This summers publication of the third edition of the European Code Against Cancer, its authors hope, will give extra impetus to the long running campaign to encourage Europes 376 million citizens to adopt healthier lifestyles. Published by the European Commission (EC), it highlights the dangers of smoking and the benefits of a varied diet, daily exercise, and weight control (see box).
There are no real surprises in the directives of the code, but many experts are raising their eyebrows at the fact that the EC is also paying €1 billion (US $1.1 billion) in subsidies to support tobacco farmers in its member countries. According to one recent estimate, the subsidies encouraging tobacco production are 60 times greater than those used to reduce consumption. Tobacco-related illness kills a half a million people per year in the 15 member EC states.
"Its absolutely ludicrous," said Amanda Sandford, of the U.K.-based group Action on Smoking and Health (ASH). "Smoking causes one-third of all cancers and more than 80% of lung cancer. They claim that theyre going to phase out these subsidies, but it never actually seems to happen. Theyve been talking about it for the last 10 years."
But Peter Boyle, Ph.D., chairman of the Cancer Experts Committee that compiled the latest version of the code, defended the commission. "Over the last 10 years [the position of] the EC has been extremely strong and rigorous against tobacco and the tobacco industry," said Boyle, who is based at the European Institute of Oncology in Milan, Italy, and is the incoming president of the International Agency for Research on Cancer. "On balance I think that what the EC has been doing is positive."
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The European Tobacco Products Directive, issued by the EC as part of its anti-tobacco drive, has resulted in larger health warnings on cigarette packs throughout Europe, a cap on tar and nicotine levels in cigarettes, and, beginning in October, a ban on the "light" and "mild" descriptions of specific brands. In addition, sponsorship of sporting events by tobacco companies will be phased out within the next 2 years.
In 1985, an ambitious, Europe-wide cancer prevention program, "Europe Against Cancer," also sponsored by the EC, directed member states to cut the expected cancer mortality rate by 15% by the year 2000. Only Austria and Finland met the target for both men and women, although Britain achieved a noteworthy 16% reduction in expected cancer deaths among men and a 10% reduction among women, according to a report in the August issue of the Annals of Oncology.
Although they acknowledge such achievements, ASH argues that the tobacco subsidies are untenable for "health, economic, and political reasons." An EC proposal that tobacco subsidies should be phased out was put to the European Council in Gothenburg, Sweden, in 2001, but, according to Sandford, "The council made no specific comment on the proposaland theres been no progress since then."
About 135,000 farmers receive tobacco subsidies, according to a recent estimate, with Greece (35%), Italy (40%), and Spain (12%) accounting for the lions share. The subsidies are part of the ECs Common Agricultural Policy (CAP) to give farmers "stable and adequate income," make Europe more competitive in world markets, improve rural life and development, reduce development gaps between regions, and ensure that agricultural products are "healthy and safe."
Jean King, director of Behavioral and Tobacco Control at Cancer Research U.K., in London, said that, in addition to the tobacco subsidies, the entire EC subsidy program should be examined. "The subsidies have been for the least healthy foods, predominantly dairy foods," King said. "We have a big problem with obesity, with manufacturers producing high-fat content food for a population with a dwindling knowledge of nutrition."
In a separate move, Englands chief medical officer, Sir Liam Donaldson, M.D., is calling for legislation to ban smoking in public places such as restaurants and shopping malls in the United Kingdom. "Moves to make public places and workplaces smoke-free would create a climate in which no-smoking was the social norm," he said. "It would help smokers give up [smoking] and remove the risk of passive smoking for millions of people, including children and babies." An estimated 3 million people in the United Kingdom are exposed to second-hand smoke in the workplace.
"Tobacco has had an unrivalled, unchallenged run as the major killer in this country over the last 50 years," Donaldson said. "It has been the David of health against the Goliath of tobacco."
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