Characterizing the implementation of innovative noncommunicable diseases policies in a high prevalence south European country: Portugal

Abstract

Noncommunicable diseases (NCDs) are the main cause of death and disability worldwide. They are responsible for more than 70% of all global mortality. Furthermore, being among the biggest generators of health care expenditure, they pose important economic sustainability challenges to health care systems worldwide. After a slow start, the international community has come to prioritise these conditions, as evidenced by high-level meetings on NCDs at the UN General Assembly. In 2015, 193 countries committed to reducing premature deaths from NCDs by a third by 2030, as part of the Sustainable Development Goals. WHO Member States have also endorsed a menu of cost-effective NCDs best buy policy options that can be used to tackle the NCD pandemic. However, many governments have been grappling with this challenge and looking for effective policy-based solutions, particularly in the area of promoting healthy eating. In Europe, NCDs are responsible for approximately 80% of all health care spending. Nevertheless, 80% of such NCDs are preventable if their behavioural risk factors are properly addressed. This was why countries in the WHO European Region have implemented a wide range of mandatory and voluntary policies to promote healthy lifestyles, including a growing number of interpretative nutrition labelling schemes, targeted food and beverage taxes, comprehensive reformulation strategies, and restrictions on the marketing of unhealthy foods. Recently, the Portuguese example has been repeatedly used by the WHO as a good role model for other countries to follow in this area. The aim of this thesis was to assess whether Portugal is a strong implementer of the WHO’s recommended policies for tackling NCDs and whether the strategy used for the implementation of the healthy nutrition policies was therefore successful. In this thesis, five of the most challenging policies to implement were individually analysed and characterised using different health impact and effectiveness assessment methods. Furthermore, all the policy areas were critically assessed regarding their implementation challenges and determinants. Among the biggest scientific innovations resulting from this thesis research development is the usage of real food consumption data from Portuguese Population cohorts in order to model the impact of both mandatory and voluntary policies. Furthermore, this thesis presents research using total SSBs consumption data at the national level for the first time in this research area. Also, the ability to model the impact of a SSBs tax on obesity incidence is one of the biggest scientific break throughs of the hereby-presented research. The outcomes of the strategy developed by Portugal in order to address its unhealthy eating habits provide an opportunity for refining the reason why some countries score better than others at implementing the WHO’s NCD policies. Furthermore, the lessons learned from this case study may contribute to the improvement of change management as a way to push for high health impact implementation of NCD policies.