A lesson in cancer prevention from New York
In the March Supplement issue of the AJPM, Heather L.M. Dacus and colleagues at the New York State Department of Health (NYSDOH) in Albany, in collaboration with the CDC, describe a successful cancer prevention program conducted in two NYS counties.
Their program illustrates an important role of preventive medicine physicians in being the ambassadors of individual patient care to the population, here specifically in cancer prevention. Thus, known risk factors of cancer, such as tobacco use, poor nutrition, and sedentary lifestyle, as individual-level risk factors, are tackled at a population level for the most effective response. Isn’t this why we entered preventive medicine and public health in the first place?! We are in a unique position to implement tremendous positive change!
The study focused on the effects of a “common framework” with Division of Chronic Diseases at the NYSDOH, to enhance coordination and cooperation between different programs across the Division.
The NYSDOH carried out two community demonstration projects to “mobilize communities to be supportive of strategies that focus on policy, system, and environmental changes in order to reduce the risk of cancer among community residents.” Via existing (and strong) county community coalitions which consists of varied partners ranging from health care providers to local businesses, with support of the NYSDOH, each participant carried out respective roles in implementing evidence-based strategies to improve the population health of the community.
Beginning in January, 2013, these coalitions conducted three cancer prevention initiatives:
- Environmental change: increasing access to nutritious foods by improving food-procurement standards, with an aim to reduce obesity and, thus, contribute to cancer prevention.
- Systems change: eliminating formula feeding promotion in selected pediatric and obstetric offices so as to promote breast feeding. Breast feeding is linked with lower rates of childhood obesity and breast and ovarian cancer in breast-feeding mothers.
- Policy change: cooperating with municipalities (at least one) to improve leave policy of workers to remove obstacles to receiving timely routine cancer screening.
While evaluation of the program is essential in the long-term and we look forward to the authors publishing a follow-up, the first 6 months of the project have demonstrated successful implementation of key activities in the domains enumerated above, to a great extent.
NY has 106,000 cancer cases a year. While we, in Michigan, have only 53,000 (based on 2007 statistics: http://www.michigan.gov/documents/mdch/Ca_burden_MI_select_stats_1993-2011_371092_7.pdf), we also have about half the population of NY. For those of us currently doing or will be doing the rotation at the state-level (Michigan state) here, this article serves as an excellent model and resource as we evaluate our own cancer prevention/promotion approaches.