Maximova Katerina, Raine Kim D, Czoli Christine, O'Loughlin Jennifer, Minkley John, Tisdale Kendall, Bubela Tania
School of Public Health (Maximova, Raine), University of Alberta, Edmonton, Alta; School of Epidemiology and Public Health (Czoli), University of Ottawa, Ottawa, Ont.; School of Public Health (O'Loughlin), University of Montreal, Montréal, Que.; Faculty of Law (Minkley), University of Alberta, Edmonton, Alta.; Canadian Partnership Against Cancer (Tisdale), Toronto, Ont.; Faculty of Health Sciences (Bubela), Simon Fraser University, Vancouver, BC
School of Public Health (Maximova, Raine), University of Alberta, Edmonton, Alta; School of Epidemiology and Public Health (Czoli), University of Ottawa, Ottawa, Ont.; School of Public Health (O'Loughlin), University of Montreal, Montréal, Que.; Faculty of Law (Minkley), University of Alberta, Edmonton, Alta.; Canadian Partnership Against Cancer (Tisdale), Toronto, Ont.; Faculty of Health Sciences (Bubela), Simon Fraser University, Vancouver, BC.
CMAJ Open. 2019 Dec 13;7(4):E745-E753. doi: 10.9778/cmajo.20190049. Print 2019 Oct-Dec.
Legal interventions are important mechanisms for chronic disease prevention. Since Canadian laws to promote physical activity and healthy eating are growing, we compared the characteristics of legal interventions targeting physical activity and healthy eating with tobacco control laws, which have been extensively described.
We reviewed 718 federal, provincial and territorial laws promoting tobacco control, physical activity and healthy eating captured in the Prevention Policies Directory between spring 2010 and September 2017. We characterized the legislation with regard to its purpose, tools to accomplish the purpose, responsible authorities, target location, level of coerciveness and provisions for enforcement.
Two-thirds (67.9%) of tobacco control legislation had a primary chronic disease prevention purpose (explicit in 5.3% of documents and implicit in 62.6%), and 29.5% had a secondary chronic disease prevention purpose. One-quarter (27.0%) of physical activity legislation had a primary chronic disease prevention purpose (explicit in 8.8% of documents and implicit in 18.1%), and 53.0% had a secondary chronic disease prevention purpose. In contrast, 69.3% of healthy eating legislation had no chronic disease prevention purpose. Tobacco control legislation was most coercive (restrict or eliminate choice), and physical activity and healthy eating legislation was least coercive (provide information or enable choice). Most tobacco control legislation (85.8%) included provisions for enforcement, whereas 47.4% and 24.8% of physical activity and healthy eating laws, respectively, included such provisions. Patterns in responsible authorities, target populations, settings and tools to accomplish its purpose (e.g., taxation, subsidies, advertising limits, prohibitions) also differed between legislation targeting tobacco control versus physical activity and healthy eating.
Legislative approaches to promote physical activity and healthy eating lag behind those for tobacco control. The results serve as a baseline for building consensus on the use of legislation to support approaches to chronic disease prevention to reduce the burden of chronic disease in Canadians.
法律干预是慢性病预防的重要机制。由于加拿大促进身体活动和健康饮食的法律不断增加，我们将针对身体活动和健康饮食的法律干预措施的特点与已被广泛描述的烟草控制法律进行了比较。
我们审查了2010年春季至2017年9月期间《预防政策目录》中收录的718项促进烟草控制、身体活动和健康饮食的联邦、省和地区法律。我们从立法目的、实现目的的手段、责任部门、目标地点、强制程度和执法条款等方面对这些法律进行了描述。
三分之二（67.9%）的烟草控制立法以预防慢性病为主要目的（5.3%的文件中有明确表述，62.6%为隐含表述），29.5%以预防慢性病为次要目的。四分之一（27.0%）的身体活动立法以预防慢性病为主要目的（8.8%的文件中有明确表述，18.1%为隐含表述），53.0%以预防慢性病为次要目的。相比之下，69.3%的健康饮食立法没有预防慢性病的目的。烟草控制立法的强制性最强（限制或消除选择），而身体活动和健康饮食立法的强制性最弱（提供信息或允许选择）。大多数烟草控制立法（85.8%）包括执法条款，而身体活动和健康饮食法律分别有47.4%和24.8%包含此类条款。在责任部门、目标人群、场所和实现目的的手段（如税收、补贴、广告限制、禁令）等方面，针对烟草控制的立法与针对身体活动和健康饮食的立法也存在差异。
促进身体活动和健康饮食的立法方法落后于烟草控制。这些结果为就利用立法支持慢性病预防方法以减轻加拿大人慢性病负担达成共识提供了一个基线。
