Policy reform

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data-block-plugin-id="system_breadcrumb_block" class="block block-system block-system-breadcrumb-block"> <div class="content"> <nav role="navigation" aria-label="breadcrumb" class="breadcrumb_custom_class"> <ol class="breadcrumb"> <li class="breadcrumb-item"> <a href="/">Home</a> </li> <li class="breadcrumb-item"> <a href="https://www.novartisfoundation.org/urban-population-health-toolkit">Urban Population Health Toolkit</a> </li> <li class="breadcrumb-item"> <a href="https://www.novartisfoundation.org/urban-population-health-toolkit/policy-reform">Policy reform</a> </li> </ol> </nav> </div> </div> </div> <div class="container"> <div class="page_title"> <section class="row region region-page-title"> <div id="block-nvs-arctic-page-title" data-block-plugin-id="page_title_block" class="block block-core block-page-title-block"> <div class="content"> <h1 class="title"><span class="field field--name-title field--type-string field--label-hidden">Policy reform</span> </h1> </div> </div> </section> </div> </div> <div id="main" class="container-fluid custom_width"> <div class="row row-offcanvas row-offcanvas-left clearfix"> <div class="container"> <div class="main-content col order-last col-md-12 column-full" id="content"> <section class="section"> <div id="block-nvs-arctic-content" data-block-plugin-id="system_main_block" class="block block-system block-system-main-block"> <div class="content"> <div about="/urban-population-health-toolkit/policy-reform" class="node node--type-interior-page node--view-mode-full clearfix"> <header> </header> <div class="node__content clearfix"> <div class="page_content"> <div class="row content_middle"> <div class="col-sm-12 content_left_side"> <div class="arctic_intro_text"> <div class="field field--name-field-intro-text field--type-string-long field--label-hidden field__item">Governments should enforce strategies and reforms, taxation and incentive structures, to address the growing burden of cardiovascular disease.</div> </div> <div class="field_body_txt"> <div class="field field--name-field-body field--type-entity-reference-revisions field--label-hidden field__items"> <div class="field__item"> <div class="paragraph paragraph--type--rich-text-content paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-content field--type-text-with-summary field--label-hidden field__item"><p>To address the growing burden of cardiovascular disease (CVD) and the leading risk factors of high blood pressure (BP), high blood sugar and obesity that contribute to millions of deaths, governments need to enforce strategies and reforms, taxation and incentive structures, that encourage healthier lifestyles. Policy reform is essential to ensuring people have equitable access to healthy food options and opportunities for exercise, putting heart-healthy choices within reach of all. As the guardians of population health, governments have an essential role to play in taking measures that encourage healthy eating, physical activity, and limit tobacco use and alcohol abuse. Enforcing such policies can have a much greater effect on population health than strengthening the health system alone, as interventions on the underlying determinants of health reach a much broader segment of the population and require less effort.</p></div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--accordion paragraph--view-mode--default"> <div class="accordion_item_wrapper accordion-stripe-close"> <div class="arctic_intro_text"> <div class="field field--name-field-title field--type-string field--label-hidden field__item">Key interventions and indicators</div> </div> <div class="field field--name-field-accordion-item field--type-entity-reference-revisions field--label-hidden field__items"> <div class="field__item"> <div class="paragraph paragraph--type--accordion-items paragraph--view-mode--default"> <div class="accordion"> <div class="accordion-group"> <div class="accordion-heading"> <button class="accordion-toggle accordion-title" data-bs-toggle="collapse" href="#accordion-paragraph--3736">Key interventions</button> </div> <div id="accordion-paragraph--3736" class="accordion-body collapse" tabindex="0"> <div class="accordion-stripe-body"> <div class="clearfix text-formatted field field--name-field-accordion-body field--type-text-long field--label-hidden field__item"><ul> <li>Implement policies with proven effect on population health and on CVD. Examples include the introduction of tobacco or sugar taxes, the total ban on salt and trans fat in processed food, or policies reducing the harmful use of alcohol. Cities engaging with urban planners to enhance possibilities for physical exercise have also seen significant successes.<br> <br> Tobacco and alcohol <ul> <li>Raise taxes on tobacco products and alcoholic beverages</li> <li>Ban tobacco/restrict alcohol advertising, promotion and sponsorship</li> <li>Establish smoke-/alcohol-free environments in public areas and workplaces</li> </ul> Food <ul> <li>Engage different sectors, such as food producers and processors, consumers, and others to reduce intake of salt/sodium, saturated fatty acids and trans fats, added sugars, etc.</li> <li>Ban the marketing and sale of foods with high levels of salt/sodium, saturated fats, trans fatty acids or free sugars in settings where children gather (nurseries, schools, pediatric clinics, etc.)</li> <li>Promote healthy food in all public institutions and in the workplace</li> </ul> Physical activity <ul> <li>Develop transport policies with relevant sectors to improve the accessibility and safety of, and supportive infrastructure for, walking and cycling</li> <li>Adopt and implement national guidelines on physical activity for health</li> <li>Improve provision of physical activity in educational settings (from infant years to tertiary level)</li> </ul> </li> <li>Use new revenues from sin taxes to increase budgets for primary healthcare and establish integrated programs for treating hypertension, diabetes, dyslipidemia and other risk factors</li> <li>Enact task-shifting policies to empower non-physician health workers to manage hypertension and cardiovascular diseases, through screening, referral for diagnosis and management, patient education for lifestyle improvement, follow-up and reminders for medication adherence and appointments</li> <li>Introduce data- and performance-based outcome measurements so primary care providers are held contractually responsible for the results they achieve in the population</li> <li>Include cardiovascular indicators in national health information systems to enable the use of reliable and timely data at all levels of the health system and to maximize the impact of interventions  </li> <li>Introduce mandatory hypertension screening for all adults over 18 years of age in all primary health centers to accelerate early detection</li> <li>Develop a national digital health strategy that includes a digitized health information system, with interoperable standards and processes across all levels of the health system</li> </ul></div> </div> </div> </div> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--accordion-items paragraph--view-mode--default"> <div class="accordion"> <div class="accordion-group"> <div class="accordion-heading"> <button class="accordion-toggle accordion-title" data-bs-toggle="collapse" href="#accordion-paragraph--3741">Key performance indicators</button> </div> <div id="accordion-paragraph--3741" class="accordion-body collapse" tabindex="0"> <div class="accordion-stripe-body"> <div class="clearfix text-formatted field field--name-field-accordion-body field--type-text-long field--label-hidden field__item"><p><em>The indicators below can come from a variety of sources (primary and secondary data collection, national or regional surveys and databases).</em></p> <p> </p> <ul> <li># and type of new (proven) health policies established<br> <br> Tobacco and alcohol <ul> <li>Tobacco use (adolescents and adults)</li> <li>Regulation and standards around taxation of tobacco related products</li> </ul> </li> <li>Alcohol <ul> <li>Level of alcohol consumption (adolescents and adults)</li> <li>Prevalence of heavy episodic drinking among adolescents and adults</li> <li>Alcohol-related morbidity and mortality among adolescents and adults</li> </ul> </li> <li>Food <ul> <li>Regulation and standards on the level of salt/sodium/sugar/trans-fat/saturated fat intake</li> <li># of people reached via awareness campaigns about importance of reducing excessive salt intake</li> <li>% of salt content in processed food</li> </ul> </li> <li>Physical activity <ul> <li>Level of physical activity (adolescents and adults)<br>  </li> </ul> </li> <li>Increase in primary care funding to improve quality of care for CVD patients</li> <li>Policy change in task-shifting to enable nurses, mid-wives, community health workers and non-traditional health workers to conduct BP screening and follow-up visits for hypertension patients</li> </ul></div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--slideshow-carousel paragraph--view-mode--default"> <div id="paragraph--3996" class="carousel slide " data-interval="6000" data-bs-ride="carousel" data-pause="true" > <div class="carousel-inner"> <div class="large carousel-item active "> <div class="carousel_img_video"> <div class="field field--name-field-image field--type-image field--label-hidden field__item"> <picture> <source srcset="/sites/novartisfoundation_org/files/styles/banner_image_1920/public/2021-04/3-policy-reform-1920x1080-image.jpg.webp?itok=BEmssnx5 1x" media="(min-width: 1025px)" type="image/webp" width="1920" height="620"/> <source srcset="/sites/novartisfoundation_org/files/styles/banner_image_tablet/public/2021-04/3-policy-reform-1920x1080-image.jpg.webp?itok=3Helh5vv 1x" media="(min-width: 768px) and (max-width: 1024px)" type="image/webp" width="1024" height="620"/> <source srcset="/sites/novartisfoundation_org/files/styles/banner_image_mobile/public/2021-04/3-policy-reform-1920x1080-image.jpg.webp?itok=x0TkJcBI 1x" media="(min-width: 416px) and (max-width: 767px)" type="image/webp" width="767" height="280"/> <source srcset="/sites/novartisfoundation_org/files/styles/banner_image_mobile_portrait/public/2021-04/3-policy-reform-1920x1080-image.jpg.webp?itok=KyPtPbLH 1x" media="(max-width: 415px)" type="image/webp" width="415" height="280"/> <img loading="lazy" title="Nurses looking at medical records" fetchpriority="high" src="/sites/novartisfoundation_org/files/styles/banner_image_1920/public/2021-04/3-policy-reform-1920x1080-image.jpg.webp?itok=BEmssnx5" width="1920" height="620" alt="Nurses looking at medical records" typeof="foaf:Image" /> </picture> </div> </div> <div class="carousel-caption d-md-block content_box left "> <div class="container"> <div class="carousel_inner--wrapper "> <h1 class="stripe_title"> <a href="/sites/novartisfoundation_org/files/2021-04/210415-nov-uh-reform.pdf" title="Highlights" >Highlights</a> </h1> <p class="carousel_desc">CARDIO approach – Policy reform</p> <div class="carousel_link_button"> <a class="button_text element_margin" href="/sites/novartisfoundation_org/files/2021-04/210415-nov-uh-reform.pdf" title="Learn more" >Learn more</a> </div> </div> </div> </div> </div> </div> <a class="carousel-control-prev" href="#paragraph--3996" role="button" data-bs-slide="prev" data-bs-target="#paragraph--3996"> <span class="carousel-control-prev-icon" aria-hidden="true" ></span> <span class="sr-only" >Previous</span> </a> <a class="carousel-control-next" href="#paragraph--3996" role="button" data-bs-slide="next" data-bs-target="#paragraph--3996"> <span class="carousel-control-next-icon" aria-hidden="true" ></span> <span class="sr-only" >Next</span> </a> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--rich-text-content paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-content field--type-text-with-summary field--label-hidden field__item"><h2>Additional external resources</h2> <h3>Guidelines</h3> <p><a href="https://apps.who.int/iris/bitstream/handle/10665/94384/9789241506236_eng.pdf;jsessionid=9DA84EC3E52C1B5CC741D368658F4ED2?sequence=1" target="_blank">Global action plan for the prevention and control of noncommunicable diseases,2013-2020. WHO 2013</a></p> <p><a href="https://www.who.int/beat-ncds/take-action/policy-brief-reduce-high-blood-pressure.pdf" target="_blank">Global NCD target: Reduce high blood pressure, WHO 2016</a></p> <p><a href="https://www.who.int/teams/nutrition-and-food-safety/replace-trans-fat" target="_blank">Replace trans fat by 2023: An action package to eliminate industrially-produced trans fat from the global food supply, WHO</a></p> <p><a href="https://www.who.int/tobacco/resources/publications/tobacco_dependence/en/" target="_blank">Tobacco Free Initiative (TFI), WHO</a></p> <p><a href="https://www.who.int/dietphysicalactivity/marketing-food-to-children/en/#:~:text=The%20set%20of%20recommendations%20on,of%20cross%2Dboder%20marketing%20" target="_blank">Global Strategy on Diet, Physical Activity and Health: Marketing of foods and non-alcoholic beverages to children, WHO</a></p> <p><a href="https://apps.who.int/iris/bitstream/handle/10665/250135/9789241511346-eng.pdf;sequence=1" target="_blank">The salt habit: The SHAKE Technical Package for Salt Reduction, 2016</a></p> <h3>Reference documents and literature</h3> <p><a href="https://www.gov.uk/government/publications/health-matters-combating-high-blood-pressure/health-matters-combating-high-blood-pressure" target="_blank">Guidance, Health matters: combating high blood pressure. Public Health England. 2017</a></p> <p><a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jch.13611" target="_blank">Science of Salt: A regularly updated systematic review of salt and health outcomes studies (April to October 2018). JCH, 2019</a></p> <p><a href="https://pubmed.ncbi.nlm.nih.gov/29955689/" target="_blank">The Impact of Policies to Reduce trans Fat Consumption: A Systematic Review of the Evidence. Curr Dev nutr. 2017</a></p> <p><a href="https://eatforum.org/eat-lancet-commission/eat-lancet-commission-summary-report/" target="_blank">EAT-Lancet Commission Summary Report</a></p> <p><a href="https://weforum.org" target="_blank">2020 Estonia built one of the world’s most advanced digital societies. During COVID-19, that became a lifeline. World Economic Forum 2021</a> </p></div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--cards paragraph--view-mode--default"> <div class="container"> <div class="field field--name-field-card-type field--type-entity-reference-revisions field--label-hidden field__items"> <div class="field__item"> <div class="paragraph paragraph--type--_-columns-1-2-and-1-2-card paragraph--view-mode--default"> <div class="row common-card-wrapper"> <a href ="/urban-population-health-toolkit/ensure-access" class="card_wrapper card_base col-md-6 image_yes" target="_self"> <div class="card_type_full card_image_video"> <div class="card_img"> <div class="video-content"> </div> <div class="img-wrapper"> <img class="img img-fluid" src="/sites/novartisfoundation_org/files/styles/cards_50_50/public/2021-03/blood-pressure-measurement.jpg.webp?itok=3FqcqqmK" alt="Woman wearing a mask measures blood pressure of a young man at a hair salon in Vietnam" title="Woman measuring blood pressure Vietnam" width="380" height="220" "/> </div> </div> <div class="card_content"> <h3 class="card_title " > Previous pillar: Ensure access </h3> <p class="basic_paragraph">Bringing health and care closer to where people live and work and engaging non-health players.</p> </div> </div> </a> <a href ="/urban-population-health-toolkit/leverage-data-and-digital-technology" class="card_wrapper card_base col-md-6 image_yes" target="_self"> <div class="card_type_full card_image_video"> <div class="card_img"> <div class="video-content"> </div> <div class="img-wrapper"> <img class="img img-fluid" src="/sites/novartisfoundation_org/files/styles/cards_50_50/public/2021-03/telemedicine-employees-working.jpg.webp?itok=q3_JOo7F" alt="Image showing telemedicine employees in Ghana at their workplace" title="Telemedicine employees" width="380" height="220" "/> </div> </div> <div class="card_content"> <h3 class="card_title " > Next pillar: Leverage data and digital technology </h3> <p class="basic_paragraph">Beside the collection and use of real-time data, digital technology provides an array of opportunities to transform the way health and care are delivered.</p> </div> </div> </a> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="content_bottom"> <div class="clearfix text-formatted field field--name-field-disclaimer field--type-text-with-summary field--label-hidden field__item"><p>Recommendations described herein were developed by the Novartis Foundation and/or its partners as part of the Better Hearts Better Cities and other initiatives; before local implementation, interested parties must ensure compliance with all applicable laws and regulations, including local industry codes and institutional policies. 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