Cost-effectiveness of reducing salt intake in the Pacific Islands: protocol for a before and after intervention study

Background
There is broad consensus that diets high in salt are bad for health and that reducing salt intake is a cost-effective strategy for preventing chronic diseases. The World Health Organization has been supporting the development of salt reduction strategies in the Pacific Islands where salt intakes are thought to be high. However, there are no accurate measures of salt intake in these countries. The aims of this project are to establish baseline levels of salt intake in two Pacific Island countries, implement multi-pronged, cross-sectoral salt reduction programs in both, and determine the effects and cost-effectiveness of the intervention strategies.

Methods/Design
Intervention effectiveness will be assessed from cross-sectional surveys before and after population-based salt reduction interventions in Fiji and Samoa. Baseline surveys began in July 2012 and follow-up surveys will be completed by July 2015 after a 2-year intervention period.

A three-stage stratified cluster random sampling strategy will be used for the population surveys, building on existing government surveys in each country. Data on salt intake, salt levels in foods and sources of dietary salt measured at baseline will be combined with an in-depth qualitative analysis of stakeholder views to develop and implement targeted interventions to reduce salt intake.

Discussion
Salt reduction is a global priority and all Member States of the World Health Organization have agreed on a target to reduce salt intake by 30% by 2025, as part of the global action plan to reduce the burden of non-communicable diseases. The study described by this protocol will be the first to provide a robust assessment of salt intake and the impact of salt reduction interventions in the Pacific Islands. As such, it will inform the development of strategies for other Pacific Island countries and comparable low and middle-income settings around the world.

Pathways to non-complex assistive technology for HACC clients in WA : full report

The project aims to identify, evaluate and make recommendations to improve the pathways by which West Australian (WA) Home and Community Care (HACC) clients access daily living equipment. Otherwise known as assistive technology (AT), these devices are largely non-complex and often low cost. Funded by HACC and conducted within the context of the WA Assessment Framework (WAAF), the project seeks to answer the following question:

Creating healthy food environments through global benchmarking of government nutrition policies and food industry practices

Unhealthy processed food products are increasingly dominating over healthy foods, making food and nutrition environments unhealthier. Development and implementation of strong government healthy food policies is currently being circumvented in many countries by powerful food industry lobbying. In order to increase accountability of both governments and the private sector for their actions, and improve the healthiness of food environments, INFORMAS (the International Network for Food and Obesity/non-communicable diseases (NCDs) Research, Monitoring and Action Support) has recently been founded to systematically and comprehensively monitor food environments and policies in countries of varying size and income. This will enable INFORMAS to rank both governments and private sector companies globally according to their actions on food environments. Identification of those countries which have the healthiest food and nutrition policies and using them as international benchmarks against which national progress towards best practice can be assessed, should support reductions in global obesity and diet-related NCDs.

Towards global benchmarking of food environments and policies to reduce obesity and diet-related non-communicable diseases : design and methods for nation-wide surveys

Introduction: 

The subjective wellbeing of 'at-risk' indigenous and non-indigenous Australian adolescents

Quantitative comparisons of subjective wellbeing (SWB) between samples of Indigenous and non-Indigenous Australian adolescents are scarce. This paper contributes to this literature by studying adolescents 'at-risk' of disengaging, or who have already disengaged, from school, their families or society. A three-group cross-sectional comparative design was employed, comparing Indigenous (N = 3,187) and non-Indigenous (N = 14,522) 'at-risk' adolescents with a mainstream sample of Victorian high-school students (N = 1,105). Age and gender differences in SWB within the three groups were also explored. All participants completed the Personal Wellbeing Index-School Children (PWI-SC), which measures SWB. Mean SWB was significantly higher in the mainstream sample than in both the Indigenous and non-Indigenous 'at-risk' groups. However, within the at-risk adolescents, the Indigenous sample scored higher than the non-Indigenous. In the mainstream sample, male and female SWB did not significantly differ, whereas males scored higher than females in both at-risk groups-with males scoring higher on all seven PWI-SC domains. Finally, in all three samples, a decline in SWB from early to mid-adolescence was observed. This suggests that mid-adolescence is a challenging time for all young people as they approach adulthood. The implications of this research for educational and government policy concerning youths in Australia is discussed. For example, the importance of obtaining normative data that will assist in the identification of young people who are most at-risk for experiencing low personal wellbeing and who are in the greatest need of support. © 2014 Springer Science+Business Media Dordrecht.

Understanding evidence: a statewide survey to explore evidence-informed public health decision-making in a local government setting

 Background: The value placed on types of evidence within decision-making contexts is highly dependent on individuals, the organizations in which the work and the systems and sectors they operate in. Decision-making processes too are highly contextual. Understanding the values placed on evidence and processes guiding decision-making is crucial to designing strategies to support evidence-informed decision-making (EIDM). This paper describes how evidence is used to inform local government (LG) public health decisions.
Methods: The study used mixed methods including a cross-sectional survey and interviews. The Evidence-Informed Decision-Making Tool (EvIDenT) survey was designed to assess three key domains likely to impact on EIDM: access, confidence, and organizational culture. Other elements included the usefulness and influence of sources of evidence (people/groups and resources), skills and barriers, and facilitators to EIDM. Forty-five LGs from Victoria, Australia agreed to participate in the survey and up to four people from each organization were invited to complete the survey (n = 175). To further explore definitions of evidence and generate experiential data on EIDM practice, key informant interviews were conducted with a range of LG employees working in areas relevant to public health.
Results: In total, 135 responses were received (75% response rate) and 13 interviews were conducted. Analysis revealed varying levels of access, confidence and organizational culture to support EIDM. Significant relationships were found between domains: confidence, culture and access to research evidence. Some forms of evidence (e.g. community views) appeared to be used more commonly and at the expense of others (e.g. research evidence). Overall, a mixture of evidence (but more internal than external evidence) was influential in public health decision-making in councils. By comparison, a mixture of evidence (but more external than internal evidence) was deemed to be useful in public health decision-making.
Conclusions: This study makes an important contribution to understanding how evidence is used within the public health LG context.

Trade union internationalism and political change in Myanmar

Networks of trade union activists working as part of the global union movement have played a central role in political change in Myanmar. In response to trade union advocacy, compliance with International Labour Organization (ILO) standards was made a key condition for the lifting of sanctions on Myanmar, leading the current civilian government to pass revised labour laws allowing the formation of independent trade unions. Union activists have taken advantage of this new freedom, with a rapid growth in registration of local union organizations since 2011. Based on recent fieldwork in Myanmar, including interviews with union leaders and ILO officials, this paper presents an empirical analysis of political relationships formed by local and international union organizations in the context of multi-level political change. In this case study of translating international norms into domestic political change, local and international trade union networks are shown to have a significant impact on achieving compliance with international labour standards.

Book review: Hannah Murphy, The Making of International Trade Policy: NGOs, Agenda-setting and the WTO (Cheltenham, UK: Edward Elgar, 2010), 240 pp., £65.00, ISBN 978 18498 00181 (hbk).

The nexus between states,non-state actors and intergovernmental organisations is an increasingly important area in both the study and practice of global governance. Hannah Murphy makes a meaningful contribution to this area in examining the informal role of non-governmental organisations (NGOs) in relation to agenda-setting within the World Trade Organization (WTO). © Dean Coldicott, Deakin University 2012.

Monitoring and accountability for the Pacific response to the non-communicable diseases crisis

BACKGROUND: Non-communicable diseases (NCD) are the leading cause of premature death and disability in the Pacific. In 2011, Pacific Forum Leaders declared "a human, social and economic crisis" due to the significant and growing burden of NCDs in the region. In 2013, Pacific Health Ministers' commitment to 'whole of government' strategy prompted calls for the development of a robust, sustainable, collaborative NCD monitoring and accountability system to track, review and propose remedial action to ensure progress towards the NCD goals and targets. The purpose of this paper is to describe a regional, collaborative framework for coordination, innovation and application of NCD monitoring activities at scale, and to show how they can strengthen accountability for action on NCDs in the Pacific. A key component is the Dashboard for NCD Action which aims to strengthen mutual accountability by demonstrating national and regional progress towards agreed NCD policies and actions.

DISCUSSION: The framework for the Pacific Monitoring Alliance for NCD Action (MANA) draws together core country-level components of NCD monitoring data (mortality, morbidity, risk factors, health system responses, environments, and policies) and identifies key cross-cutting issues for strengthening national and regional monitoring systems. These include: capacity building; a regional knowledge exchange hub; innovations (monitoring childhood obesity and food environments); and a robust regional accountability system. The MANA framework is governed by the Heads of Health and operationalised by a multi-agency technical Coordination Team. Alliance membership is voluntary and non-conditional, and aims to support the 22 Pacific Island countries and territories to improve the quality of NCD monitoring data across the region. In establishing a common vision for NCD monitoring, the framework combines data collected under the WHO Global Framework for NCDs with a set of action-orientated indicators captured in a NCD Dashboard for Action.

SUMMARY : Viewing NCD monitoring as a multi-component system and providing a robust, transparent mutual accountability mechanism helps align agendas, roles and responsibilities of countries and support organisations. The dashboard provides a succinct communication tool for reporting progress on implementation of agreed policies and actions and its flexible methodology can be easily expanded, or adapted for other regions.

Level of implementation of best practice policies for creating healthy food environments: assessment by state and non-state actors in Thailand

OBJECTIVE: To determine and compare the level of implementation of policies for healthy food environments in Thailand with reference to international best practice by state and non-state actors.
DESIGN: Data on the current level of implementation of food environment policies were assessed independently using the adapted Healthy Food Environment Policy Index (Food-EPI) by two groups of actors. Concrete actions were proposed for Thai Government. A joint meeting between both groups was subsequently held to reach consensus on priority actions.
SETTING: Thailand.
SUBJECTS: Thirty state actors and twenty-seven non-state actors.
RESULTS: Level of policy implementation varied across different domains and actor groups. State actors rated implementation levels higher than non-state actors. Both state and non-state actors rated level of implementation of monitoring of BMI highest. Level of implementation of policies promoting in-store availability of healthy foods and policies increasing tax on unhealthy foods were rated lowest by state and non-state actors, respectively. Both groups reached consensus on eleven priority actions for implementation, focusing on food provision in public-sector settings, food composition, food promotion, leadership, monitoring and intelligence, and food trade.
CONCLUSIONS: Although the implementation gaps identified and priority actions proposed varied between state and non-state actors, both groups achieved consensus on a comprehensive food policy package to be implemented by the Thai Government to improve the healthiness of food environments. This consensus is a platform for continued policy dialogue towards cross-sectoral policy coherence and effective actions to address the growing burden of non-communicable diseases and obesity in Thailand.

Progress achieved in restricting the marketing of high-fat, sugary and salty food and beverage products to children

In May 2010, 192 Member States endorsed Resolution WHA63.14 to restrict the marketing of food and non-alcoholic beverage products high in saturated fats, trans fatty acids, free sugars and/or salt to children and adolescents globally. We examined the actions taken between 2010 and early 2016 - by civil society groups, the World Health Organization (WHO) and its regional offices, other United Nations (UN) organizations, philanthropic institutions and transnational industries - to help decrease the prevalence of obesity and diet-related noncommunicable diseases among young people. By providing relevant technical and policy guidance and tools to Member States, WHO and other UN organizations have helped protect young people from the marketing of branded food and beverage products that are high in fat, sugar and/or salt. The progress achieved by the other actors we investigated appears variable and generally less robust. We suggest that the progress being made towards the full implementation of Resolution WHA63.14 would be accelerated by further restrictions on the marketing of unhealthy food and beverage products and by investing in the promotion of nutrient-dense products. This should help young people meet government-recommended dietary targets. Any effective strategies and actions should align with the goal of WHO to reduce premature mortality from noncommunicable diseases by 25% by 2025 and the aim of the UN to ensure healthy lives for all by 2030.