Approach to Cancer Prevention through Policy, Systems, and Environmental Change in the U.S. Marcus Plescia, MD, MPH Director, Division of Cancer Prevention and Control Centers for Disease Control and Prevention UICC World Cancer Congress August 29, 2012 National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention and Control
CDC s Division of Cancer Prevention and Control! One of 9 Divisions in CDC s National Center for Chronic Disease Prevention and Health Promotion! Comprehensive public health approach to cancer control and prevention! Focus on: " Risk-reduction " Early detection " Cancer survivorship " Reducing health disparities
CDC s National Comprehensive Cancer Control (CCC) Program! Convenes statewide coalitions to develop, implement, and evaluate data-driven cancer control plans! 65 programs with cancer plans " 50 US states, DC, 7 territories, 7 tribal organizations! Work on entire cancer continuum, from prevention through survivorship! Strong partnerships! Focus on policy, systems, and environmental
2000 NCCCP Status of Cancer Plans Northwest Portland Area Indian Health Board CA OR WA NV ID UT MT WY CO ND SD NE KS MN IA MO WI IL IN MI KY OH WV PA VA NY NJ VT NH MA CT DC DE MD ME RI AK AZ NM OK AR MS TN AL GA SC NC HI TX LA FL Updating or Creating New Plan Current Plan
2010 NCCCP Status of Cancer Plans South Puget Intertribal Planning Agency Northwest Portland Area Indian Health Board WA MT ND Fond Du Lac Reservation ME OR OR NV CA ID UT WY CO Aberdeen Area Tribal Chairmen s Health Board NE KS SD MN IA MO WI IL MI IN OH KY WV PA VA VT NH NY MA CT NJ DC DE MD RI AK AZ Tohono Northwest)Portland)Area) O Odham Indian)Health)Board Nation NM Cherokee Nation OK AR MS TN AL GA SC NC TX LA Alaska Native Tribal Health Consortium HI FL AMERICAN SAMOA FEDERATED STATES OF MICRONESIA GUAM COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS PUERTO RICO REPUBLIC OF THE MARSHALL ISLANDS REPUBLIC OF PALAU Creating New Plan Current Plan or Updating Plan National Comprehensive Cancer Control Program Division of Cancer Prevention and Control National Center for Chronic Disease Prevention and Health Promotion Office of Noncommunicable Diseases, Injury and Environmental Health February 2010
Smallest Impact Largest Impact Factors That Affect Health Counseling & Education Clinical Interventions Long-Lasting Protective Interventions Changing the Context to make individuals default decisions healthy Socioeconomic Factors Examples Eat healthy, be physically active Rx for high blood pressure, high cholesterol, diabetes Immunizations, brief intervention, cessation treatment, colonoscopy Fluoridation, 0g trans fat, iodization, smokefree laws, tobacco tax Poverty, education, housing, inequality Source: Frieden (2010), CDC
CCC Policy Programs! In 2010, 13 CCC programs received funds to increase focus on policy, system and environmental change (PSE) strategies! Develop a policy agenda to implement 3-5 PSE interventions over 5-yr program period " Address primary, secondary, or tertiary prevention " Evidence-based " Address a key aspect of cancer control " Impact the 3-4 highest burden cancers " CDC recommend select interventions
CCC Policy Programs Funded programs Cheroke e CO FL IN KY LA MA MI MT NY UT WA WI CS218059-A
Examples of Proposed Primary Prevention Activities by CCC Programs! Nutrition " Healthy food availability in convenience stores (Massachusetts)! Physical Activity " Implement policies that encourage physical activity for schoolaged children at least 60 minutes per day (Wisconsin)! Sun Safety/Reducing UV Exposure " Restrict youth access to indoor tanning devices (Colorado)! Patient Navigation Reimbursement " Develop and implement community health worker certificate program (Florida)
CDC Wants to Know! Does the program: " Enhance the ability of grantees to implement PSE change as part of comprehensive cancer control? " Facilitate collaboration on primary prevention of cancer with other CDC-funded chronic disease programs?! What lessons can be learned to inform future programs?
Evaluation Approach for CCC Policy Programs! Overall Approach " Inform evaluation by conducting an environmental scan on theoretical models and practical experiences " Convene an evaluation consultation group " Develop and implement an evaluation plan that identifies key questions! Additionally, each policy program will have its own written evaluation plan by September 30, 2012
Sample Evaluation Questions! What tactics were used by policy programs to implement the policy agenda and media plan?! What factors facilitated or created barriers to implementation? How were these addressed by policy programs?! What key PSE outcomes were achieved by policy programs?! Which strategies and tactics were evaluated by policy programs? Which did they find to be effective?! What lessons have been learned that could inform the expansion of the policy program to the other NCCCP-funded programs?
Overview of Data Collection Plans! Secondary data review (annually)! Focus group with TA provider " (Twice, 2012 and 2014)! Survey of all CCC programs " (Twice, early 2013, 2015)! Site visits and interviews with selected 1017 programs " (Twice, early 2013, 2015)! Coalition member survey of 1017 programs " (Once, early 2015)
Thank You! For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention and Control