During the last two decades, the world's most important health organisations, such as World Health Organisation (WHO) and others, have mainly concentrated on the prevention of contagious diseases like acquired immunodeficiency syndrome, but clearly less on chronic non-communicable diseases (CNCD) such as cardiovascular illnesses, diabetes and its sequelae, chronic pulmonary, kidney and liver disease and finally cancer in its many organ types and expressions. Yet, CNCD account for more than 85% of death in the WHO-Region Europe [1] with likewise increasing tendency in other parts of the world, especially Asia and Africa.

Because most of these CNCD are treatable today, but many of them not (yet) curable, they generate an enormous financial burden due to increasing treatment and nursing costs as well as loss of productivity in the ‘best years’ of active life. Four major health determinants account for the majority of CNCDs and their continuously increasing death toll across Europe: Tobacco, unhealthy diet, too much alcohol and lack of physical activity [2]. All of them could potentially be successfully addressed to prevent chronic disease and premature death of the European population. However, more than 97% of health expenses are presently spent on treatment and only <3% are invested for disease prevention in most European countries, and only a small fraction of it specifically for cancer prevention [3].

As far as ‘cancer’ is concerned—a rather simplifying term for more than 100 malignant neoplastic diseases—WHO estimates a substantial increase of deaths worldwide, from 8 million per year in 2010 to more than 17 million until 2030, if no dramatic changes occur in incidence, available treatment options and consequently in cure rates during the next years [2]. This rise will also take place across Europe, where these figures will rise to more than 3 million cancer deaths annually during the next 20 years [4]. And there are not only the increasing death rates that count, but rather the preceding, long-term morbidity from CNCD in general and—especially for cancer—the enormously increasing treatment costs regarding the widespread and sometimes exaggerated use of modern high-priced targeted agents, mostly in palliative treatments of advanced neoplastic disease. It is therefore time, that politics and academia get together and develop strategies to overcome this unhappy perspective of projected increasing morbidity and mortality from CNCD and its social and economical consequences.

Therefore, in an unprecedented Alliance—the Chronic Disease Alliance (CDA)—10 not-for-profit European organisations, representing more than 100 000 health care professionals, have joined forces in early 2010 to present the case for immediate political action, and to reverse this alarming rise in CNCD, which affects more than a third of the population of Europe, that is more than 120 million people. The evidence is overwhelming for tackling the four major risk factors, named above for these diseases, as an essential starting point for bringing about a healthier population across our continent [5]. This Alliance aims to support the European Commission, the European Parliament and the member states to further influence their respective policies in health care and research, but also in other related domains such as education, food regulation, agriculture, sports and recreation to improve their impact on public health, and by creating a political and social environment, which postulates improved health as a priority. If this will not be implemented effectively in time, the ‘Europe 2020 Strategy’—especially the ambitious goal of having 75% of the working population employed and productive by 2020—will suffer losses [6].

The CDA is convinced, that preventing CNCD reduces also health inequalities across Europe by narrowing gaps between vulnerable and privileged populations and recognises the importance of the socioeconomic status in prevalence and prevention of disease. Therefore, the position paper put forth by the CDA to the European Union authorities urges politics to implement the following priority recommendations [5].

Choice and information

  • Comprehensive disclosure of the physical, chemical and design characteristics of all tobacco products

  • Compulsory standardised packaging of cigarettes with adequately visible health warnings

  • Mandatory and understandable food labelling, with pictorial designs

  • Educational programmes for raising the awareness of the problems created by alcohol

Incentives

  • Ensure taxation on tobacco and alcohol is harmonised across Europe

  • Promote measures to increase the affordability of healthy food choices

  • Encourage member states to prioritise easy access to facilities encouraging physical activity

The default healthy option

  • Ban Internet sales of tobacco

  • Take measures to prohibit marketing of unhealthy food in the media (especially to children)

  • Ban alcohol advertising, promotion and sponsorship of events in TV, radio and sports

Safety and science

  • Urge member states to implement and enforce comprehensive smoke-free legislation

  • Take legislative measures to avoid producing nutrients containing trans fatty acids

  • Further reduce salt content and saturated fats from all food

  • Prioritise CNCDs within the framework of health programme of DG Research 7th Framework Programme across relevant areas

The European CDA has taken up the collective social challenge of CNCD in a constructive interdisciplinary approach. These recommendations above are based on scientific evidence and also on experience. In contributing to the CDA, its partner organisations and societies across Europe commit to bringing their combined knowledge and support to the table, to create a healthier and wealthier Europe [4]. Prevention, which is at the centre of this effort, is only one aspect of the challenge. The disease groups, represented by the partner societies in the CDA, have striking etiological similarities and respond—at least partially—to similar preventive and interventional interactions. It is therefore highly desirable that the partners of this new European CDA—including our own society, the European Society of Medical Oncology (ESMO)—remain together to expand their scientific and professional cooperation in the future in order to support the responsible political bodies—the European Commission and the Parliament—in their efforts to keep European citizens healthier and Europe intercontinentally more productive by inducing healthier lifestyle choices [2]. The ESMO Cancer Prevention Working Group is willing to cooperate towards these goals and is trying to bring into the ranks of this Alliance also additional aspects of tolerable medical interventions, which are already scientifically tested in responsible trials such as for example antihormonal prevention of breast, prostate and colorectal cancers [7, 8]. Such topics have been increasingly and successfully introduced into the scientific and educational programmes of ESMO and European Cancer Organisation congresses during the last years.

It is reassuring, that the organisers of the 13th European Health Forum in Bad Gastein, Germany have presented the European CDA on 8 October 2010 with the European Health Award 2010, which underlines the value of this important united public health initiative.

References

1.
World Health Organization. 2008–2013 Action Plan for the global strategy for the prevention and control of noncommunicable diseases
 , 
2008
WHO
2.
Senn
HJ
Schrijvers
D
A lifestyle choice: is cancer prevention the ultimate goal towards its effective treatment?
  
EU Public Service Review: European Union. Brussels/B, 2010; 20: 1–3
3.
Together for Health: A Strategic Approach for the EZU 2008-2013
  
White paper, European Commission, COM (2007) 630, final
4.
Ferlay
J
Parkin
DM
Steliarova-Foucher
E
Estimates of cancer incidence and mortality in Europe in 2008
Eur J Cancer
 , 
2010
, vol. 
46
 (pg. 
765
-
7
)-
81
)
5.
Chronic Disease Alliance. A Unified Prevention Approach
  
Position paper for the EU Commissioner of Health and Welfare. 2010: 1–20
6.
Lopez
AD
Mathers
CD
Ezzati
M
, et al.  . 
Global and regional burden of disease and risk factors. 2001: systematic analysis of population health data
Lancet
 , 
2006
, vol. 
376
 (pg. 
1747
-
17
)-
57
)
7.
Senn
HJ
Morant
R
Chemoprevention of breast and prostate cancers: where do we stand?
Ann Oncol
 , 
2008
, vol. 
19
 
Suppl 7
(pg. 
234
-
2
)-
37
)
8.
Sankaranarayanan
R
Bofetta
P
Research on cancer prevention, detection and management in low and medium-income countries
Ann Oncol
 , 
2010
, vol. 
21
 (pg. 
1935
-
19
)-
43
)