Despite significant advances, cancer continues to place a major burden on individuals, heath systems and society. This chapter brings together the main messages of this publication and describes the policy implications identified by new OECD analyses of the health, economic and societal burden of cancer. It shows the rising burden of cancer on health and health expenditure, and makes the case for investing in prevention. The chapter presents the expected impact of addressing key cancer risk factors as well as vaccination for human papilloma virus.
Tackling the Impact of Cancer on Health, the Economy and Society
OECD Health Policy Studies
Abstract
Stronger action on prevention is urgently needed to attenuate the burden of cancer on individuals, health expenditure and society
Despite significant advances, cancer continues to place a major burden on individuals, heath systems and society. Cancer causes one in four premature deaths in the OECD. It decreases the quality of life of individuals, impacting their mental health and imposing a significant toll on their work life and income. Cancer also places a considerable strain on the health systems of OECD countries. According to model-based estimates, cancer increases health expenditure by 6%, at a total cost of EUR PPP 449 billion annually, across OECD countries between 2023 and 2050 – which is more than the total annual health budget of France. At the societal level, cancer lowers labour market outputs through reduced productivity and hours worked. This is equivalent to a reduction in workforce output of EUR PPP 163 billion per year, broadly equivalent to the annual gross domestic product (GDP) of Hungary.
Large, unwarranted variation in cancer outcomes shows that there remains significant scope to improve cancer care. Survival rates for lung cancer, for example, vary more than seven‑fold across EU and OECD countries. For colorectal cancer, the variation is more than two‑fold. These inequalities are in large part driven by differences in cancer screening and care. OECD estimates suggest that, if all countries were to improve cancer screening and access to early diagnosis coupled with equitable access to timely, effective, affordable treatment to attain the best survival rates observed within the OECD and EU, a quarter of all premature deaths due to cancer could be prevented and the OECD workforce output could increase by EUR PPP 11 billion – roughly equivalent to more than one month of GDP for the Slovak Republic.
The current trajectory of cancer costs is unsustainable. The rising cancer burden due to population ageing alone – assuming that the incidence and survival rates of cancer per age group remains unchanged – is estimated to increase the per capita cancer health expenditure by 67% between 2023 and 2050, on average across the OECD. If cancer care were improved and inequalities in survival rates removed, a desirable outcome, this would add another 15% in cancer cost over the same period. On top of this, higher treatment cost from new medicines and technologies (with some studies suggesting an average growth of 14% to 17% per year), and additional cost associated with providing follow-up care for a growing number of cancer survivors, would further increase the total cost.
To give patients the best chance for survival in a sustainable way, no matter where they live, countries should improve cancer screening, early diagnosis and access to effective treatment. Screening plays a pivotal role in the fight against certain cancers, but there remain considerable differences in screening rates across and within countries. To improve uptake, countries should increase awareness and optimise the design of screening invitation and delivery. Countries can also address access delays by increasing awareness of the initial signs of cancer among patients; diagnosis delay by increasing this awareness among healthcare workers; and improve referral from primary care through to specialist oncology care to reduce treatment delays. Finally, policy makers can improve access to effective care by encouraging the entry and use of generics and biosimilars, introducing collaborative Health Technology Assessment at a multinational level, improving the use of targeted treatments, and establishing Comprehensive Cancer Centres.
Decisive action on prevention can attenuate the current trajectory of cancer costs, and reduce the wider societal burden of cancer. As around 40% of cancer cases can be prevented by healthier lifestyles, scaling up action to tackle tobacco and harmful alcohol use, high body weight, unhealthy diets, lack of physical activity and air pollution could make a crucial contribution in curbing the growing burden of cancer. However, the prevalence of all these risk factors remains high across OECD and EU countries. Despite recent progress, tobacco use remains common in the OECD, with 16% of adults smoking daily. Other cancer risk factors have seen little improvement: alcohol consumption has changed little over the past decade; only 15% of adults in the OECD eats at least five portions of fruit and vegetables daily; over half of the population is now either overweight or obese; only 40% of adults in the OECD meets the recommended level of physical activity per week; and almost all OECD countries have air pollution levels above the WHO guideline.
More ambitious policy targets on key cancer risk factors (tobacco use, alcohol use, diet, air pollution, overweight and obesity, and low physical activity), and more rigorous policy action to achieve them, would reap a wide range of benefits. International policy targets on cancer risk factors, such as those from the WHO Global Action Plan on NCDs, were used to evaluate the potential impact of scaling up action on risk factors. This analysis estimates that achieving the policy targets for six key cancer risk factors together could prevent around 8% of all cancer cases, 12% of premature deaths due to cancer, and reduce the burden of cancer on health expenditure by 9%.
Tobacco remains the most important policy area for cancer prevention in the OECD, accounting for 40‑60% of the total impact of action on risk factors, depending on the type of impact. If international policy targets on tobacco were achieved, this is estimated to prevent 56 000 premature deaths annually across OECD countries – one every ten minutes – and save health systems EUR PPP 13.3 billion in cancer health expenditure (3.0% of total cancer burden on health expenditure).
Nevertheless, it is crucial that policy makers complement tobacco control policies with strategies that effectively target a wider set of risk factors, including harmful alcohol use, diet, air pollution, overweight and physical inactivity. For example, the current international policy targets on obesity and physical activity are less ambitious than those for tobacco. Similarly, the timeline to achieve the pollution target is much longer than for other targets, which means that the health benefits are delayed. Moreover, it appears that few countries will actually achieve these policy targets.
Stronger action on risk factors would not just benefit cancer. Cancer risk factors are linked to other chronic diseases, bringing additional health and economic benefits. There are also wider societal benefits. For example, achieving the policy target on harmful alcohol use would also improve safety, preventing around 10% of premature deaths due to interpersonal violence and road traffic accidents. Changes toward a healthier diet would also have a direct impact on the environment, reducing greenhouse gas emissions by 304 Mt per year – the equivalent of taking all the cars in Germany and Spain off the road.
Cancer prevention strategies should also capitalise on the potential to protect future generations from cervical cancer through vaccination for human papillomavirus (HPV). Vaccines are highly effective in preventing HPV infection and the associated cancers. But while almost all OECD and EU countries have introduced HPV vaccination, coverage rates are generally low: the average coverage in the OECD was 69% in 2022, well below the target of 90%. According to OECD estimates, optimal vaccination for HPV could prevent around 90% of all cervical cancer cases and deaths, reducing the total burden of cancer on health expenditure by 1.3% in OECD countries; and increasing the workforce output by EUR PPP 5.7 billion per year. Evaluating the benefits and challenges of single‑dose schemes, considering catch-up vaccination campaigns if and where needed, and evaluating and addressing misinformation could help countries increase uptake and coverage of HPV vaccination.
Due to advances made in cancer prevention and treatment, the average age‑standardised cancer mortality has decreased by 26% over the past three decades across OECD countries – from 134 deaths per 100 000 population in 1987/8 to 99 per 100 000 in 2017/8 (IARC, 2022[1]). Nevertheless, cancer remains a leading cause of death and disability. In 2019, 28% of all deaths were due to cancer in the OECD, and 29% in the EU, making cancer the second cause of death after cardiovascular disease ( (IHME, 2019[2]). In addition, the burden of cancer is projected to increase in the coming years, largely driven by to population ageing. For these reasons, cancer already has far-reaching consequences for individuals, health systems and society, and its impact will be even greater in the future unless effective policies are put in place without delay.
The impact of cancer on individuals, health systems and society up to 2050 has been evaluated using advanced and validated microsimulation modelling techniques – the OECD SPHeP NCDs (Strategic Public Health Planning for non-communicable diseases) model (Box 1.1). Findings from these analyses show that every minute in the OECD, an estimated 11 people are diagnosed with cancer. This adds up to 5.6 million people who will develop cancer every year, and nearly 1 million people who die prematurely (before the age of 75) due to cancer (2.0 million and 361 000, respectively, in the EU) (Figure 1.1). As a result, the average life expectancy of OECD and EU populations is nearly 2 years lower than if there were no cancer.
Model structure
The OECD SPHeP-NCD model is an advanced systems modelling tool for public health policy and strategic planning. The model is used to predict the health and economic outcomes of the population of a country up to 2050. The model includes a comprehensive set of key risk factors (e.g. overweight, harmful alcohol use, tobacco, diet, pollution, physical activity) and their associated NCDs. The model covers 51 countries, including OECD member countries, G20 countries, EU27 countries and OECD accession and selected partner countries.
For each of the 51 countries, the model uses demographic and risk factor characteristics by age‑ and sex-specific population groups from international databases. These inputs are used to generate synthetic populations, in which each individual is assigned demographic characteristics and a risk factor profile. Based on these characteristics, an individual has a certain risk of developing a disease each year. These relative risks are based on the Global Burden of Disease study (Murray et al., 2020[3]), amongst others. Note that the model uses population predictions to adjust the size and demographic profile of country populations in the future, but maintains current (age‑ and gender-specific) rates for risk factors. In other words, it does not predict any future trends in risk factor prevalence with the exception of those caused by demographic changes.
Cancer coverage
The cancer types covered in the OECD SPHeP-NCD model together account for 75% of all disability-adjusted life years lost from cancer in the OECD in 2019 (Murray et al., 2020[3]). Cancer types were selected based on their overall burden, as well as what proportion of their burden is amenable to public health interventions (e.g. action on risk factors, screening, vaccination). The cancer types covered are: lung, colorectal, breast, liver, oesophageal, pancreatic, stomach, prostate, cervical, malignant skin melanoma, lip and oral cavity, larynx, other pharynx, and nasopharynx cancer.
Health expenditure
Total health expenditure is predicted for each patient, based on age, gender and disease status. The total cost is the sum of disease‑specific cost, residual cost (which captures costs unrelated to risk factors, for example, the costs of treating migraines or common colds), and, where relevant, the cost of comorbidities and end-of-life related cost. Patient-level cost data from France, Estonia and in the Netherlands was used to create the cost prediction formula.
The cost from France, Estonia and the Netherlands (the “anchor countries”) were extrapolated to other countries based on OECD data on inpatient curative and rehabilitative care spending per capita; outpatient curative and rehabilitative care spending per capita; and medical goods spending per capita. These three factors were weighted for each diseases using weights based on the OECD SHA data on the expenditure by disease, as well as the relative spend across the three for the anchor countries.
For more information, please refer to the online documentation for the OECD SPHeP NCDs model: http://oecdpublichealthexplorer.org/ncd-doc/.
Note: These estimates are based on the OECD SPHeP NCDs model, predicting the burden of cancer over 2023‑50. Health expenditure estimates are calculated by comparing the baseline scenario to a hypothetical scenario in which there is no cancer, and therefore take into account the cost of other diseases as well as population dynamics.
Source: OECD SPHeP NCDs model, 2024.
The impact of cancer on the quality of life and income for affected individuals is also severe. Disability associated with cancer is estimated to reduce healthy life expectancy (which takes into account years lived with illness) by 1.6 years on average in OECD and EU countries. The emotional toll of cancer, coupled with symptoms and side effects from treatment, can lead to heightened stress, anxiety, and depression. Every year across the OECD, cancer is estimated to cause an additional 160 000 cases of depression per year (85 000 in the EU). Cancer also has a significant negative impact on a person’s work life, leading to many people being forced to work part-time, exit employment and retire early. In addition, cancer affects the opportunities for continuous education and training, which are typically associated with higher wages. As a result, cancer reduces the average annual wage of people in employment by EUR PPP 2 955 – roughly three weeks’ worth of income for an average income worker (EUR PPP 2 573 in the EU).
Cancer also places a considerable strain on health systems. According to model estimates, which take into account competing diseases and population dynamics, cancer increases the health expenditure of OECD countries by a total of EUR PPP 449 billion, every year between 2023 and 2050 – more than the total health budget of France (EUR PPP 93 billion for the EU). This is 6.0% of total health expenditure in the OECD, and 4.7% in the EU.
The impact of cancer extends beyond health and health expenditure. Cancer affects all facets of people’s lives, and this has consequences for the economy and society. Through cancer’s impact on productivity and workforce participation, it is estimated that OECD countries lose the equivalent of 3.1 million full-time workers (1.1 million in the EU). This translates into a lost workforce output of EUR PPP 180 per capita per year, or EUR PPP 163 billion per year, broadly equivalent to the annual gross domestic product (GDP) of Hungary (EUR PPP 49 billion for the EU) (Figure 1.2).
The impact of cancer on the workforce output through absenteeism, early retirement, employment (combining unemployment and part-time work) and presenteeism, EUR PPP per capita (working age), average over 2023‑50
Note: Although cancer increases the chance that a person retires early, it actually reduces the overall rate of early retirement in the population. This happens because cancer can cause people to die earlier, meaning fewer people make it to the age where they would typically retire early.
Source: OECD SPHeP NCDs model, 2024. See https://stat.link/01idxo.
While cancer care has improved significantly over the past decades, large and unwarranted variation in cancer outcomes shows that there remains significant scope to improve cancer care. There are considerable differences in outcomes within countries (Box 1.2) as well as between countries. For example, there is more than seven‑fold variation in lung cancer survival rates across OECD and EU countries, ranging from 5% in Chile to 33% in Japan (Figure 1.3). Survival rates for colon cancer vary more than two‑fold, from 35% in Colombia to 72% in Cyprus. Survival rates for breast cancer are higher on average and there is only 1.3‑fold variation across OECD and EU countries. Nevertheless, in Colombia and Lithuania only 7 in 10 women survive for five years after being diagnosed with breast cancer, while 9 in 10 survive in the United States and Cyprus.
Major risk factors for cancer are consistently more prevalent among people with lower socio‑economic characteristics, such as lower income and education levels (OECD, 2024[4]). One example is smoking. Smoking – a major risk factor for cancer – is notably more prevalent among people with a lower education: on average in the EU, 19% of people with lower secondary education or less smoked daily, compared to 13% of people with tertiary education (Eurostat, 2022[5]). This is reflected in lung cancer rates, the primary cancer associated with smoking. Preliminary findings from the EUCanIneq study show that lung cancer mortality rates were 2.6 times higher among men with lower education compared to men with higher education, and 1.7 times higher among women with lower levels of education (OECD, 2024[4]).
In addition to differences in risk factors, differences in preventive care can also contribute to inequalities across population groups. On average, people with lower education or income levels are less likely to participate in screening (OECD, 2024[4]). For example, women with lower income are twice as likely to miss out on breast cancer screening: only 7.3% of EU women in the highest income quintile report never having had an X-ray breast examination, compared to 15.2% of women in the lowest income quintile (Eurostat, 2023[6]). Similarly, people with higher educational attainment are more likely to participate in breast, cervical and colorectal cancer screening. Almost 80% of EU women with a tertiary education report having had a cervical smear test within the three years prior, compared to only 61% of women with lower secondary education or less. In some countries screening rates among women with higher education are more than double those of women with lower education (Eurostat, 2023[6]).
Age‑standardised 5‑year net survival (%) for colon, lung and breast cancer, 2010‑14
Source: Allemani, C. et al. (2018[7]), “Global surveillance of trends in cancer survival 2000‑14 (CONCORD‑3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries”, https://doi.org/10.1016/s0140-6736(17)33326-3. See https://stat.link/pa15yx.
The OECD SPHeP NCDs model was used to evaluate the potential impact of reducing variation in cancer survival rates. If all countries were to improve cancer screening, diagnosis and treatment to attain the best possible survival rates observed within the OECD and EU, a quarter of all premature deaths due to cancer could be prevented (25% and 26% in the OECD and EU, respectively) (Figure 1.4). This would increase life expectancy by half a year. It would also increase the workforce output by EUR PPP 7.3 billion in the OECD – roughly equivalent to half the annual gross domestic product of Malta (EUR PPP 2.7 billion in the EU).
The impact of achieving the highest cancer survival rates observed across the OECD and EU on premature mortality (deaths in people aged under 75) due to cancer per 100 000 population; and as a percentage of total premature mortality due to cancer; per year, average over 2023‑50
Note: Digestive includes liver, oesophageal, pancreatic, and stomach cancer; head and neck includes lip and oral cavity, larynx, other pharynx, and nasopharynx cancer; and other includes prostate, cervical cancer and malignant skin melanoma.
Source: OECD SPHeP NCDs model, 2024. See https://stat.link/nvqyks.
For mouth and throat cancer, around four in ten premature deaths (41%) could be avoided if the highest survival rates were to be attained across the 43 OECD and EU countries (Figure 1.5). Improved survival rates would also prevent around one in three premature deaths due to cervical cancer (36%) and skin melanoma (31%). However, in absolute terms the impact on lung cancer is by far the largest, with 61 000 premature deaths avoided every year – nearly 30% of the total impact – followed by 33 000 premature deaths due to colon cancer and 25 000 due to breast cancer.
The impact of improved cancer survival rates on premature mortality (deaths in people aged under 75), as percentage of total premature mortality and number of premature deaths per year, by cancer type, for the 43 OECD and EU countries combined, average over 2023‑50
Source: OECD SPHeP NCDs model, 2024. See https://stat.link/suvtb5.
Two of the three cancers for which improved survival rates would see the greatest impact on premature mortality – colon and breast – are also the ones for which most OECD and EU countries have screening programmes. Screening can be highly effective in increasing the survival rate. It is estimated that 10‑yearly colonoscopy may reduce mortality from colorectal cancer by 73% (Zheng et al., 2023[8]), and that effective breast cancer screening in women aged 60‑69 may reduce their risk of dying from breast cancer by 33% (Nelson et al., 2016[9]). Despite these benefits, there are considerable differences in screening rates across countries (Figure 1.6). Breast cancer screening rates vary four‑fold, from 20% in Mexico to 83% in Denmark, and colorectal cancer screening rates 28‑fold, from 3% in Hungary and 79% in Finland.
Population coverage of breast, cervical and colorectal cancer screening programmes, 2021
1. Programme data. 2. Survey data. Breast cancer: Mammography screening in women aged 50‑69 within the past two years; Cervical cancer: Cervical cancer screening in women aged 20‑69 within the past three years; Colorectal cancer: colorectal cancer screening coverage of population aged 50‑74 who report having had faecal occult blood tests over the past two years.
Source: OECD Health Statistics 2023. See https://stat.link/675f0v.
There are various approaches to increase screening uptake. Invitation by a general practitioner (GP) letter rather than another authority, letters with fixed appointments rather than open invitations (OECD, 2020[10]), and personalised invitations compared to standard invitations were all more successful in encouraging uptake (Staley et al., 2021[11]). Including information in languages other than the primary language can help reach non-native speakers (OECD, 2020[10]). Reminders have also been shown to increase uptake, with reminders delivered by letter or email even more effective than phone call or text message. Facilities with flexible appointment times and with female providers were shown to have higher uptake of breast and cervical cancer screening (Plourde et al., 2016[12]). For women who are uncomfortable seeing a health worker for a cervical smear test, self-testing can help. HPV self-testing was found to be effective in increasing uptake among lower socio‑economic groups in France (Sancho-Garnier et al., 2013[13]). Interventions using lay health advisors, where trusted individuals from a specific community (e.g. ethnic minority groups) are trained to provide education to others in the community, have also been shown to increase uptake (Rees et al., 2018[14]).
In addition to improving screening, countries should improve early diagnosis and access to effective treatment to give patients the best chance for survival (Box 1.3). Early diagnosis can be improved by increasing awareness of the initial signs of cancer among patients and doctors, and improve referral from primary care through to specialist oncology care can help to reduce treatment delays. To increase access to effective treatments, policy makers can look at redesigning co-payment policies, introducing collaborative Health Technology Assessment, improving the use of targeted treatments by increasing access to companion diagnostics and next generation sequencing technologies, and establishing Comprehensive Cancer Centres.
Early diagnosis and access to effective treatment are crucial elements to give patients the best chance for survival from a cancer. Some of the policies implemented by OECD countries to improve quality of care include:
Electronic clinical decision support tools (eCDSTs) in cancer: The diagnosis of cancer in primary care can be complex and challenging as patients can present with non-specific symptoms (Astin et al., 2011[15]; Chima et al., 2019[16]). eCDSTs use epidemiological data, symptoms and test results to improve cancer diagnosis (Chima et al., 2019[16]; OECD, 2024[4]). Information on the patient is entered into the eCDST by the GP, or automatically populated from the patient’s electronic health record. Based on an algorithm, the eCDST then produces recommendations, prompts, or alerts for the GP to consider (Chima et al., 2019[16]).
Improved referral from primary care through to specialist oncology: Several countries such as Denmark, Ireland, Latvia, Lithuania, Poland, Slovenia and Sweden have developed fast track referral mechanisms (OECD, 2024[4]). Latvia introduced fast-track access for people with cancer (called the green corridor) in 2016. It is paid in full by the state budget and aims to streamline diagnosis and treatment decisions for suspected cancer cases by requiring specialist consultation and diagnostic examination within ten working days of the date of referral (OECD, 2024[4]). Access to cancer care improved, and the proportion of people diagnosed at early stages increased from 50% in 2015 to 55% in 2017 (OECD, 2023[17]; OECD, 2024[4]).
Encouraging the entry and use of generics and biosimilars: When the originator product has gone off patent or lost market exclusivity, the use of generics and biosimilars is becoming increasingly important in lowering prices for oncology treatments (OECD, 2024[4]). Nevertheless, there are still important country differences in the proportion of biosimilars being reimbursed. The mean time from EMA approval to public reimbursement/coverage of biosimilars also exhibited great variation between countries.
Increasing access to targeted therapies: To be able to effectively use new, targeted treatments, governments need to ensure access to their companion diagnostic. A companion diagnostic identifies whether a patient has a certain genetic feature, and would benefit from a specific targeted treatment. Fewer than half of EU countries currently have an automatic link between the coverage/reimbursement decision for a medicine and its companion diagnostic, meaning that it is possible that a treatment is covered by insurance while its companion diagnostic is not (Hofmarcher, Berchet and Dedet, 2024[18]).
Establishing Comprehensive Cancer Centres (CCCs): CCCs, which combine comprehensive, multidisciplinary care with research and education, can provide high-quality cancer care. In Europe, the Organization of European Cancer Institutes (OECI) and the European Academy of Cancer Sciences have established complementary quality accreditation systems to test the clinical and research excellence of CCCs (Oberst, 2019[19]). A benefit of these centres is increased collaboration in innovative clinical trials. For example, in Finland, four CCCs are working together on a clinical trial to determine the efficacy and toxicity of targeted anticancer drugs (OECD, 2023[20]; ClinicalTrials.gov, 2023[21]).
Continuing to improve outcomes for cancer patients is imperative. However, the financial burden associated with a more effective management of the disease would also place a significant strain on healthcare systems worldwide. The rising cancer burden due to population ageing alone – assuming that the incidence and survival rates of cancer per age group remains unchanged – is estimated to increase the per capita cancer health expenditure by 67% between 2023 and 2050 on average in the OECD (Figure 1.7). In the scenario where survival rates are aligned to the best performing country in the OECD and EU, there is an additional 15% increase in per capita cancer health expenditure in the OECD. This is solely due to people living longer with cancer and requiring treatment for longer, and potentially being diagnosed with cancer again, and does not assume any additional costs associated with the improved outcomes.
The percentage increase in per capita cancer health expenditure due to population ageing and improved cancer survival rates, in 2050 vs. 2023
Source: OECD SPHeP NCDs model, 2024. See https://stat.link/4cykpo.
In addition, new medicines and technologies can lead to higher treatment cost (Box 1.4), and additional cost will be associated with providing follow-up care for a growing number of cancer survivors. As the trajectory of cancer treatment costs continues to rise, driven by population ageing, improved care and new technologies, optimising prevention strategies becomes even more urgent to ensure the sustainability of health services.
Recent years and decades have witnessed rising prices of new cancer medicines (Chapman, Paris and Lopert, 2020[22]). Moreover, newer drug classes of targeted therapies and immunotherapies may complement rather than replace older chemotherapy options, and tend to have longer treatment durations, which increases the costs per patient per treatment (Hofmarcher, Berchet and Dedet, 2024[18]). This has resulted in a growing spend on cancer drugs, which is expected to continue: between 2024 and 2028, global spending on oncology drugs is expected to grow by 14 to 17% per year, while most other drug classes are growing in mid-single digits (Figure 1.8) (IQVIA, 2024[23])..
USD billions
Source: IQVIA Institute for Human Data Science (2024[23]), Global Use of Medicines: Outlook to 2028, https://www.iqvia.com/-/media/iqvia/pdfs/institute-reports/the-global-use-of-medicines-2024-outlook-to-2028/iqvia-institute-global-use-of-medicines-2024-forweb.pdf. See https://stat.link/5dlnvy.
However, it has been argued that it is not always guaranteed that high prices of novel medicines are justified by the health benefits they confer (OECD, 2018[24]; Brinkhuis et al., 2024[25]). To manage the budget impact, it is critical to ensure “value‑for-money” through the systematic use of health technology assessment (HTA) in the pricing and reimbursement process of new cancer drugs. When it comes to making decisions on reimbursement or coverage of new cancer medicines, 21 out of 27 OECD and EU countries indicate that the budget impact is increasingly important. While the increasing number of cancer patients and new cancer drugs contribute to this, most countries point to the rising prices of new medicines as the driver (Figure 1.9).
Countries indicating that the budget impact of new cancer medicines has become more important for public coverage/reimbursement decisions in the last five years; based on responses from 27 countries (multiple options possible per country)
Note: Even if countries did not indicate an increasing importance of the budget impact for coverage/reimbursement decisions, it does not mean that the budget impact is not a concern in these countries. In Estonia, the importance of the budget impact has remained at the same level, yet the impact of higher prices of medicines on the financing of the budget has increased. In Iceland, the budget impact has been important for a long time, especially in the aftermath of the financial crisis in 2008 but has become less important – yet remaining important overall – as the country recovered financially.
Source: Hofmarcher, T., C. Berchet and G. Dedet (2024[18]), “Access to oncology medicines in EU and OECD countries”, https://doi.org/10.1787/c263c014-en. See https://stat.link/4kzw8x.
Scaling up action to prevent the development of cancer will be crucial to alleviate the strain on healthcare systems by reducing the demand for medical services and promoting more efficient allocation of resources. Even more importantly, by investing in prevention, individuals are saved the physical, emotional, and financial tolls associated with cancer, leading to healthier, happier lives. Additionally, healthier societies are more productive, and benefit the economy. Overall, prioritising prevention aligns with principles of sustainability, efficiency, and social responsibility, ultimately contributing to stronger, more resilient societies.
Around 40% of all cancer cases can be prevented by adopting healthier lifestyles and protection from harmful exposures (WHO, n.d.[26]; European Commission, 2021[27]). Ambitious targets on cancer risk factors, and strong policy action to achieve them, should therefore be a cornerstone of the battle against cancer. Six major behavioural risk factors that should be considered in any cancer prevention strategy are tobacco use, harmful alcohol use, diet, air pollution, overweight and obesity, and low physical activity.
Progress on addressing these risk factors has been mixed. Tobacco smoking is the leading cause of cancer, and between 2011 and 2021, almost all countries saw a decrease in smoking prevalence (Figure 1.10). However, smoking remains common in the OECD, with 16% of adults smoking daily in 2021. The greatest drops were seen in countries where rates were already lower. As a result, differences between countries have increased, and rates now vary nearly four‑fold across OECD countries.
Population aged 15 and over smoking daily, 2011 and 2021 (or nearest years)
1. Data from 2019. 2. Data from 2017‑18.
Source: OECD Health Statistics 2023. See https://stat.link/fqoun5.
Contrary to tobacco smoking, alcohol consumption has changed little over the past decade. The average per capita consumption in the OECD has gone from 8.9 litres in 2011 to 8.6 in 2021; and in around 40% of countries the consumption of alcohol increased (OECD, 2023[28]). Other cancer risk factors also remain prevalent in the OECD (Table 1.1). On average, only 15% of adults in the OECD eats at least five portions of fruit and vegetables daily, ranging from 2% to 33% (OECD, 2023[28]). Overweight and obesity have been increasing, and in most OECD countries, over half of the population is now either overweight or obese. Only 40% of adults in the OECD meets the WHO recommended 150 minutes of physical activity per week, ranging across countries from 5% to 76%. Despite some progress, in 2020 all OECD countries except Finland had air pollution levels above the WHO guideline of 5μg/m3, with five‑fold variation across countries (OECD, 2024[4]).
Daily tobacco smoking rates among population aged 15 and over, 2021 (or nearest year); Alcohol consumption in litres per capita among population aged 15 and over, 2021 (or nearest year); Self-reported overweight and obese adults (BMI>25), 2021 (or nearest year); Proportion of adults reporting spending at least 150 min per week on physical activity, 2021 or most recent (2019 for EU countries); Daily consumption of five or more portions of fruit and vegetables among adults, 2019 (or nearest year); Mean annual population exposure to fine particulates (PM2.5), 2020
Note: For each risk factor, the best performance is coloured green, the worst in red, and points in between are coloured proportionally. Grey means missing data.
Source: OECD (2023[28]), Health at a Glance 2023: OECD Indicators, https://www.doi.org10.1787/7a7afb35-en/; OECD (2024[29]), OECD Data Explorer: Exposure to air pollution ; OECD (2024[30]), Beating Cancer Inequalities in the EU: Spotlight on Cancer Prevention and Early Detection https://www.doi.org/10.1787/14fdc89a-en.
Various global or international policy targets have been set to encourage countries to take action to address risk factors (Table 1.2). These policy targets were used in the OECD SPHeP NCDs model to evaluate the potential impact of addressing risk factors on cancer. This analysis estimates that achieving the policy targets for the six risk factors together could prevent around 8% of all cancer cases, 12% of premature deaths due to cancer, and reduce the burden of cancer on health expenditure by 9% (Figure 1.11).
Note: For more details on the policy targets, see Chapter 5.
Source: OECD analysis of European Commission (2021[27]), Europe’s Beating Cancer Plan (2021[27]), https://health.ec.europa.eu/document/download/26fc415a-1f28-4f5b-9bfa-54ea8bc32a3a_en; WHO (2013[31]), Global action plan for the prevention and control of noncommunicable diseases 2013‑20, https://iris.who.int/handle/10665/94384; WHO (2018[35]), Global action plan on physical activity 2018‑2030, https://iris.who.int/handle/10665/272722; WHO (2022[36]), Seventy-fifth World Health Assembly: Resolutions and decisions annexes, https://iris.who.int/handle/10665/365610; WHO (2021[37]), Global alcohol action plan: Second draft, unedited, www.who.int/publications/m/item/global-alcohol-action-plan-second-draft-unedited; EAT-Lancet Commission (2019[38]); Food Planet Health: Healthy Diets From Sustainable Food Systems – Summary Report, https://eatforum.org/eat-lancet-commission/eat-lancet-commission-summary-report/; WHO (2022[39]) WHO manual on sugar-sweetened beverage taxation policies to promote healthy diets, https://iris.who.int/handle/10665/365285; Bennett, J. et al. (2020[40]), “NCD Countdown 2030: pathways to achieving Sustainable Development Goal target 3.4”, https://doi.org/10.1016/s0140-6736(20)31761-x; European Parliament (2023[41]), Texts adopted – Ambient air quality and cleaner air for Europe, www.europarl.europa.eu/doceo/document/TA-9-2023-0318_EN.html; WHO (2021[34]), WHO global air quality guidelines: particulate matter (PM2.5 and PM10), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide, https://apps.who.int/iris/handle/10665/345329; WHO (2024[32]), Global Alcohol Action Plan 2022‑2030, https://iris.who.int/handle/10665/376939.
Cancer cases prevented (thousands and as a percentage of total number of cancer cases), premature cancer deaths avoided (thousands and as a percentage of total cancer premature mortality), and cancer health expenditure saved (EUR PPP billions and as a percentage of total burden of cancer on health expenditure) if policy targets on key cancer risk factors were achieved, total for OECD countries, per year, average over 2023‑50
Source: OECD SPHeP NCDs model, 2024. See https://stat.link/36fizb.
Action on tobacco smoking remains a fundamental element of any cancer prevention strategy, despite the progress that has already been made. Tobacco accounts for 40‑60% of the total impact of action on risk factors across the different outcomes. If the policy target on tobacco were achieved, countries would prevent 151 000 cases of cancer per year in the OECD (67 000 in the EU), and 56 000 premature deaths per year – 6.1% of total premature mortality due to cancer (28 000 and 7.8% in the EU). It would also save health systems EUR PPP 13.3 billion each year in cancer health expenditure – 3.0% of total burden of cancer on health expenditure – more than the total annual health budget of Hungary.
However, it is crucial that policy makers go beyond tobacco control, and develop cancer prevention strategies that effectively target a wider set of risk factors. This includes more ambitious targets on physical activity and obesity. The results presented here are based on the international policy target set for each risk factor, and the relatively small impact from addressing obesity and physical activity is in part a reflection of the limited ambition of these targets. While reaching the target on tobacco (a 30% relative reduction in tobacco use by 2025 versus 2010, and that less than 5% of the population using tobacco by 2040) would see a considerable impact on smoking rates, the target on obesity (to reduce current levels of obesity down to those observed in 2010) would do little to tackle high obesity levels.
The air pollution target would have seen greater impact if its timeline was shorter. For most other risk factors, the scenarios reach their target value by 2025 or 2030. For air pollution, the current policy targets aims to achieve a level of 10 µg/m³ by 2030 and the WHO Global Air Quality Guideline of 5 µg/m³ by 2050 (European Parliament, 2024[33]), which is reflected in the analyses as a linear decrease over time to reach the two targets. Moreover, under the current EU proposal, the 2030 deadline to achieve the intermediary target of 10 µg/m³ can be postponed by ten years under certain circumstances, which would further reduce the impact on cancer.
Stronger action is also needed to achieve these targets. It is estimated that, of OECD, G20 and EU countries, only Estonia and Latvia have a 20% or greater chance of reaching the obesity target for women under a business-as-usual situation. No country in the OECD, G20 or EU has a greater than 5% chance of reaching the target for men in absence of stronger policy action (World Obesity Federation, 2020[42]). The WHO Global Status Report on Physical Activity 2022 found that, if current physical activity trends continue, the global target of a 15% relative reduction in physical inactivity by 2030 will not be met (WHO, 2022[43]). And while the average PM2.5 exposure level fell from 17.5 to 11.6 µg/m³ between 2000 and 2020 in OECD countries, this is still well above the final target of 5 µg/m³ by 2050, or the 10 µg/m³ by 2030 (or 2040 under certain circumstances) target for EU Member States (OECD, 2024[4]).
Stronger action on risk factors would not just benefit cancer. All of these risk factors are linked to other non-communicable diseases (NCDs), including cardiovascular disease, diabetes, chronic respiratory disease, dementia and depression. Action on risk factors would therefore have an additional impact on disease incidence, mortality and healthcare cost through other NCDs. It would also increase workforce productivity and contribute to a higher GDP.
In addition, policies on harmful alcohol use and diet would provide societal benefits to the environment (Box 1.5) and safety. Across the OECD, it would prevent 5 645 premature deaths due to interpersonal violence each year, as well as 9 246 premature deaths due to road traffic accidents (309 and 2065 in the EU). For both this is around 10% of the total number of premature deaths from these causes.
There are strong links between our diet and the environment. About one‑third of all anthropogenic (human-caused) greenhouse gas (GHG) emissions are linked our food system (Crippa et al., 2021[44]). This includes land-use, production (farming and harvesting), processing, transporting and distribution, packaging, cooking and disposing of waste. To reflect the relationship between diet and the environment, the OECD SPHeP NCDs model links the dietary factors to GHG emissions, using data from the WHO Diet Impact Assessment model (WHO, 2023[45]).
If everyone in the OECD were to adhere to the diet policy targets, this is estimated to reduce GHG emissions by 304 Mt of carbon dioxide (CO2) equivalent per year (56 in the EU). This is the amount of GHG associated with more than 72 million gasoline‑powered passenger vehicles (13 million in the EU) (EPA, 2024[46]), or the number of cars in Germany and Spain combined.
As meat has one of the largest footprints when it comes to GHG emissions, countries with a higher baseline consumption of meat generally see a greater impact on per capita GHG emissions from meeting the diet policy targets (Figure 1.12). However, other factors also influence the relative impact: Argentina’s baseline consumption of meat is average, but a high proportion of meat consumption is beef (as opposed to pork or lamb, which have lower emission footprints). In addition, Argentina has relatively high emissions per kilo of beef due to local production inputs and methods. As a result, the per capita impact in Argentina is much higher than for other countries.
Change in per capita GHG emissions, kgCO2‑eq per year, average over 2023‑50
Note: Differences between countries are influenced by baseline consumption of target food groups, mix of animal products consumed, and the country-specific emission intensity of the food groups.
Source: OECD SPHeP NCDs model, 2024, and WHO (2023[45]) Diet Impact Assessment model. See https://stat.link/s8690n.
In countries where meat, and in particular beef, consumption is low, the additional GHG emissions from increased fruit, vegetables and whole grain consumption can outweigh the reduction related to meat. In this case, GHG emissions can increase under the diet policy target. However, it is important to note that the scenario assumes no substitution, and that any increase in consumption is on top of current dietary intake. For whole grain, an increase in consumption is likely to come from substituting processed grain, rather than additional grain consumption to meet the whole grain target. In that case, the amount of raw product needed will not be substantially affected, and the impact on GHG emissions would in fact be minimal.
A wide range of effective policies exist to address the major risk factors of cancer and reap the many benefits (Table 1.3). The least intrusive policies increase the choices available to people or decrease the cost of certain choices. For example, improving cycling and walking infrastructure can increase physical activity and reduce air pollution. Policies can also modify preferences through persuasion or provision of information; or by increasing the price of certain choices. Finally, there is the option to regulate, up to forbidding, certain options. This can be selective or partial, such as forbidding to smoke or the sale of alcohol to underage people.
Note: This table aims to provide examples of different policies across risk factors, and is not exhaustive. Policies with an * are part of the WHO NCD Best Buys to tackle NCDs. However, this does not imply that the other policies are not cost-effective and feasible.
Source: Sassi, F. and J. Hurst (2008[47]), “The prevention of lifestyle‑related chronic diseases: an economic framework”, https://doi.org/10.1787/243180781313; WHO (2003[48]), WHO Framework Convention on Tobacco Control, https://iris.who.int/handle/10665/42811; European Commission (2021[49]), “Pathway to a Healthy Planet for All EU Action Plan: ‘Towards Zero Pollution for Air, Water and Soil’”, Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions, https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=COM%3A2021%3A400%3AFIN; OECD (2021[50]), Preventing Harmful Alcohol Use, https://doi.org/10.1787/6e4b4ffb-en; WHO (2018[35]), Global action plan on physical activity 2018‑2030: more active people for a healthier world, https://iris.who.int/handle/10665/272722; OECD (2019[51]), The Heavy Burden of Obesity: The Economics of Prevention, https://doi.org/10.1787/67450d67-en; WHO (2015[52]), Fiscal policies for diet and prevention of noncommunicable diseases: technical meeting report, https://iris.who.int/handle/10665/250131; Gelius, P. et al. (2020[53]), “What are effective policies for promoting physical activity? A systematic review of reviews”, https://doi.org/10.1016/j.pmedr.2020.101095; OECD/WHO (2023[54]), Step Up! Tackling the Burden of Insufficient Physical Activity in Europe, OECD Publishing, Paris, https://doi.org/10.1787/500a9601-en; WHO (2023[55]), More ways, to save more lives, for less money: World Health Assembly adopts more Best Buys to tackle noncommunicable diseases, https://www.who.int/news/item/26-05-2023-more-ways--to-save-more-lives--for-less-money----world-health-assembly-adopts-more-best-buys--to-tackle-noncommunicable-diseases.
Vaccines against human papillomavirus (HPV) infection are safe and highly effective in preventing infection with HPV, and the cancers it causes. As a result, they have been added to the national immunisation programmes of nearly all OECD and EU countries. However, the population coverage remains low: only four OECD countries (Spain, Portugal, Chile and Norway) achieved the target of vaccinating at least 90% of girls in 2022 (Figure 1.13). While the average coverage in the OECD was 69% in 2022 (EU 56%), this varied from 8% in Japan to 96% in Norway.
HPV vaccination programme coverage, first dose, females, in 2017 and 2022
Note: Averages for 2017 covers 20 EU countries and 31 OECD countries, while the 2022 average includes 22 EU and 34 OECD countries.
Optimally implemented vaccination schemes could prevent between 84% and 92% of all cervical cancer cases, and 89% of all premature mortality due to cervical cancer (Figure 1.14). It would also reduce the total burden of cancer on health expenditure by 1.3% on average in OECD (1.6% in the EU), and add the equivalent of 120 000 full-time workers to the OECD workforce (40 000 to the EU). In monetary terms, this equates to a workforce output of EUR PPP 5.7 billion per year in the OECD (EUR PPP 1.6 billion in the EU).
Impact of HPV vaccination on premature mortality (deaths in people aged under 75) due to cervical cancer, per 100 000 population and as a percentage of total premature mortality due to cervical cancer, per year, average over 2023‑50*
Note: *Estimates cover the period 2023‑50, but they assume optimal coverage and protection from cervical cancer from the beginning. In other words, they reflect the maximum potential impact of HPV vaccination, and not a scenario where optimal vaccine uptake is achieved over time, and where the protective effect against cervical cancer is observed down the line. For more information on the methodology, see Annex 6.A of Chapter 6.
Source: OECD SPHeP NCDs model, 2024, using inputs from the ATLAS model by IARC; Bonjour, M. et al., (2021[57]), “Global estimates of expected and preventable cervical cancers among girls born between 2005 and 2014: a birth cohort analysis”, https://doi.org/10.1016/S2468-2667(21)00046-3. See https://stat.link/u1je89.
To benefit fully from the impact of HPV vaccination on population health, healthcare expenditure and workforce productivity, countries should increase uptake and coverage by:
Evaluating the benefits and challenges of adopting a single‑dose schemes and considering its implementation based on the national circumstances: while initially a two‑dose schedule was advised, a single‑dose schedule has recently been found to provide sufficient protection for the primary target of young girls (excluding immunocompromised or HIV-infected people). Moving to a single‑dose schedule could provide various benefits, including cost-savings, simplified logistics and increased acceptability by the public.
Considering catch-up vaccination if and where needed: Catch-up vaccination targets individuals who have not received doses of the vaccine for which they are eligible. This can increase coverage, while improving the resilience of the programme against interruptions.
Addressing misinformation: Misinformation is a powerful threat to vaccination campaigns, including for HPV. To address this, comprehensive multimedia campaigns are needed, which address the specific concerns of parents; monitor and engage with social media; and benefit from wide and authoritative support.
References
[7] Allemani, C. et al. (2018), “Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries”, The Lancet, Vol. 391/10125, pp. 1023-1075, https://doi.org/10.1016/s0140-6736(17)33326-3.
[15] Astin, M. et al. (2011), “The diagnostic value of symptoms for colorectal cancer in primary care: a systematic review”, British Journal of General Practice, Vol. 61/586, pp. e231-e243, https://doi.org/10.3399/bjgp11X572427.
[40] Bennett, J. et al. (2020), “NCD Countdown 2030: pathways to achieving Sustainable Development Goal target 3.4”, The Lancet, Vol. 396/10255, pp. 918-934, https://doi.org/10.1016/s0140-6736(20)31761-x.
[57] Bonjour, M. et al. (2021), “Global estimates of expected and preventable cervical cancers among girls born between 2005 and 2014: a birth cohort analysis”, The Lancet Public Health, Vol. 6/7, pp. e510-e521, https://doi.org/10.1016/S2468-2667(21)00046-3.
[25] Brinkhuis, F. et al. (2024), “Added benefit and revenues of oncology drugs approved by the European Medicines Agency between 1995 and 2020: retrospective cohort study”, BMJ, p. e077391, https://doi.org/10.1136/bmj-2023-077391.
[22] Chapman, S., V. Paris and R. Lopert (2020), “Challenges in access to oncology medicines: Policies and practices across the OECD and the EU”, OECD Health Working Papers, No. 123, OECD Publishing, Paris, https://doi.org/10.1787/4b2e9cb9-en.
[16] Chima, S. et al. (2019), “Decision support tools to improve cancer diagnostic decision making in primary care: a systematic review”, British Journal of General Practice, Vol. 69/689, pp. e809-e818, https://doi.org/10.3399/bjgp19X706745.
[21] ClinicalTrials.gov (2023), The Finnish National Study to Facilitate Patient Access to Targeted Anti-cancer Drugs (FINPROVE), Bethesda (MD): U.S. National Library of Medicine, https://classic.clinicaltrials.gov/ct2/show/study/NCT05159245 (accessed on 18 December 2023).
[44] Crippa, M. et al. (2021), “Food systems are responsible for a third of global anthropogenic GHG emissions”, Nature Food, Vol. 2/3, pp. 198-209, https://doi.org/10.1038/s43016-021-00225-9.
[38] EAT-Lancet Commission (2019), Food Planet Health: Healthy Diets From Sustainable Food Systems - Summary Report, EAT, https://eatforum.org/eat-lancet-commission/eat-lancet-commission-summary-report/.
[46] EPA (2024), Greenhouse Gas Equivalencies Calculator, https://www.epa.gov/energy/greenhouse-gas-equivalencies-calculator#results (accessed on 6 May 2024).
[27] European Commission (2021), Europe’s Beating Cancer Plan, https://ec.europa.eu/health/system/files/2022-02/eu_cancer-plan_en_0.pdf.
[49] European Commission (2021), “Pathway to a Healthy Planet for All EU Action Plan: ’Towards Zero Pollution for Air, Water and Soil’”, Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions, https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=COM%3A2021%3A400%3AFIN.
[33] European Parliament (2024), Air pollution: Deal with Council to improve air quality, https://www.europarl.europa.eu/news/en/press-room/20240219IPR17816/air-pollution-deal-with-council-to-improve-air-quality (accessed on 26 February 2024).
[41] European Parliament (2023), Texts adopted - Ambient air quality and cleaner air for Europe, https://www.europarl.europa.eu/doceo/document/TA-9-2023-0318_EN.html.
[6] Eurostat (2023), Cancer screening statistics, https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Cancer_screening_statistics#Breast_cancer_screening (accessed on 25 October 2023).
[5] Eurostat (2022), Daily smokers of cigarettes by sex, age and educational attainment level, https://ec.europa.eu/eurostat/databrowser/view/hlth_ehis_sk3e/default/table?lang=en (accessed on 27 October 2023).
[53] Gelius, P. et al. (2020), “What are effective policies for promoting physical activity? A systematic review of reviews”, Preventive Medicine Reports, Vol. 18, p. 101095, https://doi.org/10.1016/j.pmedr.2020.101095.
[18] Hofmarcher, T., C. Berchet and G. Dedet (2024), “Access to oncology medicines in EU and OECD countries”, OECD Health Working Papers, No. 170, OECD Publishing, Paris, https://doi.org/10.1787/c263c014-en.
[1] IARC (2022), Global Cancer Observatory, International Agency for Research on Cancer, https://gco.iarc.fr/ (accessed on 10 March 2022).
[2] IHME (2019), GBD Results Tool, http://ghdx.healthdata.org/gbd-results-tool (accessed on 25 October 2018).
[23] IQVIA (2024), Global Use of Medicines: Outlook to 2028, https://www.iqvia.com/-/media/iqvia/pdfs/institute-reports/the-global-use-of-medicines-2024-outlook-to-2028/iqvia-institute-global-use-of-medicines-2024-forweb.pdf.
[3] Murray, C. et al. (2020), “Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019”, The Lancet, Vol. 396/10258, pp. 1223-1249, https://doi.org/10.1016/s0140-6736(20)30752-2.
[9] Nelson, H. et al. (2016), “Effectiveness of Breast Cancer Screening: Systematic Review and Meta-analysis to Update the 2009 U.S. Preventive Services Task Force Recommendation”, Annals of Internal Medicine, Vol. 164/4, p. 244, https://doi.org/10.7326/m15-0969.
[19] Oberst, S. (2019), “Bridging research and clinical care – the comprehensive cancer centre”, Molecular Oncology, Vol. 13/3, pp. 614-618, https://doi.org/10.1002/1878-0261.12442.
[4] OECD (2024), Beating Cancer Inequalities in the EU: Spotlight on Cancer Prevention and Early Detection, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/14fdc89a-en.
[30] OECD (2024), Beating Cancer Inequalities in the EU: Spotlight on Cancer Prevention and Early Detection, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/14fdc89a-en.
[29] OECD (2024), Exposure to air pollution, https://data-explorer.oecd.org.
[20] OECD (2023), EU Country Cancer Profile: Finland 2023, EU Country Cancer Profiles, OECD Publishing, Paris, https://doi.org/10.1787/427186d4-en.
[17] OECD (2023), EU Country Cancer Profile: Latvia 2023, EU Country Cancer Profiles, OECD Publishing, Paris, https://doi.org/10.1787/3b2c7642-en.
[28] OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/7a7afb35-en.
[50] OECD (2021), Preventing Harmful Alcohol Use, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/6e4b4ffb-en.
[10] OECD (2020), OECD Reviews of Public Health: Latvia, OECD Publishing, https://doi.org/10.1787/e9f33098-en.
[51] OECD (2019), The Heavy Burden of Obesity: The Economics of Prevention, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/67450d67-en.
[24] OECD (2018), Pharmaceutical Innovation and Access to Medicines, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/9789264307391-en.
[54] OECD/WHO (2023), Step Up! Tackling the Burden of Insufficient Physical Activity in Europe, OECD Publishing, Paris, https://doi.org/10.1787/500a9601-en.
[12] Plourde, N. et al. (2016), “Contextual factors associated with uptake of breast and cervical cancer screening: A systematic review of the literature”, Women & Health, Vol. 56/8, pp. 906-925, https://doi.org/10.1080/03630242.2016.1145169.
[14] Rees, I. et al. (2018), “Interventions to improve the uptake of cervical cancer screening among lower socioeconomic groups: A systematic review”, Preventive Medicine, Vol. 111, pp. 323-335, https://doi.org/10.1016/j.ypmed.2017.11.019.
[13] Sancho-Garnier, H. et al. (2013), “HPV self-sampling or the Pap-smear: A randomized study among cervical screening nonattenders from lower socioeconomic groups in France”, International Journal of Cancer, pp. n/a-n/a, https://doi.org/10.1002/ijc.28283.
[47] Sassi, F. and J. Hurst (2008), “The prevention of lifestyle-related chronic diseases: an economic framework”, OECD Health Working Papers, No. 32, OECD Publishing, Paris, https://doi.org/10.1787/243180781313.
[11] Staley, H. et al. (2021), “Interventions targeted at women to encourage the uptake of cervical screening”, Cochrane Database of Systematic Reviews, Vol. 2021/9, https://doi.org/10.1002/14651858.CD002834.pub3.
[32] WHO (2024), Global Alcohol Action Plan 2022-2030, World Health Organization, https://iris.who.int/handle/10665/376939.
[56] WHO (2024), Immunization data, https://immunizationdata.who.int/global/wiise-detail-page/human-papillomavirus-(hpv)-vaccination-coverage?CODE=BGR&YEAR= (accessed on 4 April 2024).
[55] WHO (2023), More ways, to save more lives, for less money: World Health Assembly adopts more Best Buys to tackle noncommunicable diseases, World Health Organization, https://www.who.int/news/item/26-05-2023-more-ways--to-save-more-lives--for-less-money----world-health-assembly-adopts-more-best-buys--to-tackle-noncommunicable-diseases.
[45] WHO (2023), The Diet Impact Assessment model: a tool for analyzing the health, environmental and affordability implications of dietary change, World Health Organization Regional Office for Europe, https://iris.who.int/handle/10665/373835.
[43] WHO (2022), Global Status report on physical activity 2022, https://iris.who.int/bitstream/handle/10665/363607/9789240059153-eng.pdf?sequence=1 (accessed on 8 February 2024).
[36] WHO (2022), Seventy-fifth World Health Assembly: Resolutions and decisions annexes, World Health Organization, https://iris.who.int/handle/10665/365610.
[39] WHO (2022), WHO manual on sugar-sweetened beverage taxation policies to promote healthy diets, World Health Organization, https://iris.who.int/handle/10665/365285.
[37] WHO (2021), Global alcohol action plan: Second draft, unedited, World Health Organization, https://www.who.int/publications/m/item/global-alcohol-action-plan-second-draft-unedited.
[34] WHO (2021), WHO global air quality guidelines: particulate matter (PM2.5 and PM10), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide, World Health Organization, https://apps.who.int/iris/handle/10665/345329.
[35] WHO (2018), Global action plan on physical activity 2018-2030: more active people for a healthier world, World Health Organization, https://iris.who.int/handle/10665/272722.
[52] WHO (2015), Fiscal policies for diet and prevention of noncommunicable diseases: technical meeting report, World Health Organization, https://iris.who.int/handle/10665/250131.
[31] WHO (2013), Global action plan for the prevention and control of noncommunicable diseases 2013-2020, World Health Organization, https://iris.who.int/handle/10665/94384.
[48] WHO (2003), WHO Framework Convention on Tobacco Control, World Health Organization, https://iris.who.int/handle/10665/42811.
[26] WHO (n.d.), Preventing cancer, https://www.who.int/activities/preventing-cancer (accessed on 20 April 2024).
[42] World Obesity Federation (2020), Obesity: missing the 2025 global targets Trends, Costs and Country Reports March 2020, World Obesity Federation, https://data.worldobesity.org/publications/WOF-Missing-the-2025-Global-Targets-Report-FINAL-WEB.pdf.
[8] Zheng, S. et al. (2023), “Effectiveness of Colorectal Cancer (CRC) Screening on All-Cause and CRC-Specific Mortality Reduction: A Systematic Review and Meta-Analysis”, Cancers, Vol. 15/7, p. 1948, https://doi.org/10.3390/cancers15071948.