1. HSC PDHPE Cancer The Cancer Council NSW Carla Saunders Medical and Scientific Policy Manager The Cancer Council NSW carlas@nswcc.org.au carlas@nswcc.org.au

2. Cancer Facts * Cancer is not one disease * Some risk factors modifiable * Others cannot be avoided through personal action …..unknown risk factors * Synergic risks * Individual susceptibility

3. Extent of the Problem http://www.aihw.gov.au/publications/index.cfm/title/10476

4. Extent of the Problem http://www.cancercouncil.com.au/

5. Extent of the Problem http://www.health.nsw.gov.au/research/index.html

6. Extent of the Problem (2006) Incidence: 106,000 new cases Mortality: 39,200 deaths * Australian males have a 1 in 3 chance of a cancer diagnosis before age 75 years, and a 1 in 2 chance before age 85. * Australian females have a 1 in 4 chance of a cancer diagnosis before age 75 years, and a 1 in 3 chance before age 85.

7. Extent of the Problem (2006) * The most common cancers diagnosed in males are prostate cancer, colorectal (bowel) cancer, melanoma, lung cancer and lymphoma. * The most common cancers diagnosed in females are breast cancer, colorectal (bowel) cancer, melanoma, lung cancer and lymphoma.

8. Trends - Incidence (AIHW) The total number of cancers diagnosed in 2003 was 26% higher in 2003 than in 1993 (24% for males and 29% for females) Compared with a 12% increase in the Australian population during this period. However, the age-standardised incidence rate for ‘all cancers’ was 0.7% lower in 2003 than in 1993.

9. Among the NHPA cancers the largest decrease in rate from 1993 to 2003 was for cervical cancer (41%), followed by prostate cancer (12%), lung cancer (11%) and colorectal cancer (1.5%) The largest increase in rate for NHPA cancers from 1993 to 2003 was for melanoma (up 14%), followed by non- Hodgkin lymphoma (7.2%) and breast cancer in females (6.1%). Trends - Incidence (AIHW)

10. The total number of deaths from cancer in 2003 was 15% higher than in 1993 (14% for males and 17% for females) Compared with a 9.1% increase in deaths from all causes over this time. However, the age-standardised death rate for ‘all cancers’ was 12% lower in 2003 than in 1993. Trends - Mortality (AIHW)

11. Among the NHPA cancers the largest decrease in death rate from 1993 to 2003 was for cervical cancer (41%), followed by colorectal cancer (25%), prostate cancer (22%), breast cancer in females (20%), non-Hodgkin lymphoma (15%) and lung cancer (14%). Among the NHPA cancers the only increase in death rate from 1993 to 2003 was for melanoma (up 4.4%: 3.3% in males, 9.1% in females). Trends - Mortality (AIHW)

12. Cancer Incidence – why the fluctuations? Age Detection rates Risk factor reduction Advances in technology and understanding of cancer development and causes

14. Cost of Cancer The average lifetime financial cost of cancer on a household in NSW is around 1.7 years of annual household income.

15. The NSW Government spends approximately $800 million each year on the prevention, management and treatment of cancer. In addition, the Australian Government in NSW spends about $200 million on cancer through general practitioners and other services. Cost of Cancer

16. Social justice and Cancer Control Equitable allocation, or more precisely - benefits from, cancer control interventions and resources. Conveniently located resources may not bring equal benefit Positive discrimination often necessary to increase the opportunity to benefit Annotated Bibliography on Equity in Health http://www.equityhealthj.com/content/1/1/1 1. Equity

17. Social justice and Cancer Control 2. Access Cancer prevention, early detection and care services are available to everyone entitled. Access is free of any form of discrimination irrespective of a persons location, socioeconomic status, ethnicity, race, age, religion etc There is equal use of services across different population groups

18. Social justice and Cancer Control 3. Participation Information and understanding of cancer prevention, early detection and care services (and the capacity to act on such knowledge) is available to everyone who is entitled.

19. Social justice and Cancer Control 4. Rights Opportunities for appropriate cancer care are available Information and understanding of health care rights and provisions for disadvantaged groups (and the capacity of individuals to act on such knowledge) is available to everyone who is entitled.

20. Poverty is the single most important determinant of poor health. However, poor health is far from the single most important determinant of poverty.

21. Applying the principles of the Ottawa Charter (in Cancer Control) 1.Build healthy public policy 2.Create supportive environments 3.Strengthen community action 4.Develop personal skills 5.Reorient health services + Principles of the Jakarta Declaration

22. Health Improvement - Ottawa Charter Investment partnerships infrastructure Contemporary health promotion rightly accords greater attention to research evidence, the social determinants of health, multiple strategies/players and building the capacity of others

23. Building Healthy Public Policy Aim: To protect health across the population irrespective of SES, rurality, race ……….etc Regulation e.g laws preventing minors under 18 yrs purchasing alcohol and tobacco, OH&S Fiscal Measures e.g. Medicare reimbursement Taxation e.g. Tobacco, alcohol, ?junk food Policy e.g Vaccination / Screening programs Evidence Based Practice e.g. Clinical care guidelines, continuing professional development, cost effective interventions

24. Create Supportive Environments Aim: Generate living, playing and working conditions that support health and safety Infrastructure e.g Women's health centres, walking paths, shade structures, libraries etc Technology e.g Accessible and reliable Internet and broadband access, specialist diagnostic etc Services e.g Free phone quit (smoking) service, Cancer Helpline, Free cancer telegroup counselling, interpreter and sign lang. services Training and Resources e.g Cancer education and information, OH&S information & training

25. “the ability of people and communities to do the work needed in order to address the determinants of health for those people in that place” Bopp, GermAnn, Bopp, Baugh Littlejohns, & Smith (2000) Community Capacity

26. Community Development (Information, training and learning opportunities, resources) e.g. volunteer recruitment and training, consumer advocacy training, information on community health statistics and harmful environmental substances, cancer support group resources, financial reimbursement for volunteer transport services, community consultation etc etc…. Strengthen Community Action Aim: Empowering communities to increase control over and improve health

27. Develop Personal Skills Aim: Empowering individuals to increase control over and improve health Personal Development (Information, training and learning opportunities, resources) e.g. strengthen individual skills through free and readily available health information; target functional literacy skills to enable individuals to interpret written and oral information about health, conduct store tours to educate people about healthy foods, thereby enabling them to make healthier food choices etc etc….

28. Aim: Shift the focus towards prevention in settings focused on providing clinical and curative services. Reorient Health Services Health Professional e.g. Educate paediatricians and family doctors about assessing second hand smoke exposure in children and counselling in smoking cessation. Organisational Change e.g. Training to support cross-cultural competence in health care. Allocation of adequate resources for interpreters and multilingual information.

29. Activities Cancer, population statistics, human behaviour and the determinants of health are all complex. There are a number of very difficult concepts to grasp Start with simple tasks and work up to the more complex. Allow reasonable time for fact gathering and understanding Need to stimulate thinking and problem solving but also correct misconceptions quickly

30. Questions? Comments?