Overview

deaths arising from NCDs, reduce sodium and salt intake, reduce the prevalence of high blood pressure, reduce the prevalence of insufficient physical activity, and completely halt the rise in the incidence of diabetes and obesity. Technical guidelines and recommendations elaborate specific measures to be undertaken in the context of physical activity (8), salt and sugar intake (9, 10), and marketing of foods and non-alcoholic beverages (NABs) to children (11). In addition, domestic policy and legal frameworks (e.g. constitutional protections of the right to life and to health) can be used to reinforce broad human rights and standards specific to commitments related to NCDs (12).

Purpose and scope

This toolkit focuses on regulatory and fiscal measures to avoid or reduce the major NCD risk factors of unhealthy diets and physical inactivity. It does not address the two other major risk factors (tobacco use and the harmful use of alcohol) or secondary strategies for NCD prevention and treatment.2 As mentioned above, this publication focuses on three countries in East Africa: Kenya, Tanzania and Uganda. With few exceptions, undergraduate training of legal and public health professionals in these countries does not include the law’s role in promoting health. This toolkit is a resource that can be used to develop curricula that incorporate regulatory and fiscal measures for the promotion of healthy diets and physical activity. It can also help to strengthen capacity within the areas of law and public health, by supporting the work of legal and public health academia in universities.

The toolkit is intended for academics and students in public health, law and related disciplines. It deals with legal approaches to health; thus, students of law can use it to learn how laws, regulations and legal strategies can be used to promote public health outcomes. However, the text is designed to be accessible to students in disciplines other than law. For example, those studying medicine and public health can use it to understand how law relates to public health, and those studying government and public administration can use it to understand how law can influence public health decisions in the context of NCDs. As a common academic resource, the toolkit may stimulate and strengthen dialogue between different disciplines about NCDs and potentially about other global health challenges.

Methodology

This toolkit presents and analyses the legal and policy frameworks (international, regional and national) that orient governments’ decisions on legal and regulatory measures to promote healthy diets and physical activity, and thus to prevent NCDs. It draws on background reviews from WHO involving thorough desktop research on the legal and policy frameworks for Kenya, Tanzania and Uganda relevant to the governance of healthy diets and physical activity. The findings of this desktop research were supplemented through additional research on law and policy relevant to NCD prevention and control.

The publication also involved a participatory, consultative process with academics from schools of law and schools of public health from the three countries involved. In addition to contributing technical and geographical expertise, scholars from different disciplines helped to ensure that the content is suitable for use in legal and other disciplines at various levels. The draft was also shared for review with WHO, and legal and public health academics and expert reviewers. Data on the NCD profiles of each country were derived from national and international sources published by WHO, United Nations (UN) agencies and various ministries or departments from the individual countries.

2 Secondary strategies aim to stop the progression of disease after its occurrence.

Overview

The toolkit has four parts. The learning objectives, listed at the start of each part, describe what students should be able to do to demonstrate their comprehension after studying the relevant part. Each part also contains exercises or discussion questions intended to stimulate in-depth and practical engagement with the materials it presents:

• Part A explains what NCDs are and the risk factors for these diseases.

• Part B provides the global context, by: § considering the international human rights instruments that influence protection of the right to health, such as human rights frameworks and international trade and investment agreements; § considering the international policy frameworks that address global health policies underpinning action on NCDs (specifically, on healthy diets and physical activity); and noting the issues arising from conflicts of interest and industry challenges in other areas.

• Part C provides the African regional context, by highlighting regional policies on

NCDs and the regional human rights framework. Part C also provides examples of strategies from the African region for addressing NCDs using legal and human rights approaches.

• Part D provides the East African subregional context, by:

§ giving a broad picture of the NCD situation in Kenya, Tanzania and Uganda, referencing data on the four major

NCDs, the risk factors and mortality rates; and § reviewing policies and laws in the three countries relevant to healthy diets and physical activity. Annexes provide additional exercises (Annex 1); data on NCDs for Kenya, Tanzania and Uganda (Annex 2); and further details of relevant legislation in the three countries (Annexes 3–5).