Cancer Prevention as International Risk Governance: Exposure, Equity, and the Politics of Inaction

Despite decades of innovation in oncology, over 40 percent of cancers remain preventable. Yet only 5 percent of global cancer spending is allocated to prevention. In any other domain of risk management, such a mismatch would be considered negligence. This week on The International Risk Podcast, Dominic Bowen is joined by Dr. Joachim Schüz to explore why the global failure to prevent cancer must be treated as a systemic and international risk with long-term geopolitical, economic, and social consequences.

Dr. Schüz is the Head of the Environment and Lifestyle Epidemiology Branch at the International Agency for Research on Cancer (IARC), the World Health Organization’s cancer research body. With over three decades of experience, his work has shaped how environmental exposure, occupational conditions, and socioeconomic structures are understood as determinants of cancer, not just as medical phenomena, but as markers of regulatory justice, political will, and international responsibility.

Prevention as Political Blind Spot

While breakthrough treatments make headlines, the simple fact remains: millions of cancer deaths could be avoided through better prevention. According to Dr. Schüz, the main barrier is not scientific uncertainty, but structural delay. Prevention requires long-term investment in interventions whose benefits may only be felt decades later. For decision-makers bound by short electoral cycles and public demand for quick results, this temporal disconnect makes prevention a hard sell.

He explains that cancer often begins with exposures in adolescence or early adulthood, with consequences only surfacing in middle or old age. Sunburns at 15 may lead to melanoma at 65. Risk reduction requires action long before the visible crisis. Politicians and individuals alike struggle to prioritise threats that are slow-moving and diffuse, even when the cumulative harm is immense.

Exposure Inequality and the Global South

Cancer may be a universal disease, but its burden is not evenly distributed. Nearly 70 percent of cancer deaths now occur in low and middle-income countries, where health systems are ill-equipped to provide early detection or affordable treatment. Industrial expansion, environmental degradation, and weak occupational regulation further compound exposure. These trends are accelerating in the Global South.

But Dr. Schüz cautions against simplistic narratives. Cancer is not only a developing country issue, it is a disease of inequality. Within high-income countries, cancer disproportionately affects socially and economically disadvantaged groups. Risk is shaped less by national borders and more by structural vulnerability, including poor regulation, lack of access to care, and political marginalisation.

Environmental and Occupational Risk: The Known Unknowns

Much of Dr. Schüz’s work has focused on the intersection of cancer and environmental exposures. While over 100 carcinogens have been identified, for many of them the threshold levels and cumulative effects remain poorly understood, especially outside of occupational settings in Europe and North America. The majority of global research on workplace carcinogens has focused on industrialised nations, leaving a critical gap in knowledge about exposures in informal economies and low-regulation environments.

Emerging data from African agricultural communities, for instance, show that pesticide exposure is not highest among trained applicators, who may wear protective equipment, but among nearby workers, family members, and even children playing near fields. Dr. Schüz notes that exposure conditions are often shaped by local context, including child labour, informal employment, and co-exposure to other environmental stressors. These risk patterns are neither well captured nor well governed by current models of cancer surveillance.

Infrastructure, Urban Planning, and Climate Synergies

Dr. Schüz argues that cancer prevention cannot be confined to healthcare policy alone. Urban design, food systems, transportation, and environmental regulation all shape cancer risk. He highlights the potential for win-win strategies that reduce both cancer incidence and greenhouse gas emissions. For example, reducing meat consumption helps lower colorectal cancer risk and cuts emissions from livestock production. Expanding green spaces and promoting active transport not only improve cardiovascular health, but also help prevent certain cancers.

This intersection of cancer prevention and climate action presents an opportunity to align health with sustainability. Yet realising these co-benefits requires coordination across policy domains that are often siloed, including public health, urban planning, and economic development.

Commercial Determinants and Political Inertia

Prevention is not only a matter of evidence, but also one of power. Dr. Schüz emphasises the commercial determinants of health, where industries profit from products and practices that increase cancer risk. Tobacco, alcohol, processed foods, sunbeds, and environmental pollutants are all examples of profitable but harmful exposures. Governments are often slow to regulate these risks due to lobbying pressure, trade priorities, and concerns over economic competitiveness.

Even in Europe, where tobacco control has progressed significantly, smoking remains the leading preventable cause of cancer, responsible for around 20 percent of cases. Meanwhile, new threats such as vaping and digital marketing have emerged, renewing challenges in public health regulation. These dynamics are not isolated to tobacco, they extend to alcohol, ultra-processed food, and pollution-heavy industries.

Global Supply Chains, Trade, and Exported Risk

Cancer prevention is also entangled with global trade. Hazardous chemicals banned in one country may still be produced and exported to others. Pesticide residues on imported food, pollution from outsourced manufacturing, and occupational exposures in export-driven sectors create asymmetrical cancer risks across borders. As Dr. Schüz explains, consumer chains do not need a visa. Environmental and chemical exposures do not stop at national borders. Whether through imported goods, circulating air pollution, or contaminated water systems, health risks are routinely externalised and redistributed.

He calls for stronger global accountability, arguing that trade agreements and multinational investments should not undermine domestic protections. Cancer prevention, he insists, must be factored into trade and investment decisions, not merely addressed after harm has occurred.

Conflict, Collapse, and the Invisible Fallout

In conflict zones, from Syria to Gaza to Sudan, cancer risks are magnified by health system collapse, poor sanitation, disrupted screening, and uncontrolled exposures. Cancer does not pause for war, and Dr. Schüz warns that the longer-term burden of disease in post-conflict settings is too often ignored. He views reconstruction as an opportunity to rebuild infrastructure with long-term resilience in mind. While emergency needs are urgent, integrating cancer prevention into redevelopment plans could mitigate generational harm.

Time to Act on What We Already Know

Asked what risks concern him most, Dr. Schüz does not point to exotic new threats. Instead, he urges policymakers to implement what is already known. Many cancers can be prevented today with existing evidence and tools. What is missing is the political will to act. He warns against chasing novelty at the expense of action, and highlights tobacco, alcohol, and unhealthy diet as the three leading areas where prevention could drastically reduce future burden.

While research into new interventions must continue, Dr. Schüz believes the greatest opportunity lies in scaling existing evidence through targeted, culturally attuned implementation. Generational shifts, such as early education on healthy behaviours and stricter regulation of commercial influence, are key to reducing preventable cancers over the long term.

Cancer is no longer just a biomedical challenge, it is a systems-level issue that intersects with environment, equity, and ethics. As Dr. Schüz makes clear, prevention is not a passive hope for the future, it is a choice we must actively make, today.