Reducing risk factors for bladder cancer: the legislator’s role
Discussing the legislator’s role in beating bladder cancer, Daciana Octavia Sarbu MEP says a broader strategy including, emissions from road traffic and pesticide limits is equally important if we are to control risk factors for major chronic diseases and enact serious, prevention-based health policies
As research accumulates, we can be more certain about risk factors for different cancers and develop policies to reduce them. Some are easier to identify than others, and it may take decades before clear links are established between exposure and a particular cancer. However, over time, it has become clear that preventing bladder cancer specifically means tackling at least two key risk factors: occupational exposure to carcinogens and smoking. Legislators can and must play an important role in this process.
Reducing exposure to carcinogens and mutagens in the workplace is critical because in some industries this represents the second biggest risk factor for bladder cancer. EU health and safety rules address some of these workplace risks, but critics argue that the legislation is too weak. Three key problems can be identified. Firstly, exposure limits are defined at European level for only a small number of potentially harmful substances, which means different levels of protection in different member states.
Secondly, the length of time between exposure and onset of disease means that the financial cost of ill-health is mainly paid by healthcare systems later on in a person’s life. This creates little incentive for industry to take preventative action for current employees. Thirdly, the European Commission reports serious problems with implementation of the rules, particularly for small and medium-sized enterprises (SMEs).
The current and long-awaited revision of health and safety legislation may help. Applying exposure limits to a wider range of industrial chemicals in a single directive would increase minimum standards across the EU. Obligatory post-employment monitoring of employees and provision of medical care could improve detection, diagnosis and treatment. Such changes could bring great benefits, especially for those working in large-scale operations with the resources to implement them. But the balance between protecting workers and making legislation realistic for SMEs may prove hard to strike.
Bureaucratic complexity, insufficient guidance from national authorities, and a lack of awareness of responsibilities have already made the laws problematic for small businesses. This is relevant to the discussion about bladder cancer because several higher-risk professions are those in which people are often self-employed or work for SMEs, such as hairdressers, drivers, mechanics, and painters. In these cases, workplace rules may not provide the necessary protection. Closing the gaps in health and safety legislation alone will not be enough.
With smokers being up to four times more likely to contract bladder cancer than non-smokers, tobacco use is still a bigger risk factor than any occupational exposure. The EU and member states have taken important steps on tobacco use in recent years. Most work places and many indoor public places are now smoke-free following a 2009 Council recommendation.
More recently, the EU Tobacco Products Directive introduced standardised packaging for cigarettes, including mandatory pictorial and text warnings (the tobacco companies recently failed in their bid to overturn this law in the courts). This is important for governments because it reinforces the health messages around smoking which makes it easier to introduce laws for smoke free environments. Research now shows high public support for smoking bans in places such as bars and restaurants. Those governments which have not yet enacted such bans should take advantage of this popular support to fully implement the 2009 recommendations and reap the health, social and economic benefits that smoke free environments bring. In some member states, the health benefits have been immediately apparent, such as fewer hospital admissions for heart attacks soon after the introduction of smoke-free environments. The effects on other tobacco-related diseases like cancer will be slower to emerge and perhaps harder to quantify, but smoke-free environments are clearly associated with decreasing smoking rates. This can only have a positive impact on health, including a reduced incidence of bladder cancer.
EU policy has gone some way in addressing the risks of occupational diseases such as bladder cancer and the wider health risks posed by smoking. Experience has shown that legislation can create healthier environments – whether by introducing smoke free public places or limiting exposure to carcinogens at work. Regular reviews and strengthening of health and safety rules are vital to increasing protection, but this alone is not enough to cover all the professions at risk.
A broader strategy including, for example, emissions from road traffic and pesticide limits is equally important if we are to control risk factors for major chronic diseases and enact serious, prevention-based health policies