15:10-15:20
How much NCD policy space is eaten by trade? Navigating trade and investment barriers to regulating food and beverages
| Presenter | : | Kelly Garton |
| Abstract ID | : | A229 |
Background: International trade and investment agreements (TIAs) pose real and perceived barriers to policy development and implementation for NCD prevention, especially for policies that regulate food environments. The aim of this study was to determine whether, how, and to what extent TIAs may constrain governments' policy space for regulating food environments in different country contexts.
Methods: We conducted a realist review of legal and scientific literature to consolidate global evidence on the impacts of TIAs on domestic policy space for regulating unhealthy foods and beverages. Interventions of focus included: fiscal policies, product bans, advertising restrictions, nutrition labelling, reformulation and composition standards, and procurement policy. Interviews with trade and investment lawyers and key stakeholders provided detailed expert opinion on the potential conflicts between trade and investment law and a sub-sample of the priority policy instruments.
Results: Mechanisms of TIA influence on policy space include both substantive and process constraints. Interpretations of the rules written into agreements may vary, depend on context, and/or evolve over time. Well-designed fiscal policies are considered to withstand legal challenge, while individual product bans are not viable under TIAs. Opinions on policy space for front-of-pack labelling, advertising restrictions, and composition standards vary more widely, indicating a need for careful policy design. While most of the evidence comes from the labelling area, it seems that most substantive constraints (e.g. non-discrimination, necessity requirements) can largely be mitigated by comprehensive policy design that is informed by strong evidence, with clear and purposeful framing of objectives. Contextual factors such as actors/institutions and power structures, political will, industry power, media attention, and public opinion may moderate the mechanisms of TIAs' influence on policy space.
Conclusions: We argue that governments have more policy space than commonly perceived. Awareness of legal risk, moderating factors, and careful policy design is key to mitigating challenges.
Poster Slot
A01
15:10-15:20
India Management Hypertension Management Initiative” to control hypertension in India at primary care level
| Presenter | : | Abhishek Kunwar |
| Abstract ID | : | A225 |
Poster Slot
B01
15:10-15:20
Treatment seeking behavior of diabetic patients with special emphasis on follow-up in the public health facilities in Pudukottai District, Tamilnadu, India
| Presenter | : | Gopinath T. Sambandam |
| Abstract ID | : | A098 |
Poster Slot
C01
15:10-15:20
The Political Economy of Healthcare Data: A Systems Approach to Data Governance
| Presenter | : | Steven Harsono |
| Abstract ID | : | A117 |
Despite the increasing need for evidence-based research studies to inform policies and investments in NCD interventions, highly fragmented data remains one of the key barriers to innovative insights. This fragmentation stems from a lack of clarity on data governance, privacy concerns which limit data access, and diverse stakeholder interests related to the use of data.
A new healthcare data governance model is needed so that all sectors can work together and catalyze smarter and cost-effective interventions to address NCDs. The presentation will share case studies from Korea, the Philippines, and the United States. Each case study is an example of a successful public-private collaboration to improve the outcomes of NCD interventions.
In Korea and the Philippines, data governance policies allowed for multi-sectoral use of national health insurance data to examine economic outcomes of Type 2 diabetes treatments and prescriptions. In the U.S., the creation of the Observational Health Data Sciences and Informatics resulted in a scalable NCD research collaboration between the public and private sectors to study different NCD treatment patterns across different hospital settings globally using large-scale analytics and standardizing data models.
The case studies aim to encourage dialogue about the role of public and private stakeholders. Policymakers can work to provide strong data governance policies and recognize the value of data, while industry players can work to provide innovative data analytics methodologies and contribute to the public good.
A well-defined and favorably structured political economy can result in data sharing partnerships which serve the public good, encourage innovative research, and provide the right incentives to improve the insights necessary to maximize investments in NCD prevention and treatment.
IQVIA is a leading global provider of information, innovative technology solutions and clinical research services, dedicated to using analytics and science to improve health outcomes in over 100 countries.
Poster Slot
D01
15:10-15:20
The politics of food in the Pacific: coherence and tension in regional policies on the food environment and non-communicable diseases
| Presenter | : | Emalie Sparks |
| Abstract ID | : | A190 |
The Pacific has among the highest rates of non-communicable diseases in the world, but also boasts an innovative and proactive response. The region has also shown high-level political leadership on NCDs, with heads of state declaring NCDs a ‘crisis’ and countries committing to specific NCD prevention activities set out a regional ‘NCD Roadmap.’ Regional policies are particularly important in the Pacific given the relatively small size of most countries. Regional mechanisms develop ‘Pacific-wide’ positions and provide technical expertise that is not possible to maintain at country level. However, exposure to NCD risk factors remains stubbornly high, and many countries face challenges in introducing effective policy for healthy food environments.
This study assesses policy progress in improving the food environment in the Pacific. Following Sabatier’s Advocacy Coalition Framework we map regional policy commitments relevant to promotion of healthy diet, using outcome documents from key regional meetings over the last 10 years, across relevant sectors: agriculture, education, finance, health and trade, as well as heads of State. We find that NCDs are a stated priority across regional policy agendas and there is unequivocal agreement on the need for a multi-sectoral response. However, we also find examples of inconsistency and tension in policy action relevant to food environments across sectors. In many cases, health sector priorities have not translated into trade or economic policy goals or agricultural development objectives.
To understand these tensions, we analyse the ‘framing’ of NCD issues to identify cross-sectoral ‘policy coalitions’ with shared views and beliefs on the drivers and solutions to NCDs in the Pacific. We conclude that explicit recognition of different food policy coalitions is critical to a better understanding of the positions underpinning their policy priorities, and a more coherent NCD response in the region.
Poster Slot
F01
15:20-15:30
How do actors with asymmetrical power assert authority in policy agenda-setting? A study of non-state actors in the Australian trade policy space
| Presenter | : | Belinda Townsend |
| Abstract ID | : | A107 |
The risks from trade policy to population health are increasingly clear. Developing trade policy in a way that benefits health and other social interests would benefit many populations globally but understanding how these interests can make it into the trade agreement negotiations is relatively unknown. Understanding how non-state actors seek to establish authority and influence in policy agenda setting and whether their strategies differ if they have more or less discursive power, is vital to increasing the influence of health voices in trade.
Poster Slot
A02
15:20-15:30
Socioeconomic effect of alcohol production and use in india
| Presenter | : | Abhishek Kunwar |
| Abstract ID | : | A066 |
Poster Slot
B02
15:20-15:30
Challenges facing hypertension control goes beyond primary care services
| Presenter | : | Jin Xu |
| Abstract ID | : | A160 |
Introduction
Hypertension is a severe challenge to low and middle-income countries including China.
To better control high blood pressure among other chronic conditions, China launched nationwide the essential public health services (EPHS). The EPHS was initiated in a comprehensive health reform launched nationwide in 2009 and has been funded equally for a universal package of services provided to all population as a public good. The service package of the EPHS includes management for hypertension. This study looks at both the effects of the essential public health services as well as the influences of other social determinants on hypertension control.
Methods
The study used a multistage cluster random sample representative of the population in 34 municipalities across 17 provinces in China. The survey involved 20,777 households in 2014 among which 20,547 households were followed up in 2016, giving a total of 120,358 interviewees. 1801 among them were hypertensive patients who had not received hypertension management services in 2014 and were followed up in 2016.
We conducted a difference-in-differences analysis to identify the effects of hypertension management services on hypertension control, measured by self-reported normality of blood pressure.
Results
As our descriptive analysis suggests (Figure 1), patients in remote villages were more likely to receive hypertension management services. They were less likely to have regular use of hypertensive drugs and see their blood pressure controlled in comparison with urban residents. This is likely to be relate to the gaps in the health literacy across socio-geographical strata.
The difference-in-differences analysis suggested that the hypertension management services contributed to an increase of hypertension control odds by 1.67 times (p=0.028). Meanwhile, socio-economic status (represented by education and income quantile) and health literacy (represented by correct knowledge about salt intake) are also significant contributors to hypertension control.
Discussion
We have confirmed the effectiveness of hypertension management provided by primary care doctors and that the program has been pro-poor in hypertension management coverage in China. Our findings imply that universal coverage of essential health services is important but insufficient. Controlling NCDs in low and middle-income settings requires greater social and health systems changes, including empowering the patients with better health literacy and extending access to quality services to people with lower socio-economic status.
Poster Slot
C02
15:20-15:30
Philippine IYCF 2030 Strategic Planning: an Innovation for Participation
| Presenter | : | Romelei Camiling |
| Abstract ID | : | A270 |
Child malnutrition predisposes individuals to overweight and nutrition-related non- communicable diseases such as diabetes and heart disease in later life. Infant and young child feeding (IYCF) policy and action coherence is challenging for multi-sector stakeholders across national, regional and local levels in the devolved governance setting in the Philippines (population: 107 million). IYCF directions are embedded in two governance perspectives: the country’s overall nutrition agenda (Philippine Plan of Action for Nutrition, PPAN) and the health systems as a program component of the Department of Health (DOH). This intervention takes on a participatory approach using a modified Future Search method to widen the range of evidence used in decision-making, and the range of actors judging and interpreting evidence. Consensus guided the drafting of strategic directions for the country towards the year 2030.
Poster Slot
D02
15:20-15:30
Using of ncd disease medicines : hypertension, stroke, heart, diabetes melitus (ncd) at referral pharmacy program (prb) in bekasi city
| Presenter | : | Raharni Raharni |
| Abstract ID | : | A216 |
ABSTRACT
Some diseases categorized as non-communicable diseases (NCD) such as diabetes mellitus, hypertension, heart disease, stroke. Patients with the disease and who have been declared stable by the doctor at Hospital, the treatment is continued at the primary health care (FKTP) with the Referral Program (PRB) mechanism. Medicines taken at the Pharmacy Referral Program (PRB). The objectives of the study is to identify using medicines for NCD : diabetes mellitus, hypertension, heart disease, stroke at the PRB Pharmacy and conformity with the national formulary on JKN implementation. The research design was cross-sectional, descriptive study. Information was also explored by confirming to the Pharmacy PRB to find out the availability and using of NCD medicines. The location of the study was conducted in the Bekasi city in 2014.The results were obtained, the service of patients with diabetes mellitus, hypertension, heart disease, stroke in Bekasi city, there were only 3 Pharmacies Referral Program (PRB. The PRB pharmacy has a plus services with drug delivery services. Patient complaints that some medicines are not guaranteed by BPJS because they do not include in the Drugs National Formulary. Some empty drugs include Aspilet and Herbesser. Drug procurement at the PRB Pharmacy is still negotiating with the PBF, it cannot access e catalog. so that the PRB Pharmacy can lose and the price of medicines does not yet refer to the price of ecatalog. While medicines with regular prices are still available for the same drug. So that patients with NCD disease such as diabetes mellitus, hypertension, heart disease, stroke overcome by buying at regular prices, even though the price is much more expensive. The prescription for the PRB program is 3 months, which is 1 recipe for 3 months, but the medicine is given once a month, the prescription is given with iteration for 3 months.
Poster Slot
E02
15:20-15:30
Conceptualizing governance of non-communicable diseases
| Presenter | : | Shishi WU |
| Abstract ID | : | A268 |
Governance for Non-communicable Diseases (NCDs) requires multi-sectoral collaborations, such as between state, society and inter/supra-national organisations1. The emergence of health actors over the last few decades prompt pressing questions: What is the governance of NCDs? How can this myriad of actors shape policy coherence?
Studies have investigated the impact of policies, such as healthcare financing2, on NCDs. Recent systematic reviews had also synthesised evidence on effects of policies such as the global impact of NCDs on healthcare spending at a national level3. However, what remains mostly unexplored and unframed is the extent and scope of policy discourses in NCDs and governance of NCDs. This scoping review aims to achieve two research objectives:
• “What is known from the existing literature about the policy discourses on NCDs?”
• “What is known from the existing literature about the governance of NCDs?”
We identified published and unpublished studies from inception till Dec 2017. We searched nine electronic databases including Medline, Global Health, and websites of international organisations involved in NCDs work.
Findings are two-fold. First, we identified six frames in the governance of NCDs: “Origins and Development of NCDs”, “Causes and Consequences”, “Health Security”, “Health Systems Sustainability”, “NCDs in One Health”, and “Individual Choices or Collective Responsibility”. Each frame is siloed, yet the complexity of managing NCDs spells the need of integrating all domains driven by multi-sectoral collaborations between actors. Second, we conceptualised NCDs in Global Health Governance and Health Systems Governance. Strong partnerships between actors are instrumental in influencing the broad social determinants in a globalising world, building upon principles such as accountability and leadership. Overall, these findings highlighted the iterative dependencies between these frames and concepts in the multi-sectoral nature of NCDs within health agenda and emphasized the need for accelerated political commitment and action both at global and health systems levels.
Poster Slot