state sanitary-hygienic standards;

Tobacco products and strong alcoholic drinks(as one of the health-hazardous narcotic means) advertisement prohibition;

Prohibition of advertisement of non-alcoholic drinks and other dietary products without the testing on carcinogenic agents and appropriate certification;

Creation of insurance system on cancer secondary prevention. Population generally should cover expenses for such type of insurance. Industry owners and managers should pay expenses for occupational risk workers preventive examinations. Expenses for socially undefended population should be covered due to special program of Health Care and Social Affairs Ministry.

Ways of Occupation Cancer Prevention

Acceptance of working place air hygienic standards in order to defend the staff members from professional cancer development;

Manufacture owners and managers should be obligated to ensure sanitary -hygienic security and promote the industry (factory, enterprise and etc) technological improvement, which will be directed to maintain working place hygienic standards. Due to this, it will be possible to reduce or maximally minimize the exposition of health-hazardous toxic substances (carcinogenic among of them), contained in industrial air and dust (carcinogenic loading);

Implementation of working place air hygienic standards monitorial control;

Acceptance of fines in case of working place air hygienic standards violation;

Acceptance of hygienic guides (admitted border doses and concentrations on each carcinogenic agent) followed by establishment of appropriate fines and monitorial control, which aims the defense of industrial place's and surrounding territory's Eco-systems (atmospheric and working place air, soul, water, flora, and etc.) from pollution by carcinogenic agents and toxic industrial products;

Obligating insurance system should be accepted for professional diseases and cancer secondary prevention (professional cancer screening) for staff members, working at high professional cancer risk industries. Standards of preventive measures should be adopted for each such professional field. Targeted expenses needed for periodical preventive measures (according to risk level-once in 6 month, 1,2 or 3 year) should be accounted to salary fund and paid by industry owners and managers to insurance companies according to contract conditions.

Preparation of Legislative Project
Realization Intersectional Mechanisms

Considering the fact that mentioned problems are concerned with multiple spheres and sections, work out of real conductive intersectional mechanisms, also communication and explanation of decisions to public at large, is very essential;

For preparation of amendments and changes is Georgian social, health-care, agriculture, environmental, industrial, trading, and advertising, custom-taxing systems legislation, representatives of different fields (volunteer expert-professionals) will be invited for co-operation from country and abroad as well;

Appropriate legislative guides, standards, amendments, laws and other useful information from different leader countries (USA, Canada, UK, Germany, France, Italy, Japan and etc) will be gathered by Internet;

Leader international organizations will be offered to participate as observers in process of creation of National Cancer Control Model:

Prepared legislative packages with conductive intersectional mechanisms will be discussed in all committees and commissions of parliament (legislative, health-care, social affairs, agricultural, environmental, financial-economical, custom-taxes, industrial, trading-and advertising and etc);

Along with population sanitary education, information about association activity concerning the preparation and development of Cancer Control legislation will be distributed via the Internet, TV, radio, news-papers;

TV mediated population interactive interrogation will be conducted concerning the issues of Cancer Control legislation, followed by analyses of received results and chousing of appropriate optimal time for lobbying process in parliament, taking in to account the formed social opinion;

After the adoption of legislative acts on Cancer Control by parliament, periodical sociologic interactive interrogation of population will be conducted to evaluate the effectiveness of execution of intersectional mechanisms.