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Intersectoral Action for Addressing NCDs through the Food Environment: An Analysis of NCD Framing in Global Policies and Its Relevance for the African Context.

ABSTRACT: Noncommunicable diseases contribute the greatest to global mortality. Unhealthy diet-a prominent risk factor-is intricately linked to urban built and food environments and requires intersectoral efforts to address. Framings of the noncommunicable disease problem and proposed solutions within global and African regional diet-related policy documents can reveal how amenable the policy landscape is for supporting intersectoral action for health in low-income to middle-income countries. This study applied a document analysis approach to undertake policy analysis on global and African regional policies related to noncommunicable disease and diet. A total of 62 global and 29 African regional policy documents were analysed. Three problem frames relating to noncommunicable disease and diet were identified at the global and regional level, namely evidence-based, development, and socioeconomic frames. Health promotion, intersectoral and multisectoral action, and evidence-based monitoring and assessment underpinned proposed interventions to improve education and awareness, support structural changes, and improve disease surveillance and monitoring. African policies insufficiently considered associations between food security and noncommunicable disease. In order to effectively address the noncommunicable disease burden, a paradigm shift from 'health for development' to 'development for health' is required across non-health sectors. Noncommunicable disease considerations should be included within African food security agendas, using malnutrition as a possible intermediary concept to motivate intersectoral action to improve access to nutritious food in African low-income to middle-income countries.

SUBMITTER: Weimann A

PROVIDER: S-EPMC8582825 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Many neurocognitive studies on the role of motor structures in action-language processing have implicitly adopted a "dictionary-like" framework within which lexical meaning is constructed on the basis of an invariant set of semantic features. The debate has thus been centered on the question of whether motor activation is an integral part of the lexical semantics (embodied theories) or the result of a post-lexical construction of a situation model (disembodied theories). However, research in psycholinguistics show that lexical semantic processing and context-dependent meaning construction are narrowly integrated. An understanding of the role of motor structures in action-language processing might thus be better achieved by focusing on the linguistic contexts under which such structures are recruited. Here, we therefore analyzed online modulations of grip force while subjects listened to target words embedded in different linguistic contexts. When the target word was a hand action verb and when the sentence focused on that action (John signs the contract) an early increase of grip force was observed. No comparable increase was detected when the same word occurred in a context that shifted the focus toward the agent's mental state (John wants to sign the contract). There mere presence of an action word is thus not sufficient to trigger motor activation. Moreover, when the linguistic context set up a strong expectation for a hand action, a grip force increase was observed even when the tested word was a pseudo-verb. The presence of a known action word is thus not required to trigger motor activation. Importantly, however, the same linguistic contexts that sufficed to trigger motor activation with pseudo-verbs failed to trigger motor activation when the target words were verbs with no motor action reference. Context is thus not by itself sufficient to supersede an "incompatible" word meaning. We argue that motor structure activation is part of a dynamic process that integrates the lexical meaning potential of a term and the context in the online construction of a situation model, which is a crucial process for fluent and efficient online language comprehension.

Project description:BackgroundAddressing the social and other non-biological determinants of health largely depends on policies and programmes implemented outside the health sector. While there is growing evidence on the effectiveness of interventions that tackle these upstream determinants, the health sector does not typically prioritise them. From a health perspective, they may not be cost-effective because their non-health outcomes tend to be ignored. Non-health sectors may, in turn, undervalue interventions with important co-benefits for population health, given their focus on their own sectoral objectives. The societal value of win-win interventions with impacts on multiple development goals may, therefore, be under-valued and under-resourced, as a result of siloed resource allocation mechanisms. Pooling budgets across sectors could ensure the total multi-sectoral value of these interventions is captured, and sectors' shared goals are achieved more efficiently. Under such a co-financing approach, the cost of interventions with multi-sectoral outcomes would be shared by benefiting sectors, stimulating mutually beneficial cross-sectoral investments. Leveraging funding in other sectors could off-set flat-lining global development assistance for health and optimise public spending. Although there have been experiments with such cross-sectoral co-financing in several settings, there has been limited analysis to examine these models, their performance and their institutional feasibility.AimThis study aimed to identify and characterise cross-sectoral co-financing models, their operational modalities, effectiveness, and institutional enablers and barriers.MethodsWe conducted a systematic review of peer-reviewed and grey literature, following PRISMA guidelines. Studies were included if data was provided on interventions funded across two or more sectors, or multiple budgets. Extracted data were categorised and qualitatively coded.ResultsOf 2751 publications screened, 81 cases of co-financing were identified. Most were from high-income countries (93%), but six innovative models were found in Uganda, Brazil, El Salvador, Mozambique, Zambia, and Kenya that also included non-public and international payers. The highest number of cases involved the health (93%), social care (64%) and education (22%) sectors. Co-financing models were most often implemented with the intention of integrating services across sectors for defined target populations, although models were also found aimed at health promotion activities outside the health sector and cross-sectoral financial rewards. Interventions were either implemented and governed by a single sector or delivered in an integrated manner with cross-sectoral accountability. Resource constraints and political relevance emerged as key enablers of co-financing, while lack of clarity around the roles of different sectoral players and the objectives of the pooling were found to be barriers to success. Although rigorous impact or economic evaluations were scarce, positive process measures were frequently reported with some evidence suggesting co-financing contributed to improved outcomes.ConclusionCo-financing remains in an exploratory phase, with diverse models having been implemented across sectors and settings. By incentivising intersectoral action on structural inequities and barriers to health interventions, such a novel financing mechanism could contribute to more effective engagement of non-health sectors; to efficiency gains in the financing of universal health coverage; and to simultaneously achieving health and other well-being related sustainable development goals.

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Intersectoral Action for Addressing NCDs through the Food Environment: An Analysis of NCD Framing in Global Policies and Its Relevance for the African Context.

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