Overcoming internal challenges and external threats to noncommunicable disease control

Implementation of a sugar-sweetened beverage tax in low- and middle-income countries: recommendations for policymakers

Longitudinal and observational studies have found a link between the consumption of sugar-sweetened beverages (SSBs) and non-communicable diseases (NCDs) including obesity and diabetes. Following World Health Organization (WHO) recommendations, SSB taxes have been implemented in over 40 countries and cities to reduce sugar consumption. Despite continuing battles with communicable diseases in low- and middle-income countries (LMICs), an epidemiological transition towards NCDs warrants SSB tax implementation. However, LMICs face challenges when implementing SSB taxes including a lack of resources and opposing arguments from industry. Sharing experiences among countries can help to improve the likelihood of successful SSB tax implementation. We review experiences of tobacco, alcohol, and SSB tax implementation in LMICs. We discuss potential pitfalls for policymakers and how they might be overcome. We provide recommendations based on implementation experiences in LMICs to help governments improve implementation capacity and advance public health.

Development and implementation of guidelines for the management of depression: a systematic review

Objective

To evaluate the development and implementation of clinical practice guidelines for the management of depression globally.

Methods

We conducted a systematic review of existing guidelines for the management of depression in adults with major depressive or bipolar disorder. For each identified guideline, we assessed compliance with measures of guideline development quality (such as transparency in guideline development processes and funding, multidisciplinary author group composition, systematic review of comparative efficacy research) and implementation (such as quality indicators). We compared guidelines from low- and middle-income countries with those from high-income countries.

Findings

We identified 82 national and 13 international clinical practice guidelines from 83 countries in 27 languages. Guideline development processes and funding sources were explicitly specified in a smaller proportion of guidelines from low- and middle-income countries (8/29; 28%) relative to high-income countries (35/58; 60%). Fewer guidelines (2/29; 7%) from low- and middle-income countries, relative to high-income countries (22/58; 38%), were authored by a multidisciplinary development group. A systematic review of comparative effectiveness was conducted in 31% (9/29) of low- and middle-income country guidelines versus 71% (41/58) of high-income country guidelines. Only 10% (3/29) of low- and middle-income country and 19% (11/58) of high-income country guidelines described plans to assess quality indicators or recommendation adherence.

Conclusion

Globally, guideline implementation is inadequately planned, reported and measured. Narrowing disparities in the development and implementation of guidelines in low- and middle-income countries is a priority. Future guidelines should present strategies to implement recommendations and measure feasibility, cost–effectiveness and impact on health outcomes.