XahOihpcsl 1(117),2012 J p
CHINH SACH PHONG CHONG NGUY CO UNG THLT TAI VIET NAM GIAI DOAN 2000-2010
NGUYfiN THJ THlfiNG*
1. Gidi thieu
Theo Td chiire Y tl Thi gidi (WHO), trong thi ky 21, cdc benh khdng lay nhiem, yong dd cd ung thu, se tid thdnh nhdm benh chu ylu de dga din sure khde con ngudi, chiem 54% nguyen nhan gay tir vong d ngudi, nhdm benh nhiem trimg se bj diy xudng hang thii ylu, chi chilm 16% nguyen nhan gay tir vong. Hang ndm, tren thi gidi cd khodng 11 yieu ngudi mdc benh vd 6 trieu ngudi chit do ung thu. Dy bdo din nam 2015, mdi nam the gidi se cd 15 trieu ngudi mdi mdc benh ung thu vd 9 trieu ngudi chet do ung thu, yong do 2/3 Id d cdc nudc dang phdt yiln (Bd Y tl, 2008).
Tai hdi thdo qudc gia phdng chdng ung thu lin thii 15 dien ra ngay 7 thdng 10 nam 2010, GS.TS Nguydn Bd Diie, Phd Chii tjch Hdi Phdng chdng ung thu Viet Nam cho biet, sd ca mdc ung thu dang gia tdng vdi u6c tinh Viet Nam cd tdi thilu 126.307
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ca mdc mdi ung thu trong ndm 2010. Ty le mdi mac ung thu d nam gidi Id 181,3/100.000, nir gidi la 134,9/100.000. 6 nam gidi, ddng luu y, ung thu phdi Id loai ung thu ghi nhan sd mac nhieu nhat, tidp den Id ung thu da day, gan, dai trye trang, tien liet tuyen... Ddi vdi nur gidi, ung thu vii diing d vj tri hang dau, sau do Id ung thu
X *
da day, cd tii cung, gan, phdi, dai trye trdng, gidp trang... Nguyen nhan cua tbye trang tren, theo phan tich cua cdc nhd khoa hgc Id do hiit thudc la, lam dung rugu bia, mdi trudng sdng bj d nhiem, sii dung tran lan thudc kich thich tdng trudng, thudc bdo ve thye vat ciing nhu vide thay ddi thdi quen an udng, sinh boat hdng ngdy theo hudng tieu cyc (Ha Ngi Mdi, 2010).
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Theo WHO, it nhat 1/3 trong sd 10 trieu ca ung thu mdi hdng nam yen the gidi cd the du phdng dugc thdng qua viec kiem sodt cdc yeu td nguy co gay ung thu nhu hiit thudc Id, sii dung rugu bia, che do dinh dudng/thye pham, phdng xa/cyc tim, d nhiem mdi trudng, virus/vi khuin sinh ung thu. Vdi ngudn lyc vl yang thilt bj y te, thudc men, cdn bd y te cd the phdt hien sdm va dieu trj hieu qud them cho 1/3 sd ca benh ung thu. Ngay cd trong dilu kien ngudn lyc ban ehl thi dya vdo cdc tilp can chi phi thap vd hieu qud, dieu trj gidm dau vd cham sdc nang dd cd the cdi thien chat lugng cudc sdng cua cdc benh nhan ung thu vd gia dinh hg (WHO, 2002). Cd thi ndi, dy phdng vd kilm sodt ung thu dang Id mdt trong nhiing thdeh thiic ddi vdi y tl cdng cdng vd khoa hgc quan trgng nhdt trong ky nguyen nay.
* PGS. TS, Vien Ddn s6 va cdc vdn di xa hgi, Dgi hgc Kinh ti qudc ddn.
60 Chinh sdch phdng clidng nguy ca ung thu tgi Vi^t Nam giai dogn 2000-2010
2. Phuong phdp nghien cii'u
l/dc tinh ring khodng 95% cdc trudng hgp ung thu md bdc s^ dilu trj la do cdc ylu td mdi trudng gay ra, vd gien Id nguyen nhdn gdy ra khodng tir 2%-5% cdc trudng hgp ung thu [Cancer and Environment]. Tuy nhien, dnh hudng tuong tdc giiia gien vd mdi trudng din ung thu la mgt cau hdi Idn, mgt bi in khoa hgc, md cho din nay, van chua cd ai ed gidi ddp thda ddng (GS. Nguyen Vdn Tuin). Vi vay, ngudi ta it dung thuat ngu nguyen nhan gay ung thu ma chi diing thudt ngii nguy co gay ung thu. Ngdy nay ngudi ta biet rd ung thu kbdng phdi do mgt nguyen nhdn gay ra. Moi loai ung tbu cd nhirng nguyen nhan rieng biet. Mdt tdc nhan sinh ung thu cd the gay ra mgt sd ung thu vd nguge lai mdt loai ung thu cd the do mgt so tdc nhdn gay nen.
Nhihig chat tdn tai trong mdi trudng cd tbi dugc coi Id nhumg nguyen nhdn gay ung
X f f 7 ^ f \ f \
thu bao gdm: thude la; che dg dn, trgng lugng co the, boat dgng the chat; dd udng cd cdn;
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hire xa tia eye tim; vi rut vd vi khudn; biic xa ion hda; thudc trir sau; thudc y te; dung mdi;
sgi. hat min va byi; chat dioxin; hydrocacbon tham da vdng (PAHs); kim loai; diesel thai hat; chat dgc tir nam; vinyl clorua; benzidine [Cancer and Environment]. Phdng trdnh ung thu phdi dugc dya tren vide phdng tranh nguy co ciia cdc tdc nhdn gay nen ung thu ndi
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tren. Cdc chinh sdch lien quan den phdng trdnh cdc nguy ca gay ung thu se thudc ve mdt
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sd ITnh vyc khde nhau nhu y te dinh dudng, rugu bia vd thudc Id, mdi trudng, the due the thao... (Hinh 1).
Phuang phdp thu thap thong tin
Nghien ciiu ndy sir dung cdc phuang phdp nghien ciiu sau:
Tdng quan tdi lieu ve phdng chdng ung thu do WHO khuyen cdo vd kinh nghiem
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phdng chdng ung thu cua mdt sd nudc d Ddng Nam A, Chau A vd mdt vdi nudc phat trien nhu Australia vd My.
Rd sodt cdc chinh sdch hien hdnh ciia Vi?t Nam ve phdng chong ung thu vd phdng chdng cdc nguy co gay ung thu.
Phdng van sau dai dien cdc nhd hoach djnh chinh sdch, gdm 21 dai dien lanh dao cdc Bd nganh lien quan, nhim xdc djnh nh^n thiirc va miic dg quan tam ciia hg vl tinh hinh benh ung thu, nguyen nhdn gay ung thu, nhumg khd khan ban chi lien quan din cac uu tien phdng chdng ung thu yong he thdng cdc chinh sach hi^n hdnh.
Hgn che cua nghien ciru
Do ban ehl trong tilp can vdi thdng tin quoc tl nen rit khd tim cdc vdn bdn chi tilt vl chinh sdch phdng ung thu cua cdc quoc gia khde dl so sanh vdi chinh sdch ciia Viet Nam. Ty Id tir chdi trd Idi phdng vin tuong ddi cao (gin 30%), ndn cdn thilu thdng tin lien quan d mdt sd Bd ngdnh nhu: Bg Cdng thuang va mdt sd Vu cua Bg Y tl va Bo Ndng nghiep & Phdt triln Ndng thdn (NN&PTNT).
Nguyen Thf Thieng 61
Hinh 1. Khung ly thuyet ve moi quan hf giira c^c yeu t6 nguy cff gSy ung thur, c^ch ph6ng tr^nh vi chfnh s^ch lien quan CAc y^u t6 nguy ca - nguyfin nh§n
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~^Nguln; Tdc gia thilt kl phong theo cdc nguySn nhdn ^y ung thu trong tdc phim "Cancer and Environment" va phong theo so d l do HeahhBridge Canada thilt ke.
62 Chinh sdch phong chong nguy ca ung thu tgi Vi^t Nam giai dogn 2000-2010
3. Ket qua phan tich chinh sdch
3.1. Tong kit kinh nghidm phong chong ung thu cua mpt so nu&c tren the gi&i Kinb nghiCMii pbdng chong ung thu cua cdc nudc dr Ddng Nam A, Chau A vd cac nudc pbdt trien nhu Australia vd My dd dugc rd sodt. Ket qud cho thay nhung icinh ngbiem ed the dp dung vdo Vi?t Nam Id: Thir nhdt, cdc chuong trinh phdng chong benh ung thu ndi rieng va b?nh khdng lay truyin ndi chung can nhan dugc su cam ket chinh tri manJi nic. Dieu nay eho thay rdng de cdc chuong trinh thdnh cdng can cd sir cam ket cua Dang va eac cap ehinh quyIn thdng qua vi?c ban hanh Luat, chinh sdch hay chuong trinh hanh dgng phdng chdng ung thu hodc b?nh khdng lay nhiem; Thu hai, can cd cdc nghien cuu khoa bgc vd ed co sd dir li?u chinh xac vl ung thu vd ty 1? tu vong hdng ndm do timg loai ung thu dl eac nhd hoach dinh chinh sdch cd co sdr khoa bgc hinh thdnh cdc quyet dinh; Thir ba, mgt so loai ung thu ed tbi dl phdng dugc qua tiem chung viem gan B va tiem ehiing vi rut u nhu HPV Vi vdy, Chinh phu can d\r trii kinh phi de tdng eudng chuong trinh tiem chung ndy khdng chi cho tre em md cd nhung ngudd trudng thdnh khi cdn ndm trong ddi tugng cho phdp tiem chung; Cuoi cung, cd rat nhieu nguyen nhan dan den ung thu thudc nhieu ITnh vuc qudn ly khde nhau. Do dd, cdng tdc phdng chdng ung
\ r f y r
thu can mang tinh chat lien ngdnh. Mdt khde, cdng cugc phdng chdng ung thu can tien hdnh ddu tien ngay tu cdng ddng. Vide xdy dung mang ludi phdng chdng nguy co gay ung thu la can thiet vd phdi la mang ludi ben vimg tai cdng ddng nhdm tuyen truyen phdng ngira nguy CO ung thu, chia se trdch nhiem ve kiem sodt vd chdm sdc ung thu vd gidm sdt dich te ung thu tai cdng ddng mdt cdeh cd hieu qud.
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3.2. Rd sodt cdc chinh sdch vd chuang trinh Yte lien quan den phong chong ung thu tgi Viet Nam
He tbdng vdn ban chinh sdch phdng chdng ung thu tai Viet Nam bao gdm mdt he
f f f / *
thdng vdn ban 6 tat cd cdc cdp do: Vdn bdn chi dao cua Ddng, Cbinh Phu vd Bd Y te. Ve do manh phdp ly cua cdc chinh sdch ndy bao gdm tir Lu$t den cdc cdng vdn chi dao cua Bd Y te. Dieu ndy dd cho thay su quan tam vd mong mudn chinh tri cua idnh dao Nha nudc Viet Nam doi vdi phdng chdng ung thu.
Muc tieu cua cdc chien luge vd chuong trinh lien quan den phdng chdng ung thu bao qudt dugc nhieu ngi dung quan trgng cua cdng tde du phdng ung thu. Mdt sd muc tieu dugc neu dd ddm bao dugc nhOmg ddc tinh can thiet cua mgt muc tieu trong chinh sach dugc ban hdnh. Cdc gidi phdp dugc de xuat rat da dang vd ddi hdi cd sir phdi ket hgp, ldng ghep da ITnh vuc. Nd bao gdm gidi phap ve ban hanh chinh sach; giai phdp ve tuyen truyen, gido due; gidi phap ve tiem chung... Trong dd, giai phap vl tuyen truyin gido due dd dugc nhdn manh.
Tuy nhien, cdc chinh sdch trong ITnh vuc nay cdn cd nhihig ban chi sau: Thit nhdt, mdt sd muc tieu khdng ddm bdo cdc ddc tinh cdn cd, vi du nhu: nliilu van bdn chi neu muc tieu dinh tinh ma chua cd cdc muc tieu dugc lugng hod, mgt sd muc tieu dugc ddt ra hodn todn khdng khd thi, qua tham vgng; Thit hai, mau thuan giura cdc muc tidu cua cac vdn ban khde nhau, giua cdc van^ban chinh sdch khde nhau, tuy ciing mgt ngi dung vl
Nguyen Thi Thieng 63
phdng chdng ung thu song cdc muc tieu dugc thilt kl khdng dong nhat; Thir ba, mdt so gidi phdp cua cdc chuong trinh, dl dn, du dn chua rd rdng vd cu thi, thilu quy dinh cu thi ve cdeh thue thuc hien va cam ket ngudn lire. Hau hit cdc vdn kien chiln luge, ehuong trinh, de dn, du dn chi cd nhung quy dinh rdt chung vl td chuc triln khai trong khi thuc tl cdn phdi cd cdc quy dinh cu thi vl cdeh thuc triln khai, phuong thue phoi kit hgp va quan trgng Id pham vi trdch nhiem cua tung ngdnh, timg co quan ed lien quan. Cdc vdn kien nay cung thilu thdng tin vl dyr trii kinh phi, phan bo ngdn sdch. Day Id mot nguy eo
f f f f
khien cho vdn bdn chien luge, chuong trinh cd hieu lire tren giay nhung khdng cd cam ket thuc hien tren thuc t l vi khdng huy ddng dugc ngudn lire hay khdng bd tri duge ngdn sdch. Mat khde, cdc cbinh sdch hien hdnh edn mot so khodng trdng, vi du nhu: Ludt cham sdc sue khoe nhan dan ehua cd dieu khodn ndo de cap tdi vide phdng vd phdt hien sdm
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cae yeu td di truyen (cdc dot bien gen) cd the gay ung thu; Chuong trinh hanh ddng
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truyen thdng gido due sue khde den 2010 da bd sdt vifc tuyen truyen gido due nang cao nhdn thuc cho cd ngudi ddn lan cdc cap lanh dao, cdc nhd hoach dinh ehinh sdch vd eac
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nhd qudn ly y te.
3.3. Cdc chinh sdch lien quan den thuoc Id vd ruau bia 3.3.1. Cdc chinh sdch lien quan den thude Id
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Viet Nam la mdt trong 166 nudc da phe chuan Cdng udc Khung ve Kiem sodt thude
^ f f > f
la (FCTC) cua Td chuc Y te the gidi. Cdc quy dinh nhdm gidm cung thude Id trong ehinh sdch eua Viet Nam phii hgp vdi cdc khuyen cdo eua WHO trong Cdng udc khung. Quan diem ndy dd duge the hien xuyen sudt tir van bdn mang tinh phdp quy cao nhat la Luat cho den Nghi quyet, Nghi dinh cua Chinh phu, Quyet dinh, Chi thi eua Thu tudng Chinh phu vd cdc Thdng tu huong ddn cua Bd Tdi chinh.
Cdc ndi dung chinh sdch cua Viet Nam da theo kip cdc quy dinh eua FCTC Id: quy dinh ve ddng gdi va gdn nhdn mdc; quy dinh ve bao gdi va sd lugng dieu thudc, quy dinh ve ddn tem thudc la vd quy dinh in cdnh bdo sue khde vd quy dinh in thdng tin ve thanh phdn cdc chat cd trong thudc Id vd khdi thudc Id; cdc quy dinh ve thdng tin, gido due truyen thdng ve phdng chdng tdc hai ciia thudc Id (PCTHTL).
Cdc quy dinh chi phii hgp mdt phan vdi cdng udc khung ve kiem sodt thudc Id la:
quy dinh cdm todn dien mgi hinh thuc qudng cdo-khuyen mai-tai trg cua cdc cdng ty thudc Id; Quy dinh lien quan din phdng, chdng hdnh vi budn ban bdt hgp phdp cdc sdn pham thudc Id; Chinh sdch gidm cung thudc la trong nudc.
Viet Nam dd xay dung dugc mdt Td chuc vl PCTHTL, dd Id Ban Chii nhiem Chuong trinh PCTHTL (VINACOSH) boat ddng vdi tmh ehdt lien ngdnh. Chinh phu da phan bd kinh phi tu ngan sach qudc gia cho Chuong trinh PCTHTL, mac du muc phan bd
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con rat ban che so vdi nhu cau.
Tuy nhien, trong ITnh vuc nay cdc chinh sach hien hdnh van cd mdt sd ban ehl sau:
muc thue tren gia bdn Id cdn thdp hon so vdi khuyin cdo cua WHO va Ngan hdng thi gidi (WB). Nhin chung trong cac chinh sdch hen quan din PCTHTL co ehl xu ly vi pham vd phan cdng trdch nhiem thuc thi ve xur ly vi pham chua rd rang.
64 Chinh sdch phong chong nguy ca ung thu tgi Viqt Nam giai dogn 2000-2010
Cdc quy dinh vl in cdnh bdo sue khde cdn ylu. Chua cd cdc quy djnb cu thi ddnh cho thuoc Id nhap khau dl bdn tren thj trudng Vi?t Nam.
Cdc cbinh sdch lien quan din gido dye truyen thdng PCTHTL mdi chi cbii trgng din tuyen truyin eho ngudi dan md chua chii trong luyen truyin cdc doanh nghiep cdc nhd sdn xuat ve tac hai eiia thuoc Id ddi vdi sue khde.
3.3.2. Cdc chinh sdch lien quan den rugu bia
Trong cdc ehinh sdch hi?n hdnh vl sdn xuat vd kinh doanh rugu bia dd cd nhung quy djnh lien quan din eae uu tien phdng phdng nguy co gay ung tbu nhu: quy dinh ham lugng cdc chat metanol, furfurol vd quy djnh thudng quy ky thudt kiem tra cac chat ndi tren.
Cdc quy djnh ve ban che su dyng rugu bia cung dugc de cap tdi nhu: Ap dung muc thue lieu thy ddc bi?t vdi thue xuat cao (ludt thue tidu thy ddc bi|t); ban che mang ludi lieu thy sdn pham rugu bia; quy djnb ve tudi dugc phdp mua rugu bia; ban che qudng cdo
\a quy dinh ve xir phat hdnh chinh khi vi pham cdc quy dinh ve ve sinh an loan thuc phdm (VSATTP) cung nbu cdc quy djnb ve ban che sir dyng rugu bia. Dd cd mdt sd van ban chinh sdch ed quy dinh ve truyen thdng gido dye trong vi?c han che su dung rugu bia, trong dd ddc biet cbii trgng den truyen tbdng gido dye cho thanh nien dudi 18 tudi.
Han che lien quan den cdc uu tien pbdng chdng nguy co ung thu trong chinh sdch
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hien hdnh Id: chua cbii trgng den viec kiem sodt sdn xuat vd kinh doanh rugu ndu thii
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cdng; Thieu quy dinh ve cdnh bdo sue khde khi lam dyng rugu bia; Cdc quy djnh ve xii phat hdnh chinh chua manh; Cdc vdn bdn lien quan den truyen thdng gido due nhdm muc dich ban che rugu bia chua phong phii, cy the mdi tap trung chu yeu vao phdng chdng gay rdi trat tu tri an, chua chii trgng din phdng chdng nguy co gay ung thu.
4. Cac chinh sach lien quan den vf sinh an todn thye pham va quan ly thuoc bao ve thvc vat
• • •
f y f
Cdc uu tien phdng chdng ung thu dd dugc quy dinh trong hau bet cdc vdn bdn quy pham phdp luat ve VSATTP, tir Luat den cdc cdng vdn chi d^o cua cdc Bg ngdnh.
Ndi dung ciia cdc uu tien phdng chdng ung thu dd dugc quy dinh trong tat cd cac khdu cua qud trinh sdn xuat, kinh doanh vd phan phdi san pham thuc pham nhu: nguyen lieu, hda chdt, chat phu gia, vat li?u bdo quan, v ^ chuyen, dieu kif n cua co sd sdn xuat, xuat nhap khdu vd che biln thuc pham, t h ^ chi cdc uu tien phdng chdng ung thu cdn dugc de cap ngay trong cd vi?c kinh doanh thiic dn dudng pho.
Cdc uu tien phdng chdng ung thu cung dugc dl cap trong cdc quy dinh lien quan den timg cdng doan, tat cd cdc khau cua qua trinh sdn xudt va kinh doanh thuoc bdo ve thuc vat (BVTV) va hda chat nhu: sdn xuat, sang chai, bdo quan, ddng gdi van chuyen, nhap khau vd six dung, cung nhu tat cd cdc khau trong qua trinh san xudt vd kinh doanh ddi vdi thuc pham bien ddi gen nhu: Nghien cuu khoa hgc, phdt triln cdng nghe, khao nghiem, sdn xuat, kinh doanh va nhap khdu.
Quylt dinh va thdng tu huong dan cua cdc Bg nganh (Bg Y tl, Bg NN&PTNT...)
Nguyen Thf Thieng 65
cdn quy dinh cu thi ehi tilt hon ddi vdi tiing loai sdn phdm. Cdc Bd Y tl, Bd NN&PTNT, Bd Khoa hgc vd Cdng ngh?... dd ban hdnh dugc h? thdng quy chudn ky thuat qudc gia ve VSATTP cho nhieu loai sdn phdm. Cdc quy chuan ky thudt qudc gia eiia Vi?t Nam hien nay ciing dam bdo tinh khoa hgc, tinh tuong duong vd hdi hda vdi cdc tidu chuan ky thuat
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qudc te va khu vuc, dac biet Id sau khi Vi?t Nam dugc cdng nhdn Id thdnh vidn cua WTO.
Trong dd, cdc uu tien quy dinh hdm lugng toi da nhGng chdt cd khd ndng gdy ung tbu deu dugc quy dinh chdt che.
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Cdc chuong trinh qudc gia ve VSATTP da cbii trgng den cdc nguy co gdy ung thu trong cd myc tieu vd gidi phdp thuc hi?n vd vi?e ban hdnh vd sua ddi tieu chuan ky thuat Viet Nam theo phuong chdm ddm bdo tinh khoa hgc, hdi hda vdi mgt sd tieu chuan qudc
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te va khu vuc bode ddm bdo tinh tuong duong vdi tieu chuan qudc te vd khu vuc, ddng thdi da dua vdo chuong trinh phan tich nguy co an todn thue phdm.
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Ke hoach hdnh ddng qudc gia ve da dang sinh hgc vd De dn tdng the tdng eudng ndng lire qudn ly an todn sinh bgc doi vdi thuc pham bien doi gen (TPBDG) da chii trpng
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den cdc uu tien pbdng chdng ung thu trong cd myc tieu, gidi phdp, eae nhiem vu trgng diem vd cdc De dn thuc hien nhiem vu trgng diem.
Diem ban che trong cdc chinh sdch lien quan den VSATTP Id cdc vdn bdn quy pham phdp luat lien quan den an todn thuc pham, qudn ly thudc BVTV vd quan ly ve
r \ f t
TPBDG cdn thieu quy dinh ve xu ly vi pham bode khdng quy dinh true tiep che tai xii phat cho cdc hdnh vi vi pham. Cdc thudt ngu "xu ly theo phdp luat hien hdnh" dugc sir dyng thudng xuyen.
Ndi dung qudn ly nhd nudc ve VSATTP chua chii trgng den nghien cuu khoa bgc
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ling dyng chuyen ngdnh va hgp tdc qudc te trong ITnh vuc ndy.
Cdc Vdn bdn qui pham phdp ludt lien quan-din VSATTP chua cbii trgng den viec phan cdp, phdn quyIn cho dia phuong (cap tinh, huyen vd xa) trong qudn ly, thanh tra, kiem tra vd xur ly vi pham.
Mdt so chuong trinh chua chii trgng den cdc uu tien phdng chdng nguy co gdy ung thu nhu Chuong trinh dinh dudrng qudc gia giai doan 2001-2010; ^h dn "Qudn ly nhd nudc vl dugc phdm, an tgdn ve sinh thuc phdm, my pham giai doan 2006-2010";
"Chuong trinh hdnh dgng cua chinh phu thuc hien Chi thi sd 50-CT/TW" vd "KI hoach long thi phat triln vd ling dyng cdng nghe sinh hgc d Viet Nam din nam 2020"
5. Chinh sach quan ly va bao vf moi trirong
Cdc uu tien phdng chong ung thu dd dugc quy dinh trong rdt nhilu van bdn lien quan dIh qudn ly vd bdo ve mdi tiirdmg, tu vdn bdn mang tinh phdp ly cao nhat Id Ludt Bao ve mdi trudng. Cdc uu tien ndy dugc quy dinh trong cac chinh sdch qudn ly nhd nudc vl chdt thdi rdn, chit thdi ddc hai, khi thdi, nudc thdi da dugc ban hdnh cung vdi nhimg quy chudn ky thuat qudc gia vl chdt thdi, Chinh sdch thu phi bao ve mdi trudng.
Sir phoi kit hgp giiia cdc ngdnh khde nhau trong Bdo ve mdi hudng da dugc dat nin mdng bdng mdt sd van bdn ghi nhd (Giua Bd Tdi nguyen va Mdi tirdng (TN&MT) vdi
66 Chinh sdch phong chong nguy ca ung thu tgi Vi^t Nam giai dogn 2000-2010
Uy ban TW Mdt tran to quoc; Gi&a Bg TN&MT vdi Bg Cdng thuong; Gi&a Bg TN&MT vaBg Cdng an...).
Han ehl lien quan din vi?e phdng chong nguy eo gdy ung tbu trong chinh sdch lien quan din qudn ly vd bdo vf mdi trudng thi hi?n d chS khung phdp ly cho cdng tdc thanh tra, xii ly cdc sai pham vc Bdo v? mdi trudng chua dugc nhan manh thich ddng.
Chinh sdch bdt huge ngp phi Bdo vf mdi trudng doi vdi cdc boat dgng sdn xuat, kinh doanh, dich vy ed xd thdi mang tinh lich cue, song muc phi thu thdp sS kbdng cd tdc dyng trong han ehl xa thai va xii ly cdc chat thdi dgc hai md phdn ldm cdc chdt ndy mang nhimg nguy co gay ung thu cao.
Luat Bdo vf mdi trudng thilu cdc quy djnh lien quan den phdn loai, van chuyen, giam thieu vd tdi sii dyng nude thdi. Trong cdc Nghi djnh ciia Chinh phu hudng dan thirc hien Ludt nay cung kbdng cd cdc quy dinh dl cap den nhimg ndi dung neu tren. Chua cd chinh sdch thu phi bdo vf mdi trudng doi vdi khi thdi. Trong khi dd, chinh sdch thu phi nay da duge dp dyng vdi chdt thdi rdn vd nudc thdi.
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Hien cdn thieu cdc quy dinh ve bdo vf mdi trudmg danh rieng cho mgt sd cdc boat ddng sdn xudt kinh doanh cd lien quan nhilu din cdc ylu td cd nguy co gay ung thu cao
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nhu boat dgng sdn xudt dugc pham/phdn hod hgc; sdn xudt bgt gidt/my phdm, sdn xuat pin, sdn xudt bdng den/phich nudc, nhugm, che bien cao su, nhua (vinyl chloride diing che plastic), xdng...
6. Cac chinh sach khuyen khich ren luyfn than the nham phdng tranh benh va ung thu if Vift Nam
Chinh sdch khuyin khich ren luyf n than the cua ngudi dan hif n da cd dif n bao phu ddy du, bao gom: chinh sdch gido dye the chat cho hgc sinh, sinh vien trong nha trudng;
Chinh sdch khuyin khich the dyc-thi thao (TDTT) quan chung cho mgi nhdm ddi tugng ddn cu trong cdng ddng, chinh sdch khuyen khich TDTT cho tre em, thanh thieu nien va ngudi eao tudi.
Cdc myc tieu vd chi tieu day m ^ gido dye the chat va chii truong phdt trien TDTT qudn chiing da dugc de ra trong cdc vdn ban Chien luge phdt trien gido dye 2001-2010 va du
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thdo Chien luge phdt trien gido dye den ndm 2020. Ben c^inb dd, cdc myc tieu nay cdn dugc ddt ra trong Quy hoach phdt trien thi dye thi thao Vift Nam din nam 2010. Chuong trinh phdt triln TDTT xd, phudng, thi tran sd Id budc dgt phd giiip cdi thif n bf thdng ca sd ha tang TDTT d cap co sd ciing nhu van dgng ngdy cdng nhieu ngirdi dan tham gia TDTT.
Chii truong cua Nhd nudc vl xd hgi hod boat dgng TDTT va phdt triln cdc co sd ha tdng TDTT da dugc thi hif n rd trong cdc van bdn chinh sdch, Ddi vdd cdng tac xa hdi hoa cdc boat dgng TDTT, Chinh phu cdn chi dao manh bdng cdc vdn bdn Nghi quylt, Chi thi.
Tuy nhien, han che cua cdc chinh sdch nay la; Thu nhdt, thilu cdc chuang trinh, boat dgng de hif n thuc hod chinh sdch. Hien chi cd 2 chuang trinh nhdm thuc hif n cac chinh sdch tren Id Chuang trinh gido due the chat dugc thuc hifn bdt huge trong nha trudng va Chuang trinh phdt triln TDTT xa, phuang din nam 2010. Cdc chinh sach
Nguyen Thj Thieng 67
khuyen khich TDTT cho tre em, ngudi cao tuoi hay thanh thieu nien van chua duge hifn thuc hod bang bat ky chuang trinh qudc gia ndo. Thir hai, ngi dung ciia mgt so c^nh sdch cdn cd ban che, khd tao hifu qud trong thuc te. Vi dy, gido dye the chat duge quy dinh la ndi dung gido due bat budc ddi vdi mgi co sd gido due, vd hgc sinh, sinh vien phdi thuc hifn. Tuy nhien, ndi dung cua chinh sdch gido dye thi chdt cdn cd nhung dilm ban ehl nhu thdi lugng ddnh cho boat dgng gido dye tbi chat cdn qud it. Cdc cbinh sach ho trg cho chinh sach phdt triln gido due thi chat nhu chinh sdch diu tu trang thilt bi, cbinh sdch dao tao them gido vien the dye, chinh sdch ve bien che... van cbua dugc ban banh.
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Khuyen khich boat ddng the lyre cdn the hifn khdng chi trong eae ehinh sdch va chuong trinh lien quan den boat ddng TDTT ma edn trong cdc chinh sdch khuyin khich ngudi ddn van ddng thdn the trong sinh boat vd lam vifc, bao gdm vife khuyen khich di bd, di xe dap, gidm thdi gian tTnh, tdng thdi gian dgng trong sinh boat. Tuy nhien, tai cdc dd thi Idn hifn nay, cdc cdng vien dang cd xu hudng bi thu hep bode chuyen ddi muc dich; via he hi thu hep de md dudng cho xe co gidi bode bi su dyng cho cdc myc dich khde, hdu nhu khdng cd eho cho ngudi di bg.
7. Phan tich muc do quan tam ciia cac nha hoach dinh chinh sach doi voi benh ung thir
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Phan tich dii lifu eua cdc cudc phdng vdn sdu dai difn lanh dao cdc Bd/Ngdnh hen quan den phdng chdng ung thu cho phep nit ra nhdn dinh: cdc dai difn lanh dao eac bd
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ngdnh lien quan deu nhan thiic rdng ung thu da trd thdnh van de y te cdng ddng. Nguyen nhan chii ylu cd quan bf mat thilt tdi d nhilm mdi trudng, VSATTP. Tuy nhien, khdng nhilu ngudi nghT din van dgng thi chdt vd beo phi cimg Id mdt nguy co ung thu.
Nhiing ngudi trd Idi phdng vdn diu nhan thiic dugc trdch nhiem ciia co quan noi minh dang cdng tdc ddi vdi vife phdng trdnh nguy co gay ung thu, nhung khdng nhieu ngudi trd loi phdng vdn bilt dugc cdc uu tien phdng nguy co gay ung thu trong chinh sdch ciia cdc Bd/Ngdnh khde.
Dai difn lanh dao cdc Bg/Ngdnh nhan dinh rdng cdc ehinh sdch ndi chung ciia nudc ta dugc xay dung thilu can cir khoa hgc trong nudc md chu yeu du vao kinh nghif m hgc tap cdc
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chmh sach cua nudc ngodi. Nhu cdu thdng tin cua cdc nhd hoach dinh chinh sdch rat Idn.
Nhin chung trong mgi ITnh vuc qudn ly nbd nudc ed lien quan den phdng chdng nguy CO gay ung tbu khd khan Idn nhdt dl thuc hifn chinh sdch la thilu co ehl xur ly cdc hanh vi vi pham, bode co ehl xii ly chua nghiem nen khdng dii siic rdn de ddi vdi ngudi vi pham, chua lam cho ngudi vi pham khdng tdi pham.
8. Cac khuyen nghi nhdm hoan thifn chinh sach, chvorng trinh lien quan den dir phong ung thu* tai Vift Nam
Tren ca sd bai hgc kinh nghif m qudc tl vd nhihig dilm manh vd dilm ban ehl cua chinh sach lien quan din phdng chdng ung thu cua Vift Nam, nhdm nghien cuu dd dl xudt 5 nhdm khuyen nghi vdi 17 khuyin nghi nhdm hoan thifn chinh sdch va thuc thi chinh sdch lien quan den phdng chdng ung thu. Cu the la:
68 Chinh sdch phdng chong nguy ca ung thu tgi Vi^t Nam giai dogn 2000-2010
8.1. Khuyen nghi *'^ nhitng khodng trong trong cdc chfnh sdch
Tdng eudng dau tu cho y tl d\r pbdng tuyin ca sd (y tl xd/phudmg) ed vl co sd vat chat va kinh nghif m truyen thdng
Nhanh chdng ban hdnh Lu$t phdng chong tdc h^i cua thuoc Id vd rugu bia
Bo sung nhif m vy phdng chdng bdo phi (cho cd ngudi Idn vd tre em) trong cac ehinh sdch vd chuang trinh lien quan din dinh dudng
- Tdng eudng qudn ly VSATTP theo timg cdng do^n vd theo chuoi "tir trang trai den bdn dn"
- Quy djnh phdn quyIn manh hen cho cap xd/phudng trong kilm tra, thanh tra va xu ly vi pham cdc quy dinh vl hiit thuoc Id noi cdng c^ng, lam dyng rugu bia vd vi pham quy djnh ve VSATTP, ve bdo vf mdi trudng.
- Bd sung them quy djnh thanh tra, kiem tra vd gidm sdt djnh ky vd dgt xuat.
- Tdng eudng ddu tu tdi chinh, co sd vat chat cho phong trao TDTT qudn chiing, dac bif t can quan tdm cdc viing ngheo, vimg khd khdn.
8.2. Khuyen nghj de tdng cu&ng hi^u Iuc, tinh khd thi cda cdc chinh sdch Khi thilt kl chuang trinh can ed nguon kinh phi dl thuc hifn.
- Hoan thifn, bd sung ciing nhu cy thi hda co che xu ly vi pham trong cdc vdn bdn quy pham phdp luat ve PCTHTL, rugu bia, VSATTP, ve bdo vf mdi trudng.
- Ndng cao miic xu phat hdnh chinh ddi vdi cdc hanh vi vi pham cdc quy dinh phap ludt ve nhung ndi dung ndy.
- Xdy dung Id trinh tdng thul vd gid thuoc Id, gid rugu bia nhdm h?ui che tieu diing thudc Id vd rugu bia. Cdc nha sdn xudt thuoc Id, rugu bia can phdi chju them phi bdo ve siic khoe cgng dong.
8.3. Khuyen nghi ^^ ^^ Q^^ trinh thiet ke vd xdy dung cdc chinh sdch
Tdng eudng nghien cuu khoa hgc ling dyng trong phdng chong ung thu vd pho bien cdc ket qud de cdc nhd hoach djnh chinh sdch cd cdc ca so khoa hgc khi ra cac quyet djnh.
Xay dung co sd dG lifu khoa hgc qudc gia vl ung thu.
Can ed cdc nghien cihi ddnh gid hifu qua cua cdc chuang trinh muc tieu qudc gia lien quan den phdng chdng ung thu va nguy co gay ung thu.
8.4. Khuyen nghi ^oi v&i to chirc thuc hifn chinh sdch
- Hoat dgng phdng chdng ung thu mang tinh da nganh, nhiing can thiet phai cd mdt Bd nganh boat dgng quan ly nha nudc th\rc hifn, tdt nhdt la Bg Y te.
- Cdn cd chinh sach huy dgng sir tham gia va phoi kit hgp ciia cac doan thi chinh tri-xd hdi, cdc td chiic dan su trong cdc boat dgng tuyen truyin gido due phdng chdng cac nguy CO gay ung thu.
Nguyen Thf Thieng 69
8.5. Khuyen nghi ^oi v&i chinh sdch vi truyen thong gido due cpng dong
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Can chii trgng den gidi phdp truyen thdng, coi ddy Id gidi phdp then chdt trong phdng chdng ung thu cung nhu cdc bfnh khde. Trong cdc ndi dung eua truyen thdng de phdng chdng ung thu trong cdng ddng, cdc yeu to cd nguy co cao gdy ung thu nhu thuoc Id, rugu bia, VSATTP can dugc chii trgng trude tien.
- Chinh sdch ve truyen thdng can cbii trgng vifc Idng ghep tuyen truyen ve phdng
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chdng cdc nguy co gay ung tbu vdi nguy co gay cdc bfnh tdt khde.
Tai lifu trich dan
Bfnh ung thu de dga siic khde cdng ddng d Vift Nam. Truy cap tir
http://www.vietnamplus.vn/Home/Benh-ung-tbu-de-doa-suc-khoe-cong-dong-o- VN/20097/10120.vnplus (truy cap ngay 8/5/2010).
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Du dn Qudc gia ve phdng chdng Ung thu giai doan 2008-2010
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GS. Nguyen Vdn Tudn. 2009. Can hieu diing ve ung thu vd nguy eo gdy ung thu. Truy cap tir
http://www.sovteqnam.gov.vn/index.php?option=eom eontent&view=artiele&id
=212:cn-hiu-ung-v-ung-th-va-nguv-e-gav-ung-lb&catid (truy cap ngay 10 th^ig 5 ndm 2010).
Kim Tii La. 2005. Truy cap tir
http://www.machsong.org/moduIes.php?name=News&file=artieIe&sid=265 (truy cap thdng 7 nam 2005).
P. Thanh. 2010. Thdnh lap mang ludi phdng chdng ung thu tren todn qudc. Truy cap tir http://dantri.com.vn/c7/s7-377361/thanh-Iap-mang-luoi-phong-chong-ung-thu- tren-toan-quoc.htm (truy cap ngdy 3/2/2010).
Tung Linh. 2010. LTdc tinh cd gdn 130.000 ca mdc mdi ung thu ndm 2010. Truy cap tir http://hanoimoi.com.vn/newsdetaiI/suc khoe/383417/%C6%B0oc-tinh-co-gan- 130000-ca-mac-moi-ung-thu-nam-2010.htm (truy cap ngdy 15/10/2010).
