Policies & Legislation
Policy and legislation are essential to address the burden of cancer globally and locally. The effective use of law to achieve population health goals requires collaboration across sectors.
In 2011, a landmark high-level meeting of the United Nations General Assembly resulted in a commitment to address non-communicable diseases (NCDs) as a major development challenge. In 2013, the World Health Assembly adopted the World Health Organization Global Action Plan on NCDs, emphasizing whole-of-society approaches to reduce the major drivers of preventable NCDs. The plan also endorsed a global monitoring framework including nine voluntary global targets. (Figure 1) In 2015, a goal to reduce premature mortality from NCDs by one-third was included in the United Nations Sustainable Development Goals. (Figure 2)
Figure 1. Nine voluntary global targets for 2025 endorsed by governments in the World Health Organization (WHO) Global Action Plan on NCDs. To support the primary goal of reducing premature mortality from NCDs, targets address risk factors and national systems responses. Mortality and morbidity: 25% reduction of premature mortality from NCDs. National systems response: 80% coverage for essential NCD medicines and technologies. 50% coverage for drug therapy and counseling. Risk factors for NCDs: 0% increase of diabetes/obesity. 25% reduction of raised blood pressure. 30% reduction of tobacco use. 30% reduction of salt/sodium intake. 10% reduction of harmful use of alcohol. 10% reduction of physical inactivity.
3.A Strengthen the implementation of the WHO Framework Convention on Tobacco Control in all countries, as appropriate.
3.B Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines… and, in particular, provide access to medicines for all.
3.C Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States.
3.4 By 2030, reduce by one third premature mortality from noncommunicable diseases through prevention and treatment and promote mental health and well-being.
3.5 Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.
3.8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
The effective use of law is critical to addressing cancer and other NCDs. This is true across the cancer and NCD continuum, including prevention (reducing exposure to risk factors such as tobacco, alcohol, unhealthy diet, air pollution, and occupational exposures); conduct of research and collection and management of personal health information (protection of individual privacy, while allowing for the conduct and dissemination of essential medical and public health research); screening, diagnosis, treatment and care (access, affordability, quality, safety, regulation of health practitioners, and protection of the rights of patients, their families and carers); and life after a diagnosis (employment protection, access to insurance, pension funds, and loans).
The safety of the peopleshall be the highest law.
The effective use of law requires collaboration across sectors: government; civil society; academia; health professionals; communities; people affected by cancer or NCDs, their families and caregivers; and, as appropriate, the private sector. Collaboration across different parts of government is also needed, as few problems can be addressed by health ministries acting alone.
Addressing cancer and NCDs through law involves engaging with domestic, regional and international legal and governance frameworks, including those dealing with health, human rights, international trade, intellectual property and investment law, environment, and occupational health and safety. It also requires being able to defend against litigation, or threats of litigation, by corporate interests—such as the tobacco, alcohol and food industries—which is becoming increasingly common. (Figure 3) Legal capacity is an essential component of the cancer/NCD workforce.
ACCESS CREATES PROGRESS
Australia and Uruguay have successfully defended litigation against their tobacco packaging laws under international trade, intellectual property and investment laws.
ACTION: AUSTRALIA
Australia was challenged under a bilateral investment treaty between Australia and Hong Kong by Philip Morris Asia, claiming expropriation and a breach of obligations to provide fair and equitable treatment (case decided in Australia’s favor in December 2015), and in the World Trade Organization by Cuba, Dominican Republic, Honduras, and Indonesia, claiming breaches of obligations relating to trade restrictiveness and intellectual property protection (case decided in Australia’s favor in June 2018).
ACTION: URUGUAY
Uruguay was challenged under a bilateral investment treaty between Uruguay and Switzerland by Philip Morris Switzerland, claiming expropriation and a breach of obligations to provide fair and equitable treatment (case decided in Uruguay’s favor in July 2016).
RESULT
Australia’s and Uruguay’s successes have confirmed the policy space that countries have under international trade, intellectual property, and investment agreements to implement evidence-based tobacco control measures. However, litigation of this nature is resource-intensive and expensive to defend.
The Australian Government has successfully defended against three sets of legal challenges to its tobacco plain packaging laws: a constitutional challenge in its highest domestic court, an investment treaty claim, and a dispute in the World Trade Organization.
Text:
Australia – Certain Measures Concerning Trademarks, Geographical Indications and Other Plain Packaging Requirements Applicable to Tobacco Products and Packaging, WT/DS435/R, WT/DS441/R, WT/DS458/R, WT/DS467/R (28 June 2018).
Philip Morris Asia Ltd v. Australia (Award on Jurisdiction and Admissibility), PCA Case No. 2012–12, 17 December 2015.
Philip Morris Brands Sàrl (Switzerland), Philip Morris Products S.A. (Switzerland) and Abal Hermanos S.A. (Uruguay) v Oriental Republic of Uruguay (Award) (ICSID Arbitral Tribunal, Case No. ARB 10/7, 8 July 2016).
Liberman, J. Building a law and NCDs workforce: a necessity for global cancer and NCD prevention and control. J Cancer Policy. 2017;12, 72–74.
World Health Organization. Updated Appendix 3 of the Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020. Geneva: WHO, 2017.
Image:
Cigarette pack photo used with license under copyright from the Commonwealth of Australia.
Figure 1:
World Health Organization. Noncommunicable diseases and mental health: about 9 voluntary targets. https://www.who.int/nmh/ncd-tools/definition-targets/en/
Figure 2:
United Nations Sustainable Development Goals Knowledge Platform. https://sustainabledevelopment.un.org/sdgs
Figure 3:
Australia – Certain Measures Concerning Trademarks, Geographical Indications and Other Plain Packaging Requirements Applicable to Tobacco Products and Packaging, WT/DS435/R, WT/DS441/R, WT/DS458/R, WT/DS467/R (28 June 2018).
Liberman, J. Building a law and NCDs workforce: a necessity for global cancer and NCD prevention and control. J Cancer Policy. 2017;12, 72–74.
Philip Morris Asia Ltd v. Australia (Award on Jurisdiction and Admissibility), PCA Case No. 2012–12, 17 December 2015.
Philip Morris Brands Sàrl (Switzerland), Philip Morris Products S.A. (Switzerland) and Abal Hermanos S.A. (Uruguay) v Oriental Republic of Uruguay (Award) (ICSID Arbitral Tribunal, Case No. ARB 10/7, 8 July 2016).