POSTER PRESENTATION

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
POSTER
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

Prevalence and Political Economy of Overweight and Obesity in Bangladesh

Presenter : Ipsita Sutradhar
Abstract ID : A236
POSTER
Introduction Overweight and obesity is an important biological determinant of non-communicable diseases, however, hardly studied in Bangladesh. This study therefore aims to identify the prevalence of overweight and obesity in urban and rural Bangladesh and to explain the finding from political economic perspective. Methodology Data of a baseline survey conducted for SHASTO project was used for this study. This cross-sectional survey was carried out among >30 years old adults in two urban and two rural sites of Bangladesh in February-May 2018. WHO STEPS questionnaire was used for data collection from 4,930 participants selected using multistage cluster sampling. Asian cut-off value of body mass index (BMI) was used to identify overweight and obesity. Literature review was performed to explain the social, political and economic aspects of finding. Results Overweight and obesity was prevalent among 44% participants (male-35%, female-53%). Higher prevalence of overweight and obesity was observed among non-slum urban participants (77%). This prevalence also increased with increasing age, household income and level of education. Political economy perspective Higher prevalence of overweight and obesity among women; educated, rich and non-slum urban participants can be explained by their lack of time for performing physical activity as well as their high exposure and affordability to processed and calorie dense food. In Bangladesh, there is no policy to control production and marketing of processed food. Absence of enabling environment constrains urban residents to perform physical activity (lack of space for physical activity and security concern) and to adopt healthy dietary habit (fear of food adulteration and high price of fruits and vegetables). Conclusion Overweight and obesity is highly prevalent in Bangladesh. As excessive body weight is harmful for human health, pertinent stakeholders should take necessary steps to increase accessibility of healthy food at affordable price and to promote physical activity to curb this burden.

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

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
POSTER
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

Framing NCDs to accelerate politica actions

Presenter : Lonim Prasai Dixit
Abstract ID : A018
POSTER

Poster Slot

E01

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
POSTER
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 can health actors’ better advance coherence between trade and health sectors for NCDs? Lessons from a network, framing and power analysis

Presenter : Belinda Townsend
Abstract ID : A107
POSTER

Poster Slot

A02

15:20-15:30

India Management Hypertension Management Initiative” to control hypertension in India at primary care level

Presenter : Abhishek Kunwar
Abstract ID : A225
POSTER

Poster Slot

C02

15:20-15:30

Philippine IYCF 2030 Strategic Planning: an Innovation for Participation

Presenter : Romelei Camiling
Abstract ID : A270
POSTER

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
POSTER

Poster Slot

E02

15:20-15:30

Conceptualizing governance of non-communicable diseases

Presenter : Shishi WU
Abstract ID : A268
POSTER
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

F02

10:10-10:20

Nudge in Action: A Case Study from Thai Health Promotion Foundation

Presenter : Nutkamon Luesomboon
Abstract ID : A133
POSTER
Nowadays, diverse factors contributing to noncommunicable diseases (NCDs) ranging from socioeconomic status, living and working conditions, to individual behaviours and lifestyle have come to affect our health and wellbeing in a greater extent. Specifically, modifiable behaviours, such as unhealthy diet and physical inactivity, have been attributed to the increase risks of NCDs prevalence and millions of annual deaths. Taking these into consideration, policymakers rely on different policy tools, including regulation, economic incentives, and information provision to promote health. There are yet instances that hinder the usual policy tools’ efficacy, particularly due to our behavioural biases. Thus, many policymakers are now taking interest in an innovative approach to health promotion in the application of behavioural economics, by implementing nudging interventions to tackle this issue. Thai Health Promotion Foundation (ThaiHealth) and partners have utilized “nudges” in various innovative health promotion interventions to tactfully address the behavioural determinants, in addition to executing conventional policy tools concerning broader social determinants of health. One example from ThaiHealth is an integrated approach to reduce alcohol consumption, which includes “Give alcohol = Curse”. These nudges provide supportive environments conducive to health, aligning with the organization’s vision as well as one of key action areas identified in the Ottawa Charter for Health Promotion. Insights of this innovative mechanism and contribution to improve individual health and societal wellbeing will be reviewed, along with recommendation of nudge evaluation criteria for future health promotion interventions. To move forward, there are several issues that need to be considered. First and foremost, effectiveness and limitations of nudges are examined. Moreover, a concern regarding insufficient understanding of nudge development process is to be addressed. Most importantly, how policymakers can further incorporate this cost-effective approach to complement existing policy tools in order to effectively promote health and wellbeing of people in Thailand will be discussed.

Poster Slot

A03

10:10-10:20

Physical activity promotion: the best buy policy for NCD prevention among Thai population

Presenter : Dyah Anantalia Widyastari
Abstract ID : A250
POSTER
Physical activity promotion: the best buy policy for NCD prevention among Thai population Dyah Anantalia Widyastari, Piyawat Katewongsa Institute for Population and Social Research, Mahidol University Abstract This study aims to investigate the effects of physical inactivity on NCD prevention. It was a longitudinal study with panel data design employing Thailand Physical Activity Surveillance System 2012-2017. Multistage stratified random sampling was practiced to select a nationally representative sample by considering the place of residence (urban or rural), gender and single age. Face to face interview was conducted in 5 regions, 13 provinces and 36 villages to follow a total of 7,333 cases from Thais aged 5 and over. Survival analysis was employed to observe the age-specific physical inactivity and NCD patterns. The proportion of Thais who achieve the recommended level (at least 60 minutes moderate to vigorous physical activity daily for children and youth; and accumulation of 150 mins of moderate intensity or 75 mins vigorous intensity per week for adults) is gradually increased from 66.3 in 2012 to 72.9 percent in 2017. While the pattern of age-specific physical inactivity is in a u-shape curve with the highest level among children and elderly, the pattern of NCD is in a logistic curve where it’s increasing along with age. The intersection of physical inactivity and NCD risk is clearly observed at the age of 40 which means, physically inactive people will be 11 percent more likely to suffer from NCD at the age of 40 compared to those who physically active. Physical activity promotion is the best buy policy for NCD prevention. The results indicate that promoting physical activity to working age group or adults will be too late considering the accumulative risk of NCD. Therefore, physical activity promotion should be started since a very young age to allow the children grow at their optimum development and keep their healthy lifestyle to their adulthood which eventually will prevent NCD in the long run. Keywords: physical activity, NCD, prevention, Thailand

Poster Slot

B03

10:10-10:20

Multi-criteria decision analysis for setting priorities and integrating "best buys" and other recommended interventions into the NCDs national action plan in Iran

Presenter : Amirhossein Takian
Abstract ID : A100
POSTER

Poster Slot

C03

10:10-10:20

Prioritization of NCDs in health sector strategic plans: resource requirement estimates from 5 low and middle income countries

Presenter : Catherine Cantelmo
Abstract ID : A310
POSTER
Developing countries lack detailed NCD strategic plans and cost estimates, yet this is critical for securing government buy-in and increased resources to tackle the rising NCD burden. From 2014 to 2017, we estimated NCD resource requirements in Cambodia, Kenya, Malawi, Mozambique, and Tanzania using the OneHealth Tool (OHT), which accounts for dynamic changes in demography, epidemiology, and service coverage. We found that: 1. NCD costs are expected to grow faster than any other area. In Cambodia, NCD costs increase four-fold from 2016 to 2020, largely due to rising NCD prevalence and planned increases in coverage. 2. Levels of NCD spending vary widely by country. NCDs are projected to represent 5% of total costs by 2019 in Mozambique, compared with 26% by 2020 in Tanzania. Most countries prioritize screening and treatment of high-risk populations for cardiovascular diseases, diabetes, and common cancers compared to broader prevention efforts. 3. Health plans prioritize improved coverage and quality of infectious disease services over NCDs. All countries aimed to achieve ambitious global targets for infectious diseases such as HIV, TB, and malaria, and set lower targets for NCD services. 4. Large ranges in unit costs indicate need for improved guidance on standards of care and better cost data. For example, first-line breast cancer treatment varies from $130 to $839 per patient per year. These results reveal the urgent need for increased investment in NCDs. While all five countries used cost evidence for priority setting, health system and financial constraints resulted in relatively low levels of ambition for combatting NCDs. For example, Malawi decided to exclude the vast majority of NCD services from its Essential Health Package, while Cambodia decided to prioritize cervical cancer and cardiovascular risk screening to contain costs. This suggests that many other countries with a dual epidemiological burden may continue to de-prioritize NCDs.

Poster Slot

D03

10:10-10:20

Self-monitoring of Blood Glucose among Patients with Poor Control of Type 2 Diabetes Mellitus in the 7 Southern most Provinces (Health Network Region 12)

Presenter : WILAWAN JINGJIT
Abstract ID : A063
POSTER

Poster Slot

E03

10:10-10:20

Role of disease-specific and health-sector foreign health aid in noncommunicable disease outcomes: a longitudinal study of 116 low-income and middle-income countries

Presenter : Deliana Kostova
Abstract ID : A131
POSTER
Foreign health aid, also known as development assistance for health (DAH), is external funding provided to low- and middle-income countries (LMICs) with the goal of improving population health. DAH can be designated into two categories – DAH earmarked for specific diseases and DAH used for health sector strengthening. While DAH for health sector strengthening remains comparatively low at 10-15% of all DAH, theoretical considerations have been used to suggest that the shift in epidemiological patterns from communicable to noncommunicable diseases in LMICs may require a shift from disease-specific to health-sector funding. However, empirical evidence on the relative merits of disease-specific versus health-sector funding is largely nonexistent. The present study evaluates the association between select NCD health indicators in LMICs and disbursements of development assistance for health (DAH), distinguishing between two DAH categories - DAH allocated to NCDs (DAH-NCD) and DAH allocated to overall health sector support (DAH-HS). NCD outcomes for 116 LMICs from 2000-2016 included disease-attributable deaths and disability-adjusted life years (DALYs) for 4 leading NCD categories (cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes), as well as the population rate of elevated blood pressure. Health outcomes were modeled in relation to financing indicators using a country fixed-effects framework with multiple-year lagged effects and controls for observed and unobserved fixed and time-variant confounding factors. Preliminary results indicate that DAH-NCD was associated with reductions in NCD burden indicators for up to 3 years after funding. By contrast, DAH-HS but not DAH-NCD was associated with a reduction in the rate of elevated blood pressure after a 4-year lag. Funds earmarked for NCD programs in LMICs might play a role in reducing NCD morbidity and mortality volume, most likely through improving opportunities for clinical management. Funds for health sector support might have a limited association with reduced risk factors such as elevated blood pressure.

Poster Slot

F03

10:20-10:30

Power asymmetries, policy incoherence and noncommunicable disease control - a qualitative study of policy actor views

Presenter : Belinda Townsend
Abstract ID : A109
POSTER

Poster Slot

A04

10:20-10:30

Challenges facing hypertension control goes beyond primary care services: implications from a pooled cross-sectional study

Presenter : Jin Xu
Abstract ID : A160
POSTER

Poster Slot

B04

10:20-10:30

Service coverage for diabetes mellitus in a pluralistic health system: experience from Sri Lanka

Presenter : Nimali Widanapathirana
Abstract ID : A290
POSTER
Introduction Diabetes mellitus is the second leading cause of disability-adjusted life years in Sri Lanka with a 35% increase in disability-adjusted life years between 2007 and 2017. Screening and managing the disease well can ameliorate the negative health and economic consequences. Social determinants and gaps in supply-side capacities can influence access to high-quality diabetes care. This study evaluated the service coverage for diabetes mellitus in a pluralistic public and private health system in Sri Lanka. Method A population-based survey identified 383 diabetic patients through multi-stage cluster sampling in the Gampaha district. Data were gathered through interviewer-administered questionnaires on service coverage for six dimensions of care within overall diabetes management: patient-centred care, lifestyle management, glycemic control, self-management education, management of cardiovascular diseases and microvascular complications. Results Prevalence of diabetes in adults aged 40-69 years was 27%; 96 % had accessed diabetic care providers. The service coverage was mostly equitable across age, sex, education, income, urban/rural residence and occupation and ranged from 9% to 95%. Government services showed better service provision in blood pressure control and patient education whilst the private sector fared better in patient-centred care. Lifestyle management, screening for retinopathy, self-management education and foot care were received by less than 50% in both sectors. Conclusions Social determinants have little influence than supply-side capacities as service coverage was equitable across socio-economic-demographic stratifiers, albeit at low levels (< 50%) in four out of eight key interventions. Government services, which provide a safety net primarily for low-income families, need to improve the performance of diabetes care and strengthen patient-centred care. The government should engage private providers to ensure high-quality diabetes services.

Poster Slot

C04

10:20-10:30

Resolve to Save Lives – A Global Initiative to Partner with Communities and Prevent 100 Million Deaths from Cardiovascular Disease

Presenter : Laura Cobb
Abstract ID : A175
POSTER

Poster Slot

D04

10:20-10:30

Analyzing the Policy and Governance Environment for Non-communicable disease Control, and Identifying Potential Policy Options in Pakistan.

Presenter : Anam Feroz
Abstract ID : A232
POSTER

Poster Slot

E04

15:10-15:20

Corporate Health Impact Assessment of a fast food company - implications for NCDs

Presenter : Fran Baum
Abstract ID : A092
POSTER

Poster Slot

A05

15:10-15:20

Correlates of Physical Activity and Sedentary Behaviour in the Thai Population: a Systematic Review

Presenter : Nucharapon Liangruenrom
Abstract ID : A075
POSTER
Background: Physical activity (PA) and sedentary behaviour (SB) are complex behaviours, requiring comprehensive understanding of possible contributors to deliberate contextual actions to converse the rising trends of physical inactivity. No previous review has summarised correlates of PA/SB in the Thai population. This study, therefore, aimed to systematically synthesise evidence on individual, social, environmental, and policy correlates of PA/SB across age groups in this population. Methods and findings: We searched through 10 databases and selected studies that tested one or more PA/SB correlates in healthy Thai children/adolescents, adults, and older adults. Out of 25,007 screened records, we included 167 studies, reporting 267 associations with PA and 41 with SB. The methodological quality of the included studies assessed by Newcastle-Ottawa Scale was found moderate. Consistent evidence showed higher self-efficacy and lower perceived barriers were strongly associated with high PA in all age groups. Male and younger children/adolescents engaged more in PA than their counterparts. In younger and older adults, we found self-rated general health, mental health, perceived benefits, and attitudes towards PA were significant contributors to PA level. We also identified social attributes including social support, interpersonal influences, parent/family influences, and information support consistently contributed to higher PA in adults. However, with inadequate evidence on SB correlates, we only found strong association for obesity and high SB in adults. There is also some evidence suggesting male adults had more SB than females. Conclusions: A number of PA correlates were explored; however, more studies are needed to confirm their associations, particularly among children/adolescents and those at environmental and policy-related level. Much greater focus should also be placed on investigating SB correlates in Thailand, especially among older adults. To provide stronger evidence, adopting device-based measures of PA/SB and conducting longitudinal studies to show prospective and causal relationships are highly encouraged.

Poster Slot

B05

15:10-15:20

Designing a Community Health Worker based Strategy to Promote Community Action Against Use of Smokeless Tobacco

Presenter : Samir Garg
Abstract ID : A174
POSTER

Poster Slot

C05

15:10-15:20

System Approaches to Address the Political Economy of NCDs

Presenter : Lonim Prasai Dixit
Abstract ID : A017
POSTER

Poster Slot

D05

15:10-15:20

Access to medicines for cardiovascular disease and hypertension control: A cross-country analysis of prices, availability, and affordability

Presenter : Muhammad Jami Husain
Abstract ID : A180
POSTER
Introduction: Access to medicine is critical for long-term care of cardiovascular diseases (CVDs) and hypertension. In many countries, essential medicines may not be available, accessible, or affordable. This study provides a cross-country assessment of prices, availability and affordability of CVD and hypertension medicines to identify areas for improvement in access to medication treatment. Methods: We used survey data from the World Health Organization Health Action International database on 53 countries from 2001-2015 to analyze the following indicators: (a) availability, measured as the percentage of healthcare facilities where the medicine is offered; (b) price, expressed as the median price ratio (MPR) to international reference prices, adjusted for inflation and purchasing power; and (c) affordability, measured as the number of day's wages needed to purchase one month of treatment. We aggregated the indicators across lowest-price generic and originator brand medicines and by country income group, distinguishing between low and middle-income countries (LMICs) and high and upper middle-income countries (HUMICs). Results: The average availability for the select medicines was 54% in LMICs and 60% in HUMICs, and was higher for generic (61%) compared to brand medicines (41%). Average patient MPR was 80.3 for brand and 16.7 for generic medicines and was higher for patients in LMICs compared to HUMICs across all medicine categories. The affordability index for brand medicines was 7.7 in LMICs and 4.2 in HUMICs. The affordability index for generic medicines was 2.3 in LMICs and 1.5 in HUMICs. Conclusions: The cross-country variations in price, availability, and affordability of CVD and hypertension medicines are considerable. Patients in LMICs face higher prices and lower affordability than patients in HUMICs for both brand and generic medicines, though generic medicines are more affordable in all countries. Actions that increase access to medicines can include use of effective generics and efficient procurement mechanisms.

Poster Slot

E05

15:10-15:20

Investment law is ‘chilling’ health policy: fact or fiction?

Presenter : Ashley Schram
Abstract ID : A042
POSTER
Features of trade and investment agreements such as market liberalisation (i.e. the removal of barriers to the import and export of goods, services, and capital) have been hypothesised to facilitate the increased availability, affordability, and desirability of tobacco, alcohol, and ultra-processed food and beverage products. A growing body of increasingly robust studies on these hypothesised relationships has been emerging, particularly in relation to ultra-processed food and beverage products. However, empirical studies of the relationship between market liberalisation provisions and the subsequent production, trade, and consumption of alcohol are lacking. This study employs gravity modelling to explore whether tariff rate reductions in free trade agreements are associated with an increase in alcohol production, trade, and consumption in member countries, specifically looking at agreements between Australia and its 16 free trade partners. It also considers differential impacts on countries at varying levels of economic development with disparities in capacity to address potential negative externalities of increased alcohol consumption. Initial results of this modelling will be presented along with relevant lessons for trade policy and domestic regulatory policy in countries in the Asia-Pacific region.

Poster Slot

F05

15:20-15:30

Unhealthy Policies and Unhealthy Diets: The Political Economy of NCD Determinants in India

Presenter : Kanchan Mukherjee
Abstract ID : A145
POSTER
Title: Unhealthy policies and Unhealthy Diets: The political economy of NCD in India In India, 61% of deaths and 23% risk of premature deaths are due to non-communicable diseases (NCDs), resulting in 5817000 annual deaths (WHO, 2017). Studying fiscal policies on proximate determinants of the NCD epidemic (sugar, salt and fat), which are linked to unhealthy diets, uncovers the commercial determinants of NCDs and its political economy in India. After reviewing quantitative and qualitative data, policy documents and national surveys, this study analyses existing upstream fiscal policies and their downstream impact. The food processing industry in India is highly policy-favored, with huge financial incentives that include 100% tax exclusion for five years, followed by 25% tax-exemption for another five years for new companies. The fiscal policy permits 100% export-oriented units to sell 50% of their products in the domestic market and waives off import duty on raw materials, capital goods and exempts export from taxes and facilitates 100% Foreign Direct Investment (FDI) under the automatic route. The downstream economic impact of this at the consumer level is that unhealthy fast food is cheaper than healthier food. Analysis of cooking practices and consumption behavior reveals an unhealthy picture. Common Indian cooking practice of reusing rancid oil, using generous amounts of salt and preference for sweets results in increased consumption of trans-fat, salt and sugar. The downstream impact analysis shows India as one of world's largest consumer of sugar (18kg/year), salt (9-12g/capita/day) and trans-fat (1.64 g/day). In the last 15 years, prevalence of overweight and obesity increased almost four times and per capita consumption of sugar, salt and fat is significantly associated with occurrence of overweight, obesity, hypertension and diabetes. The above evidence on upstream fiscal polices and downstream health impact suggest an urgent need for a Whole of Government approach with horizontal integration of fiscal and health policies to address this issue in India.

Poster Slot

A06

15:20-15:30

Tackling overweight and obesity produces positive impacts on GDP and fiscal pressure

Presenter : Michele Cecchini
Abstract ID : A186
POSTER

Poster Slot

B06

15:20-15:30

Improving Access to High-Cost Medicines in China: Much to Be Done

Presenter : Xiaoyan Nie
Abstract ID : A147
POSTER
INTRODUCTION: Lack of access to high-cost medications is a complex issue and it poses a significant threat to health care in China. Despite public health insurance schemes cover 97% of China’s population after 2009, but its reimbursement for high-cost medicine is limited. Increasing access to high-cost life-saving medicines in China, especially for the poor, offers many challenges. OBJECTIVES: The aim of this study was to review current situation in access to high cost medicines reimbursed by the Chinese Health System and to propose a set of potential strategies to reduce costs and improve access. METHODOLOGY: This analysis includes a review of secondary data of NDRL (National Drug Reimbursement List) inclusion. It is supplemented with KOL opinion. RESULTS: China has initiated a series of new moves, including the zero import tax on anticancer drugs, an accelerated approval process for overseas new drug, and further reduce high drug prices and improve medical insurance coverage In 2016, China started its first round of national-wide drug price and reimbursement drug list negotiation. CONCLUSION: The negotiation mechanism provides a channel for the inclusion of high-priced innovative drugs in medical insurance. The negotiation of drug price can help to improve the accessibility of patients ' medication .However, this reform also came with some limitations.

Poster Slot

D06

15:20-15:30

Mapping Nutrition Labelling Policies in Malaysia

Presenter : SeeHoe Ng
Abstract ID : A209
POSTER
Background: Nutrition labelling is one strategy to promote healthy diets. A clear nutrient declaration on a food label displaying information on nutrients of concern, offers the opportunity for consumers to make informed choices. Government actions, together with key events and involvement of stakeholders, are critical to generate policy development and implementation in this area. Objectives: This study aimed to (1) examine the degree of implementation of policies related to nutrition labelling, against international benchmarks and (2) map the historical timeline of relevant policies related to food labelling in Malaysia. Methods: A historical timeline of identified policies was mapped. Evidence related to the implementation of nutrition labelling was gathered from publicly available information such as the Food Act 1983, Food Regulations 1985, guidelines, technical reports, and annual reports. Gaps in information were complemented with personal communication with stakeholders. Government stakeholders validated the finalised draft evidence. Separately, nutrition labelling evidence was evaluated by 26 independent public health experts, according to public sector protocol developed by the International Network for Food and Obesity/NCD Research Monitoring and Action Support (INFORMAS). Results: Malaysia applies mandatory nutrient declarations on selected pre-packaged foods and voluntary fast food labelling, with includes a recommended format to guide the display of the nutrition information by the fast food industries. Influential external events, coupled with inside initiatives from the government led to the development of these policies. Experts rated the extent of implementation of mandatory nutrient declaration policy on pre-packaged foods as ‘medium’ compared to international best practices. Conclusion: Policy mapping clarifies the gaps in policy implementation. Analysing the policy processes enables identification of the facilitators and challenges to policy implementation at the national level in the future.

Poster Slot

E06