Noncommunicable diseases (NCDs) are responsible for almost 71% of all deaths globally (1). The number of deaths due to NCDs in China accounted for 86.6% of total deaths in 2012 (2). However, the unhealthy lifestyle of Chinese residents is still prevalent, such as excessive intake of salt and edible oil, sugary beverage consumption among children and adolescents, smoking, alcohol consumption, and lack of physical activity (2). In order to maintain the people’s health, China has issued a number of policies, plans, and national actions for the prevention and control of NCDs. In particular, the Medium- and Long-Term Plan for the Prevention and Treatment of NCDs (2017–2025), the Outline of the Plan for “Healthy China 2030”, and the Healthy China Action (2019–2030) promulgated by the Chinese State Council put forward a series of indicators for NCDs control. It is necessary to systematically review the strategies for NCDs prevention and control in China so as to achieve the goal of healthy China. Based on the theory of policy instruments, we conducted a textual content analysis and a quantitative analysis of the policies on NCDs and their behavioral risk factors that were issued by the State Council and relevant national ministries and commissions from 1990 to 2020. It was found that China’s NCDs prevention and control policies experienced rapid development during the 30 years from 1990 to 2020 and that the majority of China’s NCDs prevention and control policies were environment-oriented, while supply-oriented and demand-oriented policies were insufficient. These findings suggested that attention should be paid to increasing supply-oriented and demand-oriented strategies during the formulation and revision of NCDs prevention and control policies in the future.
The methods of policy document system retrieval and policy text research were conducted in this study. The national health-related policy documents were searched in the portals of the Central Government and national ministries and commissions with the keywords of NCDs and their behavioral risk factors. The inclusion criteria of the policy documents included the following: 1) the release date should be between 1990 and 2020; 2) the departments releasing policy documents were the State Council and relevant national ministries and commissions; 3) the forms of policy documents included laws and regulations, planning, circulars, opinions, measures, announcements, health industry standards and guidelines (issued or guided and supported by health administrative departments), programs (policies); 4) the public form of the policy documents was published online on the official website; and 5) the content of policy documents was closely related to the prevention and control of NCDs or 4 behavioral risk factors (unhealthy diet, use of tobacco, harmful use of alcohol, and physical inactivity). The exclusion criteria included the following: 1) news reports, conference speeches, work reports and interpretation of policy documents related to the prevention and control of NCDs or their behavioral risk factors; 2) only keywords of NCDs or their behavioral risk factors, no substantive content; and 3) documents included in the policy text pool.
The main information elements of the policy document texts were extracted to form an analysis database, including the name of the policy document, the release unit, the release time, the document number, the file type, and the text items. The material was classified using the policy instrument theory, which divided policy instruments into three categories: supply-oriented, environment-oriented, and demand-oriented (3). Figure 1 shows the categories and mechanisms of policy instruments for NCDs prevention and control. Based on the perspective of policy instruments, a textual content analysis and a quantitative analysis were conducted with policy documents on NCDs and related behavioral risk factors in China that were issued between 1990 and 2020. Both analyses were carried out using SPSS software (version 16.0, SPSS Inc., USA).
Figure 1. Categories and mechanisms of policy instruments for noncommunicable diseases (NCDs) prevention and control.
This study retrieved 645 documents publicly available on national-level networks, excluded 233 according to the inclusion and exclusion criteria, and finally included 412 policy documents in the analysis. Among the 412 policy documents, 39 policy documents on NCDs prevention and control were released from 1990 to 2005, accounting for 9.5% of the total number of documents, 149 were released from 2006 to 2015, accounting for 36.2% of the total, and 224 were released from 2016 to 2020, accounting for 54.4% of the total (Figure 2).
Figure 2. The Distribution of the release time of policy documents on noncommunicable diseases prevention and control in China in 1990–2020.
Among the NCDs policies released in 1990–2020, on a type basis, 59 policy documents were supply-oriented, accounting for 14.3% of the total number of documents; 340 were environment-oriented, accounting for 82.5% of the total; and 13 were demand-oriented, accounting for 3.2% of the total. Supply-oriented, environment-oriented, and demand-oriented policies all showed an increasing trend, and environment-oriented policies were significantly higher than supply-oriented and demand-oriented policies. After 2011, supply-oriented and demand-oriented policies gradually increased, but their proportions were still low (Figure 3).
Figure 3. The Distribution of the types of policies on noncommunicable diseases prevention and control in China in 1990–2020.
Among the 4,455 pieces of policy instruments for NCDs prevention and control, on a content basis, 78.2% were environment-oriented, and 18.0% and 3.9% were supply-oriented and demand-oriented, respectively. In all the policy instruments, strategy-based measures accounted for 46.1% of the total policy instruments, followed by goals and planning, which accounted for 14.5%; capital investment, talents building, and information support accounted for 1.5%, 3.0%, and 3.8% of the total policy instruments, respectively; finance, taxation, and laws and regulations accounted for 0.1%, 0.2%, and 1.8% of the total policy instruments, respectively. In the supply-oriented policy instruments, public service investment accounted for 31.6%, information support 21.0%, and talent building and capital investment, respectively, 16.5% and 8.3%. In the environment-oriented policy instruments, strategic measures accounted for 59.0%, and laws and regulations, taxation, and financial instruments accounted for 2.3%, 0.3%, and 0.2%, respectively. In the demand-oriented policy instruments, cooperation models accounted for 30.1%, and government service procurement and government service outsourcing accounted for 2.9% and 1.7%, respectively (Table 1).
Type of policy instrument Sub-item Number Type-based
Supply-oriented Capital investment 66 8.3 1.5 Talent building 132 16.5 3.0 Public service investment 253 31.6 5.7 Information support 168 21.0 3.8 Institution/facility construction 181 22.6 4.1 Subtotal 800 100.0 18.0 Environment-oriented Goals and planning 648 18.6 14.5 Strategic measures 2,054 59.0 46.1 Finance 6 0.2 0.1 Taxation policy 11 0.3 0.2 Medicare support 113 3.2 2.5 Standards and guidelines 215 6.2 4.8 Laws and regulations 80 2.3 1.8 Social promotion 275 7.9 6.2 Organizational safeguard 80 2.3 1.8 Subtotal 3,482 100.0 78.2 Demand-oriented Government procurement 5 2.9 0.1 Pilot projects 36 20.8 0.8 Government service outsourcing 3 1.7 0.1 Price regulation 21 12.1 0.5 Experience demonstrations 47 27.2 1.1 International communication 9 5.2 0.2 Cooperation models 52 30.1 1.2 Subtotal 173 100.0 3.9 Total 4,455 100.0 100.0
Table 1. The Distribution of various policy instruments for noncommunicable diseases prevention and control.