|ORIGINAL ARTICLE- FORUM
|Year : 2017 | Volume
| Issue : 4 | Page : 126-128
How health policies are relevant for noncommunicable diseases: Experiences from policy forum
Kunjan Kunjan Rapporteur , Meenakshi Sharma Rapporteur
Department of Community Medicine, School of Public Health, PGIMER, Chandigarh, India
|Date of Web Publication||22-Feb-2018|
School of Public Health, PGIMER, Chandigarh
Source of Support: None, Conflict of Interest: None
Background: Risk factors of NCDs are mainly foods rich in calorie, transfat salt, use of tobacco and alcohol. Wide availability of these products driven by unfair trade, irresponsible marketing and affordable prices is prevalent. Hence healthy public policies are critical for prevention and control of NCDs.
Methodology: A brief report based on background paper ,deliberations and recommendations from the policy forum which was organised on the 4th November 2017 with key topics i.e., sugar sweetened beverages and fat products.
Discussion: Policy initiatives such as controlled marketing policy, increase in price and tax to make these products unaffordable and ban on sale of these products are important policy interventions which had worked in developed and developing nation are needed. Subsidizing fruits and vegetables may be additional initiative .There is need for addressing up streaming the social determinants for prevention of NCDs
Keywords: Alcohol, policy, regulation, sugar-sweetened beverages, tobacco
|How to cite this article:|
Kunjan K, Sharma M. How health policies are relevant for noncommunicable diseases: Experiences from policy forum. Int J Non-Commun Dis 2017;2:126-8
|How to cite this URL:|
Kunjan K, Sharma M. How health policies are relevant for noncommunicable diseases: Experiences from policy forum. Int J Non-Commun Dis [serial online] 2017 [cited 2019 Nov 14];2:126-8. Available from: http://www.ijncd.org/text.asp?2017/2/4/126/225978
| Background|| |
Non-communicable diseases (NCDs) kill 40 million people each year, equivalent to 70% of all deaths globally. Important determinants of NCDs include consumption of ultraprocessed foods, sugar-sweetened beverages (SSBs), tobacco, alcohol, and excessive salt., Many studies have shown that consumption of SSBs promotes weight gain in adults and children. Smoking is estimated to cause about 71% of all lung cancer deaths, 42% of chronic respiratory disease, and nearly 10% of cardiovascular disease. Harmful consumption of alcohol was the cause for 5.9% of all deaths in 2012 and 5.1% of the global burden of disease and injury. Excessive sodium consumption is an important cause for hypertension. Sodium consumption of more than 2 g/d is estimated to cause 1.65 million cardiovascular-related deaths each year.
Globalization has brought processed foods; diets high in salts, sugar, and fats into billions of homes. Studies have reported that people in developing countries are now consuming more processed foods than ever before. Marketing of fast food, processed food, tobacco, and alcohol contribute to this. A significant proportion of global marketing is now targeted at children in developing countries and is a key contributor to unhealthy behavior. A study reported that overall, the mean total daily salt consumption is 10.9 g in India which is higher than the recommended value (<5 g/day) by the World Health Organization.
Hence, policies/regulatory interventions such as tax and price increases on tobacco, alcohol, or regulating SSBs marketing are required. With this background, a policy forum was organized to focus how regulation and policy implementation can contribute for prevention and control of NCDs.
| Methodology|| |
A background paper was prepared on policy issues for the prevention and control of noncommunicable diseases and risk factors” and shared with all resource persons. The topic was also discussed subsequently in the Policy Forum at the World NCD Congress on November 4, 2017 in Chandigarh, India. This brief report is the combination of background paper and the deliberations and recommendations from the policy forum with key topics, i.e., SSBs and fat products.
| Discussion|| |
In the policy forum, opportunities and challenges on policy regulation for implementation of sustainable policies for NCD prevention in South-East Asia Region were discussed. Regulation of leading factors compounding NCD risk i.e., information, media marketing, prices and taxation on products in the market, especially high fat foods and SSBs were emphasised during discussion. Best buy interventions advocated by WHO for tobacco, alcohol and need for analyzing whether the targeted intervention to be regulated or not were discussed. Stress was thrown on the need of investments for better regulation and policy measures. An example from Thailand on the cost of a cigarette was illustrated; how cost is divided among stakeholders and profits are shared. Marketing of food/beverages and the promotion of fruits and vegetables were discussed in regional and global perspective with special reference to Maldives. Magnitude of the problem of overweight/obesity in children specifically in the South East Asia was focussed in the discussion. Aggressive marketing of SSBs which leaves the public blind to the problems were emphasised. Recommendation was to address the social determinants and participation of different stakeholders.
A discussion was held on multi-sector coordination as a key to approach better health in terms of a good lifestyle and subsequent better health for all. The constraints of active participation of private sector and non health sectors were focused. It was suggested that leveraging of different sectors is required for developing and implementing a policy. It was also emphasised that policy implementation is critical with regular appraisal.
Policy expert from York University, Canada shared the Canadian experience on aligning health and social policies to address NCDs. It was emphasised that we need to focus beyond the curative model and start modelling in terms of preventive care. Social policy affects health policy was highlighted during discussion. In mid 1990s in Canada, social policy was redefined to include health along with other aspects like education and social services. Health Promotion reports generated in Canada was discussed – like the Lalonde Report of 1974 and the Ottawa Charter of 1986. The Canada Health Act of 1984 was one such example where federal cash transfers were used to fuel a sustained comprehensive care model – instilling disincentives to shift the focus from curative to preventive care by early screening and diagnosis and consecutive health promotion strategies.
One of the past policy maker discussed that role of administration, legislation and regulation are not just limited to health sector, but are also relevant when it comes to planning for towns/ cities for physical activity and leisure activities of the population. He further emphasised on social responsibility apart from the need for proper legislation and policy advocacy.
The draft “Chandigarh Call for Action on Sustainable Development in Combating the Global Epidemic of Non- Communicable Diseases– Consensus Statement of World NCD Congress” was prepared on the basis of scientific deliberations during the workshop and pre workshop sessions by a group of scientists from all over the world and policy makers. The draft was presented in this forum and suggested changes on the issue of disability and rehabilitation, aspects of traditional medicines and the concept of Family-led healthcare were incorporated.
Outcome of the policy forum
Chandigarh Call for Action on Non Communicable Diseases was discussed and key messages were integrated.
| Conclusion|| |
Regulations of salt, SSBs, sugar, trans fats, alcohol, smoking and smokeless tobacco are critical for prevention and control of NCDs. This requires a comprehensive policy and its proper enforcement through multi-sectoral participation, 'whole-of-government' and “best buys” approaches. For bringing improvements in the consumption patterns of the population; enhanced taxation, banning the sale of these products to minors particularly around schools and subsidizing fruits, vegetables is required.
Resource persons/ Contributors
Dr. Thaksaphon Thamarangsi- Director NCD, WHO, SEARO, Dr. Arvind Mathur- WHO representative, Maldives, Mr. Rajiv Kumar, Director, NCD, MoHFW, New Delhi. India, Dr. Mary E Wiktorowicz, -York University, Canada, Dr. Dhirendra N Sinha – School of Preventive Oncology, Patna, India, Mr. Rajan Kashyap - Ex Chief Secretary of Punjab, Dr. Shahina Aboobakar- Ministry of Health & Quality of Life, Maldives, Moderator: Dr. Satish Kumar, Ex Advisor (Public Health Planning), MoHFW, New Delhi. India, Chair: Dr. Anjali Bhawra, Principal Secretary in the Government of Punjab, Dr. Kunjan, PGIMER, Chandigarh, India.
Dr. Akshay Chauhan, School of Public Health, PGIMER, Chandigarh, India.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dasgupta R, Pillai R, Kumar R, Arora NK. Sugar, salt, fat, and chronic disease epidemic in India: Is there need for policy interventions? Indian J Community Med 2015;40:71-4.
] [Full text]
Buse K, Tanaka S, Hawkes S. Healthy people and healthy profits? Elaborating a conceptual framework for governing the commercial determinants of non-communicable diseases and identifying options for reducing risk exposure. Globalization and Health. 2017;13:34.
Malik VS, Popkin BM, Bray GA, Després JP, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation 2010;121:1356-64.
Thakur JS, Garg R, Narain JP, Menabde N. Tobacco use: A major risk factor for non communicable diseases in South-East Asia region. Indian J Public Health 2011;55:155-60.
] [Full text]
Regional High-level Consultation in the Eastern Mediterranean Region on the Prevention and Control of Non-communicable Diseases in Low-and Middle-Income Countries Hosted in Tehran by the Government of the Islamic Republic of Iran. Available from: http://www.who.int/nmh/events/2010/Tehran_Background_Paper.pdf
. [Last accessed on 2017 Dec 27].
Kumbla D, Dharmalingam M, Dalvi K, Ray S, Shah MK, Gupta S, et al.
Astudy of salt and fat Consumption pattern in Regional Indian diet among hypertensive and dyslipidemic PaTients – SCRIPT study. J Assoc Physicians India 2016;64:47-54.