Slow Progress in Adopting WHO Policies to Cut Chronic Disease Deaths
Countries around the world were especially bad at implementing policies to provide cardiovascular drug therapies.
Countries around the world implemented, on average, only about half of the policies recommended by the World Health Organization (WHO) to reduce premature deaths from cardiovascular disease and other noncommunicable diseases (NCDs) by 2017, a new analysis shows.
Average implementation reached 49.3% in that year, an improvement from 41.8% in 2015, researchers led by Luke Allen, MBChB (University of Oxford, England), report. Gains were not seen across all policies, however, and regression was seen for efforts related to the promotion of physical activity and restrictions on alcohol sales and advertising.
Provision of cardiovascular drug therapies was one of the policies that was least likely to be carried out.
NCDs, which encompass cardiovascular disease, diabetes, cancer, chronic respiratory disease, and other conditions, account for nearly three-quarters of deaths worldwide. “In 2015, 193 countries committed to reduce premature NCD deaths by one-third by 2030, as part of the Sustainable Development Goals,” Allen et al explain, noting that the WHO has proposed a number of cost-effective, “best-buy” policies to aid in that effort.
For this analysis of WHO progress reports, published online yesterday in the Lancet Global Health, researchers checked on how 151 of those countries did in terms of implementing the policies between 2015 and 2017. Overall, 109 improved during that time period, with 32 going in the wrong direction and the rest remaining the same.
The top performers tended to be high-income countries, although the two nations at the top—Iran and Costa Rica, both with 86.1% implementation by 2017—came from the middle-income stratum. Those with the worst implementation rates came predominantly from sub-Saharan Africa, with Haiti joining South Sudan at the bottom with 5.5% of the WHO policies. The United States was ranked 50th overall (58%), performing particularly poorly when it came to restricting the marketing, sale, and consumption of tobacco and alcohol.
On the whole, countries did best at introducing clinical guidelines, placing graphic warnings on tobacco products, and performing surveys on NCD risk factors. They were least likely to apply policies related to tobacco taxation and mass-media campaigns, alcohol advertising restrictions, and the provision of cardiovascular drug therapy.
When the investigators looked for geopolitical factors to explain the variations, they “found weak evidence to support the common assumption that democracies outperform autocracies, or that center-left countries outperform more libertarian countries when it comes to implementing NCD policies. In theory, democracies are more responsive to their populations; however, they might also be less likely to impose measures that constrain industry profits, or are construed as limiting personal freedoms.”
In an accompanying editorial, Sandeep Kishore, MD, PhD, and Usnish Majumdar, BA (both from Icahn School of Medicine at Mount Sinai, New York, NY), note that the factors examined by Allen et al explained only 61.1% of the implementation differences.
“What types of social and political factors could have been included to capture the remaining variance?” they ask. “Furthermore, the associations that were found between democracy, tax burden, and human capital indices raise new questions about the relationship between democracy and public health. Nonetheless, this work represents an important step in bringing empiricism to global NCD strategy.”
Allen LN, Nicholson BD, Yeung BYT, Goiana-da-Silva F. Implementation of non-communicable disease policies: a geopolitical analysis of 151 countries. Lancet Glob Health. 2019;Epub ahead of print.
Kishore SP, Majumdar UB. Learning from progress: global NCD policy implementation at national level. Lancet Glob Health. 2019;Epub ahead of print.
- Imperial College London funded the open access fees for this paper.
- Allen reports holding a National Institute for Health Research fellowship and working as a noncommunicable disease consultant for the WHO.
- Kishore reports being an author for NCD Countdown 2030, having served as a consultant for Resolve to Save Lives for hypertension control, and having led a partnership on multiple chronic conditions supported by the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai and Teva Pharmaceuticals.
- Majumdar reports no relevant conflicts of interest.