Fiscal policy to improve diets and prevent noncommunicable diseases: from recommendations to action

The World Health Organization has recommended that Member States consider taxing energy-dense beverages and foods and/or subsidizing nutrient-rich foods to improve diets and prevent noncommunicable diseases. Numerous countries have either implemented taxes on energy-dense beverages and foods or are considering the implementation of such taxes. However, several major challenges to the implementation of fiscal policies to improve diets and prevent noncommunicable diseases remain. Some of these challenges relate to the cross-sectoral nature of the relevant interventions. For example, as health and economic policy-makers have different administrative concerns, performance indicators and priorities, they often consider different forms of evidence in their decision-making. In this paper, we describe the evidence base for diet-related interventions based on fiscal policies and consider the key questions that need to be asked by both health and economic policy-makers. From the health sector\u27s perspective, there is most evidence for the impact of taxes and subsidies on diets, with less evidence on their impacts on body weight or health. We highlight the importance of scope, the role of industry, the use of revenue and regressive taxes in informing policy decisions

Assessing the characteristics of 110 low- and middle-income countries' noncommunicable disease national action plans

Noncommunicable diseases (NCDs) are a leading contributor to preventable mortality and impoverishment in low- and middle-income countries (LMICs). To support countries in developing holistic and integrated NCD plans, the World Health Organization (WHO) has produced get rid of this a NCD Multisectoral Action Plan (MSAP) guidance. To date, over 160 countries have produced MSAPs and uploaded them to the WHO's NCD document repository. We examined the content and comprehensiveness of the MSAPs uploaded by all 110 LMICs, with reference to the WHO guidance. Overall, the MSAPs included 71% of the elements recommended by the WHO, however, there was a tendency to present situational analyses and recommended actions without providing costings or an overall funding plan. We found no correlation between MSAP comprehensiveness (alignment with the WHO guidance) and policy implementation. There were no significant differences in MSAP alignment by region or income group. Countries with higher universal health coverage indices had lower MSAP alignment score. We concluded that the existence of a comprehensive MSAP is not enough to guarantee policy implementation, and that the WHO should focus its support on helping countries to translate plans and policies into concrete actions to address NCDs

Understanding integrated service delivery: a scoping review of models for noncommunicable disease and mental health interventions in low-and-middle income countries

Abstract Background Noncommunicable diseases (NCDs) and mental health conditions represent a growing proportion of disease burden in low- and middle-income countries (LMICs). While past efforts have identified interventions to be delivered across health system levels to address this burden, the challenge remains of how to deliver heterogenous interventions in resource-constrained settings. One possible solution is the Integration of interventions within existing care delivery models. This study reviews and summarizes published literature on models of integrated NCD and mental health care in LMICs. Methods We searched Pubmed, African Index Medicus and reference lists to conduct a scoping review of studies describing an integrated model of NCD or neuropsychiatric conditions (NPs) implemented in a LMIC. Conditions of interest were grouped into common and severe NCDs and NPs. We identified domains of interest and types of service integration, conducting a narrative synthesis of study types. Studies were screened and characteristics were extracted for all relevant studies. Results are reported using PRISMA-ScR. Results Our search yielded 5004 studies, we included 219 models of integration from 188 studies. Most studies were conducted in middle-income countries, with the majority in sub-Saharan Africa. Health services were offered across all health system levels, with most models implemented at health centers. Common NCDs (including type 2 diabetes and hypertension) were most frequently addressed by these models, followed by common NPs (including depression and anxiety). Conditions and/or services were often integrated into existing primary healthcare, HIV, maternal and child health programs. Services provided for conditions of interest varied and frequency of these services differed across health system levels. Many models demonstrated decentralization of services to lower health system levels, and task shifting to lower cadre providers. Conclusions While integrated service design is a promising method to achieve ambitious global goals, little is known about what works, when, and why. This review characterizing care integration programs is an initial step toward developing a structured study of care integration

Understanding the science that supports population-wide salt reduction programs

Independent systematic reviews of the totality of the evidence by governments and international agencies throughout the world uniformly conclude that population-wide interventions to reduce salt are beneficial for health. However, some scientists continue to produce and cite studies with paradoxical findings that conflict with the evidence base used to develop national and World Health Organization (WHO) guidelines on salt reduction.[1-5] While conflicting studies are not uncommon in any area of research,[6] in the case of salt, such studies attract widespread attention in the media; misinform program leaders, clinicians, and the general public; and impede program implementation. Such impediments to progress have occurred despite the fact that the designs and methods of studies with paradoxical findings have been criticized by international experts who highlight the fact that the results are not valid.[7-9

Progress on salt reduction in the Pacific Islands: from strategies to action

BACKGROUND: Most populations are consuming too much salt which is the main contributor of high blood pressure, a leading risk factor of cardiovascular disease and stroke. The South Pacific Office of the World Health Organization has been facilitating the development of salt reduction strategies in Pacific Island Countries and areas (PICs). The objective of this analysis was to review progress to date and identify regional actions needed to support PICs and ensure they achieve the global target to reduce population salt intake by 30% by 2025. METHODS: Relevant available national food, health and non-communicable disease (NCD) plans from all 22 PICs were reviewed. NCD co-ordinators provided updates and relayed experiences through semi-structured interviews. All activities were systematically categorised according to an existing salt reduction framework for the development of salt reduction strategies. RESULTS: Salt reduction consultations had been held in 14 countries and final strategies or action plans developed in nine of these, with drafts available in a further three. Three other countries had integrated salt reduction into NCD strategic plans. Baseline monitoring of salt intake had been undertaken in three countries, salt levels in foods in nine countries and salt knowledge, attitude and behaviour surveys in four countries. Most countries were at early stages of implementation and identified limited resources as a barrier to action. Planned salt reduction strategies included work with food industry or importers, implementing regional salt reduction targets, reducing salt levels in school and hospital meals, behaviour change campaigns, and monitoring and evaluation. CONCLUSIONS: There had been good progress on salt reduction planning in PICs. The need for increased capacity to effectively implement agreed activities, supported by regional standards and the establishment of improved monitoring systems, were identified as important steps to ensure the potential cardiovascular health benefits of salt reduction could be fully realised in the region

Strengthening health information systems for preventing and controlling non-communicable diseases in the Pacific Region

Oct. 2013; Authors all members of Health Information Systems Knowledge Hub; Theme 4: Tracking progress towards Millennium Development Goal