Friday, 17 August 2012


In this exclusive series of interviews, we speak to Ertharin Cousin (Executive Director of the United Nations World Food Programme), Prof. Jeffrey Sachs (Director of the Earth Institute at Columbia University) and Carlos Pérez del Castillo (Chair of the Board of the CGIAR Consortium). We look at the true scale and nature of global hunger, exploring issues ranging from poverty to climate change, conflict to politics, economics to education and more. We discuss the realities of hunger in our world and how we can end it.


Vikas Shah, Thought Economics, August 2012

We are a hugely complex species. Our minds have overcome our biology- empowering us to achieve truly remarkable feats. This complexity exists somewhat as a paradox- the truth is, our minds have created a theatre, masking the fact that we are- at our core- tremendously simple. Our basic survival depends on (theoretically) the three most abundant resources on the planet; air, water and food- all of which, largely by our own hand, are under very real threat. Pollution is choking our air, and poisoning our food while a storm of factors ranging from climate change to overpopulation, economics and politics are exhausting our food supplies.

Hunger does not generate statistics in an instant, like a war, tsunami or an earthquake, where the scale of death over a short period of time is enough to wake society into action. Hunger is systemic, a phenomenon that stalks us. In 2011, around one billion people (one in seven of us) were acutely hungry. Their calorie intake was too low to meet even the most basic requirements for life. Existing in unjust purgatory between life and death, these individuals were joined by a further 1.5 billion who lacked the essential micronutrients to experience a baseline of health and activity. Over 8 million people (roughly the population of New York City) died from hunger in that same year (almost 6 million of them were children).

When you put these figures in context, the oversight that humanity has made becomes very apparent. “…The world today produces enough grain alone to provide every human being on the planet with thirty-five hundreds calories a day. That’s enough to make most people fat! And this estimate does not even count the many other commonly eaten foods- vegetables, beans, nuts, root crops, fruits, grass-fed meats, and fish. In fact, if all foods are considered together, enough is available to provide at least 4.3 pounds of food per person a day. That includes two and a half pounds of gran, beans and nuts; about a pound of fruits and vegetables, and nearly another pound of meat, milk and eggs….” (World Hunger- 12 Myths, Lappe, Collins and Rosset). Saying ‘the world produces enough food’ is a dramatic oversimplification of the food security situation, but illustrates the injustice of such large-scale hunger in a world with the capability to ensure it does not exist.

…The right to food stands out as one of the most urgent, and compelling, human rights in a world that already produces more than enough food to feed its current population, yet in which a child below 10 ‘dies from hunger or malnutrition related diseases’ every five seconds…. The right to food is one of the most basic economic, social and cultural rights imaginable, because it addresses one of the most fundamental needs faced by all humans…” (Accounting for Hunger, Olivier de Schutter, Kaitlin Y Cordez)

So what is the true scale of hunger in our society, and what can we do to eradicate it?

In this exclusive series of interviews, we speak to Ertharin Cousin (Executive Director of the United Nations World Food Programme), Prof. Jeffrey Sachs (Director of the Earth Institute at Columbia University) and Carlos Pérez del Castillo (Chair of the Board of the CGIAR Consortium). We look at the true scale and nature of global hunger, exploring issues ranging from poverty to climate change, conflict to politics, economics to education and more. We discuss the realities of hunger in our world and how we can end it.

Ertharin Cousin began her tenure as the twelfth Executive Director of the United Nations World Food Programme on 5 April 2012.

As the leader of the world’s largest humanitarian organization with approximately 15,000 staff serving about 100 million beneficiaries in 78 countries across the world, she is an exceptional advocate for improving the lives of hungry people worldwide, and travels extensively to raise awareness of food insecurity and chronic malnutrition.

In 2009, Ertharin Cousin was nominated by President Barack Obama and confirmed by the U.S. Senate to be the United States Ambassador to the United Nations Agencies for Food and Agriculture, and head of the U.S. Mission to the U.N. Agencies in Rome. During her nearly three years as the chief U.S. diplomatic voice for famine relief and hunger solutions, Cousin helped guide U.S. and international policy around some of the most devastating and life-threatening situations in the world. She advocated for aid strategies that integrate a transition from relief to development, including following the 2010 earthquake in Haiti, and for country-led sustainable agriculture programmes, particularly in the aftermath of the 2010 flooding in Pakistan and in response to the 2011 drought in the Horn of Africa.

Cousin worked in the Administration of U.S. President Bill Clinton for four years, including serving as White House Liaison to the State Department, and received a White House appointment to the Board for International Food and Agricultural Development. Cousin served as Executive Vice President and Chief Operating Officer of Feeding America (then known as America’s Second Harvest), the largest domestic hunger organization in the United States. She led the organization’s response to Hurricane Katrina, an effort that resulted in the distribution of various relief supplies, including food, to those in need across the Gulf Coast region of the United States.

Jeffrey D. Sachs is a world-renowned professor of economics, leader in sustainable development, senior UN advisor, bestselling author, and syndicated columnist whose monthly newspaper columns appear in more than 80 countries. He has twice been named among Time Magazine's 100 most influential world leaders. He was called by the New York Times, "probably the most important economist in the world," and by Time Magazine "the world's best known economist." A recent survey by The Economist Magazine ranked Professor Sachs as among the world's three most influential living economists of the past decade.

He serves as Director of The Earth Institute at Columbia University, as well as Quetelet Professor of Sustainable Development and Health Policy and Management. He is Special Advisor to United Nations Secretary-General Ban Ki-moon on the Millennium Development Goals, having held the same position under former UN Secretary-General Kofi Annan. He is co-founder and Chief Strategist of Millennium Promise Alliance, and is director of the Millennium Villages Project. He has authored three New York Times bestsellers in the past seven years: The End of Poverty (2005), Common Wealth: Economics for a Crowded Planet (2008), and The Price of Civilization (2011). Professor Sachs is widely considered to be the world's leading expert on economic development and the fight against poverty. His work on ending poverty, promoting economic growth, fighting hunger and disease, and promoting sustainable environmental practices, has taken him to more than 125 countries with more than 90 percent of the world's population. For more than a quarter century he has advised dozens of heads of state and governments on economic strategy, in the Americas, Europe, Asia, Africa, and the Middle East. He also advised Pope John Paul II 
on the encyclical Centesimus Annus. He works closely with international organizations including the African Union, the Asian Development Bank, the Inter-American Development Bank, the African Development Bank, the Islamic Development Bank, the World Health Organization, the United Nations Development Programme, the World Food Programme, UNAIDS, the Global Fund to Fight AIDS, TB, and Malaria, among others.

He served as advisor to Prime Minister Yegor Gaidar and Finance Minister Boris Federov during 1991-93 on macroeconomic policies. He received the Leontief Medal of the Leontief Centre, St. Petersburg, for his contributions to Russia's economic reforms. From the mid-1990s till today, Prof. Sachs has been involved with economic reforms in many parts of Asia, including India and China. He has been a senior advisor to the Indian Government, most recently on the scaling up of primary health care in rural areas (the National Rural Health Mission), a policy that he recommended and helped to promote through the Indian Commission on Macroeconomics and Health. For his broad-based support of India's economic reforms he was awarded the Padma Bhushan, one of India's highest honors. The Millennium Villages Project, which he directs, operates in more than one dozen African countries, and covers more than 500,000 people. The MVP has achieved notable successes in raising agricultural production, reducing children's stunting, and cutting child mortality rates, with the results described in several peer-reviewed publications.

Sachs is the recipient of many awards and honors, including membership in the Institute of Medicine, the American Academy of Arts and Sciences, Harvard Society of Fellows, and the Fellows of the World Econometric Society. He has received more than 20 honorary degrees, and many awards and honors around the world. His syndicated newspaper column appears in more than 80 countries around the world, and he is a frequent contributor to major publications such as the Financial Times of London, the International Herald Tribune, Scientific American, and Time magazine.

Sachs was born in Detroit, Michigan, in 1954. He received his B.A., summa cum laude, from Harvard College in 1976, and his M.A. and Ph.D. from Harvard University in 1978 and 1980 respectively. He joined the Harvard faculty as an Assistant Professor in 1980, and was promoted to Associate Professor in 1982 and Full Professor in the fall of 1983, at the age of 28.

Carlos Pérez del Castillo is Chair of the Board of the CGIAR Consortium. He has a long and successful history of international and national public service that has spanned over 35 years. In addition to being the Chair of the Consortium Board of the CGIAR Centers, he is also an independent international consultant involved in various assignments with governments, private sector, and international organizations.

In 2005 he was appointed Chairman of the WTO Panel established to examine the dispute over large civil aircrafts between the US and EC (Boeing-Airbus) and he carried out the Independent External Evaluation of Governance of the Global Environmental Facility. He was a member of the core team assigned with the Independent External Evaluation of FAO until 2007. From March 2004 until October 2005, he was the Special Advisor on International Trade Negotiations to the President of the Republic of Uruguay. Carlos Pérez del Castillo served as the Chairman of the WTO General Council, as Vice-Minister and Acting Minister of Foreign Affairs of Uruguay (1995-1998) and Permanent Secretary of the Latin American Economic System (1987-1991).

Carlos is Vice Chair of the Board of the International Food and Agricultural Trade Policy Council (IPC). He is a Member of the Steering Committee of the High Level Panel of Experts on Food Security and Nutrition (HLPE), of UNESCO Senior Expert Group on Reforms, and runs a small cattle farm. Throughout his career, Carlos Pérez del Castillo, has been the author of a substantial number of publications on a wide range of international economic issues, and has written a large number of articles for both international and regional magazines and newspapers.

In 1990 he was awarded “The Dr. Raul Prebisch Award in Economics” by the Association of Latin American and Caribbean Economists, and he is a Permanent Member of the prestigious Harvard University Trade Group. Carlos Pérez del Castillo has received the highest decorations from the Governments of Brazil, Chile, France and Venezuela.

Q: Why does hunger exist in our world?

[Ertharin Cousin] Hunger exists because food is either not available, or not accessible. Food is not available for those who need access to it due to a variety of different causes relating to natural disasters, conflict, poverty, poor agriculture, poor infrastructure and more.

Food that's in the market can also be made inaccessible because of high prices. We are seeing a time where price volatility impacts food prices, creating- for those who are most vulnerable- an inability to access food. If food is available in the market but at a high price then you. as the mother of a hungry child, will not have access to that food.

Q: What is the true scale of global hunger?

[Ertharin Cousin] Experts (including our partners the FAO) estimate that there are about 900 million people who cannot access food on a regular basis. We call those people 'food insecure'. Often when you are food insecure, you are food insecure with hunger because of the unavailability or inaccessibility of food meaning you cannot meet your dietary caloric intake requirement and you or your children, go hungry.

[Carlos Pérez del Castillo] According to FAO, 925 million people worldwide go to bed hungry every night. This is equivalent to one in seven people of this planet, a fact which is morally unacceptable. The region with the most undernourished people continues to be Asia and the Pacific with 578 million and sub-Saharan Africa with 239 million. Even in cases of adequate food availability, it may provide insufficient intake of micronutrients such as vitamin A, iron, zinc and iodine, leading to disease, deficiencies and even death. This is referred to as malnutrition. Vitamin A deficiency is the leading cause of preventable blindness in children and zinc deficiency leads to the death of 450,000 children under the age of five worldwide.

Q: Do people realise the scale of hunger, and its impact for humanity?

[Prof. Jeffrey Sachs] No, of course they don't! Not even within some of the countries affected by hunger.

India has an incredibly serious problem of childhood stunting and early-age under-nutrition, which has never been responded to adequately in that country- much less in the international community.

A lot of wealthy people have checked out, thinking none of this is about them. They feel they don't have to pay taxes or support foreign assistance. We get a bit of grotesque moralising about how the poor should pull themselves up...

When crises hit- to the extent that people in our noisy world even hear about them- they are typically linked to ideological issues such as Islamic extremism or something else. Very rarely do you hear a political leader in the US or Europe taking the time to understand and explain to the public that what we're really facing is hungry people... and that if we don't do something about it, it will be bad for our humanity and our well-being.

Q: Is the definition of hunger adequate, is it just a developing world issue or does it affect the developed world too?

[Prof. Jeffrey Sachs] There are two big issues.

The first is at a technical level. Hunger is a multi-dimensional phenomenon and the metrics and definitions we use are very imperfect. Hunger involves a mix of acute and chronic issues such as dietary intake and the ability of a fragile body to absorb nutrients. It involves macro versus micro nutrients.... and all of the interactions between need, age, location and even role in life. Workers and manual labourers need different diets than young children for example. We lack metrics on most of this, and so we use very crude indicators. This requires much greater effort- particularly by the scientific community.

The second area is the 'hidden-hunger' in the rich countries. We have in the United States, a remarkable number of people- tens of millions- who are eating on the basis of food stamps. The hunger crisis has become enormous. I pass food lines all the time in New York City. We see people in our neighbourhood waiting in food lines at churches. This has become absolutely normal and a common reality in Manhattan. US society has become so unequal and the poor are so voiceless and politically powerless, that the hunger crisis has intensified with very little public notice or discussion. This is a very real issue.

[Carlos Pérez del Castillo] There is no single worldwide formally accepted definition of hunger. It describes however the status of people whose food intake does not include enough calories to meet minimum physiological needs, estimated to be at 1800 kcal per day, although it varies for men, women and children and on how much energy they spend.

The World Food Summit of 1996 defined food security as existing “when all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life”. So the key drivers are not only the availability of global supplies of food to meet the demands of a growing world population, but the possibilities of having access to that food (income) and the safety and nutrition value of food staples.

Addressing food security is a production versus distribution question. On the production side, droughts, significant yield gaps, poor natural resources management, post harvest loses and consumer waste all contribute to hunger. On the distribution side, social inequity, food prices, quality of infrastructure and food/aid policies all contribute to hunger.

Q: Is there a relationship between hunger and conflict?

[Ertharin Cousin] Unfortunately, there is a growing relationship between hunger and conflict. In 1992 we saw that around 15% of hunger emergencies were related to conflict. That number has increased to around 35%. A growing and more complex response is required to meet the needs of those who are hungry- when that hunger generates from, or is created because of conflict situations.

The lack of food is often used as a weapon in conflicts. Denying access to food can have a detrimental impact on a population. In those situations, the ones who suffer the most are the ones who are most vulnerable- usually women and children.

[Prof. Jeffrey Sachs] Conflict undermines every aspect of life, including the ability to produce food and make sure people are food secure. Every system breaks down. Whether it's health, food security, school or any other form of basic infrastructure- you will find it's set back... often devastatingly... by conflicts.

There's no question that when a situation is allowed to deteriorate to the point where it leads to mass open violence, you will get huge compound damage from that. Most conflict situations in the world today are very poor places that have a rather significant crisis in the lead-up to conflict. In many cases.... for example Yemen, Somalia or Mali.... there is plenty of advanced warning, but the world isn't interested in taking the signals and acting ahead of time.

Q: Is there a relationship between climate change and hunger?

[Ertharin Cousin] There is of course, a relationship between hunger and climate change. We see more natural disasters, more floods, more tropical storms. We see less frequent rainy seasons too. In areas like Africa, over 90% of agriculture is still rain-fed- they're dependant on steady or predictable rain, and unfortunately rains are getting less predictable. That is the basis of the problem we are currently addressing in Sahel- which is the largest disaster we are presently addressing and is directly related to climate change.

The Horn of Africa is experiencing the exact same thing where you are seeing more frequent droughts. These impact crop cycles in areas where the population are already very vulnerable.

[Prof. Jeffrey Sachs] There's no question that the last decade has been a prolonged period of climate shocks and extreme events that are jeopardising the reliability of the world food system. We have experienced it dramatically this year, with the US experiencing the worst drought in decades- hitting right in the bread-basket of the United States- which is also the bread-basket for a lot of the world, at least where you consider maize supplies and feed grains. We're seeing this everywhere... in the Horn of Africa, the Sahel, Russia and Ukraine... We're seeing devastating heat waves and massive flooding in parts of South and South-East Asia...

Climate change has made the problem of hunger more serious and more complex. It may even turn out to be intractable in many regions. Many experts on climate fear that whole regions could become essentially uninhabitable, or at least unable to grow their own food supply. When they are poor regions that depend on their own food supply, the idea that they can somehow substitute to quickly buy food from abroad is very naive.

One of my colleagues just came back from Bhutan in the Himalayas where they have been measuring glacier retreat. The speed of retreat shocking. You hear generalisations that the Himalayan glaciers are intact, but the ground truth is that dramatic things are happening.

I've spent a lot of the last year in the Horn of Africa and Sahel. There are major droughts and societal collapse underway in both places. I was in Mali just before the coup, and the North was overrun. The governor in one of the provinces was telling me, we've got growing violence, the hardship of famine, and asked for help. Before I could get back and appeal to the international community, the coup happened, communities were overrun- violence, destruction and murder were taking place. We see these things coming but absolutely don't react to them.

For all the things that we've been advising on around the world, everything is vulnerable to large climate shifts and famines can easily undermine all of the work we do in development. Demographics are an obvious continuing threat in large countries, but climate change is the obvious one.

We've been reckless and foolish to waste the last 20 years after signing The Framework Convention on Climate Change, and continue to debate the obvious. The obvious being that we're already in the era of human-induced climate change, and it's going to get a lot more serious.

This is absolutely the biggest worry in our fight against poverty. Climate change could overwhelm all of the good efforts that are being made right now.

Q: To what extent has the 'Western World' caused global hunger?

[Prof. Jeffrey Sachs] The Western World has caused the climate change that is now deranging our planet.

The emerging economies are now themselves so big and populous that they have become around half the contribution to flow of global greenhouse gases.

Historical responsibility is a very complicated question, but what I would say is that it is a moral truth that we must get our act together to address what is now a dramatic and unprecedented crisis of development, environment and demography. This is a crisis that will require engagement on all fronts, engaging every part of the planet- rich and poor alike.

If we don't do that, the amount to which basic wellbeing in the world will be undermined will be such that I can't really see how anybody can be safe- no matter how high the gates are that protect them in their gated communities.

I just don't see how we're going to get through this very difficult and unique period for humanity where- for the first time in human history- the scale of the challenges we face environmentally are global. There is nowhere to run to or hide. There is no place so remote as to be protected from these events, and no part of the planet safe from the repercussions from hunger, conflict, disease and instability. We have a world of tremendous inertia, self-deception and corporate-deception.

Q: To what extent have the functioning of financial markets contributed to global hunger?

[Prof. Jeffrey Sachs] They have probably added some volatility due to the fact that food has become more of a financial investment vehicle with the food indexes having played a bigger role. I don't think that they are a fundamental factor in what's happening. A lot of people do- but I am a sceptic on that, and think we're seeing something far more fundamental. I have a lot of complaints about the financial markets- this is not in any way to exonerate their irresponsibility on many, many fronts- but I don't think they're the main source of the problem in this area.

Q: What is the relationship of hunger to global health challenges?

[Prof. Jeffrey Sachs] We know of course, and have long understood, that chronic under-nutrition has extremely serious and complicated pathways into disease burden and pathogenesis. There have been new studies, even in recent weeks, which show how under-nutrition can lead to chronic diarrhoea and a lack of uptake, which causes feedback into the epithelial layer in the intestines. This hinders the ability of the body to take in the nutrients that are in the diet. To put this in context, it has been estimated that approximately one third of child deaths have under-nutrition as a co-factor...

Nutrition is a fundamental factor in human health, and a fundamental factor in disease burden. We sometimes stare at these basic truths, and do little in response. It's perhaps unfair to say nothing is done, but the global response is not very impressive.

Q: How does hunger impact children?

[Ertharin Cousin] UNICEF, the organisation that focus all of their efforts on children, estimate that approximately 146 million children in developing countries are underweight. The challenge that we see is that children who are vulnerable when there is a hunger or food crisis are those children who often go moderately malnourished to acutely malnourished. These children can move from a situation where they are stunted to where they are simply wasting... Ultimately we see many children who die.

If a child is already in a very micronutrient deficient state, the inability to access food will detrimentally impact that child even further. We focus on addressing the nutrition needs of a child before the nutritional challenges result in that child wasting or becoming severely, medically malnourished.

What is very important is that we must work towards addressing the first 1,000 days of a child's life- and that is from the time a pregnancy begins until the child is 2 years old. All the data tells us that a failure to meet the nutritional needs of a child during that period will detrimentally impact that child physically and mentally- for the balance of their life.

It is so important that in our work, we meet the nutritional needs of pregnant lactating women and children under 2.

Q: What has been the impact of hunger on women?

[Ertharin Cousin] All of the data we see, anecdotal and quantifiable, demonstrates that when we meet the food security needs of women, we are also addressing the food security needs of families. Whether we are specifically identifying women who are pregnant, or providing support to women to meet the food security needs of their households... the effect is the same. We have cash, voucher and food for work programmes where we know that the participation of women results in children being able to eat.

We work specifically with women. We work specifically with our partner FAO who provide seeds, tools and technical capacity building for women- increasing the yields of those women who are smallholders. We know that when you increase the yield of smallholders, you increase the increase the economic potential of a community by over 40%.

Focussing on women is not just an opportunity for us to change their lives as individuals, but also to change the lives of their families and entire communities.

Q: What are the key challenges facing world food security?

[Carlos Pérez del Castillo] Agriculture is facing today multiple and complex new challenges. We must not only expand production and productivity to feed a growing population estimated at 9 billion persons in 2050, but must meet the demands of changing diets as a result of rising incomes. We must do so with scarce natural resources: such as water and more competition for its uses; increasing land degradation and depletion of fish stocks. We have to cope with rising food price volatility; greater competition for food staples from the energy sector (biofuels); the spread of plant and animal infectious diseases and inappropriate food and agricultural policies that distort production and trade. Climate change will exacerbate an already adverse natural situation. Increases in temperature, changing patterns of rainfall, more extreme droughts and floods, shifting distribution of pests and diseases will change the face of farming and will have an impact on food production in the future. Finally, we are also facing a debt and financial crisis in major industrialized countries with its negative impact on agricultural investment.

My perception is that the world has today and will continue to have in the future, the capacity and technologies to produce enough food to meet global demands. FAO estimated that the world at the end of the nineties was producing enough food to provide every man, woman and child with 2,700 calories a day. But as we have seen, a food secure world does not only depend on the availability of food supplies but on having access to them. Here is where the links between poverty and food security become clear.

The situation obviously differs between developed and developing regions. Fifty percent of food insecure individuals are low-income farm households in dry lands (Sahel, Southern Africa and South Asia) and mountains (Mesoamerica, East Africa and South East Asia).The Global Food Security Index launched by the Economist Intelligence Unit showed that The United States, Denmark, Norway and France are the most food secure nations. On the other hand, the Democratic Republic of Congo, Chad, Haiti and Ethiopia ranked among the least food secure nations.

Q: What is the relationship of agriculture in our fight against hunger?

[Prof. Jeffrey Sachs] Hunger affects the poor, and most of the poor are farmers. The very producers of food are the largest group of those who are hungry.

It's quite clear that these households don't produce enough food for their own needs, let alone enough to take to market to earn a reliable income. Raising agricultural productivity has a direct effect on the food supply- a key part in overcoming hunger- but it also has a direct effect on the incomes of the largest single group of the poor. That means that attention to smallholder farmers... helping them to become commercial and gain access to the credits they need for better seeds, water management, mechanisation and so forth... is absolutely at the centre of any anti-hunger or anti-poverty effort.

When I began the UN Millennium Project a decade ago and visited the development aid agencies of the donor countries, almost all of them had essentially eliminated their agriculture programmes by the early 2000s. They had done so under the shockingly wrong-headed idea of the World Bank that agriculture takes care of itself. These ideas came from the theories of people who apparently had no international experience or knowledge of realities on the ground.

During the last ten years, there has been a modest revival of interest in this issue. This peaked at the L'Aquila summit in 2009 when the G8 promised $22 billion over three years. Like most of what the rich countries promise, that promise was not fulfilled... The response has been very lacklustre, and to this day the major effort on hunger has been emergency response rather than helping on agriculture. Emergency response capacities in the world are not only inadequate, but are falling further and further short of needs. Now you have-- a famine is called, there is an emergency appeal, and only 20% of it is met. Hardly surprising when the rich countries can barely manage their OWN affairs, let alone appeals like this...

There was some turnaround rhetorically. The rich world is pretty good at hand-wringing. At moments it professes interest in these issues and announces programmes... but the reality is that there isn't much there.

Q: What are the key opportunities in developing sustainable agricultural systems?

[Carlos Pérez del Castillo] According to the World Bank, GDP growth from agriculture generates at least twice as much poverty reduction than any other sector. Agriculture can contribute to green, low-carbon economic growth and poverty reduction through improved management of crops, livestock, soil, water, and trees.

Increasing investment in agricultural research is certainly part of the solution to a more food secure global system. The outcomes of agricultural research are not only effective at increasing productivity, improving nutrition, better management of natural resources and achieving food security but they are also cost effective. Spending on agricultural research offers high rates of return estimated at around 40%. Each dollar invested in CGIAR research has yielded nine dollars in productivity improvements.

CGIAR’s comprehensive research portfolio, worth $5 billion dollars over the next five years aims to reduce rural poverty, improve the food security, health and nutrition of hundreds of millions of the world’s poorest people, and ensure sustainable management of natural resources. Fifteen new programs build on CGIAR’s accomplishments over the past 40 years, including research on natural resource management that has helped to conserve water, renew soil fertility, and reduce erosion and greenhouse gas emissions while simultaneously increasing farmers’ yields.

Improvements in crop yields since the 1960s have reduced emissions by up to 13 billion tons of carbon dioxide a year – that’s 34% of total human carbon emissions (Stanford University) (2010). Developments in genomics and the better use of genetic resources are opening up new avenues for enhancing the yield and stress tolerance of the crops, trees and animals on which people depend for food and incomes.

Q: What is the role of the financial market (and market regulations) in agriculture?

[Carlos Pérez del Castillo] The financial market can play several important roles in agriculture:
  1. Investment To address the needs of a changing world and take advantage of new opportunities, stronger investment in agricultural science is essential at the national and international level. This can be market-driven, especially for commercially-viable crops, but public sector research also plays an important role, especially in addressing the needs of the most vulnerable.

  2. Partnership The private sector can partner with other stakeholders to accelerate and expand research programmes as well as to disseminate and instruct about agricultural innovations on the ground.

  3. Regulation Appropriate regulation in commodity exchanges may contribute to manage food price volatility. IFPRI estimates that between now and 2050 staple-food prices could rise by 42-131 percent for maize, 11-78 percent for rice, and 17-67 percent for wheat, depending on the state of the world’s climate, economy, and population. Regulation is also useful in ensuring safety nets in developing countries for vulnerable farmers.
Q: How can agricultural innovation help in our fight against hunger?

[Prof. Jeffrey Sachs] The history of agriculture in the last 200 years is one of significant improvements in the quantity and often quality of food. It has a been a period during which we have recognised the importance of micro-nutrients, vitamins and the fortification and supplementation of food. This need for improvement becomes more urgent now with 7 billion people on the planet, and the global food system under stress.

If we don't have improvements in technology, climate change will wipe out a lot of our existing capacity. This will be further compounded by a depletion of groundwater and aquifers in a number of major food producing regions such as India and the Mid-Western United States over a period of decades. In Northern China, the retreat and disappearance of glaciers will put freshwater supplies for food production under severe stress.

If anyone thinks food security will be achieved for the soon to be 9 billion people on the basis of reverting to basic technologies, they don't have a realistic picture of just how serious this challenge is, and how we have walked into this Malthusian threat. The situation is likely to get a lot worse unless we get significantly more serious about this.

Q: How does gender equality impact agriculture and hunger?

[Carlos Pérez del Castillo] In most regions of the world one out of five farms is headed by a woman, and on average, women currently make up 43 percent of the agricultural workforce. Nevertheless, inequalities persist between men and women in:

  • Assets for agriculture (land, water, trees, etc.)
  • Access to education, training, credit and inputs such as fertilizers and seeds
  • Access to services such as information, technology, markets, technical assistance and labor protection
  • Ability to participate equally in farmers’ organizations
Ignoring the gender gap in agriculture has significant consequences, both in terms of agricultural output, which could increase by 20 to 30 percent if female farmers had the same access to agricultural resources as men, but also in terms of the economy, which loses additional revenue women could generate if they had equal opportunities. This could reduce the number of undernourished people in the world by 12 to 17 percent (equivalent to 100-150m people) (FAO 2010-11).

In sub-Saharan Africa, women do about 80 percent of the farm labor. That means that any effort to improve the region’s agriculture generally or the lives of its small farmers in particular must take women’s needs and roles into account.

Despite efforts to address gender issues in agriculture, changing the lives of women on the ground has remained an elusive goal. The portfolio of research programmes being currently implemented by the CGIAR has given a high priority to research on gender that commits to deliver research outputs with measurable benefits to women farmers in target areas.

Q: How do the agricultural sectors impact poverty?

[Carlos Pérez del Castillo]   Three quarters of the world’s poorest people – those who live on less that $1 a day – depend almost completely on agriculture for food and income, but many cannot grow enough food to feed their families, much less to sell.

When children go hungry or are malnourished, their physical and mental development is stunted, their ability to learn is compromised, and they are far more susceptible to disease. If malnourished children survive to adulthood, their income-earning opportunities and productivity are severely diminished, creating a vicious cycle of poverty and hunger.

Improving agriculture can dramatically change all that. When smallholder farmers have access to new agricultural technologies and crop varieties, they are able to get more out of their land, labour and livestock. Their families eat better, earn more money, are healthier, lead more productive lives, and are better able to send their children to school.

Agricultural and food policies have a crucial role in reducing rural as well as aggregate poverty in Africa, given that the bulk of the poor are in rural areas, and are employed in agriculture.

History shows that different rates of poverty reduction over the past 40 years have been closely related to differences in agricultural performance.

Q: What is the role of food-aid in disaster and conflict zones?

[Ertharin Cousin] Food assistance in disaster and conflict situations often takes the form of food-aid because of the failure of the local market to be able provide food for the community. When we bring food-aid into a community it provides for that civilian population, the stability they require during a period of conflict or emergency.

Syria is a great example of our operations in a conflict zone. In the month of June 2012, we reached over 500,000 individuals affected by the conflict- we are looking to scale this up to over 850,000. The challenge we have is a lack of access to populations in areas where conflict is raging. In these situations we try to partner with local NGOs who may be able to get access to areas where we cannot go. We also work with our other partners in the UN to ensure political leaders will provide humanitarian space to ensure we can provide food support and security to people who still live in those areas- and ensure their nutritional needs are met. We also work with UNHCR as we often see populations who become refugees. In Syria we have seen many people arrive in neighbouring countries with nothing but the shirt on their backs. UNHCR works with the population to meet their water and sanitation needs and we ensure their nutritional and food needs are met.

Our goal is to reach vulnerable people. Whether that vulnerability has been created by man-made conflict, climate change or natural disasters... WFP and our partners are there to meet the needs of the most vulnerable and hungry poor.

Q: How can corporations and individuals play a role in the fight against hunger?

[Ertharin Cousin] Firstly, we need people to be aware of the challenges facing the 900 million people in the world who are food insecure. Awareness is the first step to building the public will that is required to support governments, corporations and individuals in providing the financial support that we need to meet the food security needs of those populations. We then need that public will to build and to be reflected in the scale of the contributions we and our partners received.

It's important that this happens not just when the pictures are on CNN. So often the real problems are not on the news until they become crises. We can avoid crises by having the resource to reach populations in their times of need- so that crises do not occur. We need financial assistance and we need people to push their governments. When taxpayers tell their leaders, "...we want you to invest in the food security needs of those around the world..." - governments respond. When buyers of products and consumers tell corporations, "...we buy your products because we know you invest in supporting the hungry and food insecure in the world... " - corporations respond.

We need public will, we need voices. We need people to tell the story to ensure that no child goes hungry in a world where there is so much.

Q: Is it a realistic goal for us to say we can end hunger?

[Ertharin Cousin] I get up every single morning, along with our 14,000 people in 77 countries around the world, who work every single day because we believe that it's a realistic goal that we can end hunger.

[Prof. Jeffrey Sachs] It is a feasible objective, but not the course we're on now- not even close.

It is technically feasible because sustainable development in general is feasible. We have the wealth, the tools and the technology to address the climate crisis (albeit over a period of decades). We have the means to help Africa to become self-sufficient in food over the course of a decade. We have tremendous knowledge on nutrition and health, deeply under-deployed, which could make a huge difference for the world.

The world is very rich and the poor are so poor that it would take only a tiny fraction of the vast wealth hidden in tax havens to make a huge difference. The most powerful trend of globalisation economically is to empower the tax havens.... we even have presidential candidates who specialise in them.... most of the hand-wringing you see is disguising inaction.

This is the world we're in. We have vast wealth and technology, but people are left to die.

[Carlos Pérez del Castillo] The good news is that global hunger numbers are going down. The bad news is that there are still 925 million too many. This is an unacceptable situation, and it is morally and politically essential to deploy all efforts not only to reduce this situation, but as predicated by some, to “abolish” it.

Any realistic action plan towards the eradication of hunger, requires as an imperative first step, that decision makers raise world food security concerns to a higher political level, ensuring that they are given a higher priority place in their agendas that what they have at present. Hunger and world food security are not only humanitarian problems that require technical solutions, but an urgent political problem closely associated with poverty reduction, with crucial economic and social development objectives as well as with securing political stability, peace and security goals. In other words, they are political issues that require political solutions.

We have all the tools to firmly address this situation. In 2012 the Commission on Sustainable Agriculture and Climate Change showed us how with seven recommendations:
  1. Integrate sustainable agriculture into national and global food policies
  2. Increase investment in sustainable agriculture
  3. Sustainably intensify food production
  4. Assist the most vulnerable populations and sectors (including women)
  5. Reshape food access and consumption patterns to ensure nutritious diets
  6. Reduce waste in food systems
  7. Improve information
Are we going to be able to harness the political will, the coordination of international cooperation efforts; the implementation of a system of global governance on food security; the technology; the partnerships and the technical and financial resources to achieve that aim is still an open question. Judging from the meagre results reached in recent multilateral negotiations (WTO Doha Round, UN Climate Change negotiations, etc.) one cannot be too optimistic about the prospect of ending hunger in the world in the foreseeable future.

This does not mean, however, that we should give up on this essential obligation. We at CGIAR can certainly make a contribution towards that goal. Examples of potential impact from CGIAR’s new research portfolio are given below:

Maize and wheat: By 2030, 33% higher maize productivity will meet the annual food demand of an additional 600 million people, and 21% higher wheat productivity will do the same for 397 million.

Climate change and agriculture: Research will make crops less vulnerable to drought, flooding, salinity, pests and disease; reduce greenhouse gas emissions; and help cut poverty by 10% and the number of undernourished rural poor by 25%

Rice: Higher yields will raise farmers’ incomes and lower prices, reducing how much the very poor spend on rice by $11 billion annually and lifting 150 million people out of poverty.


In his 2001 book, ‘The Third FreedomGeorge McGovern stated that, “Hunger has plagued the world for thousands of years. But ending it is a greater moral imperative now than ever before, because for the first time humanity has the instruments in hand to defeat this cruel enemy at a very reasonable cost. We have the ability to provide food for all within the next three decades… If we can now reach other planets thanks to the scientific genius of our space architects, there is no acceptable reason why this planet should still have millions of hungry and starving men, women and children….” He continues, “…There is no excuse for this kind of massive lifelong torture, ending only with an agonizing early death. Yet this is the fate that has been dictated from cradle to grave for one out of every seven human beings on our planet. No war in all of history has ever killed so many humans and spread so much suffering and disease in any year as world hunger does annually.”

…Food isn’t fashion,” write Fraser and Rimas in ‘Empires of Food’, “…It’s survival- for individuals and for civilizations. And the New Gluttony habit of turning food into a fashion statement risks undermining the critical danger we face. It’s easy to dismiss the fear that our food system is threatened- after all; our minds are already too crammed with time bombs. If loose nukes aren’t ticking down to Armageddon, then the glaciers are. Or the banks.” The authors pick up on an important point. The developed world has a tendency to only act on issues which manifest in their own society, or which threaten their livelihood. As it stands, for the majority of developed world hunger is something happening ‘over there…’ a developing world issue which charities and governments will eventually get around to solving. As populations and demand rise, without corresponding improvement in food security- prices go up. Much like we see with energy, a tipping point will occur whereby those with political voice find it hard to afford food. When that point comes, and billions more are tipped into poverty- maybe the world will act. When that point comes, however- it may be too late. And that is a terrible injustice.

1n 1948, the majority of countries in the developed world adopted a Universal Declaration of Human Rights. A document founded on the consideration that, “…recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world…” For most of those in the world who are hungry, their hunger a function their poverty- and as President George Bush identified in a 2002 speech, “…A world where some live in comfort and plenty, while half of the human race lives on less than $2 a day, is neither just nor stable…

We sometimes treat poverty as a phenomenon existing outside us, like a weather system. “…Like slavery and apartheid, poverty is not natural. It is manmade and it can be overcome and eradicated by the action of human beings. And overcoming poverty is not a gesture of charity. It is an act of justice. It is the protection of a fundamental human right, the right to dignity and a decent life. While poverty persists, there is no true freedom…” (Nelson Mandela, 2005)

For tens of thousands of years, humanity has faced a constant struggle to survive- but we have persisted. We have faced obstacles ranging from natural disasters, to conflict, disease and more- but we have persisted. Humanity now faces one of the most profound challenges since it emerged on earth, that being to ensure that we don’t starve. If we persist through that, and win… It could be one of our most profound and important victories.

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Thursday, 9 August 2012

Our Fight with Cancer

In these exclusive interviews, we speak to Dr. Christopher Wild (Director of the International Agency for Research on Cancer, IARC - an intergovernmental agency forming part of the World Health Organisation of the United Nations) and Prof. Nic Jones (Chief Scientist of Cancer Research UK and Director of the Manchester Cancer Research Centre). We discuss the very nature of cancer itself; how it affects us, and our society. We look at the causes of cancer, it's impact around the world, and- most importantly, how we can fight it.


Vikas Shah, Thought Economics, (Updated April 2013)

Humanity has been astonishingly successful. We have used intelligence to combat our physical weakness; becoming the dominant species on the planet. Our arrogance dictates that we see ourselves as free of predators, but the truth is that we- ourselves- are that predator. Cancer is a disease that emerges from deep within us- from the very DNA that forms the basis of life itself. This disease claims over 8 million lives each year, taking 22,000 of us, each and every day.

Dr. Siddhartha Mukherjee in his 2011 book 'The Emperor of All Maladies' writes that, "Cancer, we now know, is a disease caused by the uncontrolled growth of a single cell. This growth is unleashed by mutations- changes in DNA that specifically affect genes that incite unlimited cell growth. In a normal cell, powerful genetic circuits regulate cell division and cell death. In a cancer cell, these circuits have been broken, unleashing a cell that cannot stop growing. that this seemingly simply mechanism- cell growth without barriers- can lie at the heart of this grotesque and multifaceted illness is a testament to the unfathomable power of cell growth. Cell division allows us as organisms to grow, to adapt, to recover, to repair- to live. And distorted and unleashed, it allows cancer cells to grow, to flourish, to adapt, to recover, and to repair- to live at the cost of our living. Cancer cells grow faster, adapt better. They are more perfect versions of ourselves..."

"To confront cancer..." he continues, "is to encounter a parallel species, one perhaps more adapted to survival than we are. This image- of cancer as our desperate, malevolent, contemporary doppelganger- is so haunting because it is at least partly true... If we, as a species, are the ultimate product of Darwinian selection, then so, too, is this incredible disease that lurks inside us...."

Conservatively, cancer costs the world (in premature deaths and disability) close to $1 trillion every year; or around 1.4% of global GDP. In very real terms it is like the world loses an economy the size of Australia each and every year. The social costs are even higher- there are few people on the planet who, by the time they reach adulthood, will not have been affected by cancer in some way. It is for those reasons that the fight against cancer has been described as "one of the most significant scientific challenges faced by our species..."

So what is the true scale of cancer in our society?

In these exclusive interviews, we speak to Dr. Christopher Wild (Director of the International Agency for Research on Cancer, IARC - an intergovernmental agency forming part of the World Health Organisation of the United Nations)and Prof. Nic Jones (Chief Scientist of Cancer Research UK and Director of the Manchester Cancer Research Centre). We discuss the very nature of cancer itself; how it affects us, and our society. We look at the causes of cancer, it's impact around the world, and- most importantly, how we can fight it.

Dr. Christopher Wild obtained his PhD in 1984 from the University of Manchester, UK, and was awarded an IARC postdoctoral fellowship (held at IARC) and subsequently a UK Royal Society European Exchange Fellowship (at the Netherlands Cancer Institute, Amsterdam). In 1987, he rejoined IARC as a staff scientist and later became Chief of the Unit of Environmental Carcinogenesis. In 1996, he was appointed to the Chair of Molecular Epidemiology at the University of Leeds; he headed the Centre for Epidemiology and Biostatistics and became Director of the Leeds Institute of Genetics, Health and Therapeutics in December 2005. Dr Wild was elected Director of IARC from 1 January 2009.

The main research interest of Dr Wild is to understand the interplay between environmental and genetic risk factors in the causation of human cancer. He proposed the concept of the “exposome” to match the genome in order to better address this research topic. He has particularly sought to apply biomarkers in population-based studies to this end in relation to liver and oesophageal cancers. He supervises directly the Gambia Hepatitis Intervention Study.

Professor Jones obtained his BSc in Microbiology at University College London in 1971 before completing a PhD at the University of Edinburgh in 1974 focusing on the link between DNA replication and cell division. His first post-doctoral position took him to the United States and the University of Connecticut Medical School studying bacterial cell division, before moving to set up his own research laboratory in 1978 at Purdue University, Indiana, studying how DNA tumour viruses affect cell proliferation and growth, and key genes involved in viral-mediated transformation of normal cells to cancer cells.

After establishing his own research laboratory in the USA, Nic returned to the UK in 1985 to join the Imperial Cancer Research Fund in London. He moved on to become Director of the Paterson Institute for Cancer Research from 1999-2011. Nic continues his world leading research as Group Leader of the Institute’s Cell Regulation Laboratory, which studies how cells respond to sudden adverse changes in their surroundings, known as 'environmental stress'. Nic was appointed as Chief Scientist of Cancer Research UK in February 2011 and is responsible for the scientific direction and strategy of the charity. He is also the Director of the Manchester Cancer Research Centre (MCRC), which was established in 2006. The MCRC brings together the key cancer research players in the region to coordinate the research strategy across the basic to clinical research spectrum. Since its creation the MCRC has grown in strength and has become a model for CR-UK Centres across the UK.

Q: What is cancer?

[Dr. Christopher Wild] Cancer at its most basic level, is a disease where normal cells of the body start to grow in an unregulated fashion.

Once they grow beyond a certain point, these cells start to invade adjacent and it’s that invasiveness which causes the eventual spread of cancer throughout the body, to other organs, leading to the breakdown of the function of those organs and... the death of the patient.

[Prof. Nic Jones] At the simplest level, cancer is a disease that involves normal cells being changed in terms of their behaviour. Cancer causes cells to become unregulated, they divide when they're not supposed to divide and- as a result of this- they grow in an uncontrolled way, forming tumours. These tumours can cause problems locally where they arise, invading surrounding tissue- and they can also spread to other parts of the body. In terms of people dying from cancer, it's usually due to the metastasis- the spread that occurs. Once that happens, it's extremely difficult to treat successfully.

Over the past few years, we have also learned that cancer is a very complex genetic disease. This uncontrolled behaviour of cancer cells versus normal cells is due to changes in certain genes present within the cell. These genes control how cells respond to signals, how they divide, and more. By mutating and changing these regulatory genes, we see the abnormal behaviours we associate with cancer cells.

We now know an awful lot about cancer and what causes it. This has given us the foundation on which we build the promise of more successful future treatments.

Q: Do we really understand the causes of cancer?

[Dr. Christopher Wild] We can think of understanding the causes of cancer at two levels: what changes cause a normal cell to become cancerous and what are the risk factors which lead to those changes.

We certainly understand a lot more about the underlying mechanisms of how cancer develops- - the molecular changes in cells as they grow in an unregulated fashion- and how they become invasive. The last few years have seen unprecedented advances in these areas of fundamental knowledge.

At the same time, over the last four or five decades, we have learned a tremendous amount about the factors in the environment, lifestyle and genetics which can provoke some of those molecular changes. Smoking is predominant in its contribution to total cancer burden worldwide, but other major risk factors are often underestimated, such as include chronic infections. For example, about 1 in 6 cancers worldwide (and 1 in 3 in Sub Saharan Africa) are linked to infections of one type or another. There are other important risk factors including radiation, sunlight, alcohol, environmental contaminants and now- increasingly- obesity and a lack of exercise. You also have occupational exposures to chemical processes which can represent an increased cancer risk.

Q: What are the most significant cancers?

[Dr. Christopher Wild] The answer to that question really depends on where you live. In the high income countries we see a predominance of lung cancer and other cancers associated with tobacco such as oesophagus, throat, bladder and so on. We also see a huge number of breast, prostate and colorectal cancers. For some of these, prostate and colon cancer being prime examples, we really still don't understand the major causes although different aspects of lifestyle are suspected to be important..

In the developing world, we see really high incidences of cancers of the liver, stomach and cervix for example. Despite the limitations on treatments in these regions for these cancers there are some hopeful messages in that there are effective vaccines against Hepatitis B as a cause of liver cancer and human papillomavirus as a cause of cervical and some other cancers. There are also excellent approaches for the early detection and treatment of cervical and breast cancers, for example.

Q: What is the social and economic burden of cancer in the world?

[Dr. Christopher Wild] It’s a very difficult calculation to make. The raw numbers state that currently around 12.5 million people are diagnosed with cancer, and around 7.5 million will die from the disease. The bad news is that in 20 years time, those numbers are going to be a lot higher- we predict that in two decades time over 21 million people will be diagnosed with cancer and over 13 million will die - each and every year. These increases are based only on the effects of an aging population and there being more people in the world The economic burden of treating and caring for such numbers of people is a huge one, felt especially keenly in countries where resources are limited.

So just in numbers, you can see the huge burden of this disease worldwide. On top of that you have the social and emotional impact of the disease which is even more difficult to measure but felt heavily at a personal level across society. In many developing countries cancers occur in relatively young people, parents of young children, and the hardship that places on the family is devastating.

Q: Why has cancer and the fight against it become so culturally significant versus other diseases?

[Dr. Christopher Wild]
First, the sheer numbers and the visible presence of the disease.... everybody knows somebody affected by cancer. At the same time it can seem to strike randomly without an obvious reason.

I say to the staff in our Agency that while we're predominantly doing research... and so on one level we're professionals studying cancer , at the same time none of us have been untouched by this disease in our own lives.

Second, when you don't understand something- and when it seems to strike randomly- there's a fear associated with that. cancer has been seen previously as a death sentence because treatments were so often ineffective.

Those factors,- the scale and lack of understanding- give cancer that aura. However, knowledge and openness have evolved and changed a lot in the developed countries over the last two to three decades. In contrast, in the developing world , a lot of those original fears and lack of understanding persist and still need to be addressed.

Q: Do you see differences in the types of cancer and attitudes towards the diseases in the developed vs. developing world?

[Dr. Christopher Wild] The types of cancers are quite different, as I mentioned earlier, but also the occurrence of cancer is increasing most rapidly in the developing world. In addition, in these same countries cancer often affects younger people, those who are at the heart of their family- providing income.

Since cancer is mainly a disease of ageing- you found (sadly) that people in the past died of other things first, particularly infectious diseases. As the life expectancy in the developing world is increasing so unfortunately the incidence of cancer is increasing as well. Those developing countries are only just now becoming more aware of this double-burden they will increasingly carry of both infectious and chronic diseases.

In the very few surveys we do have in developing countries- it’s clear that there is also a lot less understanding about cancer in the average person in the street. It’s still most often seen as a hopeless situation- a death sentence. This is something which is now different in the more developed high income countries.

Q: Are there any differences in cancer between ethnicities?

[Dr. Christopher Wild] What we see very clearly are differences in the rates and types of cancer geographically. If you go to Sub Saharan Africa and South East Asia you see a lot of cancers of the liver , stomach , oesophagus and cervix – often associated with chronic infections.

In the Western countries- , North America and Europe you see a lot of cancers of the lung, colorectal and breast with a mix of these two patterns in countries in a process of economic and social transition.

Those are very striking patterns but seem to be associated mainly with differences in risk factors. In general the differences between ethnic groups within a population are much smaller and where there are differences, for example in prostate cancer rates between different ethnic groups in the USA, it's unclear how much this is due to shared environments or shared genes. However there are some individuals at a particularly high risk because they have inherited a specific form of a gene that predisposes to cancer. In addition, there are some

The overwhelming message , however, is that it's lifestyle and environment that drives the risk rather than the ethnic make-up of the population.

Q: Is cancer a modern-world disease?

[Dr. Christopher Wild]
Cancer has probably always been there…

Nevertheless, there are some important developments in the modern world which mean that cancer is a greater burden than ever before. Firstly, life expectancy is increasing and cancer is predominantly a disease of old age- Secondly, many risk factors were introduced in the modern world! Smoking, obesity, lack of exercise, occupational exposures… these are all things we’ve introduced with a more western lifestyle.

In contrast, not all risk factors are new, in Sub Saharan Africa and parts of Asia many cancers are linked to an infection- and those infections are not new.

Therefore there have always been cancers but due to ageing, changing lifestyles, changing environments and population growth – we are seeing more people suffering the disease.

Q What are the biggest challenges and opportunities in cancer detection?

[Dr. Christopher Wild]
One of the major challenges we have is that cancer is often detected so late and one of the biggest opportunities therefore is to move this detection forward....

Because of the way cancer develops, through the multiplication of cells- the cancer has reached a large percentage of its final size before it’s detected - meaning that you don’t see it until it’s well-advanced... unless you really make an effort to look for it. In the developing world, most cancers are detected at a very late stage- often when they have spread to other organs in the body, making it very difficult to treat.

The fact that this disease takes such a long time to develop also gives us opportunities through screening and other approaches to catch it sooner. Technologies in molecular testing and imaging have certainly played an important role in the earlier detection of cancer...

The other important factor is an awareness of the disease- with people understanding some of the signs of early stage cancer. This awareness extends to the medical services and health professionals who must be alert and responsive to the disease and it’s early symptoms.

[Prof. Nic Jones] If we are ever going to make an impact in reducing deaths from cancer, we have to do more to diagnose cancer at an earlier stage.

We can split diagnosis into two parts. Firstly is how we affect the behaviour of people. We need people to recognise the symptoms of cancer and do something about it. They shouldn't be scared to go to their GP, but should get checked out. We need to be educating people as to what the signs of cancer are, and give them confidence to get checked. In most cases, everything is fine- in some cases, it's an early sign of cancer. People must understand that the sooner we detect cancer, the better the chances of recovery and cure are. Equally we must educate GPs in terms of recognising the signs and transferring patients on to specialists at an earlier stage. This is tough- it's very difficult to change people's behavioural patterns- but we are making inroads. Tobacco control has been hugely successful in changing people's behaviour towards tobacco...

The second area is how we identify- for example- blood borne markers as signs of early cancers. That's a big area of research we need to invest in more. We tend to invest more in therapeutics than diagnosis, and I feel that balance has to change somewhat. Globally, we need to invest more into early diagnosis- creating accurate, sensitive blood borne tests.

Q: What are the biggest challenges and opportunities in the field of cancer treatment?

[Dr. Christopher Wild]
The biggest challenge is the heterogeneity of the disease. We’re speaking about ‘cancer’ but you can develop cancer in virtually any organ of the body, and each of those cancers may have quite distinct underlying molecular changes. This means that each cancer will respond differently to treatment, and is the reason why some patients respond well to a specific treatment while others don’t.

In the past there was very little understanding of why this heterogeneity in response existed. What’s exciting now is that as more is understood about the underlying molecular changes, it’s becoming possible- for the first time- to speak about the particular characteristics of this cancer and this patient, leading to the possibility of so-called “stratified medicine” or “personalized medicine”.

There are some areas of particular promise here. If you look at breast cancer or melanoma- drugs are being tailored to a sub-type of the cancer based on a particular genetic change.

It is important though to maintain an international perspective - as these very sophisticated treatments are only available in rich countries. In the low income countries, many patients still have no access to standard cancer treatment and too many do not even have access to basic pain relief let alone palliative care. This is truly unacceptable. We have to ensure that people have access to treatments, and equity of access. That’s something which is desperately lacking globally.

On top of this, if we consider that the burden of cancer may nearly double over the next two decades; we cannot hope to solve that problem by incremental improvements in treatment alone. This is really the biggest challenge to cancer treatment; that is just can’t solve the impending problem. Therefore we absolutely must scale up in unprecedented fashion a commitment to prevention and early detection. To me, this is where there is an almighty imbalance in our efforts globally- as a society- in our current approach to tackle cancer.

One of the lessons is that it's very difficult to change individual behaviours. Look at the example of the fight to get people to stop smoking.... I remember when I started research I assumed that if you gave people information, they would act on that and avoid harmful exposures. However, you come to realise that the biggest impacts have been policy decisions around banning advertising and increasing taxes. If you increase the cost of a packet of cigarettes you reduce consumption. When we're thinking about newer problems such as with obesity and physical inactivity... we have to realise it's not just an individual choice, but a problem with the structure of our societies and cities.

The predominant investment over the last 30-40 years has been to fight the disease… by curing patients. But from now on there has to be a far greater emphasis on prevention, with innovative and integrated initiatives across different sectors of society and government.

[Prof. Nic Jones] The more we learn and understand cancer, the more we realise how complex it is. We knew that cancer was not a 'single' type of disease, but the level of complexity we now see in cancer is mind-boggling. The types of genetic changes that can give rise to cancer are varied, and differ enormously from one patient to the next. Right now we use a one-size-fits-all treatment regime- and that's not going to be suitable in the future. We increasingly have to tailor treatment for the individuals themselves based on the genetic characteristics of their tumour. This personalised medicine approach is exciting, beginning to happen, and gives us a lot of optimism for the future.

We also face a big issue of cancer not being a static disease. The genetic changes one sees within a cancer continue as the disease evolves- it's dynamic. We are treating a disease which is constantly changing its genetics, and we have to respond to those changes in the treatment regime we apply- otherwise resistance to chemotherapy and even targeted therapy- can develop rapidly and efficiently. Our aim is to stay one step ahead of the cancer.

There is a similar situation in radiotherapy, which is used to treat around 50% of all cancer patients. The current approach is somewhat of a one-size-fits-all regime, but we now know that patients, and tumours themselves, have different sensitivities to radiation treatment- depending on those genetic changes. We need to understand how a particular tumour or patient will respond to a particular dose of radiotherapy- this will allow every patient to get the optimal dose of radiation for treatment. Personalisation doesn't therefore just apply to drugs.

There has been some discussion about the relationship between stem-cells and cancer. Much of this actually centres around the origin of cancer. There is a body of work that suggests that stem-cells are more likely to be the cell of origin of particular cancers- giving rise to the changes that cause mutations and behaviours that cancer cells have. That could well be.... and some evidence suggests that stem-cells or stem-like cells are inherently more resistant to some types of treatment. It's a very interesting area, and one that has a lot of validity.

Q: What has been the impact of computing on the fight against cancer?

[Prof. Nic Jones] The great thing about being in science and research is that it's very open. We publish our results quickly, and that information is then available for the whole research world to digest, explore, repeat and so on. It's a very important aspect of science. The internet has helped this enormously, we now have incredible access to data and studies- we can communicate better as individuals and organisations- and can collaborate more effectively, and build consortiums.

If you look at the genetics of cancer, a lot of information is coming out of huge international consortiums working together on a common goal. The data coming out of this kind of work is put on the internet live, you almost have instant-access to the data from these big sequencing endeavours.

Computer science is hugely important in cancer research. We have a mind-boggling amount of data, and it takes very complex bioinformatics and computer modelling to really make sense of it.

Q: How do institutions choose 'which' cancers to prioritise?

[Prof. Nic Jones] This is a question which we have been looking at in some detail.

We certainly look at the clinical need... there are certain cancers such as lung, pancreatic, oesophageal and brain where- relative to some other cancers such as breast, leukaemia and lymphoma- the research spend has been low, even though the clinical need is huge. If one looks at survival in these cancers I've mentioned, it's extremely poor compared to breast cancer where 80% of women survive 5 years or more. In lung and pancreatic cancers, you're in the single numbers. One good way of doing it is to look at the clinical need and the level of research spend. You quickly then find many devastating cancers which clearly do need more investment. This is not just an opportunity, but a real need to invest for the future.

Q: Are there any key ethical debates emerging from the fight against cancer?

[Prof. Nic Jones] There has been some debate about the fact that many treatments extend life, but often only for a short time, and with a quality of life which is not necessarily good. And these treatments cost a lot of money. There is an ethical dilemma that arises in this sense in terms of the fact that we have a fixed pot of money for healthcare in the country, and it must be spent effectively.

Thankfully, I don't have to answer these questions- but organisations like NICE make recommendations after taking into account the clinical benefit of treatments, and the cost to the healthcare system. These are tremendously difficult decisions, as no matter what is decided- there will be people who feel it's the wrong decision. These issues cannot be addressed by clinicians or researchers, it has to be done by a committee with the range of expertise to simultaneously consider all aspects.

Q: What is the role of policy makers, academics and business in the fight against cancer?

[Dr. Christopher Wild]
One really exciting development was the United Nations high-level meeting (of heads of state and government) discussing non-communicable diseases. This took place in New York in September last year. It’s only the second time that the UN, at the level of the General Assembly, has discussed a health issue. The last time was for HIV/AIDS. A political declaration on the control of non-communicable diseases, including cancer came from that meeting.

The encouraging thing about this is that policy makers and now seeing cancer and other chronic diseases such as diabetes and cardiovascular disease- as health problems worldwide, not just in the richer countries.

This context provides an excellent political momentum for many players to work together towards cancer control.

When we think about how to tackle cancer specifically- there is a very natural co-operation between academics and the drug companies to try and develop new treatments. There are opportunities there to ‘get a return on your investment!’. There is far less money to be made in prevention although the savings for governments are remarkable…

So while there is a natural market and drive to develop treatments using that natural public-private partnership It is down to governments and non-profit organizations to step-in to really make an effort on investing in prevention. There’s less immediate profit in that area, but it will save society a huge amount of money if we can prevent the disease rather than having to treat it.

Q: What is the role of education in the fight against cancer?

[Dr. Christopher Wild]
Education to build awareness of cancer and remove the fear of it is very important.

Those educated people are also the people who- in the future- will drive governments to fund more cancer research, and demand emphasis on prevention. Having awareness of the disease can therefore have broader benefits in terms of support for change.

In terms of a professional setting, we need to understand more about the causes of the disease, and then we must invest in understanding how that knowledge can be translated to prevention and put into practice. To give you an example, for many years we had an effective Hepatitis B vaccine- this disease is a major cause of liver cancer – but It took years to get that vaccine to the children who are most in need of it – in the developing world (because of a wide range of financial and health-systems barriers). How do you get a vaccine into rural areas of Africa? How do you establish a cold-chain to maintain the vaccine in good condition? How do you have trained people to deliver the vaccine? How do you educate the population to remove fear of what is being injected into their children? These types of question have to be mainstream for the future of cancer research

For me, research is not just about understanding the causes and demonstrating prevention strategies- we need perform research into how we implement that information. It is through this route that we will see the public health benefits.

Q: What has been the role of philanthropy in the fight against cancer?

[Prof. Nic Jones] In the UK, philanthropy has been absolutely essential. The majority of cancer research is funded through charities. One can discuss and debate whether it should be that way around, whether charitable donations to cancer should be on the back of massive investment by government... but the fact is that without cancer charities and the work they do, progress in fighting cancer would be diminished. The UK public has been incredible in terms of their support for their cancer effort- far greater than most countries I know of. 1 in 3 people get cancer, that's not just true in the UK, but around the world.

Cancer is the number one fear for the British public, and it's not surprising. It can hit anybody, rich or poor, regardless of ethnicity. There are no boundaries. As we live longer, the incidence of cancer is going-up- even though our fight is successful and we are treating more cancer. This naturally makes cancer a part of culture, and it's not surprising that when asked to support our efforts against this disease- people relate to it and want to help.

The fight against cancer is really for the next generation- our children, our grandchildren. We want to make the world a better place for them.

Q: What have been the biggest milestones of the past 50 years in our understanding of cancer?

[Dr. Christopher Wild]
Without doubt, to my mind, it was the epidemiological demonstration that the majority of human cancers are caused by environmental and lifestyle risk factors. This understanding opened the door to informed prevention. The classic studies were those of migrant populations, geographic variations in incidence and also changes over relatively short time periods. For example, when Japanese populations moved to the USA, within one or two generations they took on the cancer patterns of the USA – that’s clearly not a genetically driven change, it’s a lifestyle and environment change. Rapid changes over time were observed for lung cancer which went from being a very rare disease to being the most common type of cancer. Eventually it was identified that this was due to the habit of smoking cigarettes. Discoveries like this give great hope for our better understanding of this disease and its prevention and it is for this reason I select it as the biggest milestone.

During this period, we have also gained a phenomenal understanding of the underlying structure and changes in cancer cells-. When I studied for my PhD some 30 years ago, we were looking at environmental chemicals and cancer but we didn’t know what part of the DNA those chemicals were damaging in order to provoke cancer. Now we know exactly which genes are damaged, how genes change as the tumour grows, and how chemicals interact with DNA. That’s also been a major step forward and gives hope in two directions. Firstly, it allows us to tailor drugs to specific types of tumour- but we can also learn what caused the changes we see in the tumour. If you are exposed to sunlight or a chemical pollutant- you will see different genetic changes in cells. The risk factor leaves an imprint in the cancer itself. This should provide new clues to causes and prevention.

Q: Is there a role for complimentary medicine in cancer treatment and care?

[Dr. Christopher Wild] We should demand rigorous scientific evaluation of any proposed therapies be they traditional or complimentary treatments.

There is certainly a need to understand that as an individual facing cancer, we each look for different ways to cope- and these methods are not always medical. This has been a very important advance- understanding that the patient needs broad support- psychological and emotional as well as medical. That's helping people to face, on an individual level- this disease and the impact it has on them and their families.

Q: Do you think we will ever cure cancer?

[Dr. Christopher Wild] If we look back at what’s been achieved in recent years, there have been huge steps forward in the treatment of a number of cancers. This has been in very specific areas such as childhood cancers, breast cancer and testicular cancer- where cure rates and survival are very high. There is hope for more to come in terms of refining treatments

However, if we’re facing twice as many cancers worldwide in 20 years time, it’s hard to imagine curing all these patients. Vision and leadership is needed now to focus efforts on prevention.

[Prof. Nic Jones] If you take the very long term view? I think we will!

Pragmatically, what will happen over the next 20 to 30 years, is that some cancers will be cured- and many will be controlled- in the same way we control diabetes... we don't cure diabetes, we control it.

The ultimate goal has to be curing all cancers, and as much as that vision is a long-way away- it cannot be discarded. Now however, we have three key ways we can make impact:

  • diagnosing cancer earlier, and preventing cancers occurring in the same place by changing behaviours, environment and so on.
  • Having better treatments that will keep cancer at bay and will control the disease for significant periods of time
  • Having treatments that do, where we can, cure cancer.
In many ways, if we prevent a lot of cancer- that's fantastic... if we control it and not necessarily cure it- that's great as well- but in some cases, we will cure it too.

When we speak of our "fight against cancer" we liken it to a battle against an enemy- in effect, we humanise it.

"People conceive of wrathful gods, fickle computers, and selfish genes, attributing human characteristics to a variety of supernatural, technological, and biological agents. This tendency to anthropomorphize nonhuman agents figures prominently in domains ranging from religion to marketing to computer science. Perceiving an agent to be humanlike has important implications for whether the agent is capable of social influence, accountable for its actions, and worthy of moral care and consideration." ('Social Cognition Unbound : Insights Into Anthropomorphism and Dehumanization' - Waytz, Epley, Cacioppo - 2010)

Where cancer is concerned, the need to perceive it as humanlike is important. This is a disease from within ourselves, a disease that is unique to each individual. In effect, my cancer will be different to yours. The question then begs as to whether the world would mobilise billions of dollars just to fight my cancer- in truth, the answer is no. By perceiving cancer as an agent outside us, we can give it a face (albeit in abstract)- we can turn it into an enemy, and find the will to collectively declare war. A declaration by which we admit that however remote.... there is some prospect of victory.

Cancer is a symptom of being human. "...Illness is the night-side of life" wrote Susan Sontag "...a more onerous citizenship. Everyone who is born holds dual citizenship in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place." (Illness as a Metaphor, 1978)

This inevitability of illness, of diseases like cancer is a perverse darkness that draws us together and- in that desperation, brings out something beautiful about our species - our humanity.

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