European Cancer Patient Coalition (ECPC)
  • Date submitted: 1 Nov 2011
  • Stakeholder type: Major Group
  • Name: European Cancer Patient Coalition (ECPC)
  • Submission Document: Download
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Full Submission

October 31, 2011 Re: Contribution to Rio + 20 Outcome Document

Dear Ms. Tonya Vaturi , Dear Mr. Arthur de la Cruz

The European Cancer Patient Coalition welcomes the opportunity to contribute to discussions on the Rio + 20 Outcome Document. We recognise that behind the Rio Conference is a commitment at the highest levels of Member State Governments to focus on areas of society where policies to promote innovative mechanisms and solutions that could help to generate increased development and to tackle poverty.

We would encourage the delegates to put a strong emphasis on health, especially on Non- communicable Diseases. As you are aware, this issue is just barely on the radar screen of economic policy-makers, who most often do not see that NCDs pose a threat to development, economic growth and poverty alleviation. Over the next 20 years, NCDs will cost more than US$ 30 trillion, representing 48% of global GDP in 2010, and pushing millions of people below the poverty line. For example:

-Cancer: an estimated US$ 290 billion in 2010 rising to US$ 458 billion in 2030.

-Cardiovascular disease: an estimated US$ 863 billion in 2010 rising to US$ 1.04 trillion in 2030.

As it will be evidenced by our contribution below: a unified front is needed to turn the tide on NCDs. Governments, but also civil society and the private sector must commit to the highest level of engagement in combating these diseases and their rising economic burden. The economic impact of not dealing with NCDs, in particular cancer would be devastating to developing economies and health care systems alike.

Therefore, in order to achieve positive economic impact and growth as well as in a number of other policy areas for developing countries, we advocate that it is essential that the international community adjust the framework so as to include actions on NCDs in particular cancer on Rio+20.

Yours Sincerely,

Francesco De Lorenzo ECPC Vice President FAVO

ECPC Contribution to Rio + 20 Outcome Document


i. The current focus of the structure for the future RIO+20 Conference does not take into account sufficiently the economic burden of health inequalities nor the economies benefits that can be realized through the establishment of effective health systems so as to tackle poverty and ill health for future generations. Health impacts several economic outcomes: wages, hours worked, labour force participation, early retirement, labour participation of those caring for a ill member of the household, education outcomes (good health in childhood reduces school absenteeism and early drop-out rates.

ii. In the area of health, priority should be given to focus on Non Communicable Diseases (NCD): they are responsible for the majority of disability adjusted life years lost and therefore threaten the economic viability of developing countries. The World Economic Forum has identified NCDs as the second most severe threat to the global economy in terms of likelihood and potential economic loss. Currently, more than 60% of all deaths worldwide stem from NCDs. Health inequalities have been estimated to cost the EU around ?141 billion in 2004 or 1.4% of GDP, when taking into account labour productivity lost and costs to social security. A recent study conducted by the American Cancer Society estimated the cost of DALYs due to cancer worldwide in 2008 at US$ 895 billion (John & Ross, 2010).

iii. An improved management of NCDs would render the biggest positive impact in terms of increased well-being, economic growth and in a reduction of the economic burden of non-communicable disease.

iv. The economic impact of not dealing with ill-health would be devastating to developing economies and health care systems alike. Therefore, in order to achieve positive economic impact and growth, it is essential that the Rio+20 agenda adjust its framework so as to address Health and the issue of Non-Communicable Diseases.

v. The most cost effective solution to reduce NCDs are through public health interventions that take a health prevention approach, which address the determinates of health (nutrition, alcohol, tobacco, physical activity and the social determinants of health.). vi. Addressing this imbalance through projects to combat health inequalities, potential discriminating legislation and attitudes, to raise awareness and improve data collection should be a strong priority for the inclusion of this in Rio+20 Conference. Furthermore, by tackling the economic burden of diseases and health inequalities, the Rio+20 could accomplish much towards achieving the goal of ensuring sustainable health systems and relieving the economic burden that this has on developing countries.

In the following pages, we have provided suggestions to the questions posed in the Guidance Document on the ?Inputs for Compilation Document?.

Question 1: What are the expectations for the outcome of Rio+20, and what are the concrete proposals in this regard, including views on a possible structure of the Outcome document?


i. While the emergence of the G-20 at the level of heads of states and governments provide the opportunity for strengthening global economic and financial governance to a kind of a steering committee of the global economy.

ii. Nevertheless, institutions need to be legitimate and have credible enforcement power in order for global governance to work. The G-20 seen to be effective, needs to deliver a good solution to the serious problem of health imbalances in developing countries. G20 nations represent around 88% of world GDP and 65% of the population. However, 35% of the world?s population and 80% of countries do not have a voice around the table.

iii. Additionally, the world population is increasing. The UN projections indicate that there will be approximately 2 billion more people by 2050. In addition, the share of those aged 60 and older has begun to increase and is expected to grow very rapidly in the coming years. Since NCDs disproportionately affect this age group, the incidence of these diseases can be expected to accelerate in the future. Increasing prevalence of the key risk factors will also contribute to the urgency, particularly as globalization and urbanization take greater hold in the developing world.

iv. In the Report by the Secretary General for the Preparatory Committee for the United Nations Conference on Sustainable Development, 17-19 May 2010, the report stated that ?The concept of sustainable development is like a bridge. It seeks to bring together not only the three domains ? economic, social and environmental ..Development is the midwife of sustainability, just as sustainability is the life support system for development?.

v. There is now a growing body of evidence to support the principle that the bridge to sustainable development is through a healthy population which will allow sustained economic growth, and evidence indicates that well directed investment designed to improve the health of a population is one of the most cost-effective means of stimulating gross domestic product (GDP) growth. For example, the WHO has identified a set of interventions they call ?Best Buys?.

vi. The commonality of the challenges facing the developed/developing countries and the opportunities for growth through better health make a strong argument for its inclusion within the Rio+20. Health has a particular value as a unique bridge and offer an important complement to the orientation of Rio+20 and reinforces its focus as outlined in Resolution 64/236 which states that the focus of the Conference will be on ?the following themes  of sustainable development and poverty eradication and the institutional framework for sustainable development".

vii. Most of this burden of disease is preventable, given the will and resources to do so; the means to address the relevant risk factors is known: what is needed is more innovation in the application of these means to populations. Improving the health status of the people worldwide is very largely a challenge to health promotion (which includes health education, health protection, and disease prevention), and health inequalities need to be addressed also in the context of improved systems of health promotion. Other policy areas, such as tax, education and transport, are important for achieving a reduction of risk from lifestyle determinants. . Policy of health professionals is for instance connected to vertical policies such as labour- and migration policies, which determine the efficiency of healthcare professionals. Another important policy area to bring about an efficient healthcare system is research, which can help develop new instruments, one example being e-Health. 1


1.1 Inclusion of Health and Health Indicators

i) To meet the aspiration of the G+20, we need to improve the well-being of all people, so that they can actively participate to the societal and economical

world. There is a need to promote the value of healthcare to the wider economy. ii) Indicators should be coherent with the aims of the UN Declaration on Non-

Communicable Diseases and the Millennium development Goals. iii) Objectives should either be seeking to produce outcomes and recommendations that feed directly into future policy development or be used to augment the implementation of health policies.

iv) For example in Europe, three areas of ill-health (cardiovascular diseases, cancer, and neuropsychiatric disorders) are the cause of 74% of deaths in Europe, and contribute 54% of the overall disease burden in Europe, as calculated in Disability Adjusted Life Years (DALYs). The most effective way to make improvements in these three areas would be to focus on the underlying determinates of health.

a. there is considerable coincidence between the risk factors for these conditions which need to be influenced and improved if the disease burden they create is to be reduced which can be tackled at the international level

through the WHO. 1.2 Involvement of Civil Society ? Patient Organisations

i) National control mechanisms should not only depend on agents of horizontal accountability (the system of checks and balances in the partner country and the capacity of state institutions to provide oversight and to audit the use of public resources), but also on mechanisms of vertical accountability (mechanisms used by citizens and non-state actors such as civil society, nongovernmental organisations and the media to hold government to account).

ii) Capacity development of NGOs and the media with regard to budget scrutiny and audit reports should be actively supported by the EC.

iii) Support mechanisms of social accountability such as for instance social audits, participatory budgeting and citizen report cards to increase the accountability of government not only to parliament, but most importantly to its citizens.


2.1 Funding

i. Funding from the international community has been widely recognized as crucial if the world?s poorest countries are to stand any chance to ?safeguard their hard-won economic gains?. The financing gap was estimated by the IMF in September 2009 for low-income countries in 2009?10 as likely to increase by around US$25 billion a year. In January, the World Bank?s Chief Economist estimated that poorest countries that rely on subsidized loans may require an additional $35 billion to $50 billion in funding just to maintain pre-crisis programs.

2.2 Health Expenditure

i. In Europe, health expenditure accounts for nearly 10% of EU Gross Domestic Product and is one of the biggest economic sectors in the EU. The health sector employs one in 10 workers in the EU, with a higher than average proportion of workers with a tertiary level of education and is on the leading edge of innovation and technology. The sector plays a major role in achieving the EU 2020 targets for smart, sustainable and inclusive growth.

ii. According to the recent report by the World Economic Forum and the Harvard School of Public Health: ?Over the next 20 years, NCDs will cost more than US$ 30 trillion, representing 48% of global GDP in 2010, and pushing millions of people below the poverty line?. Therefore, if no measures are put in place to tackle NCDs, this estimate cost of US$ 30 trillion will contribute to the overall burden of poverty on developing countries. As such, there is a growing attention to the potential economic benefits of improvements in population health. The report by the WHO Commission on Macroeconomics and Health report in 2001, demonstrated that health improvement can be seen as a key strategy for income growth and poverty reduction in low-income and middle-income countries.

iii. This is far from new: historically, one of the origins of the public health movement lies in the awareness that the prosperity of nations is partly dependent on the health of their populations.

2.3 Health is Wealth

i. We would emphasize that "Health is Wealth" and point out that by achieving good health, a developing economy can be more viable and competitive. Health is the greatest wealth, expresses the understanding that illness is a real economic cost and good health is a precondition for full productivity. This requires an active engagement of many policy sectors, not only of the public health and healthcare systems but also of many other policy areas, including education, social security, working life, city planning and so forth. Without implementing this action, it is estimated that ?the period 2011-2030, the total lost output from the four NCD conditions that are the focus of the UN High-Level meeting and mental health conditions is projected to be nearly US$ 47 trillion.

2.4 Health in All Policies

i. An integrated approach to health is therefore necessary. We need to ensure that a health dimension remains in the core of all policies in general, but especially in innovation and research policy, social policy, regional policy, education policy and agriculture policy.

ii. Developing synergies with all sectors is crucial for a strong development policy. Member States of the UN have acknowledged that the challenge of maintaining a sustainable healthcare system cannot be met without more integration in other policy areas such as employment, social, regions, agriculture and research including innovation. Health is very unevenly distributed across society. In all countries, significant inequalities in health exist between socioeconomic groups in the sense that people with lower levels of education, occupation and/or income tend to have systematically higher morbidity and mortality rates.


i. Health should be included on the agenda Rio+20 Conference and Agenda. This should be introduced as a cross-cutting approach so as to avoid ?silo trap?:

ii. Suggest the inclusion of a holistic approach to health and ill-health: from an increased understanding of what determines health and what determines ill-health, citizens can be encouraged and supported to lead healthy lives by pursuing the former and avoiding the latter. This builds resilience and resistance in citizens so they can remain healthy, resist stressors that could potentially make them unwell and thus enable them live longer productive and independent lives.

iii. The Rio+20 should support health policies which are based on evidence and provide a stimulus with which to implement recommendations and policies to improve citizens health, address entrenched health inequalities, which, as an outcome, will ultimately lead to sustainable health systems.

iv. To ensure that the IMF deliver its package of measures to assist low-income countries, and monitor the IMF?s disbursements to those countries, and the conditionalities attached to them so as to realize health gains


i. One of the main sources of criticism on the previous meetings was the lack of clear targets. This allowed the building-up of unsustainable levels of health imbalances that is destabilising for development and reduces global welfare.

ii. Many of the policy orientations articulated by this forum would have to be implemented by the relevant international institutions. Effective global economic and financial governance would, thus, require continuation of intensive reforms in the existing institutions, and also increased collaboration with NGOs such as patient organisations.

iii. The international community should reaffirm the economic burden that NCD will have on developing countries as they have done through the UN Declaration on Non- Communicable Diseases.


i. Support a concentrated prioritisation approach. In the past, it was insufficiently transparent, vested interests are poised to dominate, and there has been duplication of efforts without proper evaluation. The choices of priority need re-appraisal so as to

ensure that they meet the health need of the citizens. ii. Programme should support health in all policies which are based on evidence and provide a stimulus with which to implement recommendations and policies to improve citizens health, address entrenched health inequalities, which, as an outcome, will ultimately lead to sustainable health systems.

iii. Including an objective better regulation and harmonization of health development policy aimed at simplifying and improving existing regulation in order to enhance the design of new regulations and reinforce rule compliance and effectiveness in line with the needs of the different peoples

Question 2: What are the comments, if any, on existing proposals: e.g., a green economy roadmap, framework for action, sustainable development goals, revitalized global partnership for sustainable development, or others?


i. Current development policy is based on the principle that the good health of a population is a precondition for meeting the basic objectives of prosperity, solidarity and safety. All peoples should have access to universal, quality health care, including preventive healthcare, and healthcare should be patient-centred and based on scientific evidence.

ii. To ensure social cohesion, inequalities in health both between and within countries should be reduced. Because of the multidisciplinary character of health issues, Health Policy has to be well coordinated with other policies, and new partners such as the private sector and civic society must be involved.

iii. Additionally, please refer to comments in Q1 as a contribution to the response to this question.


i. Potential adverse effects of climate change on human health include both direct and indirect effects. Direct effects concern impacts on the human organism, for example in consequence of heat waves or extreme weather events.

ii. In particular the elderly and people with a weakened immune system and children are at risk. High pressure weather conditions in the summer can increase ground-level ozone causing mucous membrane irritation and respiratory problems. Indirect effects and risks are caused by environmental changes. These include improved living conditions for vectors of disease pathogens, the possible geographical extension of allergenic plants and animals and influences on food and drinking water.

iii. Besides measures addressing health effects of climate change, attention should be paid to synergies and possible antagonisms between climate change mitigation and air pollution control so as to prevent diseases such as cancer.

iv. Although successful reductions in the levels of several air pollutants were achieved, articulate matter and ozone remain a major environment-related health concern, linked to a loss of life expectancy, acute and chronic respiratory and cardiovascular effects, impaired lung development in children and reduced birth weight.


For a green economy, the following policy options are proposed:

i. Provide additional funds for cross-border collaboration across Member States to improve ambient air quality. Address the synergies, as well as the conflicts, between air quality management and other policy areas such as climate change mitigation.

Establish a coherent policy framework for indoor air policies and support the development of worldwide guidance on indoor air quality.

ii. Adopt a systemic approach to chemicals assessment which, besides addressing and energy use, toxicity and eco-toxicity, should also include material, water a transport, release of emissions as well as Waste generation.

iii. Fill knowledge gaps concerning mixture toxicity and the contribution of chemical exposure to the total burden of disease especially cancer.

iv. Involve citizens through education and participation.

v. Improve regulations concerning labelling to provide transparent information for consumers on food and nutrients (nutritional labelling, health claims, clean labelling).

Question 3: What are the views on implementation and on how to close the implementation gap, which relevant actors are envisaged as being involved (Governments, specific Major Groups, UN system, IFIs, etc.);

In the ?Synthesis report on best practices and lessons learned on the objective and themes? by the Preparatory Committee for March 7th/8th, it stated that ?Political commitment is best measured through legislation Factors such as budgetary allocation, development of institutions and stakeholder participation are strong indicators of political commitment translated into action. Quantitative indicators (such as budgetary allocation and financial support) can be effective.?

i. Stakeholder Involvement: Both because smaller and poorer countries will need to be part of any lasting solution to the global imbalance problem and because corrective action by systemically significant G-20 members will necessarily impose externalities on these states, the G-20 quickly needs to find a credible way of bringing these voices into its deliberations. It could do this either through a constituency based system such as through the use of a bicameral system where the G-20 could be made accountable to a body such as the UN General Assembly.

ii. Civil Society Involvement: At the national level, key strategies for increasing patient empowerment and enabling meaningful patient participation in healthcare and effective self-care. Such empowerment will be an essential element of future healthcare over the next 20 years as health is predicted to shift increasingly towards a home and community environment and towards using eHealth and ICT based solutions for patient- centred chronic disease management.

iii. Implementing Best Practices from Other Member States: New effective preventive strategies are currently available that offer the potential to reduce the morbidity and mortality from this cancer in low- and medium-, as well as high-income countries. Surveillance, including high-quality cancer registries, linked to screening and vaccination registries is essential to track the impact of these prevention strategies and to provide the foundation for advocacy, national policy and global action.

In the Report of the Secretary General, the report stated that ?There is evidence of progress towards convergence between the economic and social pillars, but evidence of convergence between those pillars and the environmental pillar is far more limited and the overall picture is one of divergence; progress to date is also threatened by the series of crises that affected the global economy starting in 2008?.

i. For the policy area ?resource efficiency?, the following policy options are proposed:

a. Increase the relevance of resource efficiency, e.g. by proposing a directive on resource efficiency, which could contain quantitative resource efficiency targets and/or provisions for preparing resource efficiency plans.

b. Provide financing for projects which focus on resource-free ways to satisfy consumer demands, sustainable lifestyles, immaterial services and the efficient use/maintenance of products.

c. Put more focus on how to cover consumer needs in an immaterial way and on how to provide low-resource consumer services.

d. Develop the ecosystem services concept further and make use of it when assessing materials, products and processes.

Question 4: What specific cooperation mechanisms, partnership arrangements or other implementation tools are envisaged and what is the relevant time frame for the proposed decisions to be reached and actions to be implemented?

1) Focused Measurable Impacts

If spending programmes are to have any measurable impact, they need to be concentrated on selected activities that are identified through strategic planning according to a rigorous set of priorities. The number of priorities should be commensurate with the available budget, as having too many priorities will reduce the chances of achieving impact in any individual area.

If spending programmes are to have any measurable impact, they need to be concentrated on selected activities that are identified through strategic planning according to a rigorous set of priorities. The number of priorities should be commensurate with the available budget, as having too many priorities will reduce the chances of achieving impact in any individual area.

? Developing sharper priorities that are driven by stakeholder expectations and citizens? needs as well as meeting policy goals and high standards of probity; monitoring its activities against not only the aims of each project but also the overall aims of the programme decision;

? Communicating its priorities and actions more crisply to stakeholders, and targeting tailored messages to members of the wider public health community.

? Understanding what is required to deliver this would be facilitated by developing a logic model capable of tracing the precise causal relationships that are anticipated to connect the programme activities to its intended outcomes.?

2) Possible approaches to ensure implementation

i. education of health and finance ministers of countries on the association between healthy populations and GDP growth, on the main health challenges in preventing such good health, and on potential actions within countries, needed to remedy these;

ii. financial incentives by international community,

iii. involving the inactive countries in the design of the call for projects, the call for projects. Their participation will ensure that projects will meet health needs in their country, thusincreasing the possibility that local stakeholders will apply for projects;

iv. assisting countries not involved to develop relevant capacity (especially public health capacity) where serious capacity deficiencies are identified; and specifically targeted towards low-GDP countries (for example leadership development in health, or change management courses) could increase the number of participants from low-GDP countries and awareness of the Programme and its activities.

1 v. organising high-level conferences or technical consultations about Health topics in countries with low participation levels as an instrument to deliver impulses and mobilise country representatives

vi. tackling language barriers which occur in the comprehension of terminology and applying it in the national context;

vii. more involvement of essential stakeholders in countries, e.g. a special initiative to educate and to collaborate with academic institutions and civil society representatives in MS, at which worldwide plans and priorities could be publicised;
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