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1.
BMC Health Serv Res ; 20(1): 982, 2020 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-33109172

RESUMO

BACKGROUND: Over the past decade, an increasing number of low- and middle-income countries have reduced or removed user fees for pregnant women and/or children under five as a strategy to achieve universal health coverage. Despite the large number of studies (including meta-analyses and systematic reviews) that have shown this strategy's positive effects impact on health-related indicators, the repercussions on women's empowerment or gender equality has been overlooked in the literature. The aim of this study is to systematically review the evidence on the association between user fee policies in low- and middle-income countries and women's empowerment. METHODS: A systematic scoping review was conducted. Two reviewers conducted the database search in six health-focused databases (Pubmed, CAB Abstracts, Embase, Medline, Global Health, EBM Reviews) using English key words. The database search was conducted on February 20, 2020, with no publication date limitation. Qualitative analysis of the included articles was conducted using a thematic analysis approach. The material was organized based on the Gender at Work analytical framework. RESULTS: Out of the 206 initial records, nine articles were included in the review. The study settings include three low-income countries (Burkina Faso, Mali, Sierra Leone) and two lower-middle countries (Kenya, India). Four of them examine a direct association between user fee policies and women's empowerment, while the others address this issue indirectly -mostly by examining gender equality or women's decision-making in the context of free healthcare. The evidence suggests that user fee removal contributes to improving women's capability to make health decisions through different mechanisms, but that the impact is limited. In the context of free healthcare, women's healthcare decision-making power remains undermined because of social norms that are prevalent in the household, the community and the healthcare centers. In addition, women continue to endure limited access to and control over resources (mainly education, information and economic resources). CONCLUSION: User fee removal policies alone are not enough to improve women's healthcare decision-making power. Comprehensive and multi-sectoral approaches are needed to bring sustainable change regarding women's empowerment. A focus on "gender equitable access to healthcare" is needed to reconcile women's empowerment and the efforts to achieve universal health coverage.

2.
J Environ Manage ; 278(Pt 1): 111396, 2020 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-33113393

RESUMO

State and local governments consider payment for ecosystem services (PES) a valuable tool for watershed protection. However, regional differences in PES policies, which significantly influence province-scale cooperation, have been seldom documented. The interrelationships among these policies directly affect overall PES development in the Yangtze River Economic Belt (YREB). Textual analysis was used to categorize the content of PES policies in 11 provinces from 2004 to 2018. Then, we assessed these PES policies with four indicators (i.e., policy intensity, interdepartmental coordination, diversity, and duration). Finally, we analyzed the impact factors of these regional differences. The results showed that the number of PES policies increased yearly, reaching a peak in 2017. Provinces in the upper reaches had the highest policy-intensity score (7.38), followed by downstream provinces (6.39) and provinces in the middle reaches (4.52). Regarding interdepartmental coordination, the downstream areas exhibited the most interdepartment interaction (27.92%), followed by the upstream areas (20.76%) and the middle areas (19.18%). Diversity in the middle reaches was the highest (scored 4.3) while the upstream area exhibited the lowest diversity value (3.25). Downstream provinces issued PES policies the earliest, with a duration 5.52 years, followed by the upstream provinces (4.68) and middle provinces (4.28). Policy intensity was significantly correlated with fixed-asset investment, solid-waste generation, and population. The results suggest that PES in the YREB needs to be strengthened by enhancing policy consistency. In this regard, identifying regional differences in PES policies can help improve the coordination of PES policies for the whole YREB.

3.
Artigo em Inglês | PAHO-IRIS | ID: phr-52799

RESUMO

[ABSTRACT]. Objective. In 2010, the principle of proportionate universalism (PU) has been proposed as a solution to reduce health inequalities. It had a great resonance but does not seem to have been widely applied and no guidelines exist on how to implement it. The two specific objectives of this scoping review were: (1) to describe the theoretical context in which PU was established, (2) to describe how researchers apply PU and related methodological issues. Methods. We searched for all articles published until 6th of February 2020, mentioning “Proportionate Universalism” or its synonyms “Targeted universalism” OR “Progressive Universalism” as a topic in all Web of Science databases. Results. This review of 55 articles allowed us a global vision around the question of PU regarding its theoretical foundations and practical implementation. PU principle is rooted in the social theories of universalism and targeting. It proposes to link these two aspects in order to achieve an effective reduction of health inequalities. Regarding practical implementation, PU interventions were rare and led to different interpretations. There are still many methodological and ethical challenges regarding conception and evaluation of PU interventions, including how to apply proportionality, and identification of needs. Conclusion. This review mapped available scientific literature on PU and its related concepts. PU principle originates from social theories. As highlighted by authors who implemented PU interventions, application raises many challenges from design to evaluation. Analysis of PU applications provided in this review answered to some of them but remaining methodological challenges could be addressed in further research.


[RESUMEN]. Objetivo. En 2010 se propuso el principio del universalismo proporcional como solución para reducir las desigualdades en materia de salud. Aunque tuvo una gran resonancia, no parece haber sido aplicado ampliamente y no existen directrices sobre cómo aplicarlo. Los dos objetivos específicos de esta revisión sistemática exploratoria fueron: 1) describir el contexto teórico en el que se estableció el universalismo proporcional, y 2) describir cómo los investigadores aplican el universalismo proporcional y las cuestiones metodológicas relacionadas. Métodos. Se buscó en todas las bases de datos de la Web of Science los artículos publicados hasta el 6 de febrero de 2020 que tuvieran como tema “universalismo proporcional” o sus sinónimos “universalismo dirigido” o “universalismo progresivo”. Resultados. Esta revisión de 55 artículos permitió tener una visión global del universalismo proporcional en cuanto a sus fundamentos teóricos y su aplicación práctica. El principio del universalismo proporcional se basa en las teorías sociales del universalismo y el direccionamiento, y propone vincular estos dos aspectos para lograr una reducción efectiva de las desigualdades en materia de salud. Respecto de su aplicación práctica, las intervenciones basadas en este principio son poco frecuentes y dan lugar a diferentes interpretaciones. Todavía existen muchos desafíos metodológicos y éticos en relación con la concepción y la evaluación de las intervenciones relacionadas con el universalismo proporcional, incluida la forma de aplicar la proporcionalidad y la identificación de las necesidades. Conclusión. En esta revisión se llevó a cabo un mapeo de la literatura científica disponible sobre el universalismo proporcional y sus conceptos relacionados. Este principio se basa en teorías sociales. Tal como lo destacaron autores que implementaron intervenciones de universalismo proporcional, su aplicación plantea muchos desafíos, desde el diseño hasta la evaluación. El análisis de las aplicaciones del universalismo proporcional presentado en esta revisión respondió a algunos de ellos, pero los desafíos metodológicos restantes requieren ser abordados en futuras investigaciones.


Assuntos
Equidade em Saúde , Política de Saúde , Fatores Socioeconômicos , Equidade em Saúde , Política de Saúde , Fatores Socioeconômicos
4.
Obes Sci Pract ; 6(5): 562-583, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33082998

RESUMO

Obesity prevention policies are a priority for many governments and intergovernmental agencies. Policy makers not only use systematic reviews of effectiveness but also consider contextual issues including cost and cost-effectiveness, equity, rights, acceptability and feasibility. To support their work, the present narrative review examines three contextual issues (costs, equity and acceptability) in relation to three policies for obesity prevention: sweetened beverage taxes, front-of-pack nutrition labelling and restrictions on advertising to children. Literature searches led to over 1100 documents, of which 125 informed the present review. Beverage taxes were found likely to be highly cost-effective, moderately favourable for health equity, supported by the public (depending on the use of revenues) and by health professionals and civil society groups and opposed by commercial interests. Depending on the design, front-of-pack nutritional labelling is likely to be highly cost-effective, moderately favourable for health equity, supported by the public, health professionals and civil society groups, and opposed by commercial interests. Restrictions on child-directed advertising are likely to be highly cost-effective in the longer term, moderately favourable for health equity, supported by the public, health professionals and civil society groups and opposed by commercial interests (unless voluntary). The evidence base needs strengthening, but the authors find that all three policies merit consideration by governmental authorities, and should be implemented to reduce obesity risk.

5.
Artigo em Inglês | MEDLINE | ID: mdl-33008258

RESUMO

BACKGROUND: Healthy and sustainable food systems underpin the well-being of Indigenous peoples. Increasingly governments are taking action to improve diets via population-wide policies. The United Nations Declaration on the Rights of Indigenous People states that Indigenous peoples have the right to participate in all decisions that affect them. We analysed Australian national food and nutrition policy processes to determine: (i) the participation of Aboriginal organisations, (ii) the issues raised in Aboriginal organisations' policy submissions, and (iii) the extent to which Aboriginal organisations' recommendations were addressed in final policy documents. METHODS: Political economy and cultural safety lenses informed the study design. We analysed publicly-available documents for Australian population-wide food and nutrition policy consultations occurring 2008-2018. Data sources were policy documents, committee reports, terms of reference and consultation submissions. The submissions made by Aboriginal organisations were thematically analysed and key policy recommendations extracted. We examined the extent to which key recommendations made by Aboriginal organisations were included in the subsequent policy documents. RESULTS: Five food and nutrition policy processes received submissions from Aboriginal organisations. Key themes centred on self-determination, culturally-appropriate approaches to health, and the need to address food insecurity and social determinants of health. These messages were underrepresented in final policy documents, and Aboriginal people were not included in any committees overseeing policy development processes. CONCLUSION: This analysis suggests that very few Aboriginal organisations have participated in Australian population-wide food and nutrition policy processes and that these policy development processes are culturally unsafe. In order to operationalise First Nations peoples' right to self-determination, alternative mechanisms are required to redress the power imbalances preventing the full participation of Aboriginal and Torres Strait Islander peoples in population-wide food and nutrition policy decisions. This means reflecting on deeply embedded institutional structures and the normative assumptions upon which they rest.

6.
Public Health ; 186: 271-282, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32871449

RESUMO

OBJECTIVE: The aim of the present study is two-fold. First, it attempts to identify the barriers and enablers of implementing clinical commissioning policy. Second, it synthesises how these barriers and enablers affect the success of National Health Service (NHS) efforts to reduce health inequalities in the UK. METHODS: A systematic review was conducted. We searched large biomedical bibliographic databases, namely MEDLINE, EMBASE, CINAHL, Allied & Complementary Medicine, DH-DATA, Global Health and CINAHL for primary studies, conducted in the UK, that assessed the factors - barriers and enablers related to health inequalities, published from 2010 onwards and in English, and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We used Joanna Briggs Institute (JBI) Critical Appraisal and Mixed Methods Appraisal tools to assess the methodological qualities, and synthesised by performing thematic analysis. Two reviewers independently screened the articles and extracted data. RESULTS: We included six primary studies (including a total of 1155 participants) in the final review. The studies reported two broad categories, under four separate themes: (1) the agenda of health inequalities has not been given priority; (2) there was very little evidence for reducing health inequalities through the clinical commissioning (CC) process; (3) CC was positively associated with the restructuring of NHS; and (4) CC brings better collaboration and engagement, which led to some improvements in health services access, utilisation and delivery at the local level. CONCLUSION: This study provides useful factors - barriers and enablers - to implement and deliver clinical commissioning policy in improving health and well-being. These factors could be assessed in future to develop objective measures and interventions to establish the link between commissioning and health inequalities.

7.
Nurs Outlook ; 68(4): 517-522, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32896304

RESUMO

Climate change has a significant global impact on individuals' mental health and well-being. However, global health systems are inadequately prepared to address this issue. Studies indicate that climate events such as floods, droughts, tornados, earthquakes, and fires not only exacerbate chronic mental illness, but also impact well-being causing anxiety, stress, and in the worst case, suicide. The World Health Organization estimates that 12.6 million preventable deaths per year can be attributed to environmental factors, all of which are exacerbated by climate change, and an additional 250,000 deaths per year are projected between 2030 and 2050. Nurses must advocate for research, education, and policies that support disaster-resilient infrastructure and human services that allow communities across the globe to effectively mitigate the impact of climate change on human health.


Assuntos
Mudança Climática , Promoção da Saúde/métodos , Transtornos Mentais/epidemiologia , Transtornos Mentais/prevenção & controle , Papel do Profissional de Enfermagem , Recursos Humanos de Enfermagem/psicologia , Estresse Psicológico/epidemiologia , Adulto , Política Ambiental , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-32923355

RESUMO

Objectives: To outline the situation in Ireland with regard to the COVID-19 pandemic. Methods: Analyse the evolution of the COVID-19 pandemic in Ireland. Review the key public health and health system responses. Results: Over 1,700 people have died with COVID-19 by July 19th while almost 3,000 people had been admitted to hospital with COVID-19. A high proportion of the deaths occurred in nursing homes and other residential centres who did not receive sufficient attention during the early phase of the pandemic. Conclusions: Ireland's response to the COVID-19 crisis has been comprehensive and timely. Transparency, a commitment to a relatively open data policy, the use of traditional and social media to inform the population, and the frequency of updates from the Department of Health and the Health Services Executive are all commendable and have led to a high level of compliance among the general public with the various non-medical measures introduced by the government.

10.
J Clin Oncol ; 38(29): 3439-3448, 2020 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-32783672

RESUMO

ASCO strives, through research, education, and promotion of the highest quality of patient care, to create a world where cancer is prevented and every survivor is healthy. In this pursuit, cancer health equity remains the guiding institutional principle that applies to all its activities across the cancer care continuum. In 2009, ASCO committed to addressing differences in cancer outcomes in its original policy statement on cancer disparities. Over the past decade, despite novel diagnostics and therapeutics, together with changes in the cancer care delivery system such as passage of the Affordable Care Act, cancer disparities persist. Our understanding of the populations experiencing disparate outcomes has likewise expanded to include the intersections of race/ethnicity, geography, sexual orientation and gender identity, sociodemographic factors, and others. This updated statement is intended to guide ASCO's future activities and strategies to achieve its mission of conquering cancer for all populations. ASCO acknowledges that much work remains to be done, by all cancer stakeholders at the systems level, to overcome historical momentum and existing social structures responsible for disparate cancer outcomes. This updated statement affirms ASCO's commitment to moving beyond descriptions of differences in cancer outcomes toward achievement of cancer health equity, with a focus on improving equitable access to care, improving clinical research, addressing structural barriers, and increasing awareness that results in measurable and timely action toward achieving cancer health equity for all.

11.
Artigo em Inglês | MEDLINE | ID: mdl-32751174

RESUMO

The decentralization of the provision of health services at the subnational level produces variations in healthcare offered to asylum seekers (ASs) across the different Italian regions, even if they are entitled to healthcare through the national health service. The present study aims to map the healthcare path and regional policies for ASs upon arrival and identify challenges and best practices. This is a multicentric, qualitative study of migrant health policies and practices at the regional level within four Italian regions. For the analysis, a dedicated tool for the systematic comparison of policies and practices was developed. The collection and analysis of data demonstrated the presence of many items of international recommendations, even if many gaps exist and differences between regions remain. The analysis of practices permitted the identification of three models of care and access. Some aspects identified are as follows: fragmentation and barriers to access; a weakness in or lack of a governance system, with the presence of many actors involved; variability in the response between territories. The inclusion of ASs in healthcare services requires intersectoral actions, involving healthcare sectors and other actors within local social structures, in order to add value to local resources and practices, reinforce networks and contribute to social integration.


Assuntos
Política de Saúde , Refugiados , Programas Governamentais , Acesso aos Serviços de Saúde , Humanos , Itália , Medicina Estatal
12.
Obes Rev ; 21(12): e13126, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32761763

RESUMO

Understanding the drivers and dynamics of global ultra-processed food (UPF) consumption is essential, given the evidence linking these foods with adverse health outcomes. In this synthesis review, we take two steps. First, we quantify per capita volumes and trends in UPF sales, and ingredients (sweeteners, fats, sodium and cosmetic additives) supplied by these foods, in countries classified by income and region. Second, we review the literature on food systems and political economy factors that likely explain the observed changes. We find evidence for a substantial expansion in the types and quantities of UPFs sold worldwide, representing a transition towards a more processed global diet but with wide variations between regions and countries. As countries grow richer, higher volumes and a wider variety of UPFs are sold. Sales are highest in Australasia, North America, Europe and Latin America but growing rapidly in Asia, the Middle East and Africa. These developments are closely linked with the industrialization of food systems, technological change and globalization, including growth in the market and political activities of transnational food corporations and inadequate policies to protect nutrition in these new contexts. The scale of dietary change underway, especially in highly populated middle-income countries, raises serious concern for global health.

13.
Environ Resour Econ (Dordr) ; : 1-16, 2020 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-32836831

RESUMO

Emergence of COVID-19 joins a collection of evidence that local and global health are influenced by human interactions with the natural environment. Frameworks that simultaneously model decisions to interact with natural systems and environmental mechanisms of zoonotic disease spread allow for identification of policy levers to mitigate disease risk and promote conservation. Here, we highlight opportunities to broaden existing conservation economics frameworks that represent human behavior to include disease transmission in order to inform conservation-disease risk policy. Using examples from wildlife markets and forest extraction, we call for environment, resource, and development economists to develop and analyze empirically-grounded models of people's decisions about interacting with the environment, with particular attention to LMIC settings and ecological-epidemiological risk factors. Integrating the decisions that drive human-environment interactions with ecological and epidemiological research in an interdisciplinary approach to understanding pathogen transmission will inform policy needed to improve both conservation and disease spread outcomes.

14.
Glob Health Promot ; : 1757975920941435, 2020 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-32748728

RESUMO

Twenty-five years ago, the International Conference on Population and Development highlighted the need to address sexual and reproductive health (SRH) rights on a global scale. The sub-Saharan Africa region continues to have the highest levels of maternal mortality and HIV, primarily affecting the most vulnerable populations. Recognising the critical role of policy in understanding population health, we conducted a systematic review of original primary research which examined the relationships between equity-focused legislation and policy and the utilisation of SRH services by vulnerable populations in sub-Saharan Africa. We searched nine bibliographic databases for relevant articles published between 1994 and 2019. Thirty-two studies, conducted in 14 sub-Saharan African countries, met the inclusion criteria. They focused on maternal health service utilisation, either through specific fee reduction/removal policies, or through healthcare reforms and insurance schemes to increase SRH service utilisation. Findings across most of the studies showed that health-related legislation and policy promoted an increase in service utilisation, over time, especially for antenatal care, skilled birth attendance and facility-based delivery. However, social health inequalities persisted among subgroups of women. Neither the reviewed studies nor the policies specifically addressed youth, people living with HIV and people with disabilities. In the era of the sustainable development goals, addressing health inequities in the context of social determinants of health becomes unavoidable. Systematic and rigorous quantitative and qualitative research, including longitudinal policy evaluation, is required to understand the complex relationships between policy addressing upstream social determinants of health and health service utilisation.

15.
Artigo em Inglês | MEDLINE | ID: mdl-32610487

RESUMO

The study aimed to compare the effectiveness of a suite of implementation strategies of varying intensities on centre-based childcare service implementation of nutrition guideline recommendations at 12-month follow-up. A six-month three-arm parallel group randomised controlled trial was undertaken with 69 services, randomised to one of three arms: high-intensity strategies (executive support; group face-to-face training; provision of resources; multiple rounds of audit and feedback; ongoing face-to-face and phone support); low-intensity strategies (group face-to-face training; provision of resources; single round of audit and feedback); or usual care control. Across all study arms, only three high-intensity services were compliant with overall nutrition guidelines. A significant group interaction was found between the three arms for compliance with individual food groups. Relative to control, a significantly greater proportion of low-intensity services were compliant with dairy, and a significantly greater proportion of high-intensity services were compliant with fruit, vegetables, dairy, breads and cereals, and discretionary foods. No significant differences between the high- and low-intensity for individual food group compliance were found. High-intensity implementation strategies may be effective in supporting childcare service implementation of individual food group recommendations. Further research is warranted to identify strategies effective in increasing overall nutrition compliance.


Assuntos
Serviços de Alimentação , Política Nutricional , Adulto , Criança , Creches , Dieta , Seguimentos , Promoção da Saúde , Humanos
16.
Int J Public Health ; 65(7): 995-1001, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32712695

RESUMO

OBJECTIVES: To analyze the fundamentals of the global health agenda from 1944 to 2018, especially regarding Universal Health Coverage, in order to unveil its relations with capital accumulation in health services and to contribute to world social mobilization to change this tendency. METHODS: A historical study was carried out based on a purposeful selection of primary sources on the global health agenda from multilateral organizations and secondary sources about the changes of capitalism from the study period. RESULTS: The global health agenda changed from the state responsibility for health to an insurance healthcare system based on markets. The medical-industrial complex pressured national economies, broke postwar pacts, and urged economic globalization. The neoliberal, neoclassical, and neo-institutional discourse that promoted a new state-market relationship eased the new capital accumulation in healthcare into financial and cognitive capitalism. CONCLUSIONS: Understanding these relationships allows us to provide elements for social mobilization geared to transform the healthcare sector toward a new vision of health with a nature-society relationship that contributes to socially constructing human and environmental health, rather than gaining profits based on illness and chronic suffering.

18.
Environ Sci Pollut Res Int ; 27(31): 38995-39018, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32642896

RESUMO

This study investigates the causal connection between economic growth, foreign direct investment, primary and renewable energy utilization, trade openness, and ecological footprint for 33 upper-middle-income countries (UMICs) from Africa, Asia, Europe, and America during the period from 1994 to 2017. Initially, first- as well as second-generation panel unit root tests are applied to check the integration order after confirming the cross-sectional dependency and heterogeneity. Four different tests (FMOLS, DOLS, FGLS, and AMG) are applied to estimate the long-run elasticity, whereas Dumitrescu and Hurlin (D-H) non-causality test is used to test growth, conservation, and feedback hypothesis. Results show negative relationship of economic growth on ecological footprint in Africa and Europe; renewable energy utilization in Asia, Europe, and America; and trade openness in Asia. Moreover, the results revealed an adverse impact of trade openness on ecological footprint in case of Africa and America. Furthermore, the results of D-H panel non-causality test confirm the growth hypothesis for economic growth to ecological footprint in Africa, Asia, and Europe; foreign direct investment to ecological footprint in Africa and Asia; primary energy utilization to ecological footprint in Asia; renewable energy utilization to ecological footprint in America; and trade openness to ecological footprint in Africa, Asia, and America. Furthermore, the feedback hypothesis was confirmed between economic growth and ecological footprint in Asia and Europe; foreign direct investment and ecological footprint in Africa and Asia; renewable energy utilization and ecological footprint for America; and trade openness and ecological footprint for Asia and America. Finally, in context to efficient policy implications, it is suggested to associate the economic growth with clean energy and environment-friendly technologies by expanding the share of renewable energy in America and economic growth in Africa and Europe. Furthermore, Asian policy makers need to focus on foreign direct investment and trade openness by using green energy to overcome the environmental degradation. Impulsion with these findings, the central authorities of UMICs need to focus on more investments in environmental quality not only through foreign direct investment but also exchanging their clean energy technologies through trade policies such as tax exemption, feed-in tariffs, and subsidies. Government of these countries ought to upgrade the conventional capital which will ultimately improve the human lives by providing clean environment.


Assuntos
Países em Desenvolvimento , Desenvolvimento Econômico , África , Ásia , Dióxido de Carbono/análise , Estudos Transversais , Europa (Continente) , Humanos , Investimentos em Saúde , Energia Renovável
19.
Artigo em Inglês | MEDLINE | ID: mdl-32677762

RESUMO

Removing trans fatty acids (TFAs) from the food supply in the Eurasian Economic Union (EAEU) are one of the most effective public health interventions for reducing the risk of noncommunicable diseases. EAEU Member States have taken important steps to reduce TFA in oil and fat products to <2% of the total fat content. The authors summarize existing policies in the region, identify challenges in implementation, and suggest measures to strengthen regulation to achieve compliance with WHO guidelines. Documents published between 2011 and 2019 in Russian and English were reviewed, including EAEU and Member State restrictions on TFA in food products, data on TFA content in foods, and food labeling policies. The EAEU has established TFA limits in oil and fat products; however, Member States are currently not achieving the WHO guideline of <2% of total fat content in food products. A lack of harmonized monitoring systems and sanctions create challenges in monitoring compliance. The authors recommend developing an EAEU-wide monitoring system to test TFA content and organize population intake surveys. Discrepancies exist within regulatory frameworks that allow higher levels of TFAs in dairy products and infant formula. The authors recommend extending the current regulation to mandate TFA limits for all food products. Research found that strengthening regulation to meet the WHO guidelines should be prioritized. Member States should implement actions to replace TFAs with healthier fats, develop standardized surveillance methods, and scale-up strategic communication to ensure the food industry and the public follow public health recommendations to protect the health of the EAEU population.

20.
Addiction ; 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32710455

RESUMO

AIMS: To comprehensively review enacted and proposed alcohol laws and existing impact evaluations of national alcohol policies in Chile. METHODS: We searched enacted laws in the Chilean National Library of Congress, proposed laws in the websites of the House of Deputies and Senate and impact evaluations in PubMed, Web of Science, Scopus, Scielo, JSTOR, Epistemonikos and OpenGrey from inception to February 2019. Eligibility criteria included enacted laws and proposed laws on national alcohol policies and research studies evaluating the impact of national alcohol policies. One author screened enacted laws and proposed laws; two authors independently screened research records. We included any national alcohol policy intervention and classified policies according to 10 World Health Organization (WHO) alcohol policy domains. We used the Cochrane EPOC Review Group criteria to assess risk of bias of research records. We registered the review protocol in PROSPERO, registration record CRD42016050156. RESULTS: We identified and screened 229 enacted laws, 138 proposed laws and 1538 research records. Of these, 72 enacted laws, 118 proposed laws and three research articles were eligible for synthesis. We found enacted policies in all WHO alcohol policy domains. Regarding the most cost-effective policies, Chile has made limited use of taxation, has not regulated alcohol marketing and has weakened alcohol availability regulation. We found a large number of proposed laws, 79% of which would strengthen alcohol control. The few impact evaluation studies examined drink-driving policies and found a short-term reduction of alcohol-related injuries and deaths. CONCLUSIONS: Chile has enacted alcohol policies in all World Health Organization policy domains, but has not adopted policies with highest likely cost-effectiveness. Only the impact of drink-driving policies has been evaluated.

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