Politicians are often hesitant to promote primary prevention, as it is said that its benefits can only be seen after many years – and therefore beyond their term of office. In practice, however, doctors observe something different. As Marián Hajdúch, director of the Institute of Molecular and Translational Medicine (IMTM) at the Faculty of Medicine of Palacký University in Olomouc, pointed out at the Healthcare Daily’s conference titled “Economics of Prevention”, when a smoker of conventional cigarettes quits the habit or switches to one of the less harmful alternatives, the risk of health complications decreases very quickly, within months. He also used data on the incidence of smoking-related cancers in the Czech Republic to show that harm reduction clearly works and therefore different taxation of nicotine products based to their level of harm should be adopted.
„The risk of health complications for citizens with cardiovascular disease and cancer decreases the moment they quit smoking or switch to a less harmful alternative. We see those changes within months,“ Hajdúch said. „Prevention therefore pays off, even within the mandate of one government,“ he added. Concrete changes can be seen within one or two years, he said, citing as an example the results of a community activity in the US city of Milwaukee, where a change in behaviour by residents who reduced smoking and played more sport resulted in a three-year increase in life expectancy. „If primary prevention measures are not implemented, there will be a major health crisis within 10 to 17 years. And if we want to prevent it, we need to do something about it today,“ he said emphatically.
Excise tax as an effective prevention tool
Smoking causes a wide range of cancers, most affecting the lungs and to a lesser extent other parts of the body such as the bladder, colorectum, pancreas, kidneys, liver, stomach, oesophagus, mouth, nose and several others. Tumours are not caused by nicotine itself, but by the smoke burned. The chemicals released prevent cells from repairing damaged DNA, and it is this damage or lesions that can cause cancer. This is a long-term process that usually takes ten to fifteen years. „That gives us plenty of time to do something about it,“ Hajdúch appealed.
At the conference, Hajdúch also presented the recent development of smoking and tobacco consumption in the country. „The number of daily and occasional smokers has been steadily declining over the years and the proportion of alternative nicotine products has been increasing,“ he said, pointing to the positive trend, adding that around one-third of smokers now use less harmful alternatives to conventional cigarettes. „It is good that the proportion (of alternative users) is increasing, but we need to prevent the younger generation from getting used to nicotine in the first place. There should be targeted intervention,“ Hajdúch believes. „Smoking is something that no longer belongs in today’s society,“ he added.
The director of the IMTM also pointed to the decline in the incidence of smoking-related cancers following the introduction of anti-tobacco policies (ban on advertising, increase in excise duty, etc.). „Around 2017, when the first alternative products were introduced to the Czech market, the curve starts to bend even more sharply,“ he described on the graph. The harm reduction policy is thus clearly working, he said. „In the case of cardiovascular or lung diseases, the effect can be seen within months, in the case of cancer, within years. But it is almost certain that we will see it,“ Hajdúch added.
He pointed to the government’s original consolidation package, which imposed a high excise tax on alternatives to combusted tobacco. „If these products are too expensive in the Czech Republic, imports from abroad will increase, which will lead to the tax not being collected and people will continue to smoke. So we won’t eliminate the problem and we will lose the means that we can use to prevent these addictions,“ Hajdúch pointed out the limitations of setting the excise tax. After a wave of criticism, the government watered down the proposal to heavily tax nicotine products without regard to their harmfulness.
Boxed wine is too cheap
The second area that Hajdúch addressed in his presentation at the conference was alcohol consumption. „Alcohol is not usually thought of as a cancer-causing substance, but it is actually the second most important carcinogen,“ he said. „Wherever it flows, it increases the risk of cancer,“ he simplified the idea of organs that alcohol puts at risk of developing cancer. Specifically, the colorectum, mouth and oropharynx, larynx, oesophagus, liver and, in women, the breasts. „In women, alcohol causes 15 per cent of breast cancers,“ he elaborated.
Alcohol contributes to cancer by converting into the highly reactive compound acetaldehyde in the body after it is metabolized. This substance binds to macromolecules and damages them in a fundamental way. „Acetaldehyde damages DNA and produces a large number of pro-inflammatory factors,“ Hajdúch further explained.
He also recalled the high level of alcohol consumption and tolerance in Czech society. The Czech Republic regularly tops global rankings in alcohol consumption, with beer in particular dominating. However, the head of the Molecular and Translational Medicine Institute also expressed concern that wine is not taxed. „That is one of the problems we have,“ he said, adding that making wine more expensive by imposing excise duty on wine would not ruin Czech winemakers but would help reduce consumption of cheap boxed wine, which is consumed in large volumes.
Government subsidies against public health principles?
According to Hajdúch, the third area that is linked to the development of cancer is meat eating. In terms of carcinogenic substances, processed meat products such as salami, sausages, bacon and other smoked meats are the most risky. „They are on a par with tobacco smoke,“ Hajdúch stressed. Slightly less risky is red meat, meaning pork, beef and mutton. Poultry meat and fish are not a concern.
A carcinogenic element of these meat products is the addition of additives such as nitrite and nitrate, which ensure that the meat retains its pink colour and does not turn brown. „To make it look nice, we add a whole range of factors to the diet, these lead to the production of nitrous oxide and this is extremely reactive,“ Hajduch explained. „About 70 grams per day is considered a safe limit for eating unprocessed meat. Every additional 50 grams of processed meat products per day can increase the lifetime risk of colorectal cancer by up to 18 percent,“ he said.
As an example of the discrepancy between actors, he cited the fact that the Ministry of Agriculture subsidizes the Agrarian Chamber’s „I Eat Meat“ campaign. „This is totally inconsistent with the principles of public health protection,“ he lamented the content of the campaign, which he said contained a number of half-truths.
At the end of his speech, Hajdúch warned of an imminent increase in the number of cancer cases. Citing World Health Organisation figures, he said that if nothing changes, the number of cancer deaths will almost triple by 2040. „There will be a 150 percent overrun of current care, funding and staff capacity,“ he calculated, adding that there is a need not only to change society’s harmful habits but also to focus on training the next generation of oncologists.
In this context, he also highlighted the role of prevention. „We have a huge amount of money waiting for us when we get sick. Yet primary prevention is the cheapest mechanism and the most effective way to prevent the development of disease,“ he concluded.
Photo by Radek Čepelák
We would like to thank the General Health Insurance Company, National Sports Agency, RBP, Health Insurance Company of the Ministry of Interior of the Czech Republic, Military Health Insurance Company, EUC Medical Group and Sprinx for their support of the conference.