In Papua New Guinea, where a majority of the adult population chews betel nuts, the rate of oral cancer per capita is the highest in the world. It is also the most common form of cancer among men and the second most common among women.
In a country with a weak healthcare system and only a few specialized doctors, most people are likely to die without being diagnosed. In the Northern Mariana Islands, which have a more robust healthcare system, the odds for those affected are better. But betel nuts still cause a lot of damage to public health. And it’s not just about cancer.
“There’s a growing list of systemic problems associated with betel nuts. Cardiac issues, renal, liver, adverse outcomes in pregnancy. The story that’s unfolding is that betel nut should really be thought of similarly to alcohol and tobacco independently,” William Moss says.
In the Northern Mariana Islands, most betel nut chewers are still unaware of the risks, as evidenced by a survey study Moss was involved in. ”Of 300 chewers a staggering 87 percent did not know that the betel nut is a carcinogen,” he says.
Two decades after betel nut was classified as carcinogenic, sales are still sparsely regulated in most parts of the world, and warnings about the health risks are scarce. Moss argues that this is reminiscent of the situation with tobacco in the middle of the last century, when sales were unregulated even though the health risks were known.
“It took a collective international effort to bring big tobacco to the table and hold them accountable. Here, we have another powerful billion-dollar industry, but the target consumers are marginalized, impoverished populations with minimal education,” he says.