summary:

YEAR XII // 1 - 2007

NUMBER

4201 editorial

02 Policies that guarantee output in the event of lack of sunlight in photovoltaic plants: an insurance response at a crucial environmental juncture

06 Kanat. Insurance Fund for Natural Risks in Agriculture – Israel

10 interview: Francisco González

Robatto National Chairman of the

Spanish Cancer Society

(AECC)

16 agenda

A Publicationwww.mapfrere.com

Renewable energy sources such as wind and

solar power call for large investments in infras-

tructure from which an appropriate return is

expected. The instability of this type of energy

owing to lack of sunlight or wind may give rise to

falls in output and performance that are insura-

ble. Trébol analyses the available cover and the

procedures for calculating the claims.

The ongoing close collaboration between the

government and the Israeli agricultural sector’s

farming and businessmen’s associations over a

period of forty years has allowed a wide range

of cover to be offered at appropriate prices. In

this article Trébol explains how this collaboration

works and supplies data and historical back-

ground for analysis.

Finally, Trébol interviews the Chairman of the

Spanish Cancer Society, which in addition to

carrying out research has managed to promote

public awareness of the disease, thereby facilita-

ting prevention and early detection that mitigate

the effects of this dreadful illness.

2 number 42 // 1 - 2007

Santiago CurberaDirector Contingencies and Special Risks Dept.MAPFRE EMPRESAS (Spain)

“By means of extensive legislation

(see www.idae.es), a new

framework for the sector was

established under which a series

of public grants (subsidies), credits

and tax incentives were

established for setting up and

operating Photovoltaic Plants”

General context

The latest reports on this subject stress

that it is not reasons of exhaustion of fos-

sil fuel reserves that are driving the devel-

opment of alternative energy sources,

but something even more compelling.

The continuing use of these fuels, mainly

hydrocarbons and coal, through the

emission of CO2 and other contaminating

elements is causing, in addition to serious

atmospheric pollution, unprecedented cli-

mate change (greenhouse effect), that is

beginning to have devastating effects on

the climate and health.

It seems that we cannot use even a quar-

ter of today’s known reserves if we wish

the planet to survive the danger of these

aforementioned devastating effects.

And yet, according to current records,

during the present year the sun will sup-

ply the earth with four thousand times

more energy than we are going to con-

sume. To fail to take advantage of it is not

only a question of environmental defence,

but economic logic is also beginning to

introduce sustainability cost as a long-

term parameter.

It is well known that the initial concern

of some countries has been converted,

with some notable exceptions, into gen-

eral awareness of the need for a radical

change to clean energy (solar-thermal

and photovoltaic, wind, biomass and rub-

bish, hydrogen, geothermal, hydroelectric

and tidal power).

The situation in Spain

Spain is a signatory of the “Kyoto

Protocol”, and has committed to achiev-

ing a drastic reduction in contaminat-

ing gas emissions (30% by 2020 and

80% by 2050). By the same token

the Renewable Energy Plan 2005-10

estimates a cost of EUR 23,600 mil-

lion to realize its main objective: 12% of

domestic energy demand to be met by

clean energy generation by the end of

the present decade.

To this end and in view of the situation

and conditions in our country, successive

governments have implemented a series

of measures conducive to encouraging

and developing these alternative energy

sources. Amongst them, solar photo-

voltaic power (which transforms solar

radiation into electricity) has merited spe-

cial attention. Not for nothing is Spain one

of the sunniest countries in Europe.

By means of extensive legislation (see

www.idae.es), a new framework for the

sector was established under which a

series of public grants (subsidies), credits

and tax incentives were established for

setting up and operating Photovoltaic

Plants (henceforth referred to as IFVs).

It was determined that the electricity

companies are obligated to purchase

the energy generated by these plants at

a price to be adjusted annually by Royal

Decree (currently EUR 0.44038/kWh,

which represents 5.5 times the general

sales price to the consumer).

Policies that guarantee output in the event of lack of sunlight in photovoltaic plants: an insurance response at a crucial environmental juncture

3number 42 // 1 - 2007

Furthermore, the formation of this new

sector has also lead to the appearance

of soft credit lines that different financial

institutions offer their customers to devel-

op the various photovoltaic projects.

IFVs in Spain

All this has created an important sector

with a sharp rise in the number of plants

(4,800 in December 2005, which is three

times greater than in 2003) with total

installed power of 80 MW, which the gov-

ernment wishes to increase by a factor of

5 to 400 MW in the next 4 years.

Any company or individual may promote

an IFV.

As a result the plants have proliferated

throughout the country, and the number is

still growing. A wide variety of IFVs can be

seen on the roofs of residential and indus-

trial buildings, and sharing agricultural land

and wasteland with the numerous wind

farms. The objective of almost all IFVs is

to generate energy for subsequent sale to

the nearest electricity company.

The plants tend to vary between 5/7

kWh of nominal power and the so-called

photovoltaic “arrays”, a group of fairly

numerous plants of 100 kWh under single

management.

The insurance response

Originally it was the institutions that lent

money for establishing IFVs who began

to demand adequate guarantees from

their customers for the repayment of

credits.

Amongst other methods, these guaran-

tees may be given through a policy that

guarantees constant plant output based

on the provisions of the Technical Report,

in which power generation and resulting

turnover are forecast. These calculations

are in turn conditional on a certain solar

radiation, which may vary unpredictably

from one year to another.

The policy denominated Guarantee of

Output in the Event of a Lack of Sunlight

is intended to cover payment of the differ-

ence between said estimated output and

that actually obtained during the period

of the policy, on account of a reduction

in the anticipated hours and intensity of

sunlight.

When, at the beginning of 2005, it was

decided to draw up a specific product for

this purpose, MAPFRE EMPRESAS had

already been insuring this type of plant

for some time by guaranteeing risks of

Property Damage, Loss of Consequential

Profit and Public Liability.

We are talking, therefore, of new cover

that completes a comprehensive insurance

programme for IFV owners/managers.

Steps towards development of a policy

Information and risk assessment

In the first instance it was necessary to

consult a number of organizations and

technical bodies to collect information on:

1. Types of IFV:

Power and output.

Fixed-angle plants or those with solar

tracking devices of single or dual axis

4number 42 // 1 - 2007

(IFVs may be fixed and are normally

best located facing south at an inclina-

tion of 20o, or equipped with tracking

devices on an azimuthal or dual axis

for maximum advantage, as it receives

solar radiation perpendicularly from

dawn until sunset).

A system for following up incidents

and daily generation control. Similar

to “black boxes”, where all incidents

in the life of a plant are recorded and

which are of vital importance when

determining a claim. For example,

when establishing the difference

between a reduction in power through

lack of sunlight and a stoppage/reduc-

tion for other reasons that are not

covered.

2. Solar radiation in Spain (direct and

diffuse, in hours and intensity) by times of

the year and areas. It is unnecessary to

state that in our country the sun shines

with very different intensity. If we consult

average annual figures, the minimum is

found in Gijón, in the north of Spain, with

953 kWh/m2/year and the maximum in

Huelva, in the southwest, with 1,342, or

41% more.

On the first point, we obtained excellent

information and technical support from

MAPFRE Technical Institute for Safety

(ITSEMAP), Association of Photovoltaic

Industries (ASIF) and Centre for

Energy, Environmental and Technical

Research (CIEMAT). On the second

point, the statistical information dat-

ing back over more than 30 years from

the Radiometric Centre of the National

Meteorological Institute, via its 52 sta-

tions throughout the country (including

the Canary and Balearic Islands), was

highly valuable.

Information to be supplied by the customer. The questionnaire

In spite of the highly technical nature of

the cover under discussion, there is no

reason for the questionnaire to be long

and complicated. Generally the following

information is sufficient:

Name of engineering company installing

plant and the Owning company.

Exact location (postal address). Most

important for estimating presence of

cumulus clouds.

Plant configuration and total installed

power.

Estimated output in kWh/year (and that

transferred to the national grid).

Estimated annual turnover in euros.

Solar station(s) used as reference point for

obtaining the previous figures.

In the event of discrepancies with the

objective calculations in the hands of the

insurance company, the Technical Report

on the plant approved by the industrial

engineer should be requested for analysis

and special consideration. This document

carries a descriptive section setting out

the configuration and power generation

capacity, and another with calculation of

output, in which the estimated income

and profitability (generally over 25 years)

is analysed.

Sums insured, rates and exclusions

Armed with this information it is possible

to carry out, in line with various studies

on the subject, an approximate calcula-

tion of the output of the most common

plants by time of year and area. The

final generation figure in kWh/year mul-

tiplied by the kW tariff price gives a reli-

able estimate of the turnover in euros of

each plant.

“The policy denominated

Guarantee of Output in the

Event of a Lack of Sunlight is

intended to cover payment of the

difference between said estimated

output and that actually obtained

during the period of the policy,

on account of a reduction in the

anticipated hours and intensity of

sunlight.”

A percentage of said turnover, broadly

estimated at between 25% to 30%, may

be established as the insured sum. In

the case of Spain it is not possible to

contemplate a greater reduction in lack

of sunlight over and above the average

of recent years. The rates were studied

and priced by the Actuarial Department

based on the information supplied by the

National Radiometric Centre.

Limitations of Photovoltaic Plants

Factual: The plants have to be located in the vicinity of a high tension power line, otherwise a substantial amount of energy would be lost through transportation by cable.

Legal: These plants should not exceed 100 kW of nominal power. (In 2000 a figure of 5 kW was established initially, however it was later thought that this was too low to encourage this type of energy adequately and generate satisfactory profitability for the plant. Consequently in 2004 it was increased to 100 kW).

5number 42 // 1 - 2007

The benefits of this policy become effec-

tive as a result of a reduction of 10%

in overall annual solar radiation in com-

parison with the historical average over

the past 10 years, in the IFV’s specific

location.

Insurance claims

Under the circumstances set out

above, the policyholder may make a

claim which will be settled in accord-

ance with the following parameters and

criteria:

I = TR (PE – PR – PEP) – COM

Where:

I = Indemnification by the insurance com-

pany.

TR = Regulated tariff, expressed in euros

per kWh/year, relating to the current year

and officially approved by the competent

authority.

PE = Estimated production in kWh/year, in

accordance with the plant project based

on sunlight statistics accepted by the offi-

cial body.

PR = Production effectively obtained dur-

ing the life of the policy, never in excess

of 365 natural days and expressed in

kWh/year.

PEP = Production estimated during stop-

pages, due to maintenance, post-sales

work carried out, own consumption or

because of property damage or other inci-

dents that are not covered but that reduce

the plant’s output, expressed in kWh/year.

COM = Indemnifications received for loss

of profit. or compensation which, in cer-

tain circumstances, the policyholder may

receive for lack of supply.

As previously stated, in the PEP calcula-

tion both the plant’s daily detection sys-

tem (that records all events occurring,

apart from those already mentioned,

and others such as stoppage incidents

due to high temperatures, off-limit fre-

quencies, short-circuits and interrupted

connections for whatever reason, etc.),

must be taken into account together

with the daily reading of direct current

generated and alternating current trans-

ferred to the national grid for sale, that

will establish which reductions may have

occurred through lack of solar radiation

and which for other reasons that are not

covered.

6 number 42 // 1 - 2007

David GinzburgCEO KANAT (Israel)

“KANAT’s Executive Management

maintains close ties with the

farmers and their representatives,

as well as with the Ministry of

Agriculture, the Meteorological

Service and research institutes in

order to continue enhancing the

efficiency of the services it

provides.”

Established in 1967 in Israel, KANAT

is an Insurance Fund for Natural Risks

in Agriculture, It is a government cor-

poration, jointly owned by the Israeli

Government (50%) and 13 farmers’

organizations (50%).Operating under

license of the Insurance Commissioner of

Israel, KANAT is an insurance company

specializing in insurance of natural risks in

agriculture.

Due to its unique holding structure,

KANAT does not distribute profits or

dividends to its shareholders. Rather, it

reinvests all its revenues and assets in

developing and promoting additional serv-

ices for its clients.

As the leader in its field, KANAT offers

insurance services for a highly com-

prehensive range of agricultural crops,

as well as for the broadest range of

natural risks at low, highly-attractive

premiums.

As an expert in this unique insurance

segment, KANAT has drawn specific,

custom-tailored insurance policies for 14

different agricultural branches, in order to

provide insurance solutions for the unique

problems that characterize each branch

and crop.

Kanat’s insurance policies are drawn up,

based on the insurance history of each

crop in order to spread the risk over as

many years as possible. Kanat’s business

philosophy is to ensure damage indemni-

fication at minimal premiums, and at low

operating costs.

Recently, KANAT has launched some

new insurance schemes, such as the

NDI (Natural Disaster Insurance) pro-

gram. NDI was developed to insure

the farmers against all types of climatic

risks not covered under Kanat’s tradi-

tional insurance policies. The policy is

activated when the damage incurred is

higher than 40% of the insured crop and

is not covered by the traditional policies.

The introduction of this product enables

farmers to purchase a comprehensive

coverage.

Many of the crops are insured under

insurance policies signed by KANAT

with the Production and Marketing

Boards. Structural changes in Israeli

agriculture have triggered KANAT to

introduce direct insurance for individual

farmers. To date, direct insurance con-

stitutes approximately 85% of Kanat’s

operations.

A review of KANAT’s 40-year history

demonstrates that it has been remark-

ably successful in carrying out the tasks

entrusted to it by the Government and

the farmers. Sustaining these success-

ful operations depends on continued

cooperation with the Government and

the farmers through the different farmers’

organizations.

Insured branches

KANAT insures the majority of agricultural

branches and crops in Israel at total liabil-

ity of approx. USD 1.5 billion (EUR 1.11

billion). The insured branches include:

Vegetables • Deciduous and sub-

tropical fruits • Bananas • Avocados

• Ornamental plants • Greenhouses •

Citrus • Wine grapes • Cotton

KANAT. Insurance Fund for Natural Risks in Agriculture – Israel

7number 42 // 1 - 2007

• Groundnuts • Arable crops Poultry

(broilers, layers, and breeding flocks)

• Fisheries • Dairy cattle • Breeding bulls

in beef herds • Sheep.

Natural risks covered

Most insurance policies provide cover-

age for crops against direct damage

by various natural causes, such as

frost, hail, storms, floods, heat waves,

as well as specific rain damage during

the harvest season (in groundnuts, cot-

ton, grapes and dates), and damage

caused by birds to vegetables and ara-

ble crops, as well as many other risks

according to the specific susceptibility

of each crop.

Premiums

A separate and distinct premium

is calculated for each insured crop

based on the accumulated experience

in the damage costs (claim to liability

ratio), and the probability of future

losses.

In the traditional insurance, the

Government pays 30% of the premium

and the farmers 70%. In the NDI pro-

gram, the government pays 80% of

the premium as it is an alternative way

for governmental ad-hock payments to

protect the farmers against natural dis-

asters according to the natural disaster

law.

“To provide an attractive service

to its clients, KANAT entitles

farmers in most agricultural

branches to “no claims

bonuses”, which may come up

to a maximum of 60% of the

premium in cases where no

claims have been filed for 6

consecutive years.”

The insurance reserves for all branches

are formed by the difference between

revenues from premiums and the

indemnification and administrative

costs. This reserve, combined with

reinsurance carried with the Accountant

General and with a foreign reinsurance

8number 42 // 1 - 2007

company, enables KANAT to meet its

obligations.

No claim bonus

To provide an attractive service to its cli-

ents, KANAT entitles farmers in most agri-

cultural branches to “no claims bonuses”,

which may come up to a maximum of

60% of the premium in cases where no

claims have been filed for 6 consecutive

years.

Loss adjustment

Notification of damage is received

at Kanat’s offices by telephone, fax,

or in writing. This information is then

rerouted to adjusters in one of the

three insurance districts of Israel. The

district adjuster assigns priorities to

the damage notices and distributes the

adjustment tasks to Kanat’s adjusters

who determine the damage according

to a manual of loss adjustment instruc-

tions.

Indemnities

Indemnities are paid after the occurrence

of damage covered by the KANAT and

its assessment by KANAT loss adjusters.

Having received all the documents listed

in the insurance policy for loss validation

and approval, the Claims Department cal-

culates the indemnities according to the

grower. These indemnities are paid to the

farmer directly or through the Production

and Marketing Boards (in which case the

grower is notified accordingly).

Indemnities typically cover the production

cost and in some crops, even loss of profits.

Arbitration

In case of doubt or conflict, growers may

forward an appeal against KANAT’s deci-

sion to an arbitration committee, composed

of a chairperson appointed by the Director

General of the Ministry of Agriculture, a repre-

sentative of the growers, and a representative

of KANAT. The Committee’s decision is final.

The bottom line

In recent years, KANAT has introduced

improvements in its insurance policies,

resulting in better insurance contracts,

more insured crops and more risks cov-

ered. These initiatives were implemented

in full cooperation with the Government,

Production and Marketing Boards and

professional agricultural organizations.

KANAT’s Executive Management main-

tains close ties with the farmers and their

representatives, as well as with the Ministry

of Agriculture, the Meteorological Service

and research institutes in order to continue

enhancing the efficiency of the services it

provides.

This cooperation between the farm-

ers, the government and KANAT ena-

bles improvement of the insurance

programs, insurance that meets the

farmers’ needs and prevents the gov-

ernment from being involved in direct

payments to farmers.

9number 42 // 1 - 2007

Chart 1: Agregate evolution (USD millions)

600

500

400

300

200

100

0

0 10 20 30 40 50

Agre. Loss A. Premiums

Total Agre. Pre.

Chart 1. Show the aggregate losses paid during the period and the premiums collected from individuals farmers. The top line considers the total average premiums paid by farmers includes government participation. Such a contribution was definitive in order to balance the initial years. The positive gap was used to pay expenses, reinsurance and to form a stability found that allow the progressive reduction of the State contribution.

Chart 2: Israel. Agro Insurance statistics (USD millions)

3%

2%

1%

0

1967

-68 Rates S.I.

Tendency lineal (Rates)

Chart 2. Show the rate tendency The average rates were reduced during the years mainly because:1. Insurance and farming experience. 2. Increasing of the varieties of crop insured (starting in 1967 with 8 crops nowadays 21 crop with 38 different insurance programs). 3. Improving the insurance programs.The chart also shows the logical fluctuation of the average rates due cyclical loses and the introduction of new products.

Chart 3: State stability contribution

60%

50%

40%

30%

20%

10%

0%

Total State contribution

% State contribution

Chart 3. Show the State contribution in % of the total premium as well as the per year contribution in USD millon.

1,6001,4001,2001,0008006004002000

1970

-71

1973

-74

1976

-77

1979

-80

1982

-83

1985

-86

1988

-89

1991

-92

1994

-95

1997

-98

2000

-01

2003

-04

1967

-68

1971

-72

1975

-76

1979

-80

1983

-84

1987

-88

1991

-92

1995

-96

1999

-00

2003

-04

12

10

8

6

4

2

0

US

D m

illio

nsR

ate

%

S.I.

mill

ions

US

DU

SD

mill

ions

% o

f to

tal p

rem

ium

Elaped years

Season

Season

Rate & S.I. tendency

10number 42 // 1 - 2007

interview

Francisco González Robatto National Chairman of the Spanish Cancer Society (AECC)

• Francisco González-Robatto was born in Madrid 56 years ago and is the sixth of eight children. He’s married with four daughters. He considers himself Galician for family reasons: his parents were from Ferrol (A Coruña), as were all his ancestors.

• He studied Law at the Universidad de Deusto and Economics at ICADE. He did a year at Cambridge. After military service as an infantry Second Lieutenant in Valencia, in January 1975 he began to work in the Research Department of the Banco de Fomento, which he was able to combine with work in a law office.

• From there he progressed to First National Citibank, where he was the first Spaniard to enter the bank. He remained there for seven years and was able to continue his studies with a Harvard Master’s degree in Brussels.

• In 1987 he joined Midland Bank as General Manager, however in 1990 he accepted an offer from Banco de Santander, where he was Assistant General Manager. A health problem led him to take early retirement, but it did not stop him from accepting the AECC chair-manship when he was approached.

People’s sensitivity about accidents is curious, because it’s not an issue in the case of cancer

"One in every four persons will suffer from some sort of cancer during their lifetime, although in countries such as Spain more than 50% of the cases are curable. To make progress against cancer it must be fought with compassion, as demonstrated by the 14,000 volunteers and 83,000 AECC members since its foundation. AECC’s aim, as explained by the Chairman, is to help alleviate the suffering and reduce the figure of 100,000 people who die annually from this cause. Information, prevention, research and welfare of sufferers are basic factors in reaching a point where the disease is wholly curable".

11number 42 // 1 - 2007

How did you become Chairman of an

organization such as this?

I’m just another volunteer. I charge noth-

ing – I’m only paid representational

expenses. And furthermore I’m proud of

the fact. I had a very hectic professional

life, however I reduced the pace because

of heart problems and took early retire-

ment. I then found myself with time on my

hands and a desire to do something for

others. The fact that I had worked with

the British gave me a different perspec-

tive, because the Anglo-Saxon world is

more conversant with the concept of peo-

ple giving their time to help others.

Is health the top priority for all human

beings?

I’m certain of it. The point is that to be

happy, when you look at it objectively,

health has to go together with other fac-

tors. It is of course the first consideration,

although above all the priority must be

to refrain from jeopardizing one’s health.

It’s a highly prized asset and we may be

unlucky, but we should not go purposely

in search of misfortune.

What are the figures for cancer in

Spain?

There are some 162,000 cases annually

and about 500,000 persons or families

with someone close suffering from

some type of cancer. Each year

100,000 people die of it; in 2005 there

were 100,189 deaths. The leading

cause of death is lung cancer, which

accounts for 90% of cases because of

smoking or breathing in others’ smoke.

The second is colon cancer, whereas

the third is breast cancer. People’s sen-

sitivity about accidents is curious,

because it’s not an issue in the case of

cancer.

“Our first commitment is to

provide information and this we

do in different ways. The most

important is our website. Two

years ago we launched a new

one: www.todocancer.org that

has answers to many questions

in an intelligible format: types of

cancer, manner to adopt with ill

persons, how the family should

face up to the disease, etc.”

What is the Spanish Cancer Society? When and how did it originate?

It was formed almost 54 years ago on

the initiative of a group of benevolent

individuals. They were influential from

both an intellectual and an economic

standpoint, and had encountered people

who had the disease but couldn’t obtain

medical attention because there was no

health system available to treat cancer.

In fact I believe that the first cobalt bomb

in Spain was bought by AECC. Its for-

mation was related to welfare concerns

in view of the scarcity of public health

resources. Today we are an NGO where

some 14,000 people work; in excess of

13,300 are effectively volunteers, where-

as there are 700 salaried employees.

We are present in 52 Spanish provincial

capitals in addition to a further 2,000

locations. Our operational area is Spain,

although we provide information to other

countries if requested. We also run some

specific programmes in conjunction with

USA and Portugal. We are members of

different international bodies, provided

they are free of charge, the exception

being the International Cancer Union

(UICC), which is the body to which all

societies throughout the world belong.

The UICC includes more than 100 coun-

tries and 400 societies. We are also

members of many European bodies,

but only those that are truly worthwhile

because the principle of austerity is para-

mount.

Of what use has AECC been in these

54 years?

A great deal, I’m absolutely convinced.

There are four tasks that we have to per-

form, some more in the short term than

others. Firstly, we must be able to pro-

vide information. We’re all customers and

potential members of the public. These

people aren’t the ones who are ill, nor

their relatives. Statistically, one in every

four persons will get cancer, however

this does not mean that we are going

to die. Today many cancers are curable.

It should be remembered that cancer

is made up of 200 different diseases.

In USA, which has very good statistics,

there is evidence that deaths from cancer

have fallen in recent years. As already

mentioned, our first commitment is to

provide information and this we do in dif-

ferent ways. The most important is our

website. Two years ago we launched

a new one: www.todocancer.org and I

must say that it is superb, and this fact

is endorsed by leading experts and sci-

entists. It carries answers to many ques-

tions in an intelligible format: types of

cancer, manner to adopt with ill persons,

how the family should face up to the dis-

ease, etc. And furthermore we enhance

it as much as possible. It gets some

150,000 monthly hits and sometimes up

to 200,000. We know that almost 22% of

these hits originate in Latin America and

also the USA. Additionally we have a free

telephone service where 6 or 7 people

answer the commonest questions. We

issue other information in the form of

catalogues and brochures.

The second important topic is preven-

tion. Research and pharmacology have

interview

12number 42 // 1 - 2007

interview

allowed survival – meaning in excess of

five years from the date of diagnosis of

the cancer until cure – to go from 30/31%

to 51%; more than half the cancers are

being cured. This data does not include

small cancers, spots, etc. There are three

types of cancer that the World Health

Organization (WHO) takes into account

for prevention purposes: breast, cervix

and colon cancers.

What action has AECC taken for each

of these cancer types?

For breast cancer we used to do mam-

mographies. That has now changed.

Health is the responsibility of the

Regional Administrations and in collabo-

ration with them AECC has arranged

for all women over 45 or 50 to receive a

letter from the regional health authority

advising them to have a mammogra-

phy. Today we do no mammographies

that have not been arranged through

the public health service. What have

we achieved? That 100% of women

at risk receive a letter inviting them to

have a checkup. It’s a big step forward.

This year we’re going to spend part of

our budget on discovering how many

attend. We estimate that 35/45% don’t

go, which means that from 1,500 to

2,000 tumours are not caught in time.

When we say that screening is neces-

sary, this means that there are preven-

tion methods which, in view of the

number of patients that may emerge

in the checkup, indicate that the test

makes sense. Prevention of cancer of

the cervix is highly developed in Spain.

Spanish women go to the gynaecolo-

gist regularly. It should be remembered

however that we have an ever greater

percentage of immigrants and this

aspect should also be monitored. As

regards colon cancer we are still in

the early stages. Everyone, men and

women, over 50 should have a colonos-

copy under sedation so that should pol-

yps be detected they can be removed,

thereby avoiding transformation into

tumours. If this is not done they can

take anything from 5 to 20 years to

develop, and when they are discovered

it is too late. For this reason there are

more deaths in Spain from colon cancer

than from breast cancer. Our objective

is to raise awareness and request all

regional health authorities to begin to

carry out checkups. It’s an expensive

problem, however the potential 16,000

annual deaths from this cause are even

worse.

13number 42 // 1 - 2007

“The second important topic is

prevention. There are three cancer

types that the World Health

Organization (WHO) takes into

account for prevention purposes:

breast, cervix and colon cancers.

Research and pharmacology have

allowed for half of these cancers

to be cured.”

Further to the service commitments

undertaken by AECC, what other

matters are being developed?

The third important topic is research.

We have a Scientific Foundation, to

whom we have to give more money.

In fact everything that we channel into

research should be done through it. At

present we contribute about 10% of

our gross income. Research is most

important and is ever more in need

of resources. We also provide grants

to undertake research projects. The

fourth topic relates to welfare. We have

20 hospices, although I trust that with

the advances in welfare systems this

service will be increasingly unneces-

sary. Persons without means can come

to the hospices both as children and

adults. The most important aspect is

the welfare factor and currently these

centres are the palliative care units for

the terminally ill. At present we have

64 teams paid for by us, but gradually

we’ll reach agreements to transfer these

units to the Regional Administrations

as they’re extremely expensive.

Furthermore they’re made up of a doc-

tor, a nurse and a psychologist and

attached to a public hospital where the

oncologists decide which patients can

be better looked after at home. They

receive home visits and both they and

their relatives are helped in every way.

This assistance ranges from how to

take medication, through to their last

moments and accompanying family

members in their grief. We consider that

this type of support should be a right

interview

14number 42 // 1 - 2007

enjoyed by all Spaniards suffering from

any illness, although cancer is the prime

example. For this reason we want the

Regional Administrations to take over

this welfare task, and we hope that at

some future date we may be able to

concentrate exclusively on information,

prevention and research.

“The third important topic is

research. We have a Scientific

Foundation, through which we

channel all research funds. We

are now dedicating about 10%

of our gross income for this

purpose.”

What is AECC’s budget and where

does its income come from?

About EUR 30 million annually. The

principle source of funds is the annual

charity collections which bring in

approximately EUR 7 million. We col-

lect almost EUR 3 million through the

special National Lottery draw. In addition

we have 83,000 members who contrib-

ute, and our aim is to reach a figure of

250,000. Spaniards are very generous,

however we need more members. On

the other hand we also obtain public

support that accounts for between 10%

and 15% of our income, and finally, we

do a bit of everything to balance the

budget, from bullfights and pop con-

certs to golf tournaments, etc. Complete

transparency is required; everything

must be crystal clear. The first rule is

that everyone who contributes must be

convinced that it will be used for the pur-

pose stated. We are audited by Deloitte.

All our contributions are audited and we

also have our own internal auditors.

Helping AECC to establish corporate

social responsibility. What can the

insurance companies do for you?

It is important that, as an act of cor-

porate responsibility, companies give

money to societies like ours. Generally

speaking, private individuals in Spain

are very generous but companies have

been slow to make donations. It is vital

that they begin to do so and make

contributions to charitable causes.

Insurance companies can do a number

of things such as giving grants for can-

cer research programmes or assisting

in prevention campaigns. Over the last

two years we have received Insurance

Solidarity Prizes, however their dona-

tions have been small. The insurance

industry should do more, because,

amongst other things, thanks to preven-

tion it will have to pay out on fewer life

policies, to give just one example. The

important factor for companies is know-

ing to whom the money is going, and

for this purpose there is the Fundación

Lealtad which monitors each NGO and

ensures that is complies with its pro-

grammes. We are proud to state that

over the last three years AECC has

obtained the highest marks awarded by

this foundation.

“The fourth topic relates to

welfare. We have 20 hospices

and 64 of our own teams to

provide care to terminally ill

cancer patients. We consider

that this type of support is the

right of all Spaniards suffering

from any illness. For this

reason we want the Regional

Administrations to take over this

welfare task, and we hope that

at some future date we may be

able to concentrate exclusively

on information, prevention and

research.”

Is it still necessary to travel to USA for

a cancer cure?

This is an eternal question. There are

many well-known persons who have

travelled abroad, but this has much more

to do with media pressure than with

other factors. Cancer is a disease that

must be borne with serenity, both by suf-

ferers and those surrounding them. For

certain types of cancer, the more com-

mon ones, the standard of oncological

The palliative home care units in 2005

8,357 Ill persons treated.

4,146 Patients received psychological treatment.

5,056 Families received psychological treatment.

2,818 Families received grief counselling.

10,521 Technical Medical Specialists.

52,731 Medical visits.

42,553 Nursing visits.

5 Medical visits – daily nursing (average per team).

2.5 Psychological visits per day (average per psychologist).

50 Days on programme per patient (average).

70% Deaths at home.

147,746 Follow-up telephone calls.

792,911 Distance travelled (km).

15number 42 // 1 - 2007

treatment in Spain is as good as or bet-

ter than abroad. We have highly-trained

leading specialists. The situation is that,

for certain types of rare cancer, in Spain

there may be insufficient background

and very little case history, whereas in

USA, if only on account of its size and

population, there are many more cases

and perhaps for this reason they are also

more used to treating them. However, in

most cases where the prognosis is bleak

because it has been discovered late and

there is widespread metastasis, nothing

is gained by travelling to USA. Although

I say this and I consider that our health

system has admirable specialists, we

are also aware that speed of treatment

varies in different areas of Spain, and

this is of fundamental importance; per-

haps it may be necessary to go to the

private sector or elsewhere. One of our

demands is the need for awareness

that action on cancer must be more

expeditious, and this is borne out in the

Comprehensive Cancer Plan.

What remains to be done?

A great deal. We have to announce that

we’re closing the hospices because the

Regional Administrations are satisfy-

ing this requirement very effectively, and

that it’s unnecessary for us to subsidize

research because as a result of it cancer

has become a normal disease instead of

a fatal one.

What will you say on the day that you

bid farewell to the chairmanship?

That I’ve been happy in this position

and that it’s provided me with a wealth

of experience from a human point of

view. I’ve had the privilege of see-

ing how many generous individuals

there are in this country. And finally, I

hope that my successor will be equally

aware of the need for austerity and

transparency.

AECC Scientific Foundation. Manifesto for the advancement of the fight against cancer in Spain (summary).

1.- Make aware and involve the entire society in the fight against cancer.

2.- Create a real, effective awareness of cancer prevention.

3.- Apply the acknowledged procedures on early detection across the board in public institutions.

4.- Ensure comprehensive treatment for the patient.

5.- Uphold the patient’s right to individual welfare.

6.- Acknowledge the importance of research. Encourage basic, clinical and epidemiological research and interrelation between them all.

7.- Provide Spanish hospitals with the structures and means to facilitate clinical and transnational research.

8.- Promote careers for researchers.

9.- Demand that the authorities institute a strategic plan to combat cancer.

10.- Eradication of cancer as a cause of death and suffering in Spain calls for a firm undertaking by the whole of society. Advances in research, prevention, diagnosis and treatment, however, mean that this is an attainable goal.

16number 42 // 1 - 2007

Is a MAPFRE RE publication. Chairman: Juan Antonio Pardo. Editor: Ramón Aymerich. Coordinator: Carmen Cejas. Editorial Board: Esther Cerdeño, Javier Fernández-Cid, Eduardo García, Pedro de Macedo, Lorenzo Garagorri, Juan Mayo, Luis de Mingo, Enrique Orsolich, Faustino Pérez, Eduardo Pérez de Lema, Mª Teresa Piserra, Juan Luis Román, Javier San Basilio, Eduardo Sánchez, Juan Satrustegui. Technical Coordination: ITSEMAP Servicios Tecnológicos MAPFRE, S.A. Design: Tau. Publisher and printer: Gráficas Palermo. ISSN: 1137-246X. Deposito Legal: M. 33.551/1996.

TRÉBOL MAGAZINE contact address: We now have an exclusively dedicated email address trebol@mapfre.com for TRÉBOL readers to contact us with their feedback, suggestions, letters and requests that will reach the Management and Board of this publication. We also invite your comments on the technical content of articles and interviews published that will be relayed, when relevant, to the respective authors.

agenda

Courses Date City Country

Technical Investigation of Claims. 9-10 July Mexico, D.F. Mexico

Technical Investigation of Claims. 12-13 July Caracas Venezuela

Technical Investigation of Claims. 16-17 July Bogotá Colombia

Technical Investigation of Claims. 19-20 July Sao Paulo Brazil

Technical Investigation of Claims. 23-24 July Buenos Aires Argentina

Technical Investigation of Claims. 26-27 July Santiago Chile

Inspection and Assessment of Risks. 6 November Tunis Tunisia

Inspection and Assessment of Risks. 8 November Casablanca Morocco

COURSES ORGANIZED BY MAPFRE RE (2007)

Courses Date City Country

The risk of crowd concentration. Prevention and emergency planning.

4-5 September Barcelona Spain

The new Technical Building Code SI basic document, safety in case of fire.

11-13 September Madrid Spain

Assessment of contaminated soil within the scope of R.D. 9/2005 (preparation of preliminary situation report).

18-19 September Barcelona Spain

Safety in the transport of Hazardous Goods. The Safety Consultant 26-27 September Madrid Spain

The practical design of emergency plans to comply with regulatory requirements.

1-4 October Valencia Spain

Technical tools to assess environmental risks in industrial plants. 10-11 October Barcelona Spain

Provisions regarding safety due to potentially explosive environments (RD 681/2003 of 12 June).

16-17 October Madrid Spain

The new Technical Building Code. SI basic document, safety in case of fire.

23-25 October Andalusia Spain

The efficient management of corporate emergency planning. 6 November Madrid Spain

Fire Safety Regulations in industrial establishments (RD 2267/2004 of 3 December).

13-14 November Madrid Spain

Safety and Prevention of Electrical Risks in Low and High Tension Environments.

13-15 November Madrid Spain

Assessment of contaminated soil within the scope of R.D. 9/2005 (preparation of preliminary situation report).

21-22 November Málaga Spain

The new Technical Building Code. SI basic document, safety n case of fire.

27-29 November Madrid Spain

COURSES ORGANIZED BY ITSEMAP Servicios Tecnológicos MAPFRE (2007)