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Persian Gulf states outline regional approach to tackle cancer
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Persian Gulf states outline regional approach to tackle cancer
For more on the GCC meetings see http://www.who.int/ mediacentre/news/ statements/2012/ ncds_20120106/en/index.html
For the UN Declaration on Non-communicable Diseases see http://www.un.org/apps/ news/story.asp?NewsID=39600& Cr=non+communicable+diseases
Kamran Jebreili/AP/Press Association Images
For more on the WHO’s MPOWER measures see http://www.who.int/tobacco/ mpower/en/
In December, 2011, the heads of state of the countries that make up the Gulf Cooperation Council (GCC)—Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates— endorsed a regional approach for addressing non-communicable diseases, including cancer. The first week of 2012 saw a follow-up meeting of the GCC’s Ministers of Health in Muscat, Oman, during which details of this regional strategy were revealed. Omani Minister of Health, Ahmed Al Saidi, explained that the strategy outlined plans for “reducing people’s exposure to causative risk factors and improving services to prevent and treat these leading health problems”. WHO praised the GCC, pointing out that the region is the first to have collectively acted to fulfil the commitments it signed up to in the UN General Assembly’s Political Declaration on Non-Communicable Diseases in September, 2011. “There’s been a huge joint effort in improving cancer registration in the region”, Andreas Ullrich (WHO, Geneva, Switzerland) told The Lancet Oncology. “The Gulf now has countries with very good cancer registries so they know their problems with cancer and this makes them very proactive and willing to translate this into action”, he said. Ullrich talked of close collaboration
Lifestyles in the Gulf tend to be sedentary
126
between the Gulf states and the International Agency for Research on Cancer, and of the nations’ intentions to establish targets and indicators to reduce cancer mortality. The countries of the GCC have some unusual characteristics. All six are high-income nations, yet cancer death rates are low—aside from tiny Qatar, cancer accounts for around a ninth of deaths in the region (in France, this proportion is nearer a third). For example, in Saudi Arabia, by far the most populous GCC country, the age-standardised death rates for cancer are 79·2 per 100 000 for men, and 66·2 per 100 000 for women; by contrast, the USA has rates of 141·4 per 100 000 for men and 103·7 per 100 000 for women. Saudi Arabia also has very low smoking prevalence (6%), although elsewhere rates are higher. Kuwait and Bahrain, for example, have smoking rates more typical of richer countries: around a fifth of the adult population. Few women smoke—prevalence ranges from 0·2% in Oman to 6·2% in Bahrain— although it is also possible that some women do not admit it, in view of the associated stigma in these societies. Nevertheless, the MPOWER measures used by WHO to cut tobacco consumption—eg, advertising bans, high taxation, and public awareness campaigns—have barely been enforced in the Persian Gulf. “I think it is fair to say that [the Gulf states] haven’t really developed cancer control programmes to prevent smoking”, Ian Magrath (International Network for Cancer Treatment and Research, Brussels, Belgium) told The Lancet Oncology. For women, the biggest killer is breast cancer, for which a regional conference is planned for April, 2012. Bahrain is assessing its screening programme. “Bahrain has very strong NGOs working to lobby for women’s health”, adds Ullrich, “and breast
cancer is a major agenda for them”. Oman has plans to establish a breast cancer screening programme, but there is some way to go yet. Rates of cervical cancer, however, remain low. The Gulf is made up of highly conservative, Muslim societies, even compared with other Arab nations. “Generally the Gulf states say they have no problem of cervical cancer”, affirms Ullrich. But he believes that the decreasing price of the HPV vaccine, the widespread nature of HPV, and growing enthusiasm for adoption of the vaccine in nearby Arab countries could eventually lead to GCC countries including the vaccine in their routine immunisation schedules. Diet is an issue in the Persian Gulf. Lifestyles tend to be sedentary, and it is particularly tricky for women to find places to exercise. More than twothirds of Saudi Arabia’s 27 million people are overweight; a third of the population is obese. Elsewhere in the region these rates are even higher, with the exception of Oman (although even there, more than half the population is overweight). “Perhaps these countries need to invest a bit more in sending health messages to the public focusing on diet”, says Magrath, “particularly given that some of their commonest cancers are related to diet”. The region is awash with money. Saudi Arabia, for example, has excellent cancer hospitals and stateof-the-art centres that attract medical tourism. However, authorities in the Gulf might not be accustomed to providing the public with detailed information such as that needed for public health campaigns. “These countries now need to allow planning of cancer control beyond the healthcare centre”, says Ullrich. “Prevention and early detection are very important, it’s not enough just to invest in tertiary care.”
Talha Khan Burki www.thelancet.com/oncology Vol 13 February 2012
Persian Gulf states outline regional approach to tackle cancer
For more on the GCC meetings see http://www.who.int/ mediacentre/news/ statements/2012/ ncds_20120106/en/index.html
For the UN Declaration on Non-communicable Diseases see http://www.un.org/apps/ news/story.asp?NewsID=39600& Cr=non+communicable+diseases
Kamran Jebreili/AP/Press Association Images
For more on the WHO’s MPOWER measures see http://www.who.int/tobacco/ mpower/en/
In December, 2011, the heads of state of the countries that make up the Gulf Cooperation Council (GCC)—Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates— endorsed a regional approach for addressing non-communicable diseases, including cancer. The first week of 2012 saw a follow-up meeting of the GCC’s Ministers of Health in Muscat, Oman, during which details of this regional strategy were revealed. Omani Minister of Health, Ahmed Al Saidi, explained that the strategy outlined plans for “reducing people’s exposure to causative risk factors and improving services to prevent and treat these leading health problems”. WHO praised the GCC, pointing out that the region is the first to have collectively acted to fulfil the commitments it signed up to in the UN General Assembly’s Political Declaration on Non-Communicable Diseases in September, 2011. “There’s been a huge joint effort in improving cancer registration in the region”, Andreas Ullrich (WHO, Geneva, Switzerland) told The Lancet Oncology. “The Gulf now has countries with very good cancer registries so they know their problems with cancer and this makes them very proactive and willing to translate this into action”, he said. Ullrich talked of close collaboration
Lifestyles in the Gulf tend to be sedentary
126
between the Gulf states and the International Agency for Research on Cancer, and of the nations’ intentions to establish targets and indicators to reduce cancer mortality. The countries of the GCC have some unusual characteristics. All six are high-income nations, yet cancer death rates are low—aside from tiny Qatar, cancer accounts for around a ninth of deaths in the region (in France, this proportion is nearer a third). For example, in Saudi Arabia, by far the most populous GCC country, the age-standardised death rates for cancer are 79·2 per 100 000 for men, and 66·2 per 100 000 for women; by contrast, the USA has rates of 141·4 per 100 000 for men and 103·7 per 100 000 for women. Saudi Arabia also has very low smoking prevalence (6%), although elsewhere rates are higher. Kuwait and Bahrain, for example, have smoking rates more typical of richer countries: around a fifth of the adult population. Few women smoke—prevalence ranges from 0·2% in Oman to 6·2% in Bahrain— although it is also possible that some women do not admit it, in view of the associated stigma in these societies. Nevertheless, the MPOWER measures used by WHO to cut tobacco consumption—eg, advertising bans, high taxation, and public awareness campaigns—have barely been enforced in the Persian Gulf. “I think it is fair to say that [the Gulf states] haven’t really developed cancer control programmes to prevent smoking”, Ian Magrath (International Network for Cancer Treatment and Research, Brussels, Belgium) told The Lancet Oncology. For women, the biggest killer is breast cancer, for which a regional conference is planned for April, 2012. Bahrain is assessing its screening programme. “Bahrain has very strong NGOs working to lobby for women’s health”, adds Ullrich, “and breast
cancer is a major agenda for them”. Oman has plans to establish a breast cancer screening programme, but there is some way to go yet. Rates of cervical cancer, however, remain low. The Gulf is made up of highly conservative, Muslim societies, even compared with other Arab nations. “Generally the Gulf states say they have no problem of cervical cancer”, affirms Ullrich. But he believes that the decreasing price of the HPV vaccine, the widespread nature of HPV, and growing enthusiasm for adoption of the vaccine in nearby Arab countries could eventually lead to GCC countries including the vaccine in their routine immunisation schedules. Diet is an issue in the Persian Gulf. Lifestyles tend to be sedentary, and it is particularly tricky for women to find places to exercise. More than twothirds of Saudi Arabia’s 27 million people are overweight; a third of the population is obese. Elsewhere in the region these rates are even higher, with the exception of Oman (although even there, more than half the population is overweight). “Perhaps these countries need to invest a bit more in sending health messages to the public focusing on diet”, says Magrath, “particularly given that some of their commonest cancers are related to diet”. The region is awash with money. Saudi Arabia, for example, has excellent cancer hospitals and stateof-the-art centres that attract medical tourism. However, authorities in the Gulf might not be accustomed to providing the public with detailed information such as that needed for public health campaigns. “These countries now need to allow planning of cancer control beyond the healthcare centre”, says Ullrich. “Prevention and early detection are very important, it’s not enough just to invest in tertiary care.”
Talha Khan Burki www.thelancet.com/oncology Vol 13 February 2012