Better policies for better plans:
Overview of IPS policies
Non-communicable diseases (NCDs) have posed a critical health challenge in Sri Lanka for several decades. Estimated to account for 83 percent of all deaths in Sri Lanka today, NCDs have serious health and economic consequences for individuals and the country.1 In 2000 and 2010, deaths from NCDs were estimated at 74 and 76 per cent. hundred. total deaths respectively.2 Unhealthy dietary habits are one of the main behavioral causes of the increasing incidence of NCDs.3 While 72.5% of the Sri Lankan population eat less than five servings of fruit and /or vegetables on average per day4, only 26.9 percent of men and 28.0% of women consume at least five servings of fruit and/or vegetables per day5. Additionally, 26.5% of schoolchildren aged 13-17 reported consuming a soft drink at least once a day.6 This shows how unhealthy eating habits are followed in Sri Lanka on a daily basis.
Political economy and NTM
Fiscal interventions are crucial to correct market failures, create incentives to reduce NCD food risk factors and generate government revenue.7 Fiscal policies and regulations are implemented within complex country-specific systems . They are influenced by several contextual factors such as social norms and acceptances, stakeholders, their interests and influences, resource implications, equity and human rights, and feasibility. These factors are collectively recognized as the political economy. The political economy of a country greatly influences the development, implementation and realization of policies. A good understanding of political economy can help formulate better policies to address the challenge of NCDs and create a healthy food environment.
Sri Lanka has introduced various measures including tax policies and regulations to promote healthy eating habits. The main objective of this policy brief is to highlight how the political economy of the food environment in the country influences the development of healthy food policies. The following conclusions are based on a political economy analysis conducted by the Sri Lanka Institute of Policy Studies (IPS) as part of the study on “Fiscal Policies and Regulations to Promote Healthy Diets in Sri Lanka”. “. The study examines the following aspects:
Policy formulation – recognition of the main policy problem (underlying assumptions, perceptions and concepts);
Content of the policy – recognition of the key elements of the policy; and Policy development – actors, stakeholders and their interests.
Conclusions and recommendations are based on a review of policies introduced from the year 2000.
It should be noted that NCDs, nutrition and the food environment are recognized as important policy issues and well framed in policy documents prepared by the health sector, mainly by the Ministry of Health.
Content of the policy
Healthy food consumption, healthy food production, social marketing and health promotion campaigns, nutrition labelling, nutrition education and healthy food retailing are the areas relatively well covered. in the policy documents reviewed. However, many policy documents do not pay enough attention to some crucial aspects such as funding sources, governance, gender sensitivity and stakeholder identification. For example, the National Health Strategic Master Plan 2016-2025 Preventive Services Program – Food Safety states, “The Government of Sri Lanka will take responsibility in terms of finance and resource allocation to improve food safety” as an assumption.8 But it does not explain or present the financial sources and mechanisms to be used for this purpose. Similarly, in most policy documents, there is no explicit commitment to adopt fiscal measures to achieve the objectives specified in those respective policies.
The Ministry of Health plays a central role in shaping policies to reduce non-communicable diseases, promote healthy diets and establish a safer food environment in Sri Lanka. In addition to the Ministry of Health, the Ministry of Agriculture has also shown interest in nutrition and the food environment. Production of safe food, marketing and trade, and nutrition education are some of the key areas covered by agricultural sector policy documents. Apart from these two ministries, other public sectors have not shown significant interest in NCDs, nutrition or the food environment.
In addition, international development partners such as the World Health Organization (WHO), United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA), World Food Program (WFP) and the World Bank (WB) are important stakeholders playing a supporting role in improving nutritional status and the food environment and addressing non-communicable disease issues.
Continue to focus on policy development and cover critical policy elements:
Acknowledgment and attention to NCDs, nutrition and the food environment are progressive steps that need to be continued. This is particularly important given the current burden of NCDs in Sri Lanka and the increasing trend in NCD-related morbidity and mortality. However, the review of policy documents revealed the lack of comprehensive coverage of important policy elements where some of the crucial aspects such as governance structures, funding sources and gender sensitivity are not adequately addressed.
It is essential to fully recognize all crucial aspects to effectively implement policies and achieve the desired results. For example, identifying governance structures is important for effective policy implementation. It also indicates the country’s commitment and responsiveness to the issues identified in the policies. Similarly, it is necessary to identify the sources of funding to implement the proposed actions. No matter how well developed a policy is, it will not achieve the expected impact if the resources needed to implement it are not available.
Proactively search for assets
involvement of all stakeholders
in policy making:
The efforts of the health sector (i.e. the Ministry of Health) to develop policies on NCDs, nutrition and the food environment are commendable. Yet, the lack of involvement and interest from other sectors is a huge obstacle to achieving the expected results of policies to promote healthy diets in Sri Lanka. Currently, these issues are considered “health issues” and other sectors/ministries do not adequately recognize or completely ignore these concerns when formulating policies for their respective sectors. The food environment, nutrition and NCDs are complex and interconnected issues.
Thus, policies that seek to address these issues need to adopt a more holistic approach that actively involves all relevant parties. In addition, the involvement of the highest level of government, such as the National Nutrition Council chaired by the President, is recommended to lead and coordinate these processes, thereby ensuring the highest level of political will and commitment.
This policy overview was prepared by IPS researcher Sunimalee Madurawala ([email protected]) based on the findings of a study on “Fiscal Policies and Regulations to Promote Healthy Diets in Sri Lanka” funded by International Development Research Center (IDRC), Canada. For more information on IPS policies, visit: https://www.ips.lk/publications/policy-insights/.