Memorandum by Cancer Research UK (WP 44)
This memorandum represents the view of Cancer
Research UK. All correspondence regarding this submission should
be directed to Mr Richard Davidson, Director of Policy and Public
Affairs at Cancer Research UK, at the address above.
Cancer Research UK is the world's largest independent
cancer research organisation, with an annual research spend of
over £213 million. Cancer risk is greatly affected by our
lifestyle choices, particularly smoking habits, diet and physical
activity, alcohol consumption, and home and working environment.
Public health policy is therefore of great interest to Cancer
Research UK, and we welcome the opportunity to submit evidence
to this important inquiry.
Our Chief Executive, Professor Alex Markham,
is available to provide oral evidence to the Committee.
GENERAL COMMENTS
AND SUMMARY
Cancer Research UK supports many of the public
health measures outlined in the Government's Public Health White
Paper (hereafter referred to as "the White Paper").
With regard to the prevention of cancer, tobacco control policies
are of paramount importance. We have therefore chosen to focus
our submission to the Committee on this public health area.
The tobacco control policies outlined in the
White Paper show progress but do not go far enough. In particular,
we urge the Committee to recommend that the Government remove
the proposed exemptions from the legislation to restrict smoking
in workplaces and enclosed public places, and instead introduce
comprehensive legislation to make all workplaces and enclosed
public places smoke-free.
TOBACCO CONTROL
POLICIES
The Health Committee has asked whether the White
Paper proposals will enable Government to achieve its public health
goals: Specifically, the Government has a target to reduce smoking
rates from 27% to 21% or less by 2010. Cancer Research UK believes
that stronger tobacco control policies than those outlined in
the White Paper will be needed to achieve this goal.
We endorse the submission made to the Committee
by Action for Smoking and Health. Further to that submission,
we wish to highlight certain areas as outlined below, and urge
the Committee to consider making recommendations along these lines
to the Government.
Tobacco Control Strategy development and co-ordination
We welcome the proposal for a new public health
cabinet sub-committee. However, a smaller tobacco co-ordinating
group of political and civil society membership also needs to
be established to develop and oversee the implementation of the
Department of Health's tobacco control strategy and conform with
the guiding principles of the Framework Convention on Tobacco
Control.
We welcome the establishment of a health information
and intelligence task force. Key information would include a longitudinal
panel survey to monitor smokers' behaviour in response to national
policy initiatives, with publicly available results.
There should be greater funding commitment for
longer-term social marketing mass media and public education campaigns.
Smoking in workplaces and enclosed public places
The SCOTH report's unequivocal conclusions about
the harmful effects of second hand smoke should be reported to
the UK Committee on Carcinogens and the Committee should be asked
to assess whether second-hand smoke is a workplace carcinogen.
The present proposal to make all enclosed public
places smoke-free by 2008, excluding pubs that do not serve food
and private membership clubs (chapter 4, para 76) should be re-worded
to recognise that legislation is vital and that the proposed exemptions
should be removed. This is because:
(a) the present announcement will leave many
thousands of workers still exposed to second hand smoke;
(b) it will miss a timely opportunity to
reduce smoking prevalence rates as much as possible;
(c) it will contribute to increased inequalities
in health; and
(d) regulation without legislation will not
achieve even the White Paper's present proposals.
We therefore urge the Committee to recommend
that the Government include a comprehensive bill in the first
Queen's Speech after the General Election to make all workplaces
and enclosed public places smoke-free.
Tobacco and Nicotine Regulation
The White Paper provides conflicting information
about the need to set up a UK agency to regulate tobacco. Smoked
tobacco is by far the most harmful form of nicotine consumption,
but other forms of nicotine, such as medicinal nicotine which
is at least 100 times less risky, are currently only available
as an aid to giving up smoking. Some form of regulatory body is
needed as a matter of priority to ensure uniform regulation on
all products containing nicotine. The remit of such a regulatory
framework should be to minimise the proportion of regular nicotine
users in society, and, amongst them, the proportion regularly
obtaining nicotine from smoked tobacco products.
Stop smoking services
The White Paper correctly recognises that the
Government's Stop Smoking Services have been very important. However,
the White Paper does not pick up some of the criticisms set out
in the latest Wanless report. In particular, the four-week quit
targets give a misleading impression of success. We recommend
therefore that targets for cessation services should be re-framed
to cover both referrals and success rates, and standard measures
for quit rates are needed. Performance indicators must also reflect
the extent to which smokers from deprived groups are being targeted.
Finally, smoking cessation also needs to be fully integrated into
clinical guidelines for all smoking-related chronic diseases.
Health Warnings
Increasing evidence shows that graphic warnings
can be powerful in reducing the number of smokers. We welcome
the Government's move to consult on how to use them after the
development of the EC's final proposals.
Tax and Smuggling
We believe that the price of tobacco should
continue to be an important element of government tobacco control
policy. An FCTC protocol on smuggling should therefore be a priority.
OTHER POLICY
AREAS
Beyond tobacco control, there are a number of
other initiatives identified in the White Paper which could have
an impact on the prevalence of cancer in this country.
In general terms, we support the initiatives
outlined to combat the growing prevalence of obesity. Among non-smokers,
who now comprise the majority of the population, obesity is the
most important preventable cause of cancer. Although we have chosen
to focus this submission of evidence on tobacco control policy,
we nevertheless urge the Committee to give careful consideration
to the proposals regarding obesity. If required by the Committee,
Cancer Research UK experts in the field could provide further,
detailed advice and information as to the likely efficacy of the
White Paper's proposals.
We are also encouraged by the plans to strengthen
public health research as outlined in Annex B of the White Paper.
Cancer Research UK is actively involved in some of the initiatives
outlined in the White Paper, through the National Cancer Research
Institute. We urge the Committee to call on Government to give
high priority to ensuring the effective implementation of its
proposals for public health research.
January 2005
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