The palm oil industry and noncommunicable diseases.

Large-scale industries do not operate in isolation, but have tangible impacts on human and planetary health. An often overlooked actor in the fight against noncommunicable diseases is the palm oil industry. The dominance of palm oil in the food processing industry makes it the world's most widely produced vegetable oil. We applied the commercial determinants of health framework to analyse the palm oil industry. We highlight the industry's mutually profitable relationship with the processed food industry and its impact on human and planetary health, including detrimental cultivation practices that are linked to respiratory illnesses, deforestation, loss of biodiversity and pollution. This analysis illustrates many parallels to the contested nature of practices adopted by the alcohol and tobacco industries. The article concludes with suggested actions for researchers, policy-makers and the global health community to address and mitigate the negative impacts of the palm oil industry on human and planetary health.

Les grandes industries ne fonctionnent pas en vase clos; elles ont des effets tangibles sur la santé des individus et de la planète. Un acteur souvent négligé dans la lutte contre les maladies non transmissibles est l'industrie de l'huile de palme. Étant donné sa prédominance dans l'industrie alimentaire, l'huile de palme est l'huile végétale la plus largement produite au monde. Nous avons appliqué les déterminants commerciaux de la santé pour analyser l'industrie de l'huile de palme. Nous mettons en évidence la relation mutuellement profitable entre cette industrie et l'industrie des aliments transformés ainsi que ses effets sur la santé des individus et de la planète, et notamment des pratiques culturales néfastes liées à des maladies respiratoires, la déforestation, la diminution de la diversité biologique et la pollution. Cette analyse établit de nombreux parallèles avec la nature contestée de pratiques adoptées par les industries de l'alcool et du tabac. L'article se conclut par des propositions d'action pour que les chercheurs, les responsables politiques et la communauté mondiale de la santé examinent et atténuent les effets négatifs de l'industrie de l'huile de palme sur la santé des individus et de la planète.

Las industrias a gran escala no operan de forma aislada, sino que tienen un impacto tangible en la salud humana y del planeta. Un agente que a menudo se ignora en la lucha contra las enfermedades no contagiosas es la industria del aceite de palma. El predominio del aceite de palma en la industria del procesamiento de alimentos lo convierte en el aceite vegetal más producido del mundo. Se han aplicado los determinantes comerciales del marco de la salud para analizar la industria del aceite de palma. Cabe destacar la relación mutuamente beneficiosa de la industria con la industria de los alimentos procesados y su impacto en la salud humana y del planeta, incluidas las prácticas de cultivo perjudiciales que están relacionadas con las enfermedades respiratorias, la deforestación, la pérdida de biodiversidad y la contaminación. Este análisis ilustra muchos paralelismos con la naturaleza controvertida de las prácticas adoptadas por las industrias del alcohol y el tabaco. El artículo concluye con varias sugerencias de posibles medidas para que los investigadores, los responsables de la formulación de políticas y la comunidad mundial de la salud aborden y mitiguen los impactos negativos de la industria del aceite de palma en la salud humana y del planeta.

Health sector fragmentation: three examples from Sierra Leone.

BACKGROUND: Fragmentation across governance structures, funding, and external actor engagement in Sierra Leone continues to challenge the efficiency and coherence of health sector activities and impedes sustained health system strengthening. Three examples are discussed to highlight the extent, causes, and impacts of health sector fragmentation in Sierra Leone: the community health worker programme, national medical supply chain, and service level agreements. RESULTS: In these examples we discuss factors contributing to fragmentation, the impact on efficiency of systems and sustainability of interventions, and persistent barriers to achieving sustainable improvements in health system performance. Prolonged external dependence and a proliferation of partner and donor involvement tending towards vertical programming and funding have contributed to this fragmentation. CONCLUSION: Alignment of policy and planning initiatives, investment in proactive (to reduce need for reactive) policy and plan development, strengthened partnerships, and strengthened governance and accountability mechanisms offer opportunities for greater health sector integration.

Making health system performance measurement useful to policy makers: aligning strategies, measurement and local health system accountability in ontario.

This study examined the experience of the Ontario Ministry of Health and Long-Term Care in enhancing its stewardship and performance management role by developing a health system strategy map and a strategy-based scorecard through a process of policy reviews and expert consultations, and linking them to accountability agreements. An evaluation of the implementation and of the effects of the policy intervention has been carried out through direct policy observation over three years, document analysis, interviews with decision-makers and systematic discussion of findings with other authors and external reviewers. Cascading strategies at health and local health system levels were identified, and a core set of health system and local health system performance indicators was selected and incorporated into accountability agreements with the Local Health Integration Networks. despite the persistence of such challenges as measurement limitations and lack of systematic linkage to decision-making processes, these activities helped to strengthen substantially the ministry's performance management function.