WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTÉ
EB65/PC/WP/7 5 November 1979 EXECUTIVE BOARD
Programme Committee of the Executive Board Sixty-fifth Session
Provisional agenda item 8 19-23 November 197 9
INDEXED
PROGRESS REPORT ON THE WORK OF THE DIRECTOR-GENE R A L1S COORDINATING COMMITTEE ON CÁNCER
The report outlines the work of the Director-General's
Coordinating Committee on Cancer from its establishement in April 1978 to October 1979. It reflects the Committee's role in dealing with programme policy issues and matters requiring coordination at the technical level.
1.1 In January 1977 the Executive Board decided in resolution EB59.R32 to set up an A d H o c Committee to make recommendations with respect to all activities of Ш 0 in the field of cancer.
1.2 In its report， which was presented to the sixty-first session of the Executive Board in January 1978 (document EB6l/22)，the Ad H o c Committee r e c o m m e n d e d , inter a l i a，t h a t the cancer programme within WHO headquarters and that of the International Agency for Research on Cancer
(IARC) should retain their separate identities, but should be better coordinated. F u r t h e r , for global coordination of the total p r o g r a m m e , it recommended the creation of a Director- General 1 s coordinating conmittee which should function on a permanent basis•
1.3 The proposed role of the coordinating committee was to dea,l with programme policy issues at a high level, covering the whole range of problems directly or indirectly connected with cancer prevention, control and research. The following terms of reference were suggested:
- t o draw up by mutual agreement the overall programme of cancer p r e v e n t i o n , control and research, assigning to each of the agencies involved the tasks appropriate to it;
- t o act jointly in adjusting that programme, in the course of its implementation to changes in circumstances；
- t o study the problems of overlapping - acceptable o r inadmissible；
- t o evaluate jointly the results of the overall programme.
1.4 It was recommended that I A R C , WHO headquarters, and the International Union against Cancer (UICC) should be appropriately represented on the coordinating c o m m i t t e e , which would define the objectives, m e t h o d o l o g i e s , responsibilities and budget for the coordinated programme.
The coordinating committee should function in a flexible m a n n e r , inviting representatives from the regions and other organizations whenever indicated, and should constantly evaluate its own effectiveness. Its achievements should be periodically reviewed by the Programme Committee of the Executive Board,
Introduction
E B 6 5 / P C / W P / 7 p a g e 2
1. 5 T h e A d H o c C o m m i t t e e1 s r e c o m m e n d a t i o n s w e r e a p p r o v e d by the E x e c u t i v e B o a r d in
r e s o l u t i o n E B 6 1 . R 2 9 , In a c c o r d a n c e w i t h that r e s o l u t i o n , the D i r e c t o r - G e n e r a l ' s C o o r d i n a t i n g C o m m i t t e e o n C a n c e r w a s e s t a b l i s h e d in A p r i l 1978 u n d e r the c h a i r m a n s h i p of the D i r e c t o r -
G e n e r a l , a n d w i t h a p p r o p r i a t e p a r t i c i p a t i o n o n the p a r t of W H O and I A R C . U I C C h a s b e e n i n v i t e d to p a r t i c i p a t e in the C o m m i t t e e1 s m e e t i n g s a n d a c t i v i t i e s to the e x t e n t c o n s i s t e n t w i t h its o w n f u n c t i o n s .
2• C o o r d i n a t i o n
2 . 1 T h r e e m e e t i n g s of t h e D i r e c t o r - G e n e r a l1 s C o o r d i n a t i n g C o m m i t t e e on C a n c e r h a v e b e e n h e l d , in J u n e 1978， A p r i l 1979 a n d O c t o b e r 1 9 7 9 , T h e s e m e e t i n g s of r e p r e s e n t a t i v e s of W H O , I A R C a n d U I C C h a v e p r o v i d e d v a l u a b l e o p p o r t u n i t i e s for d i s c u s s i o n s on p o l i c y m a t t e r s and the m e c h a n i s m to d e a l w i t h the r e c o m m e n d a t i o n s of the A d H o c C o m m i t t e e of the E x e c u t i v e B o a r d in its r e p o r t ( d o c u m e n t E B 6 l / 2 2 ) , w h i c h d e f i n e d the r e s p e c t i v e role and o b j e c t i v e s of W H O , I A R C a n d U I C C .
2.2 In p u r s u a n c e of t h e s e o b j e c t i v e s the C o o r d i n a t i n g C o m m i t t e e s o u g h t to reach a g r e e m e n t on the o v e r a l l p r o g r a m m e in s u p p o r t of n a t i o n a l e f f o r t s to f o r m u l a t e c a n c e r c o n t r o l p o l i c i e s . It d e t e r m i n e d to study t h e s e n a t i o n a l e f f o r t s to try to learn m o r e of w h a t c a n , a n d c a n n o t , be d o n e a t the i n t e r n a t i o n a l l e v e l . T h e C o m m i t t e e a l s o d e c i d e d to e x p l o r e w h e t h e r g u i d e l i n e s for f o r m u l a t i n g n a t i o n a l c a n c e r c o n t r o l p o l i c i e s could h e l p c o u n t r i e s w i t h limited r e s o u r c e s to r a t i o n a l i z e t h e i r c a n c e r p r o g r a m m e s .
2 . 3 In J a n u a r y 1 9 7 9 , f o l l o w i n g a r e v i e w of a s i t u a t i o n a n a l y s i s o n p r e s e n t c a n c e r a c t i v i t i e s c a r r i e d o u t in S r i L a n k a , T h a i l a n d , I r a q , K u w a i t a n d S u d a n by a j o i n t I A R c / w H O t e a m , the
C o o r d i n a t i n g C o m m i t t e e c o n v e n e d a w o r k i n g g r o u p w i t h p a r t i c i p a n t s f r o m W H O , I A R C and U I C C w h i c h f o r m u l a t e d g u i d e l i n e s f o r n a t i o n a l c a n c e r c o n t r o l a c t i v i t i e s and r e s e a r c h for p o s s i b l e u s e as a p r o t o c o l to d e v e l o p n a t i o n a l c a n c e r p o l i c i e s .
2 • 4 T h e g u i d e l i n e s c o n t a i n the m a i n o b j e c t i v e s a n d the b a s i c e l e m e n t s for a c o m m o n p r o t o c o l for c a n c e r c o n t r o l , as u n d e r s t o o d at p r e s e n t . T h e b a s i c e l e m e n t s a r e i n t e n d e d to serve as a f r a m e w o r k . E a c h m u s t be c o n s i d e r e d a n d d e v e l o p e d b y i n d i v i d u a l c o u n t r i e s in r e l a t i o n to the h e a l t h s e r v i c e s i n f r a s t r u c t u r e , a v a i l a b i l i t y of p e r s o n n e l , and a p p r o p r i a t e e q u i p m e n t and r e s o u r c e s . T h e p r o t o c o l p e r m i t s the n a t i o n a l h e a l t h a u t h o r i t i e s to p o s e r e l e v a n t q u e s t i o n s w i t h i n the l o c a l c o n t e x t a n d to s e l e c t p r i o r i t i e s .
2 . 5 T h e g u i d e l i n e s i n c o r p o r a t e the p r i n c i p l e that a p p r o a c h e s to the f o r m u l a t i o n of n a t i o n a l c a n c e r p l a n s s h o u l d e n s u r e the i n v o l v e m e n t of a l l levels of h e a l t h s e r v i c e s a n d a d m i n i s t r a t i o n . P l a n s s h o u l d b e b a s e d o n the e x i s t i n g h e a l t h s e r v i c e s i n f r a s t r u c t u r e , i n t o w h i c h the c a n c e r c o n t r o l p r o g r a m m e should be i n t e g r a t e d . T h e f o r m u l a t i o n and i m p l e m e n t a t i o n of a n a t i o n a l c a n c e r p o l i c y is a l o n g - r a n g e p r o c e s s , váiich m u s t f i r s t a t t e m p t to i d e n t i f y w h a t it is p o s s i b l e to a c h i e v e in the f i e l d of c a n c e r , arid the a s s o c i a t e d c o n s t r a i n t s ,
2 . 6 It w a s s u g g e s t e d that t h e s e a s p e c t s m i g h t b e u s e f u l l y e x p l o r e d by m e a n s of a s i m u l a t i o n e x e r c i s e in one or m o r e d e v e l o p i n g c o u n t r i e s . T h e s i m u l a t i o n e x e r c i s e , u t i l i z i n g the g e n e r a l g u i d e l i n e s , w o u l d be c a r r i e d out by s e l e c t e d c o u n t r y p a r t i c i p a n t s , t o g e t h e r w i t h an inter- n a t i o n a l t e a m c o n t a i n i n g m e m b e r s f r o m W H O , I A R C , a n d U I C C . Such e x e r c i s e s p e r f o r m e d in a n u m b e r of c o u n t r i e s , a n d t h e i r s u b s e q u e n t e v a l u a t i o n , w i l l p e r m i t a b e t t e r p e r s p e c t i v e f r o m w h i c h c o m m o n f e a t u r e s w i l l e m e r g e . It m a y b e p o s s i b l e , in spite of the v a r y i n g c o n d i t i o n s in d i f f e r e n t c o u n t r i e s , to e l a b o r a t e a b a s i c f r a m e w o r k for n a t i o n a l c a n c e r p l a n s for u s e in d e v e l o p i n g c o u n t r i e s •
2.7 A c c o r d i n g l y , a s i m u l a t i o n e x e r c i s e for the f o r m u l a t i o n of a n a t i o n a l p o l i c y and p r o g r a m m e f o r c a n c e r p r e v e n t i o n a n d c o n t r o l w a s c o m p l e t e d in Sri L a n k a d u r i n g a W H o / I A R C / U I C C team v i s i t f r o m 2 to 15 S e p t e m b e r 1 9 7 9 . It w a s b a s e d on i n f o r m a t i o n and data f r o m n a t i o n a l s t u d i e s , W H O m i s s i o n s d u r i n g 1978 a n d 1 9 7 9 , and d i s c u s s i o n s c o n c e n t r a t e d on p o l i c y m a t t e r s . A " N a t i o n a l p o l i c y a n d p r o g r a m m e for c a n c e r p r e v e n t i o n a n d c o n t r o l in Sri L a n k a " w a s f o r m u l a t e d by the N a t i o n a l A d v i s o r y a n d C o o r d i n a t i n g C o m m i t t e e for the C o n t r o l of C a n c e r , in c o n s u l t a t i o n w i t h t h e v i s i t i n g t e a m , u t i l i z i n g the g u i d e l i n e s for n a t i o n a l c a n c e r c o n t r o l a c t i v i t i e s and r e s e a r c h p r e p a r e d b y the W H o / I A R c / u i C C w o r k i n g g r o u p . T h e p o l i c y d o c u m e n t w i l l serve as the b a s i s for a c t i o n t a k e n by the G o v e r n m e n t in r e s p e c t to c a n c e r p r o b l e m s .
E B 6 5 / P C / W P / 7 p a g e 3
2.8 The simulation e x e r c i s e in Sri L a n k a h a s d e m o n s t r a t e d the scope for t e c h n i c a l c o o p e r a t i o n among n a t i o n a l p e r s o n n e l , W H O , IARC and U I C C . Other important p o i n t s concern the identifica- tion of topics worthy of f o l l o w - u p , and the lessons learned from the e x e r c i s e . T h e s e include the n e e d for n a t i o n a l a n a l y s i s i r r e s p e c t i v e of the m o d e l used ； the i d e n t i f i c a t i o n of social and a d m i n i s t r a t i v e problems in a d d i t i o n to the t e c h n i c a l p r o b l e m s ； and the c o n s t r a i n t s to the i n t r o d u c t i o n of m e a s u r e s for cancer p r e v e n t i o n . A m o n g the implications of the e x e r c i s e as a m o d e l for possible r e c o m m e n d a t i o n by W H O to other d e v e l o p i n g c o u n t r i e s interested in f e m u - lating a n a t i o n a l cancer control policy is the need for w i d e f l e x i b i l i t y in a p p l y i n g the m o d e l , 2•9 Cancer statistics w a s a f u r t h e r topic for d i s c u s s i o n s on c o o r d i n a t i o n by the Coordinating C o m m i t t e e , since b o t h W H O and IARC h a v e technical p r o g r a m m e s in this a r e a . To a v o i d
u n n e c e s s a r y o v e r l a p , the Committee d e c i d e d that c a n c e r s t a t i s t i c s in support of c a n c e r e p i d e m i o l o g y w i l l be the d o m a i n of I A R C , and other cancer s t a t i s t i c s w i l l be subjects for t e c h n i c a l programmes w i t h i n W H O .
3 . F u t u r e a c t i v i t i e s
3.1 F o l l o w i n g a p r e l i m i n a r y e v a l u a t i o n of the S r i L a n k a e x p e r i e n c e , the Coordinating Committee w i l l consider if simulation e x e r c i s e s should be c o n t i n u e d , on a selective b a s i s . It m a y a l s o consider o t h e r a p p r o a c h e s , such as m o r e o p e n - e n d e d g u i d e l i n e s than those used in the Sri Lanka e x e r c i s e , to ensure that m o d e l s do not supplant independent t h i n k i n g .
3.2 The Coordinating Committee w i l l a l s o concern itself w i t h v a r i o u s g e n e r a l p o l i c y issues r e l a t i n g to c a n c e r . It w i l l consider v a r i o u s m e c h a n i s m s , such as ad h o c c o m m i t t e e s , for this p u r p o s e . A t the p r e s e n t t i m e , p o l l u t i o n and e n v i r o n m e n t a l factors involved in carcino- genic risk have given rise to d e e p concern t h r o u g h o u t the w o r l d , and it is not at a l l clear to w h a t extent such concern is really j u s t i f i e d . It m a y be timely for the World H e a l t h
A s s e m b l y to c o n s i d e r issuing a s t a t e m e n t , drafted in the light of the C o o r d i n a t i n g C o m m i t t e e ' s d e l i b e r a t i o n s , b a s e d on a n u m b e r of a u t h o r i t i e s in the f i e l d .
