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 Implementation is slowly improving, yet alcohol and tobacco policies
are the least widely practiced, researchers report in The Lancet
Global Health.
"It's a matter of holding countries accountable for their
international commitments and speaking truth to power when they fail
to take action," said Dr. Luke Allen of the University of Oxford in
the United Kingdom, who led the research.
Non-communicable diseases, like cancer and heart disease, account
for 73% of deaths globally, the researchers note. In 2015, 193
countries committed to reducing these deaths by one third, by 2030,
through 18 policies to improve healthcare provision as well as
public health through nutrition, physical activity, tobacco use and
alcohol use.
"We need to understand which policies are being systematically
overlooked and which particular groups of countries may require
additional support so that we can help to protect people from these
conditions," Allen told Reuters Health by email.
The researchers analyzed WHO progress monitor reports from 2015 and
2017 to calculate implementation scores for 151 countries for the 18
policies.
In 2017, the average policy implementation score was 49%. Costa Rica
and Iran had top scores for implementing 86% of the recommendations.
Scores were lowest in Haiti and South Sudan, with 5.5% of the
policies implemented. Overall, scores rose in 109 countries between
2015 and 2017 and dropped in 32 countries.
In general, implementation increased for all 18 policies except for
mass-media campaigns around physical activity and bans on alcohol
advertising. The most commonly implemented policies were graphic
warnings on tobacco packaging, disease risk-factor surveys and
national clinical guidelines. Least-implemented policies included
tobacco taxation, anti-tobacco mass-media campaigns and provision of
cardiovascular therapies.
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Scores tended to be highest in wealthy countries that invest in
healthcare and education, the authors note. Countries in Europe and
central Asia, for instance, landed in the top 20 more often. Their
weaknesses often involved market-related changes, such as failure to
reduce marketing around tobacco and alcohol.
Among the bottom 20 countries, 17 were in sub-Saharan Africa, and
none of the bottom countries scored points for interventions around
fats, child food marketing or heart therapies. This highlights an
area where financial and technical support could be provided, the
study authors write.
Allen said a large number of low-income countries and former Soviet
Union states landed at the top of the list.
"You wouldn't naturally think of Iran, Costa Rica, Moldova and
Estonia as offering the highest standards of health policies to
their populations, but it goes to show that it isn't actually that
expensive - just a matter of political will - to prioritize health,"
he said. "All 151 countries have repeatedly committed and publicly
endorsed the full list of policy options, yet no country has
actually implemented all of them."
Future studies should look at the effects of the policies that are
implemented, said Robert Beaglehole of the University of Auckland,
New Zealand, who wasn't involved in the analysis.
"Of course, 'implementation' is self-described and says nothing
about impact at the population level," he noted in an email.
Health officials could help countries with lower scores identify and
focus on a smaller number of priority policies, he added.
"Perhaps countries are being asked to do too many things at once,"
Beaglehole said. "Countries might be better off if they focused on
three or four high priorities with the greatest chance of actually
improving population health."
SOURCE: https://bit.ly/2Mlq0F9 and https://bit.ly/377n2fq The Lancet
Global Health, online December 5, 2019.
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