Implementation of non-communicable disease policies: a geopolitical analysis of 151 countries
File(s)
Published version
Author(s)
Allen, Luke
Nicholson, Brian
Yeung, Beatrice
Goiana-Da-Silva, Francisco
Type
Journal Article
Abstract
Background
Most countries have endorsed the WHO NCD ‘best buy’ policies but we know very little about global implementation patterns and which geopolitical factors might influence adoption.
Methods
We 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.
Findings
In 2017, the mean NCD policy implementation score was 48.4% (SD 18.4%). Costa Rica and Iran had the joint-highest implementation scores (86.8% of all WHO-recommended policies). Scores were lowest in Haiti and South Sudan (5.3%). 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<0.001) but we found evidence of a high degree of collinearity between the explanatory variables.
Interpretation
Implementation of WHO-recommended NCD policies is increasing over time. In 2017 the average country had introduced just under half of the WHO-recommended measures. Polices relating to alcohol and physical activity were the most likely to have been dropped. Aggregate implementation scores tended to be highest in countries with healthier, wealthier and more educated populations.
Most countries have endorsed the WHO NCD ‘best buy’ policies but we know very little about global implementation patterns and which geopolitical factors might influence adoption.
Methods
We 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.
Findings
In 2017, the mean NCD policy implementation score was 48.4% (SD 18.4%). Costa Rica and Iran had the joint-highest implementation scores (86.8% of all WHO-recommended policies). Scores were lowest in Haiti and South Sudan (5.3%). 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<0.001) but we found evidence of a high degree of collinearity between the explanatory variables.
Interpretation
Implementation of WHO-recommended NCD policies is increasing over time. In 2017 the average country had introduced just under half of the WHO-recommended measures. Polices relating to alcohol and physical activity were the most likely to have been dropped. Aggregate implementation scores tended to be highest in countries with healthier, wealthier and more educated populations.
Date Issued
2020-01-01
Date Acceptance
2019-10-01
Citation
The Lancet Global Health, 2020, 8 (1), pp.e50-e58
ISSN
2214-109X
Publisher
Elsevier
Start Page
e50
End Page
e58
Journal / Book Title
The Lancet Global Health
Volume
8
Issue
1
Copyright Statement
© 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/)
License URL
Subjects
0605 Microbiology
1117 Public Health and Health Services
Publication Status
Published
Date Publish Online
2019-12-05