Abstract
SummaryBackgroundMost countries have endorsed WHO non-communicable disease (NCD) best buy policies, but we know very little about global implementation patterns and about the geopolitical factors affecting implementation. We aimed to assess global implementation based on analysis of multiple geopolitical datasets.MethodsWe used the 2015 and 2017 WHO NCD progress monitor reports to calculate aggregate implementation scores for 151 countries, based on their implementation of 18 WHO-recommended NCD policies. We ranked all countries and used descriptive statistics to analyse global trends. We used linear regression to assess the associations between policy implementation and World Bank geographic region, risk of premature NCD mortality, percentage of all deaths caused by NCDs, World Bank income group, human capital index, democracy index, and tax burden.FindingsIn 2017, the mean NCD policy implementation score was 49·3% (SD 18·4%). Costa Rica and Iran had the joint-highest implementation scores (86·1% of all WHO-recommended policies). Scores were lowest in Haiti and South Sudan (5·5%). Between 2015 and 2017, aggregate implementation scores rose in 109 countries and regressed in 32 countries. Mean implementation rose for all of the 18 policies except for those targeting alcohol and physical activity. The most commonly implemented policies were clinical guidelines, graphic warnings on tobacco packaging, and NCD risk factor surveys. Our multiple linear regression model explained 61·1% of the variance in 2017 aggregate scores (p<0·0001), but we found evidence of a high degree of collinearity between the explanatory variables.InterpretationImplementation of WHO-recommended NCD policies is increasing over time. On average, countries implemented just under half of the NCD policies recommended by WHO in 2017. Nutrition-related policies saw gains, while those related to alcohol and physical activity were the most likely to have been dropped. Aggregate implementation scores tended to be highest in high-income countries that invest in health care and education.FundingNational Institute for Health Research, Imperial College London, University of Oxford.
Highlights
Non-communicable diseases (NCDs) are responsible for 73% of all global mortality.[1]
We aimed to explore the extent to which variance in national NCD policy implementation is explained by commonly cited geopolitical factors: region, NCD burden, human and financial resources, and political ideology and social solidarity
Democracy index scores were available for 144 countries, and risk of premature mortality and proportion of deaths caused by NCDs were available for 147 countries
Summary
Non-communicable diseases (NCDs) are responsible for 73% of all global mortality.[1]. In 2015 and 2017, WHO released NCD progress monitor reports[3,4] that assessed the extent to which 18 NCD policies aligned to the best buys that had been implemented in 151 countries. The reports grouped policies under four time-bound commitments adopted at the second UN High-Level Meeting (appendix pp 2–3). Both reports consist of 151 country profiles and an assessment of whether each of the policies had been implemented fully, partially, or not at all in each country. These assessments were based on national expert opinion, pre-existing data, and policy documents submitted for WHO NCD country capacity surveys
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