Table 4 Summary of the Kingdon framework’s three streams describing problem, policy and politics surrounding cardiovascular disease in Brazil and outcomes directly or indirectly attributed to the urban population health initiative (bold/italic)
Problem stream | Policy stream | Politics stream |
|---|---|---|
2006–2020 Launch of the nationwide Vigitel surveys on NCD risk factors 2008 NCD Guidelines 2008 Brazilian Household Budget Survey 2008–2009 • Average national salt consumption in adults – is more than double (12 g per day) the WHO recommended 5 g per day • Salt and salt-based condiments added to meals represent 76% of daily salt intake 2014 First registry for hypertension and diabetes HIPERDIA discontinued 2016 National Vigitel Survey • Obesity prevalence increased from 11.8% in 2006 to 18.9% in 2016 • Between 1974 and 2009, overweight in adults increased from 18.5 to 50.1% for men and from 28.7 to 48% for women 2018 WHO NCD country profiles • NCDs account for 74% of all deaths in Brazil, and 28% are caused by CV disease s 2020 A comprehensive national estimate of hypertension prevalence is unavailable. However, city and/or state-based studies and surveys suggest: • A hypertension prevalence in adults of 23–30% Despite high access to medicines around 35 to 50% of hypertension patients treated by medication do not achieve BP control | 2003 Brazil launches a national policy for the health of elderly persons, following the WHO approach for Active Aging 2003 Adoption of mandatory food labelling law (including trans-fats), taking effect in 2007 2003 Agreement between ABIA and MOH to reduce salt, sugar and trans-fat content in processed foods, renewed in 2010 2006 Approval of a broad health promotion policy including a series of intersectoral actions, health education, disease and risk factor monitoring, and health care promotion centred around healthy nutrition, physical activity, smoking cessation and reduction of the harmful use of alcohol. 2007 National policy for alcohol includes educational actions, advertisement and sale regulations, law enforcement for drinking and driving, and provision of care for those with alcohol-related problems 2009 A national legislation is enacted that requires at least 30% of the national school lunch budget to be spent on fresh foods from local agricultural production and family farms. 2010 Launch of 10-year Strategic Action Plan to Tackle NCDs 2011–2022 2014 Adoption of Tobacco Control Act By 2016, a comprehensive ban is introduced on all tobacco advertising, promotion and sponsorship, including at the point-of-sale | 1988 Creation of the unified Brazilian Healthcare System 2003 WHO and the Food and Agriculture Organization recommend that ‘trans’ fat consumption should be less than 1% of the total daily energy calories 2003 Harmonization process within Mercosur to make food labelling mandatory 2003 FCTC holds the first international public health convention under the auspices of the WHO • Brazil acts as Vice-President of the Working Group that prepared the first draft of the convention • Brazil chairs the FCTC Intergovernmental Negotiation Body and heads the working group that prepared the first Conference of Parties 2005 To support local health promotion activities, the MOH transfers US$2 million to 27 state capitals. By 2009, the allocation had increased to US$25 million, distributed entirely to 1277 states and municipalities 2011 Agreement signed to establish goals for the reduction of salt in food as a priority 2014 Brazil appointed to preside the FCTC Secretariat |