The state of diet-related NCD policies in Afghanistan, Bangladesh, Nepal, Pakistan, Tunisia and Vietnam: a comparative assessment that introduces a 'policy cube' approach
The state of diet-related NCD policies in Afghanistan, Bangladesh, Nepal, Pakistan, Tunisia and Vietnam: a comparative assessment that introduces a 'policy cube' approach
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DOI：
10.1093/heapol/czz175
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发表时间：
2020-06-01
影响因子：
3.2
通讯作者：
Hawkes, Sarah
中科院分区：
文献类型：
--
作者：
Buse, Kent;Aftab, Wafa;Hawkes, Sarah
我们根据世界卫生组织预防和控制非传染性疾病的“最划算”准则，评估了六个国家的糖、盐和反式脂肪政策的技术含量。国家研究小组确定了与促进健康饮食和限制不健康消费有关的政策和战略，包括国家立法、发展计划和战略以及与卫生部门有关的政策和计划。我们确定了与发行机构、总体宗旨、目标、指标和时间框架、具体政策措施和行动、问责制、预算、对人口群体（包括性别）不平等脆弱性的响应以及人权有关的相关文本。我们在“政策立方体”中收集了调查结果，该立方体包含三个维度：政策全面性、政治显著性和实施手段的有效性，以及公平/权利。我们比较了与饮食相关的非传染性疾病政策与人类免疫缺陷病毒政策在权利、性别和健康公平方面的关系。所有六个国家都对解决非传染性疾病作出了高级别承诺，但饮食非传染性疾病政策各不相同，而且在具体目标和实现这些目标的手段方面往往不发达。国际公认的、循证的技术干预措施参差不齐，而且倾向于关注阻力最小的干预措施，例如，行为改变沟通，而不是解决食品重新配方、税收、补贴和推广/营销问题。政策往往处于权威范围的低端，很少有确定的预算承诺或明确的问责机制。令人关切的是，对公平和基于权利的方法的承认有限。这些国家的健康饮食政策与非传染性疾病负担的严重程度不匹配，其设计方式也没有使政府行动侧重于最关键的饮食驱动因素和面临风险的人群。我们提出了一系列建议，通过调整饮食相关政策，扩大各国的政策立方体，以确保人人享有健康饮食。
We assessed the technical content of sugar, salt and trans-fats policies in six countries in relation to the World Health Organization 'Best Buys' guidelines for the prevention and control of non-communicable diseases (NCDs). National research teams identified policies and strategies related to promoting healthy diets and restricting unhealthy consumption, including national legislation, development plans and strategies and health sector-related policies and plans. We identified relevant text in relation to the issuing agency, overarching aims, goals, targets and timeframes, specific policy measures and actions, accountability systems, budgets, responsiveness to inequitable vulnerabilities across population groups (including gender) and human rights. We captured findings in a 'policy cube' incorporating three dimensions: policy comprehensiveness, political salience and effectiveness of means of implementation, and equity/rights. We compared diet-related NCD policies to human immunodeficiency virus policies in relation to rights, gender and health equity. All six countries have made high-level commitments to address NCDs, but dietary NCDs policies vary and tend to be underdeveloped in terms of the specificity of targets and means of achieving them. There is patchwork reference to internationally recognized, evidence-informed technical interventions and a tendency to focus on interventions that will encounter least resistance, e.g. behaviour change communication in contrast to addressing food reformulation, taxation, subsidies and promotion/marketing. Policies are frequently at the lower end of the authoritativeness spectrum and have few identified budgetary commitments or clear accountability mechanisms. Of concern is the limited recognition of equity and rights-based approaches. Healthy diet policies in these countries do not match the severity of the NCDs burden nor are they designed in such a way that government action will focus on the most critical dietary drivers and population groups at risk. We propose a series of recommendations to expand policy cubes in each of the countries by reorienting diet-related policies so as to ensure healthy diets for all.