More People, More Active, More Often for Heart Health - Taking Action on Physical Activity.

Physical inactivity is a leading contributor to increased cardiovascular morbidity and mortality. Almost 500 million new cases of preventable noncommunicable diseases (NCDs) will occur globally between 2020 and 2030 due to physical inactivity, costing just over US$300 billion, or around US$ 27 billion annually (WHO 2022). Active adults can achieve a reduction of up to 35% in risk of death from cardiovascular disease. Physical activity also helps in moderating cardiovascular disease risk factors such as high blood pressure, unhealthy weight and type 2 diabetes. For people with cardiovascular disease, hypertension, type 2 diabetes and many cancers, physical activity is an established and evidence-based part of treatment and management. For children and young people, physical activity affords important health benefits. Physical activity can also achieve important cross-sector goals. Increased walking and cycling can reduce journeys by vehicles, air pollution, and traffic congestion and contribute to increased safety and liveability in cities.

The Impact of Alcohol Consumption on Cardiovascular Health: Myths and Measures.

Over the past several decades, the prevalence of cardiovascular disease (CVD) has nearly doubled, and alcohol has played a major role in the incidence of much of it. Alcohol has also been attributed in deaths due to infectious diseases, intentional and unintentional injuries, digestive diseases, and several other non-communicable diseases, including cancer. The economic costs of alcohol-associated health outcomes are significant at the individual as well as the country level. Risks due to alcohol consumption increase for most cardiovascular diseases, including hypertensive heart disease, cardiomyopathy, atrial fibrillation and flutter, and stroke. The widespread message for over 30 years has been to promote the myth that alcohol prolongs life, chiefly by reducing the risk of coronary heart disease (CHD). Lack of universal advice and stringent policy measures have contributed towards increased uptake and easy availability of alcohol. The WHO has called for a 10% relative reduction in the harmful use of alcohol between 2013-2025. However, lack of investment in proven alcohol control strategies, as well as persistence of misinformation and industry interference, have hindered the efforts of public health professionals to make sufficient progress in reducing alcohol related harms and death.

Civil society's role in improving hypertension control in Latin America.

Despite effort in Latin America to implement the HEARTS initiative, hypertension control is still inadequate. There are many advances in the medical and technical arena, but little to promote political and systemic change. The vibrant civil society that has advanced policy change in tobacco control, food policy, and other public health initiatives can make a crucial contribution to prioritize hypertension control in the political agenda, ensure sustainable funding, promote the procurement of affordable and effective medications, and expand community demand for action. The recommended first step for civil society's involvement is to analyze the political landscape to design an advocacy plan. The political landscape includes a legal analysis, policy mapping, stakeholders mapping, identifying obstacles, mapping community strategies, and risk assessment. The second step is to define policy goals and an advocacy strategy. Based on experience, there would be two main policy goals: to increase political will to make hypertension a top priority, securing necessary resources; and strengthen community awareness and social demand for action. The third step is to develop and implement the advocacy plan with the tools familiar to civil society, including building a case for support, advocacy towards decision makers, media advocacy, coalition building, countering the opposition, and civil society monitoring and accountability. To jumpstart this approach, there should be incentives for civil society and a transition for transferring competencies to a new arena. The results would be more sustainable and scalable hypertension control, better health outcomes, and advances toward the 2030 Sustainable Development Goals and universal health coverage.

A pesar de los esfuerzos para poner en marcha la iniciativa HEARTS en América Latina, el control de la hipertensión sigue siendo inadecuado. Ha habido muchos avances en el ámbito médico y técnico, pero poco ha logrado hacerse para promover el cambio político y sistémico. La vibrante sociedad civil que ha logrado avances en el cambio de políticas sobre el control del tabaco, las políticas relacionadas con los alimentos y otras iniciativas de salud pública puede realizar una contribución crucial para que se dé prioridad al control de la hipertensión en la agenda política, se garantice la financiación sostenible, se promueva la compra de medicamentos asequibles y efectivos, y se amplíe la demanda de medidas por parte de la comunidad.El primer paso recomendado para lograr la participación de la sociedad civil es analizar el panorama político para diseñar un plan para abogar por la causa. El panorama político incluye el análisis legal, el mapeo de políticas y de las partes interesadas, la definición de los obstáculos y las estrategias comunitarias, y la evaluación de riesgos. El segundo paso es definir los objetivos de las políticas y diseñar una estrategia para abogar por la causa. Con base en la experiencia, las políticas tendrían dos objetivos principales: lograr una mayor voluntad política para convertir la hipertensión en una prioridad absoluta, asegurando los recursos necesarios, y fortalecer la concientización de la comunidad y la demanda de acción por parte de la sociedad. El tercer paso es elaborar y ejecutar un plan para abogar por la causa con herramientas familiares para la sociedad civil, lo que incluye buscar argumentos para lograr el apoyo, abogar ante los responsables de tomar decisiones y los medios de comunicación, crear coaliciones, contrarrestar la oposición, dar seguimiento a la sociedad civil y establecer mecanismos de rendición de cuentas de la sociedad civil.Para impulsar este enfoque, debería haber incentivos para la sociedad civil y una transición para la transferencia de competencias en un nuevo escenario. Los resultados serían un control de la hipertensión más sostenible y ampliable, mejores resultados de salud y avances hacia los Objetivos de Desarrollo Sostenible de la Agenda 2030 y la cobertura universal de salud.

Apesar dos esforços feitos na América Latina para implementar a iniciativa HEARTS, o controle da hipertensão arterial continua sendo inadequado. Houve muitos avanços na área médica e técnica, mas pouco no sentido de promover mudanças políticas e sistêmicas. A sociedade civil vibrante que impulsionou mudanças nas políticas de controle do tabaco, na política de alimentação e em outras iniciativas de saúde pública pode fazer uma contribuição fundamental no sentido de priorizar o controle da hipertensão na agenda política, garantir financiamento sustentável, promover a aquisição de medicamentos eficazes a preços acessíveis e aumentar a demanda da comunidade por ações.Recomenda-se que o primeiro passo para envolver a sociedade civil seja uma análise do cenário político para elaborar um plano de promoção da causa. O cenário político inclui análise jurídica, mapeamento de políticas, mapeamento de interessados diretos, identificação de obstáculos, mapeamento de estratégias comunitárias e avaliação de riscos. O segundo passo é definir metas para as políticas e uma estratégia de promoção da causa. Com base em experiências anteriores, as políticas teriam duas metas principais: aumentar o compromisso político de dar prioridade máxima à hipertensão, assegurando os recursos necessários, e fortalecer a conscientização da comunidade e a demanda social por ações. O terceiro passo é desenvolver e implementar o plano de promoção da causa utilizando ferramentas já familiares para a sociedade civil, como a elaboração de argumentos para obter apoio, a defesa da causa junto a tomadores de decisão, a promoção nos meios de comunicação, a formação de coalizões, o combate a oponentes e o monitoramento e responsabilização da sociedade civil.Para alavancar essa abordagem, deve haver incentivos para a sociedade civil, com uma transição para a transferência de competências para uma nova área. Os resultados seriam um controle mais sustentável e expansível da hipertensão, melhores resultados de saúde e avanços em direção aos Objetivos de Desenvolvimento Sustentável 2030 e à cobertura universal de saúde.

Two countries, similar practices: the political practices of the food industry influencing the adoption of key public health nutrition policies in Guatemala and Panama.

OBJECTIVE: To identify the corporate political activity (CPA) strategies used by food industry actors during the development of two public health nutrition policies in Central America: Law #570 (taxation of sugar-sweetened beverages) in Panama and Bill #5504 (labelling and food marketing regulations) in Guatemala. DESIGN: We triangulated data from publicly available information from 2018 to 2020, (e.g. industry and government materials; social media material) with semi-structured interviews with key stakeholders. SETTING: Guatemala and Panama. PARTICIPANTS: Government, academia and international organisations workers in health and nutrition. DESIGN: CPA strategies were categorised according to an existing internationally used taxonomy into action-based, instrumental strategies (coalition management, information management, direct involvement and influence in policy, legal action) and discursive strategies. RESULTS: Instrumental strategies included the establishment of relationships with policymakers and direct lobbying against the proposed public policies. Discursive strategies were mainly criticising on the unfounded ground that they lacked evidence of effectiveness and will imply negative impacts on the economy. The industry pointed at individuals for making their own food choices, in order to shift the focus away from the role of its products in contributing to ill health. CONCLUSION: We provide evidence of the political practices used by the food industry to interfere with the development and implementation of public health nutrition policies to improve diets in Central America. Policymakers, public health advocates and the public should be informed about those practices and develop counterstrategies and arguments to protect the public and policies from the vested interests of the food industry.

Hypertension Pharmacological Treatment in Adults: A World Health Organization Guideline Executive Summary.

Hypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries. Despite the availability of safe, well-tolerated, and cost-effective blood pressure (BP)-lowering therapies, <14% of adults with hypertension have BP controlled to a systolic/diastolic BP <140/90 mm Hg. We report new hypertension treatment guidelines, developed in accordance with the World Health Organization Handbook for Guideline Development. Overviews of reviews of the evidence were conducted and summary tables were developed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach. In these guidelines, the World Health Organization provides the most current and relevant evidence-based guidance for the pharmacological treatment of nonpregnant adults with hypertension. The recommendations pertain to adults with an accurate diagnosis of hypertension who have already received lifestyle modification counseling. The guidelines recommend BP threshold to initiate pharmacological therapy, BP treatment targets, intervals for follow-up visits, and best use of health care workers in the management of hypertension. The guidelines provide guidance for choice of monotherapy or dual therapy, treatment with single pill combination medications, and use of treatment algorithms for hypertension management. Strength of the recommendations was guided by the quality of the underlying evidence; the tradeoffs between desirable and undesirable effects; patient's values, resource considerations and cost-effectiveness; health equity; acceptability, and feasibility consideration of different treatment options. The goal of the guideline is to facilitate standard approaches to pharmacological treatment and management of hypertension which, if widely implemented, will increase the hypertension control rate world-wide.

Civil society's role in improving hypertension control in Latin America / El papel de la sociedad civil en la mejora del control de la hipertensión en América Latina / O papel da sociedade civil na melhoria do controle da hipertensão arterial na América Latina

ABSTRACT Despite effort in Latin America to implement the HEARTS initiative, hypertension control is still inadequate. There are many advances in the medical and technical arena, but little to promote political and systemic change. The vibrant civil society that has advanced policy change in tobacco control, food policy, and other public health initiatives can make a crucial contribution to prioritize hypertension control in the political agenda, ensure sustainable funding, promote the procurement of affordable and effective medications, and expand community demand for action. The recommended first step for civil society's involvement is to analyze the political landscape to design an advocacy plan. The political landscape includes a legal analysis, policy mapping, stakeholders mapping, identifying obstacles, mapping community strategies, and risk assessment. The second step is to define policy goals and an advocacy strategy. Based on experience, there would be two main policy goals: to increase political will to make hypertension a top priority, securing necessary resources; and strengthen community awareness and social demand for action. The third step is to develop and implement the advocacy plan with the tools familiar to civil society, including building a case for support, advocacy towards decision makers, media advocacy, coalition building, countering the opposition, and civil society monitoring and accountability. To jumpstart this approach, there should be incentives for civil society and a transition for transferring competencies to a new arena. The results would be more sustainable and scalable hypertension control, better health outcomes, and advances toward the 2030 Sustainable Development Goals and universal health coverage.

RESUMEN A pesar de los esfuerzos para poner en marcha la iniciativa HEARTS en América Latina, el control de la hipertensión sigue siendo inadecuado. Ha habido muchos avances en el ámbito médico y técnico, pero poco ha logrado hacerse para promover el cambio político y sistémico. La vibrante sociedad civil que ha logrado avances en el cambio de políticas sobre el control del tabaco, las políticas relacionadas con los alimentos y otras iniciativas de salud pública puede realizar una contribución crucial para que se dé prioridad al control de la hipertensión en la agenda política, se garantice la financiación sostenible, se promueva la compra de medicamentos asequibles y efectivos, y se amplíe la demanda de medidas por parte de la comunidad. El primer paso recomendado para lograr la participación de la sociedad civil es analizar el panorama político para diseñar un plan para abogar por la causa. El panorama político incluye el análisis legal, el mapeo de políticas y de las partes interesadas, la definición de los obstáculos y las estrategias comunitarias, y la evaluación de riesgos. El segundo paso es definir los objetivos de las políticas y diseñar una estrategia para abogar por la causa. Con base en la experiencia, las políticas tendrían dos objetivos principales: lograr una mayor voluntad política para convertir la hipertensión en una prioridad absoluta, asegurando los recursos necesarios, y fortalecer la concientización de la comunidad y la demanda de acción por parte de la sociedad. El tercer paso es elaborar y ejecutar un plan para abogar por la causa con herramientas familiares para la sociedad civil, lo que incluye buscar argumentos para lograr el apoyo, abogar ante los responsables de tomar decisiones y los medios de comunicación, crear coaliciones, contrarrestar la oposición, dar seguimiento a la sociedad civil y establecer mecanismos de rendición de cuentas de la sociedad civil. Para impulsar este enfoque, debería haber incentivos para la sociedad civil y una transición para la transferencia de competencias en un nuevo escenario. Los resultados serían un control de la hipertensión más sostenible y ampliable, mejores resultados de salud y avances hacia los Objetivos de Desarrollo Sostenible de la Agenda 2030 y la cobertura universal de salud.

RESUMO Apesar dos esforços feitos na América Latina para implementar a iniciativa HEARTS, o controle da hipertensão arterial continua sendo inadequado. Houve muitos avanços na área médica e técnica, mas pouco no sentido de promover mudanças políticas e sistêmicas. A sociedade civil vibrante que impulsionou mudanças nas políticas de controle do tabaco, na política de alimentação e em outras iniciativas de saúde pública pode fazer uma contribuição fundamental no sentido de priorizar o controle da hipertensão na agenda política, garantir financiamento sustentável, promover a aquisição de medicamentos eficazes a preços acessíveis e aumentar a demanda da comunidade por ações. Recomenda-se que o primeiro passo para envolver a sociedade civil seja uma análise do cenário político para elaborar um plano de promoção da causa. O cenário político inclui análise jurídica, mapeamento de políticas, mapeamento de interessados diretos, identificação de obstáculos, mapeamento de estratégias comunitárias e avaliação de riscos. O segundo passo é definir metas para as políticas e uma estratégia de promoção da causa. Com base em experiências anteriores, as políticas teriam duas metas principais: aumentar o compromisso político de dar prioridade máxima à hipertensão, assegurando os recursos necessários, e fortalecer a conscientização da comunidade e a demanda social por ações. O terceiro passo é desenvolver e implementar o plano de promoção da causa utilizando ferramentas já familiares para a sociedade civil, como a elaboração de argumentos para obter apoio, a defesa da causa junto a tomadores de decisão, a promoção nos meios de comunicação, a formação de coalizões, o combate a oponentes e o monitoramento e responsabilização da sociedade civil. Para alavancar essa abordagem, deve haver incentivos para a sociedade civil, com uma transição para a transferência de competências para uma nova área. Os resultados seriam um controle mais sustentável e expansível da hipertensão, melhores resultados de saúde e avanços em direção aos Objetivos de Desenvolvimento Sustentável 2030 e à cobertura universal de saúde.

World Heart Federation Policy Brief: Front-Of-Pack Labelling: Unhealthy Changes in the Global Food System.

On World Food Day, the World Heart Federation calls on governments to implement mandatory front-of-pack food labels. The World Heart Federation (WHF) has developed a new policy brief on front-of-pack labelling (FOPL) aimed at improving global standards on nutrition and creating healthy food environments. Poor diet is responsible for more deaths worldwide than any other risk factor, and is a leading cause of obesity, type 2 diabetes, and cardiovascular disease (CVD). Global estimates suggest that almost 2.3 billion children and adults are overweight. The growing availability of ultra-processed foods, which contain high levels of sugars, sodium, saturated fats and refined carbohydrates, is a key contributor to the current obesity epidemic, which is increasingly impacting low- and middle-income countries. The WHF Front-of-Pack Labelling Policy Brief highlights front-of-pack labelling as a way to create environments where consumers are able to make better informed, healthier food choices for themselves and their families. Currently, a wide variety of front-of-pack labelling systems have been implemented by governments and food manufacturers around the world, with varying levels of success. The new WHF Policy Brief provides evidence-based, practical guidance that can be adapted to local contexts. It highlights that in order the be implemented successfully, FOPL systems must take into account consumer literacy and prevailing cultural norms around food and nutrition. FOPL must be mandatory, government-led, and accompanied by broad public nutrition education initiatives. The WHF Policy Brief includes a set of policy recommendations to give governments the tools they need to select the FOPL system that will best meet the needs of their populations, including recommendations on how to develop an effective FOPL programme, how to implement it successfully, and how to monitor and evaluate outcomes.

Body Fat Percentage Rather than Body Mass Index Related to the High Occurrence of Type 2 Diabetes.

BACKGROUND: Diabetes prevalence estimation and reduction of its risk factors remain the major goals of health services. While obesity is the major risk factor for diabetes, body fat distribution may be a better predictor. AIMS: To estimate the prevalence of diabetes in an adult working population in Mexico City, and to evaluate the strength of association with different risk factors. METHODS: A cross-sectional survey was conducted in two city halls of Mexico City. Anthropometrics, blood pressure, physical activity, diet, and biochemical parameters were assessed. Diabetes was defined as a fasting plasma glucose level ≥7.0 mmol/l or referred diabetes. The bioelectrical impedance analysis of body components was performed and weight, soft lean mass, body fat percentage and abdominal fat were obtained. Prevalence with 95% confidence intervals was estimated, as well as odds ratios derived from a logistic regression model. RESULTS: The prevalence of type 2 diabetes was 11.0% (95% CI 9.6-12.4%). The proportion of individuals with diabetes who were unaware of having the disease was higher in women (42.5 vs. 36.9%), and the degree of metabolic control was better in women (39.1 vs. 25.0%). Age, blood pressure, triglycerides and the percentage of body fat, were major risk factors related to the occurrence of type 2 diabetes. No relation was observed with physical activity and diet. CONCLUSIONS: The prevalence of type 2 diabetes in Mexico continues to be high and obesity measured by body fat percentage seems to be a better predictor of its occurrence than body mass index.

Implementing evidence-based smoking cessation treatment in psychosocial care units (CAPS) in Brazil.

BACKGROUND: The prevalence of smoking among mental health and addiction (MHA) patients is 3 times higher than it is in the general population, yet this patient population has received little help to combat smoking. Considering this, psychosocial care centers (CAPS - Centros de Atenção Psicossocial) are strategic locations for integrating tobacco dependence treatment (TDT) into existing treatment activities. METHODS: Our team provided an 8-hour training package to the staff of CAPS that have not been providing specialized TDT for smokers. Our curriculum included the following topics focused on the implementation of treatment for MHA smokers: management, epidemiology, medications, psychotherapy, and smoking/mental health assessment instruments. RESULTS: Our team trained the staff of 17 CAPS units within 10 cities - which included more than 186 health professionals. There were many barriers encountered as we provided this training. A summary of problems we faced were as follows: resistance to incorporating TDT in addiction/mental health-care units, resistance to the implementation of cognitive-behavioral therapy (CBT) (psychodynamic therapy and harm reduction were preferred) and treatment for smoking is already implemented in primary care network; resistance to the use of medication in addiction treatment (a preference for psychotherapy and psychosocial approach). CONCLUSION: We learned a number of important lessons as we worked to improve the delivery of TDT to MHA patients in Brazil: provide clinicians an opportunity to explore how they feel/think about providing TDT to their clients at the very outset of the training, rather than focusing on a specific type of behavioral therapy for TDT (such as CBT), which some may find objectionable; use more generic descriptions of behavioral therapy such as 'supportive counseling'; include training professionals who are open to other forms of behavioral therapy in addition to psychoanalysis and discuss the important impact that MHA units can have in improving the quality of life for their patients who smoke.

Analysis of a voluntary initiative to reduce sodium in processed and ultra-processed food products in Argentina: the views of public and private sector representatives.

The Less Salt, More Life program was the first voluntary salt reduction initiative in Argentina. This article analyzes the perspectives of the stakeholders involved in this voluntary agreement between the Ministry of Health and the food industry to gradually reduce sodium content in processed foods. This exploratory case study used a qualitative approach including 29 in-depth interviews with stakeholders from the public and private sectors and identified the role of the different stakeholders and their perceptions regarding the challenges encountered in the policy process that contribute to the debate on public-private partnerships in health policies. The article also discusses the initiative's main challenges and controversies.

Analysis of cigarette demand in Argentina: the impact of price changes on consumption and government revenues.

OBJECTIVE:: To estimate cigarette demand and to simulate a tax policy targeted to reduce tobacco consumption. MATERIALS AND METHODS:: Demand was estimated using a vector error correction model. Simulation exercises present the impact of a tax increase on consumption and revenues. RESULTS:: Changes in real income and the real price of cigarettes affect the demand for cigarettes in Argentina. The long term price elasticity is 0.279 (a 10% increase in real prices reduces cigarette consumption by 2.79% per quarter) and the long term income elasticity is 0.411 (a 10% increase in real income raises consumption by 4.11% per quarter). Even in a conservative scenario, simulations show that increasing the price of cigarettes by 100% using excise taxes would maximize revenues and reduce cigarette consumption. CONCLUSION:: There is sufficient room to increase taxes, reducing cigarette consumption, while still increasing tax revenues.

Analysis of cigarette demand in Argentina: the impact of price changes on consumption and government revenues / Análisis de la demanda de cigarrillos en Argentina: impacto de variaciones de precios en el consumo y recaudación

Abstract: Objective: To estimate cigarette demand and to simulate a tax policy targeted to reduce tobacco consumption. Materials and methods: Demand was estimated using a vector error correction model. Simulation exercises present the impact of a tax increase on consumption and revenues. Results: Changes in real income and the real price of cigarettes affect the demand for cigarettes in Argentina. The long term price elasticity is 0.279 (a 10% increase in real prices reduces cigarette consumption by 2.79% per quarter) and the long term income elasticity is 0.411 (a 10% increase in real income raises consumption by 4.11% per quarter). Even in a conservative scenario, simulations show that increasing the price of cigarettes by 100% using excise taxes would maximize revenues and reduce cigarette consumption. Conclusion: There is sufficient room to increase taxes, reducing cigarette consumption, while still increasing tax revenues.

Resumen: Objetivo: Estimar la demanda de cigarrillos y simular una política fiscal dirigida a reducir el consumo de tabaco. Material y métodos: Se estima la demanda mediante el modelo de corrección de errores. Se simula el impacto del incremento de los impuestos en el consumo y la recaudación. Resultados: Las variaciones en ingreso y precio real de los cigarrillos afectan la demanda. La elasticidad precio de la demanda de largo plazo es de 0.279 (10% de aumento en los precios reales reduce el consumo de cigarrillos en 2.79% en un trimestre) y la elasticidad ingreso de largo plazo es 0.411 (10% de aumento en el ingreso real aumenta el consumo en 4.11% en un trimestre). Aun en un escenario conservador, un incremento del precio de los cigarrillos de 100% vía impuestos maximizaría la recaudación y reduciría el consumo de cigarrillos. Conclusión: Es posible incrementar los impuestos reduciendo el consumo de cigarrillos e incrementando la recaudación.

Analysis of a voluntary initiative to reduce sodium in processed and ultra-processed food products in Argentina: the views of public and private sector representatives / Análisis de una iniciativa voluntaria para reducir el sodio en productos procesados y ultra-procesados en Argentina: perspectivas de los representantes del sector público y privado / Análise de uma iniciativa voluntária para reduzir o teor de sódio em produtos alimentícios processados e ultra-processados na Argentina: as perspectivas de representantes dos setores público e privado

Abstract: The Less Salt, More Life program was the first voluntary salt reduction initiative in Argentina. This article analyzes the perspectives of the stakeholders involved in this voluntary agreement between the Ministry of Health and the food industry to gradually reduce sodium content in processed foods. This exploratory case study used a qualitative approach including 29 in-depth interviews with stakeholders from the public and private sectors and identified the role of the different stakeholders and their perceptions regarding the challenges encountered in the policy process that contribute to the debate on public-private partnerships in health policies. The article also discusses the initiative's main challenges and controversies.

El programa Menos Sal, Más Vida fue la primera iniciativa voluntaria para la reducción de la sal en Argentina. Este artículo analiza las perspectivas de los representantes del sector público y privado involucrados en este acuerdo voluntario, entre el Ministerio de Salud y la industria alimentaria, para reducir gradualmente el contenido de sodio en las comidas procesadas. Este estudio de caso se basó en una aproximación cualitativa, incluyendo 29 entrevistas en profundidad, con las partes interesadas del sector público y privado e identificó el papel de los mismos y sus percepciones respecto a los desafíos enfrentados durante el proceso, con el fin de contribuir al debate de las colaboraciones público-privadas en políticas de salud. El artículo también discute los principales desafíos y controversias.

O programa Menos Sal, Mais Vida foi a primeira iniciativa voluntária para reduzir o teor de sal em produtos alimentícios na Argentina. O artigo analisa as perspectivas dos atores envolvidos nesse acordo voluntário entre o Ministério da Saúde e a indústria alimentícia para reduzir gradualmente o teor de sódio nos alimentos processados. O estudo de caso exploratório utilizou uma abordagem qualitativa com 29 entrevistas em profundidade com representantes dos setores público e privado, e identificou o papel dos diversos atores e suas percepções quanto aos desafios enfrentados no processo político, contribuindo para o debate sobre parcerias público-privadas em políticas de saúde. O artigo também discute os principais desafios e controvérsias dessa iniciativa.

Real price and affordability as challenges for effective tobacco control policies: an analysis for Argentina.

OBJECTIVE: To describe the evolution of cigarettes' real price and affordability during the last decade in Argentina. METHODS: To analyze the real price of cigarettes, the weighted average monthly price of a pack of 20 cigarettes was divided by the consumer price index (CPI) from 2004 to 2014. The relative income price (RIP) was evaluated for the same period, defining RIP as the percentage of the income required to buy 100 packs of 20-per-pack cigarettes. The RIP was calculated for first-quartile, median, and third-quartile income groups. The lower the RIP, the higher the affordability. RESULTS: The nominal price of a pack of 20 cigarettes sold in Argentina increased from AR$ 2.24 in March 2004 to AR$ 14.36 in June 2014 (nominal price increase of about 19.7% per year). The real price fell from AR$ 2.24 in March 2004 to AR$ 2.11 in June 2014 (real price drop of about 0.6% per year). Between June 2004 and June 2014, the RIP decreased about 39% for the 3rd quartile income group (from 31.3% to 19.2%), about 42% for the median (from 55.7% to 32.0%), and about 50% for the 1st quartile (from 104.4% to 51.8%). CONCLUSIONS: In Argentina, inflation and rising income were greater than growth in cigarette prices. Cigarette affordability increased for each income group, with the highest shifts occurring among the poorest and most vulnerable income earners. The increased affordability of cigarettes might reduce the impact of implemented tobacco control policies.

Successful up-scaled population interventions to reduce risk factors for non-communicable disease in adults: results from the International Community Interventions for Health (CIH) Project in China, India and Mexico.

BACKGROUND: Non-communicable disease (NCD) is increasing rapidly in low and middle-income countries (LMIC), and is associated with tobacco use, unhealthy diet and physical inactivity. There is little evidence for up-scaled interventions at the population level to reduce risk in LMIC. METHODS: The Community Interventions for Health (CIH) program was a population-scale community intervention study with comparator population group undertaken in communities in China, India, and Mexico, each with populations between 150,000-250,000. Culturally appropriate interventions were delivered over 18-24 months. Two independent cross-sectional surveys of a stratified sample of adults aged 18-64 years were conducted at baseline and follow-up. RESULTS: A total of 6,194 adults completed surveys at baseline, and 6,022 at follow-up. The proportion meeting physical activity recommendations decreased significantly in the control group (C) (44.1 to 30.2%), but not in the intervention group (I) (38.0 to 36.1%), p<0.001. Those eating ≥ 5 portions of fruit and vegetables daily decreased significantly in C (19.2 to 17.2%), but did not change in I (20.0 to 19.6%,), p=0.013. The proportion adding salt to food was unchanged in C (24.9 to 25.3%) and decreased in I (25.9 to 19.6%), p<0.001. Prevalence of obesity increased in C (8.3 to 11.2%), with no change in I (8.6 to 9.7%,) p=0.092. Concerning tobacco, for men the difference-in-difference analysis showed that the reduction in use was significantly greater in I compared to C (p=0.014). CONCLUSIONS: Up-scaling known health promoting interventions designed to reduce the incidence of NCD in whole communities in LMIC is feasible, and has measurable beneficial outcomes on risk factors for NCD, namely tobacco use, diet, and physical inactivity.

Real price and affordability as challenges for effective tobacco control policies: an analysis for Argentina / El precio real y la asequibilidad como obstáculos para las políticas de control del tabaquismo: análisis de la situación en la Argentina

Objective. To describe the evolution of cigarettes' real price and affordability during the last decade in Argentina. Methods. To analyze the real price of cigarettes, the weighted average monthly price of a pack of 20 cigarettes was divided by the consumer price index (CPI) from 2004 to 2014. The relative income price (RIP) was evaluated for the same period, defining RIP as the percentage of the income required to buy 100 packs of 20-per-pack cigarettes. The RIP was calculated for first-quartile, median, and third-quartile income groups. The lower the RIP, the higher the affordability. Results. The nominal price of a pack of 20 cigarettes sold in Argentina increased from AR$ 2.24 in March 2004 to AR$ 14.36 in June 2014 (nominal price increase of about 19.7% per year). The real price fell from AR$ 2.24 in March 2004 to AR$ 2.11 in June 2014 (real price drop of about 0.6% per year). Between June 2004 and June 2014, the RIP decreased about 39% for the 3rd quartile income group (from 31.3% to 19.2%), about 42% for the median (from 55.7% to 32.0%), and about 50% for the 1st quartile (from 104.4% to 51.8%). Conclusions. In Argentina, inflation and rising income were greater than growth in cigarette prices. Cigarette affordability increased for each income group, with the highest shifts occurring among the poorest and most vulnerable income earners. The increased affordability of cigarettes might reduce the impact of implemented tobacco control policies.

Objetivo. Describir la evolución del precio real y la asequibilidad de los cigarrillos durante la última década en la Argentina. Métodos. Para analizar el precio real de los cigarrillos, se dividió todos los meses el promedio ponderado del precio de un paquete de 20 cigarrillos por el índice de precios al consumidor entre el 2004 y el 2014. Se calculó durante el mismo período el precio relativo a los ingresos, definido como el porcentaje de los ingresos necesario para adquirir 100 paquetes de 20 cigarrillos. Se calculó el precio relativo a los ingresos en los cuartiles primero, segundo y tercero de los grupos de ingresos. Cuanto más bajo es el precio relativo a los ingresos, mayor es la asequibilidad. Resultados. El precio nominal en la Argentina de un paquete de 20 cigarrillos pasó de los 2,24 pesos de marzo del 2004 a los 14,36 pesos de junio del 2014 (un aumento próximo a 19,7% por año). El precio real pasó de 2,24 pesos en marzo del 2004 a 2,11 pesos en junio del 2014 (reducción real de cerca de 0,6% por año). Entre junio del 2004 y junio del 2014, el precio relativo a los ingresos se redujo cerca de 39% en el tercer cuartil de ingresos (de 31,3% a 19,2%), 42% en la mediana (de 55,7% a 32,0%) y cerca de 50% en el primer cuartil (de 104,4% a 51,8%). Conclusiones. En la Argentina, la inflación y el aumento de los ingresos fueron mayores que el crecimiento de los precios de los cigarrillos. La asequibilidad de los cigarrillos aumentó en todos los grupos de ingresos y las variaciones más acusadas se produjeron en los grupos más pobres y más vulnerables. La mayor asequibilidad de los cigarrillos puede reducir la repercusión de las políticas de control del tabaquismo llevadas a cabo.