Public health policy and legislation instruments and tools: an updated review and proposal for further research

This document reviews the current policy and legislation instruments and tools in place for delivering public health operations in the WHO European Region. It aims to underpin and complement the European Action Plan for Strengthening Public Health Capacities and Services (EAP). It provides initial findings on the wide spectrum of legal and policy frameworks at regional and global levels discovered by mapping the available public health instruments and tools across 10 essential public health operations (EPHOs). The main findings are that at the global level legally binding instruments and tools are mainly concentrated in EPHO 3 (health protection) with 306 tools, EPHO 4 (health promotion) with 31 and EPHO 6 (governance) with 41. This corresponds to more than 90% of the total number of public health tools. However, there were only 2 tools for EPHO 5 (disease prevention), 3 for EPHO 7 (workforce) and 1 for EPHO 8 (organizational structures and financing). No legally binding tools were found for EPHO 9 (communication) and EPHO 10 (research). For EPHO 1 (surveillance) and EPHO 2 (response to health hazards and emergencies), there is a more balanced use of both legally and nonlegally binding tools. More evidence is needed on the cost–effectiveness of such instruments and tools. In addition, there is a need for greater advocacy, with a balance of regulation and persuasion, on what already exists – such as “best buy” interventions for noncommunicable diseases (NCDs) and the WHO Framework Convention on Tobacco Control (FCTC) – as well as a need to strengthen approaches to intersectoral governance.