Chronic diseases and health promotion

Part Three. What works: the evidence for action

Chapter Two. Review of effective interventions

Laws and regulations

National and local legislation, regulations, ordinances, international laws and treaties and other legal frameworks are fundamental elements of effective public health policy and practice. Historically, laws have played a crucial role in some of the greatest achievements in public health such as environmental control laws, seat-belt laws, warnings on cigarette packs and other tobacco control measures, and water fluoridation to reduce dental caries.

Current laws relating to chronic disease have proved to be an effective and central component of comprehensive prevention and control strategies. Advertising bans for tobacco products and the reduction of salt in food (whether through voluntary agreement with industry or enforced) are both very cost-effective in all regions, as assessed by the WHO-CHOICE project.

The WHO-CHOICE project analyses the health effects and costs of interventions (see Annex 5). Interventions are grouped into three broad categories: very cost-effective, cost-effective or cost- ineffective. Results presented in this publication represent a sub-set of all the interventions that were studied by the WHO-CHOICE project, and were selected based on their relevance to chronic disease prevention and control, as well as their cost-effectiveness.

More could be done

Legal frameworks have been used extensively with regard to tobacco control, although the WHO Framework Convention on Tobacco Control is the only global framework. Legislation and regulations could be used more effectively to reduce the burden of chronic disease, and to protect the rights of people with a chronic disease.

Spotlight: Tobacco control in the Philippines

In 1999, the Philippines introduced major changes in tobacco control policies which have contributed to positive changes. The Philippines Clear Air Act of 1999 identified cigarette smoke as a pollutant and instituted smoke-free indoor air laws. The national law allows designated smoking areas in restaurants and other indoor areas, but some cities have declared all indoor areas to be completely smoke-free. Taxes on cigarettes have also been increased. The Youth Smoking Cessation Programme in 2003 declared campuses to be smoke-free, improved training for students and teachers, and levied penalties for smoking. The Tobacco Regulatory Act of 2003 seeks to increase public education measures, ban all tobacco advertising, strengthen warning labels on tobacco products, and prohibit sales to minors.

All programmes have received extensive national and local media coverage. Evidence of the success of this legislation in combination with other interventions can be seen in the significant drop in the number of students who reported being current cigarette smokers or using other tobacco products over the period 2000–2003. The percentage of students who had never smoked but were likely to initiate smoking in the next year also decreased, from 27% in 2000 to 14% in 2003. Among adolescent boys, the percentage of current tobacco smokers declined by around a third, from 33% in 2000 to 22% in 2003. Among adolescent girls, the decline was similar, from 13% in 2000 to 9% in 2003.