• Cancer imposes a heavy financial burden on individuals and families, with costly treatments and lost wages plunging millions into poverty. This strain is particularly felt in countries like Uganda, where 80% of cancer patients are diagnosed at advanced stages, contributing to a high mortality rate. As the global cancer burden is expected to rise in the coming decades, addressing cancer must become an urgent development priority. It requires coordinated efforts across all sectors to implement comprehensive, cost-effective strategies to reduce the growing impact of the disease.

• Law is central to these efforts and remains the most cost-effective tool for governments to safeguard the health of their people. Legal frameworks, in the form of constitutions, legislation, acts, regulations, policies, judicial rulings, and even customary law, define the roles and responsibilities of various sectors in disease control, authorize public health functions, and allocate critical resources. The importance of law has been evident throughout the history of public health and continues to play a pivotal role in modern approaches to preventing disease and injury.

• For instance, the global response to the COVID-19 pandemic showcased how legal strategies, such as lockdowns and social distancing, were employed as protective measures even before the scientific community fully understood the threat. Beyond infectious diseases, legal frameworks also address other public health priorities, as demonstrated by the Tobacco Control Act of 2015, which effectively regulated tobacco use in Uganda.

• The power of law in shaping public health policies cannot be overstated, making it an indispensable tool in the fight against cancer and other diseases."

• Infections:
  In Uganda, approximately 28.7% of cancers are linked to infectious agents, with the largest proportion attributed to human papillomavirus (HPV)—the virus responsible for cervical cancer, the most prevalent cancer in the country. As a sexually transmitted infection, HPV can be effectively prevented through vaccination for both girls and boys, as well as regular screening for women.

• To combat this, there is a pressing need to intensify public health campaigns that promote self-testing, encourage participation in cancer screenings, and emphasize the importance of seeking early medical advice when symptoms arise. A multisectoral approach is essential in this fight against cancer. For instance, education policies could mandate HPV vaccinations for all girls in schools, extend the vaccination to boys, and replicate similar strategies for other infection-associated cancers.

• Unhealthy Diet:
  Poor dietary habits are the most widespread lifestyle risk factor in Uganda, affecting 88% of both men and women. The government must prioritize public health policies that address the entire food system, from production to consumption. This includes implementing excise taxes on unhealthy products and promoting healthier food choices.

• Overweight and Obesity:
  Among women in Uganda, overweight and obesity rates range between 9% and 24%, making it the second most significant risk factor. Targeted interventions are necessary to address this issue through education, access to healthier food, and encouragement of physical activity.

• Alcohol Use:
  Harmful alcohol consumption is the second major lifestyle risk factor among men in Uganda, with prevalence rates between 14% and 26%. Globally, alcohol is the second leading cause of death, and recent studies confirm that even minimal alcohol consumption is carcinogenic. To curb this, we must enact and enforce stricter laws regulating the availability of alcohol, such as reducing sale hours.

• Tobacco Use:
  Tobacco use in Uganda ranges from 0.8% to 10%. Building on existing policies, such as the smoking ban in public spaces, further action is required to reduce the demand for tobacco products, both domestically and internationally.

• Physical Inactivity:
  Physical inactivity affects between 3.7% and 4.9% of the population in Uganda. Policies should be introduced to foster active lifestyles from an early age, integrating physical activity behaviors into everyday life.

Unhealthy Diet:
Trade laws could play a vital role in limiting the availability of unhealthy foods. Encouraging healthier food choices at home, workplaces, and schools can be facilitated through ongoing partnerships with food and beverage manufacturers, employers, businesses, and the education sector. Implementing levies on unhealthy products, such as sugary drinks, and establishing minimum pricing regulations would mark significant progress in this area.

Physical Activity:
Road safety and traffic laws should enhance environments conducive to walking and cycling, while urban planning and environmental regulations must ensure access to open spaces for recreational activities. Education laws should mandate adequate space, time, and quality lessons for physical education (PE) in schools to foster lifelong physical activity.

Environmental and Occupational Health:
Laws that establish air quality standards are crucial, as air pollution is a recognized cancer risk factor. Employers are essential partners in promoting cancer prevention and early detection. Workplace policies should encourage physical activity, making exercise more accessible to employees. Additionally, welfare benefits for cancer caregivers, survivors, and patients should be strengthened. Policies allowing employees affected by cancer to take leave, maintain workplace engagement, and benefit from flexible schedules are vital. Furthermore, stringent regulations on asbestos use, chemical handling, and mandatory personal protective equipment (PPE) for workers exposed to hazardous materials, along with laws governing fuel content, vehicle emissions, and waste management, are critical to occupational health.

Screening, Diagnosis, and Treatment:
Regulating the safety, quality, and effectiveness of cancer screening, diagnosis, and treatment services is essential. Information about available treatment options in Uganda, including financial implications, should be accessible to support informed decision-making. New diagnostic and screening methods for common cancers, such as cervical and breast cancer, must be made more affordable and accessible. Early detection is a key aspect of secondary and tertiary cancer prevention. Public health campaigns must convey that cancer is no longer a death sentence but a manageable chronic illness. Highlighting advances in treatment and survivorship through cancer champions will help dispel fear and encourage self-testing, screening participation, and early medical consultation for cancer symptoms. Countries with organized screening programs and call-recall systems report the best outcomes, and Uganda should be supported by a National Cancer Control Programme (NCCP) law to implement centralized, accessible screening and treatment services. This law should encompass public education, ensuring no one is left behind, raising awareness of cancer symptoms, and integrating health information systems, including cancer registries.

Cancer Survivors' Laws:
There is a need for laws and policies that promote the well-being of cancer survivors throughout their post-diagnosis lives. These policies should protect against discrimination and stigmatization, safeguard income, ensure privacy of health information, and offer employment protections, including flexible working arrangements. Survivors should also have access to insurance (health, life, travel), pension funds, and loans without facing discrimination.

Cancer Registries and Data Collection:
Cancer registries play a crucial role in collecting and analyzing data to inform cancer control efforts. Currently, Uganda has only two functional registries, in Kampala and Gulu, both of which face significant challenges, including incomplete data due to the fact that cancer is not a notifiable disease in the country. There is an urgent need for legislation to establish comprehensive cancer registries, mandate reporting of cancer cases by all healthcare providers, and ensure adequate funding, data access, and training of cancer registrars across Uganda.

Many individuals have a personal connection to cancer, whether through knowing someone affected, caring for a loved one, or facing a diagnosis themselves. Research indicates that approximately 90% of cancers are associated with personal lifestyle choices, including smoking, alcohol use, sexual behavior, diet, and physical activity. To mitigate cancer risks, it is essential to implement policies that enhance the accessibility of healthy choices, particularly for the most vulnerable populations.

 In Uganda, around 28.7% of cancer cases are attributable to infectious agents, with human papillomaviruses (HPV) being a significant contributor. HPV, which is linked to cervical cancer—the most prevalent cancer in Uganda—is a sexually transmitted infection that can be prevented through vaccination for both girls and boys.

 Governments must prioritize public health policies that regulate the food system, encompassing production, processing, distribution, and disposal, along with the introduction of excise taxes on unhealthy products. Furthermore, implementing laws to limit alcohol availability (such as reduced sales hours) and enhancing restrictions on smoking in public spaces are critical steps in decreasing the demand for harmful products.

A collective effort from all sectors is vital in the fight against cancer. For instance, legislation should require schools to administer HPV vaccines to all girls, with programs also extending to boys, while simultaneously addressing other cancer-causing infectious agents.

Public health campaigns play a crucial role in raising awareness about early detection. Encouraging individuals to self-test, participate in regular cancer screenings, and seek medical attention for early symptoms can significantly improve outcomes.

Cancer control is a challenge that requires a comprehensive societal approach; no single ministry or institution can tackle it alone. Therefore, policymakers must actively contribute by establishing supportive laws and policies, and importantly, by ensuring these initiatives are backed by the necessary resources. While we await further policies to enhance cancer control, it is imperative to ensure that girls receive the HPV vaccine, attend regular cancer screenings, conduct breast self-examinations, refrain from using tobacco products, limit alcohol consumption, engage in at least 30 minutes of daily physical activity, maintain a nutritious diet (avoiding sugary and processed foods as well as excessive salt), and prevent excessive body weight.

—Agnes Hillary Ataro, Director for Policy, Information, and Communication at Ananda Center for Cancer Research (ACCR)