By Angelina Wilson
Contributing authors, Peter Delobelle, Emily Fisher and Helga Bjørnøy Urke
Health Public Policy (HPP) has been recognized as an important tool for promoting health across different levels from the local, national to the international level. A focus on HPP should lead to countries creating and sustaining supportive environments that make a healthy choice an easier choice for society members (1). The WHO Adelaide Conference on HPP defined HPP as explicit concern for health and equity in all areas of policy and called for accountability for how health is impacted by policy initiatives (2). One key recommendation from this conference was the need for governments to ensure that all sectors take into account health as a key element in policy formulation. They recommended paying “as much attention to health as to economic conditions” when considering policy formation or changes (2).
HPP has also been identified as a necessary tool for reducing the incidence of Non-Communicable Diseases (NCD). NCDs are a result of many factors, including behavioral and environmental factors: as a result, they are impacted by policies on every level. A few examples of policies adopted to check the rise of NCDs include bans on tobacco smoking in public places, increases of taxes on alcohol and tobacco, and reducing salt content in foods for sale (3).
The pattern of NCDs in different countries worldwide highlights the need for a global perspective on policy issues impacting the prevalence of NCDs. For example, contrary to popular opinion, there is a higher prevalence and incidence of NCDs such as obesity, coronary heart disease and cancer, in low and middle income countries, than in high income countries (4). In addition, there has been an increase in tobacco usage and lung cancer among women in Korea, China and Jordan (4). To further complicate the situation, low and middle income countries are still often focusing on tackling communicable diseases: their respective international donors are also placing more emphasis on eradicating CDs before NCDs.
The WHO Global status report provides some “best buys” that will help combat NCDs (3), but the differential pattern in NCD incidence, prevalence, as well as in governmental approach across contexts, raises some important questions. What are the contextual meanings and applications of healthy public policy around NCDs? To what extent has HPP been applied in combating NCDs across the globe? What are the factors responsible for the gaps in application and what are the possible health promoting solutions to these problems?
Global Perspectives: ISECN Members and Regional Editors
In the African region, the need for HPP as a tool to improve population health has not achieved the required endorsement. This seems to be because health is still viewed as the prerogative of the health sector, and the medical approach to health continues to dominate (5). The Consortium for NCD Prevention and Control in Africa (CNCD-Africa) highlighted that the predominant approach is reactive medicine as proactive health promotion is pushed to the background. In Ghana for example, limited funds, lack of policies and the need to continue the battle against communicable disease, has resulted in limited application of HPP when tackling NCDs (6) and generally minimized efforts towards eradicating NCDs.
In Europe, health in all policies are driven by the European health strategy: ‘Together for health: A strategic approach for the EU 2008-2013.’ To promote the goals of the strategy, the European Commission has developed partnerships with NGOs, industry, academia and the media, such as the EU platform for diet, physical activity and health, a forum for organizations that range from the food industry to consumer protection NGOs which are committed to tackling current trends in diet and physical activity. Other initiatives include EuroHeart, a project initiated jointly by the European Heart Network and the European Society of Cardiology which involved partners in 21 countries and which culminated in the launch of the European Heart Health Charter in 2007. In 2006, WHO-Europe also adopted the European Strategy for the Prevention and Control of Non-Communicable Diseases, which was recently translated into an Action Plan in the context of the work to develop a new European health policy, Health 2020.
NCDs are one of the most pressing health issues in Latin America and the Caribbean (7). Though the importance of HPP has been stated in several health promotion declarations and statements (8), implementation of these in direct relation to reduction of NCDs is lacking. This could be related to a lack of evidence on effective policies on regional and country level, as well as to difficulties in bringing the issue to the forefront of political discussions and policy developments (9). However, several initiatives in the region should be mentioned: Regional Strategy and Plan of Action on an Intergrated Approach to the Prevention and Control of Chronic Diseases (10), and the newly formed Healthy Latin American Coalition (HLAC) aiming at advocating and actively work for a reduction in NCDs in the region (11).
In the US, HPP has begun to play a larger role in reducing disparities among different socioeconomic groups to tackle the occurrence of NCDs. For example, the recent obesity epidemic has caused stakeholders at all levels to reassess policy from access to healthcare to urban planning to school settings. The need for HPP in controlling NCDs, however, is new in the country of Georgia. This gap was mainly due to lack of knowledge, influence of donor agencies and other political structures in place. Originally, there were some public policies in place for controlling communicable diseases because most deaths were attributed to them. It was not until this year that it was recognized that the high percentage of death was caused by NCDs.
Comparisons and discussion
It is worthwhile to note that the drive towards HPP for NCDs was largely due to international influences such as the European Union (EU) and WHO. The situation in Georgia is in sharp contrast to Norway where a lot of attention has been given to HPPs for controlling NCDs.
It is quite clear that there is disparity in the usage and application of HPP in the battle against NCDs. Generally, low-income countries seem to be lagging behind most often due to many reasons: preoccupation with communicable diseases, lack of funds, limitation of the health systems, or inadequate commitment from policy-makers. One intriguing finding in the research was the influence of donor and international agencies in this battle, especially evidenced in low income countries. Although each country has its own policy regarding funding for health issues, there is a lot of dictatorship from those who actually fund projects. Another interesting issue is the place of mental health among NCDs. Not until recently did India advocate for mental health to be counted as among the NCDs. The absence of mental health in HPP for NCDs is also found in Africa where mental health has been relegated to the background. An important recommendation for moving forward is that we should have a clearly defined view of what constitutes HPP for NCDs across all WHO regions. In addition, it is necessary that we, as health promoters, advocate for and ensure that HPP is promoted at all national levels.
1. WHO | The Ottawa Charter for Health Promotion. (1986). Retrieved May 23, 2011, from http://www.who.int/healthpromotion/conferences/previous/ottawa/en/
2. WHO | Adelaide Recommendations on Healthy Public Policy. (1988). Retrieved May 23, 2011, from http://www.who.int/healthpromotion/conferences/previous/adelaide/en/index.html
3. Alwan, A. (2010). Global Status Report on non-communicable disease 2010 (NLM classification No. WT 500) (p. 176). Geneva: World Health Organization.
4. Beaglehole, R., & Yach, D. (2003). Globalization and the prevention and control of non-communicable disease: the neglected chronic diseases of adults. The Lancet, 362(9387), 903-908. doi:16/S0140-6736(03)14335-8
5. Aikins, A., & Arhinful, D. (2008). Chronic disease intervention in Africa: bridging the gaps between theory, practice, practice and policy.
6. The African Regional Health Report. (2006). (p. 194). Africa: WHO/AFRO Region. Retrieved from whqlibdoc.who.int/afro/2006/9290231033_rev_eng.pdf
7. Perel, P., Casas, J.P., Ortiz, Z. & Miranda, J.J. (2006). Non-communicable Diseases and Injuries in Latin America and the Caribbean: Time for Action. PLoS Medicine 3(9), 1448-1451.
8. Caribbean charter for health promotion, 1993; The Chile Commitment for Health Promotion, 2002; Report of the Trinidad and Tobago Achievements in Health Promotion with respect to the commitments in the Mexico Declaration
9. PAHO, 2002
10. PAHO, 2006
Published: May 2011