Policies to improve global public health generally focus on delivering population health improvement through medical services – whether preventative, acute, or rehabilitative. Yet there is increasing evidence that policies that cross economic sectors, such as transportation, agriculture, or energy, can have a large impact on public health by reducing disease and injury.
Given the kaleidoscope of possibilities, governments and policymakers need to understand which of these “inter-sectoral” policies are most effective for improving global public health. A new study by a team of ten researchers, including Gavin Yamey, MD, MA, director of the Center for Policy Impact in Global Health at the Duke Global Health Institute, examined the available evidence and proposes a package of 29 inter-sectoral policies that could be implemented by all low- and middle-income countries to improve public health.
- Reducing the use of tobacco by imposing large excise taxes and banning smoking in public places.
- Improving nutrient intake by financing school feeding and ensuring that subsidized foods and school feeding programs have adequate nutritional quality, fortifying foods with iron and folic acid, and fortifying salt with iodine.
- Reducing road traffic injuries by enacting legislation and enforcement of personal transport safety measures, including seatbelts in vehicles and helmets for motorcycle users.
- Reducing suicide by enacting strict controls and moving to selective bans on highly hazardous pesticides.
While the relationship between many of these inter-sectoral policies and public health is easy to understand, the authors relied on evidence and provided case studies of successful implementations including:
- A program in Sri Lanka in the 1980s and 1990s that gradually banned the most toxic forms of pesticide that was also associated with marked declines in suicide rates.
- A national mandatory helmet law in Vietnam, implemented in December 2007 that has prevented as many as 2,200 deaths and 29,000 head injuries in the year after its introduction.
“Our paper shows the power of joined-up approaches in reducing death and disabilities,” says Yamey. “Governments that take bold actions that cut across different sectors, as they did in Sri Lanka and Vietnam, can reap tremendous public health benefits.”
The study appears in the 3rd edition of Disease Control Priorities, published by the World Bank.