Abstract
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 re-orienting diet-related policies so as to ensure healthy diets for all.
Highlights
We interrogated the documents with two considerations: (1) given inherent inequitable distribution of noncommunicable diseases (NCDs) and risk factors, plus disproportionate burdens and/or barriers some populations face in benefiting from policy actions we looked for acknowledgement of vulnerable/at-risk populations as a particular target or concern of the policy
All countries have adopted a goal for salt reduction, with a time-bound target of 30% reduction by 2025 in Bangladesh, Nepal and Vietnam
The making of policy is less technical and more political in nature as it impacts on the interests of a range of actors, e.g. through the regulation of the market or the allocation of state resources. This is most obvious in economic policy, but it is true in public health policy
Summary
Diet-related NCDs are significant contributors to the overall burden, with diets high in salt and low in fresh fruit/whole grains estimated to account for approximately half of deaths and two-thirds of diet-related DALYs (Ashkan et al, 2019). Low- and middle-income countries (LMICs) are affected with higher age-standardized death rates than in highincome countries, including for cardiovascular diseases, diabetes and a number of other NCDs. A systematic review by Allen et al (2017) of NCD risks in LMICs found clear differences in the distribution of risk behaviours including consumption of unhealthy fats, low consumption of fruit, vegetables and fish and diets high in processed foods. The authors found in general that less affluent groups ‘consum[e] the least healthy diet’, whereas more affluent groups consume more healthy foods while consuming larger amounts of ‘fats, salt and processed food’ (Allen et al, 2017)
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