Why do we need legislation for a health issue?
Worldwide, high blood pressure is estimated to cause 7.5 million deaths yearly, making it the world’s leading cause of death, followed by tobacco use.
Fortunately, we know what works: a comprehensive set of actions that, if supported by legislation and implemented by countries, can help to reduce the prevalence of high blood pressure.
- Promoting a balanced diet
- Reducing salt intake
- Discouraging tobacco use
- Discouraging harmful use of alcohol
- Promoting regular physical activity
Each of these items has a set of legal measures that, once adopted, can significantly reduce the death toll associated with high blood pressure, help those affected by it and prevent future morbidity and mortality.
World Health Day 2013, with its focus on high blood pressure, can provide new impetus for the development and implementation of effective laws at national level. Such laws will help people to improve their quality of life and oblige the food industry, together with national authorities, to implement certain measures and take actions proven to work.
Legislation is at the heart of effective control of different health risks, including high blood pressure. Legislation institutionalizes a country’s commitment, creates a focus of activity and controls private conduct in ways that informal measures cannot. It is therefore very important.
What are the legal measures needed?
For each of the actions above, there are certain measures that if implemented by the government will help to reduce the prevalence of high blood pressure at national level. Table 1 provides examples of suggested measures to be included in legislation to help reduce the prevalence of high blood pressure.
Table 1. Suggested measures to be included in legislation to help reduce prevalence of high blood pressure.
| Action | Expected partners | Suggested measures to be included in legislation (examples) |
|---|---|---|
| Promoting a balanced diet | Ministry of Education, Ministry of Health, Ministry of Youth, Bureau of Standards and Specifications |
Mandatory food labelling with nutrition information, including for food served in restaurants. Regulation of the marketing of infant formula and complementary food and food supplements. Adoption of WHO “healthy schools” measures including regulations on food served in canteens or sold in vending outlets. Regulation of food advertisement and promotion. |
| Reducing intake of saturated fat and trans fatty acids | Bureau of Standards and Specifications, Ministry of Trade, Ministry of Health, consumer protection agencies, private sector, Ministry of Agriculture, academia and research centres |
Mandatory food labelling stating the saturated fat and trans fat content Regulation of trans fatty acid content in foods. |
| Reducing salt intake | Bureau of Standards and Specifications, Ministry of Trade, Ministry of Health, Consumer Protections Agencies, Private Sector, Ministry of Agriculture |
Iodization of all salt used in food processing. Mandatory food labelling stating the salt content. |
| Discouraging tobacco use | Ministry of Health, Ministry of Finance, Ministry of Trade, Ministry of Justice, national legislative authority |
Implementation of the WHO Framework Convention on Tobacco Control:
|
| Discouraging harmful use of alcohol | Ministry of Health, Ministry of Interior, taxation authority, health professionals, parliament |
Minimum legal age to buy alcohol Government monopoly of retail sales Restrictions on hours or days of sale Restrictions on the density of sales outlets Taxes on alcohol |
| Promoting physical activity | Ministry of Transportation, Ministry of Urban Planning, Ministry of Education, Ministry of Youth and Sports, sports clubs, youth associations |
Creation of safe walking spaces in cities and towns Integration of periods of regular physical activity into different phases of education |
What is needed for the development of effective legislation?
A national lead agency should be identified to initiate the process. Since the measures needed to address high blood pressure cut across many sectors, it is unlikely that all necessary legislative action can be incorporated into one law. It is therefore crucial to have a lead agency coordinating the development of various laws to ensure all necessary technical measures are incorporated.
The lead agency along with many other partners at national level will follow the country’s normal procedures for revising or initiating legislation.
The technical lead agency must have control of the process and access to the concerned authorities at all stages of the process. Otherwise changes can be made to the proposed actions that are not based on evidence and that may reduce the effectiveness of the new legislation.
Once the idea of legislation is proposed, the items that will go into the legislation must be identified. This should be the responsibility of the specialized technical team established by the lead agency. It should not be left to the legal departments to draft the legislation and to decide on what measures to include.
The different phases of the legislative development process are expected to be as follows.
What are the potential obstacles?
Technical recommendations ignored during legal drafting. It is very important for the lead agency to have access to all partners during all phases in order to make sure the relevant technical recommendations are incorporated into the legislation.
No social or media support. Awareness campaigns should be initiated for all partners, the public and the media at the beginning of the process in order to ensure support for the new legislation.
Weak implementation and enforcement of legislation. It is vital to identify an enforcement authority within the legislation, as without one there is a high risk of weak enforcement. Sometimes, the lead agency is assigned this task in the legislation. It is also very important to have a strong monitoring system; nongovernmental organizations and civil society groups can be excellent partners in this area. The selection of the right enforcement authority, the right mix of penalties and the right enforcement procedures is critical for effective enforcement.