1. Cancer inequalities in Europe Kielce, Polish conference on cancer, 13/15 June 2011 Dr. Andrea Micheli Director Descriptive Study and Health Planning Unit Fondazione IRCCS “Istituto Nazionale dei Tumori” Milan

2. EUROCHIP-1..3 Cancer is an element of our societies Why? To fight inequalities What? Translational research project How? Economy of scale: EU From actions to common actions Tanks to Magdalena

3. Macro-economic approach - background European vision Cancer - inequalities - Europe

4. LIFE EXPECTANCY IN EU-27, ICE, N, and CH 2005-2009 Source: United Nations Population Division

5. LIFE EXPECTANCY TRENDS IN EUROPE Inequalities in health increased increased Source: United Nations Population Division

6. Life expectancy at birth $PPP $PPP yrs I) GDP < = 20,000 73.3 II) 20,000 < GDP < = 30,000 79.1 II) 20,000 < GDP < = 30,000 79.1 III) 30,000 <GDP <36,000 79.6 III) 30,000 < GDP < = 36,000 79.6 IV) GDP > 36,000 80.0 GDP AND LIFE EXPECTANCY AT BIRTH I, Bulgaria, Romania, Latvia, POLAND, Lithuania, Hungary, Estonia, Slovakia II, Portugal, Malta, Czech Republic, Slovenia, Cyprus, Greece, Spain, Italy III, France, Germany, Finland, United Kingdom, Belgium, Sweden, Denmark IV, Austria, Iceland, The Netherlands, Switzerland, Ireland, Norway, Luxembourg Sources: United Nations Population Division. For GDP International Monetary Fund

7. GROSS DOMESTIC PRODUCT (GDP) AND CANCER INCIDENCE Source: GLOBOCAN 2002, IARC & United Nations (UN) Age-standardized incidence rates, World Standard Population per 100,000, GDP: at current prices US $, 2006.

8. GROSS DOMESTIC PRODUCT (GDP) AND CANCER MORTALITY Age-Standardized incidence rates, World Standard Population per 100,000, GDP: at current prices US $, 2006. Source: GLOBOCAN 2002, IARC & United Nations (UN)

9. GDP and age-standardized incidence rates for all cancers. Men Sources: Human Development Report 2009; Ferlay et al. 2008

10. GDP and age-standardized mortality rates for all cancers. Men Disks are proportional to the public health expenditure ($ PPP) Sources: Human Development Report 2009; Ferlay et al. 2008

11. Source: Verdecchia A. et al. EUROPE Gross Domestic Product (GDP), Total National Health Expenditure (TNHE) and Public Health Expenditure (PHE) Countries are ranked by GDP in 1995

12. EUROCARE-4 5-year relative survival, all cancers countries are ordered by Total Health Expenditure Poland Europe Berrino F. et al, The Lancet Oncology, 2007

13. 5 YEARS RELATIVE SURVIVAL FOR ALL CANCERS EUROCARE 3 Ranked by 1995 TNEH Source: Verdecchia A. et al. European Journal of Public Health, 2008

14. GDP AND EPIDEMIOLOGICAL CANCER DATA All cancers M & F COUNTRIES BY QUARTILE of GDP per capita ($PPP) Incidence per 100,000 Mortality per 100,000 Survival % LOWEST GDP < 20,000 (BG, RO, LV, PL, LT, HU, EE, SK) 336209- 20,000 < GDP < = 30,000 (PT, MT, CZ, SI, CY, EL, ES, IT) 36317250 30,000 < GDP < = 36,000 (FR, DE, FI, UK, BE, SE, DK) 41117149 HIGHEST GDP > 36,000 (AT, IS, NL, CH, IE, NO, LU) 40517653 Sources: Ferlay et al. EJC, 2010. EUROCARE-4. For GDP International Monetary Fund

15. Produce cancer plans (and follow them) Promote cancer information, i.e. cancer registration Organize screening programs for cancer of cervix, breast and colorectum And invest in primary prevention actions Against cancer inequalities: indications from Europe

16. Health Strategies in Europe. Lisbon, 12-13 July 2006. Coleman M., modified

17. Health Strategies in Europe. Lisbon, 12-13 July 2006. Coleman M.

18. L. von Karsa et al. Cancer Screening in the European Union. First Report.

21. Lung cancer in Poland and EU-27, males Source: GLOBOCAN 2008, WHO. For Survival: EUROCARE-4. Sant et al. EJC 2009. WORLD Standard Population, per 100.000 Rate per 100,000 per 100

22. Smoking trends in European countries (M+F) Source: WHO, Health For All Europe, 2011

23. NO smoking Eat better, five portion per day Reduce alcohol consumption Increase physical activity, 30’ of walking per day Cancer inequalities: promote health