Reducing cancer mortality: Does health promotion work? A discussion paper

Abstract

Objectives To examine cancer mortality in the period 1988 to 1992 in relation to health education (HE) and health promotion (HP) in 1976 and 1986. Design Self-completion questionnaires on HE/HP returned by mail. Incidence and mortality data from reliable published sources for comparison. Setting The EC-funded Standing Committee of the Hospitals of the European Union (HOPE) Project. Subjects Representatives of 15 EU Member States. Main outcome measures Coordination, cancer focus, approaches and content of HE/HP, services and legislation relating to cancer risk reduction in 1976 and 1986. Age standardised incidence and mortality data for the five year periods 1973 to 1977,1978 to 1982,1983 to 1987,1988 to 1992. Results The following characteristics of HE/HP were found to be associated with reduced mortality from cancers between 1973-77 and 1988-92 and with the lowest cancer rates in 1988-92: an established programme in 1976; coordination of the programme by an alliance between government, a national health agency and cancer society; year- long programmes with a specific focus backed by short, intensive campaigns; communication by the multi-stage process, namely authoritative sources followed by a personalised letter or word-of-mouth to individuals; cognitive, affective and behavioural elements in the programme, that is information together with skills- and self-efficacybuilding and behaviour change techniques; a community-wide approach; regular tax increases on cigarettes; bans on tobacco advertising; control of asbestos and carcinogens in industry; and a cervical and breast- screening service backed by personalised health education. Conclusion Cancer HE/HP established in 1976 was reflected in reduced mortality in 1988/92. By 1986, most of the countries had developed such programmes with the characteristics listed above and allowing for the latent period of most cancers, the effect on mortality might be expected in the first decade of this century.