Adherence to the new policy framework of the World Cancer Research Fund International in developing a policy package for the prevention of gastrointestinal cancers in Iran: a Delphi study

Figures & data

Table 1. Predetermined policy options used in round 1 of the Delphi survey

Policy options
Controlling and monitoring food processing and food distribution industries
Controlling and monitoring food imports
Encouraging physical activity in the society and equipping parks with sports facilities and exercise equipment
Allocating more funds to gastrointestinal cancer prevention and screening programs
Higher taxation on unhealthy food items
Allocating targeted subsidies on healthy foods (such as fruits and vegetables) for the lower socioeconomic groups
Restricting the marketing of unhealthy foods
Restricting the marketing of unhealthy lifestyle behaviors
Restricting opium availability and accessibility
Prohibiting harmful pesticides in the agriculture section
Promoting safe food products and production practices
Limiting the availability of unhealthy fast foods for the young population
Promoting healthy transportation policies
Promoting safe water supply policies
Improving multi-sectoral engagement across government sectors in gastrointestinal cancer prevention policy process
Improving the fair distribution of GIC diagnostic devices and gastroenterologists in the secondary care
Promoting the collaboration between NGOs and the private sector in financing and service provision of related activities in the secondary care
Encouraging NGOs and the scientific community to participate in the policymaking process
Establishing public education campaigns on healthy lifestyles and gastrointestinal cancers prevention and screening
Promoting efficiency in primary health care (e.g. delivering Fecal-Immunochemical Test by mail to all target populations)
Promoting oral health services
Helicobacter pylori screening for individuals under 40 years old
Integrating physical activity promotion programs in primary health care services
Giving more priority to evidence-based screening programs in strategic purchasing of services
Educating and Enhancing knowledge and awareness of health managers and policymakers at different levels of the decision-making process

Figure 1. The new policy framework outlined by the World Cancer Research Fund (WCRF) International [17]

Table 2. Characteristics of the Delphi expert panel

Expert	Gender	Professional background	Completed 2^nd round (Yes/No)
1	M	Health economist	Y
2	F	Public economist	Y
3	M	Medical specialist/gastroenterologist	Y
4	M	Health policy/researcher	Y
5	M	Health policy/academic	Y
6	M	Health education and promotion	Y
7	M	Health policy/academic	Y
8	M	Health policy/researcher	Y
9	M	Community medicine/futures studies in health	Y
10	F	Health policy/researcher	Y
11	M	Health services management/non-communicable diseases	Y
12	F	Health policy/researcher	N
13	M	Medical specialist/gastroenterologist	Y
14	M	Health services management/non-communicable diseases	Y
15	M	Health policy/academic	Y
16	M	Epidemiologist	Y

Table 3. Round 2 Delphi survey results of the four criteria for policy options

Policy options	Level of agreement
	Public health impact	Feasibility	Economic impact (Cost-effectiveness)	Budgetary impact
Controlling and monitoring food processing industries	93%	80%	100%	93%
Controlling and monitoring food distribution centers	93%	80%	100%	93%
Controlling and monitoring food imports	87%	80%	87%	87%
Encouraging physical activity in schools, universities, and workplaces	100%	93%	100%	87%
Allocating more funds to gastrointestinal cancer prevention and screening programs	100%	73%	93%	93%
Higher taxation on unhealthy food items	93%	73%	93%	87%
Allocating targeted subsidies on healthy foods (such as fruits and vegetables) for the lower socioeconomic groups	100%	80%	93%	93%
Restricting the marketing of unhealthy foods	100%	73%	100%	93%
Restricting the marketing of unhealthy eating behaviors	100%	73%	100%	93%
Prohibiting the promotion of inactive lifestyles through media, especially for children and adolescents	100%	80%	100%	93%
Restricting opium availability and accessibility	100%	40%	87%	87%
Prohibiting harmful pesticides in the agriculture section	100%	73%	80%	73%
Promoting safe food products and production practices	100%	93%	100%	87%
Limiting the availability of unhealthy fast foods for the young population	100%	73%	83%	87%
Making a safe environment for walking and cycling in urban areas	87%	87%	100%	53%
Equipping parks with sports facilities and exercise equipment	100%	93%	100%	87%
Promoting transportation policies that encourage walking, cycling, and use of public transportation	87%	87%	100%	53%
Promoting safe water supply policies	93%	93%	93%	93%
Promoting clean air policies	87%	87%	100%	53%
Improving multi-sectoral engagement across government sectors in gastrointestinal cancer prevention policy process	100%	93%	93%	80%
Making fair distribution of gastroenterologists in rural Iran with the participation of the private sector and Non-Governmental Organizations (NGOs)	80%	73%	93%	87%
Making fair distribution of gastrointestinal cancer screening and diagnostic devices (e.g. colonoscopy and endoscopy) in rural Iran with the participation of the private sector and NGOs	80%	73%	93%	87%
Encouraging NGOs and the scientific community in the policymaking process	93%	87%	93%	93%
Establishing public education campaigns on healthy lifestyles	87%	73%	67%	53%
Establishing public education campaigns on gastrointestinal cancers prevention and screening	87%	73%	67%	53%
Promoting efficiency in primary health care (e.g. delivering Fecal-Immunochemical Test* by mail for all target populations).	100%	87%	100%	93%
Promoting active care provision in oral health**	87%	87%	100%	93%
Helicobacter pylori screening for individuals under 40 year-olds***	87%	80%	67%	60%
Integrating physical activity promotion programs in primary health care services	93%	87%	100%	100%
Giving more priority to evidence-based screening programs in strategic purchasing of services	100%	67%	100%	93%
Educating and enhancing knowledge and awareness of health managers and policymakers at different levels of the decision-making process	67%	80%	80%	80%
Including content related to the consumption of healthy foods in the educational curriculum of schools	100%	87%	100%	80%

*: Disease-specific policy option for the screening of colorectal cancer

**: Disease-specific policy option for the prevention of esophageal cancer

***: Disease-specific policy option for the screening of gastric adenocarcinoma (non-cardia)

Table 4. Policy framework for a package of actions needed to prevent gastrointestinal cancers

Domains	Policy areas	Policy options	The national focal point for implementation
Health-enhancing environments	Labeling and packaging	Controlling and monitoring food processing industries	Government, Health Commission in the Parliament of Iran, and the Supreme Council of Health and Food Security
		Controlling and monitoring food distribution centers	General Inspection Organization, Standard Organization
		Controlling and monitoring food imports	Ministry of Internal Affairs, Ministry of Industry, Mine, and Trade
	Create healthy and safe settings	Encouraging physical activities in schools, universities, and workplaces	Ministry of Sport and Youth, Ministry of Education, Ministry of Welfare, Labor and Social Affairs
	Fiscal policies	Allocating more funds to gastrointestinal cancer prevention and screening programs	Ministry of Health
		Higher taxation on unhealthy food items	Parliament of Iran, The Cabinet
		Allocating targeted subsidies (such as fruits and vegetables) on healthy foods for the lower socioeconomic groups	Parliament of Iran, The Cabinet, Organization of Targeted Subsidies
	Marketing restrictions	Restricting the marketing of unhealthy foods	Parliament of Iran, Ministry of Industry, Mine, and Trade, Islamic Republic of Iran Broadcasting, Municipalities
		Restricting the marketing of unhealthy eating behaviors	Parliament of Iran, Islamic Republic of Iran Broadcasting, Municipalities
		Prohibiting the promotion of inactive lifestyles through media, especially for children and adolescents	Parliament of Iran, Islamic Republic of Iran Broadcasting
		Restricting opium availability and accessibility	Police force (Iran Drug Control Headquarters)
	Improve the food and drink supply	Prohibiting harmful pesticides in the agriculture section	Ministry of Agriculture, Standard Organization
		Promoting safe food products and production practices	General Inspection Organization, Standard Organization
		Limiting the availability of unhealthy fast foods for the young population	General Inspection Organization, Standard Organization
	Incentives in communities	Making a safe environment for walking and cycling in urban areas	Municipalities
		Equipping parks with sports facilities and exercise equipment	Municipalities, Ministry of Sport and Youth
	Healthy urban designs	Promoting transportation policies that encourage walking, cycling, and use of public transportation	Ministry of Road and Transportation, Road Maintenance and Transportation Organization, municipalities
		Promoting safe water supply policies	Ministry of Energy
		Promoting clean air policies	Organization of environment, Ministry of Road and Transportation, Road Maintenance and Transportation Organization, Municipalities
System change	Integrate actions across sectors	Improving multi-sectoral engagement across government sectors in gastrointestinal cancer prevention policy process	Health Commission in the Parliament of Iran, the Supreme Council of Health and Food Security
		Making fair distribution of gastroenterologists in rural Iran with the participation of private sector and Non-Governmental Organizations (NGOs)	Ministry of Health, The Cabinet
		Making fair distribution of gastrointestinal cancer screening and diagnostic devices (e.g. colonoscopy and endoscopy) in rural Iran with the participation of the private sector and NGOs	Ministry of Health, The Cabinet
		Encouraging NGOs and the scientific community to participate in the policymaking process	Ministry of Health
Behavior change communication	Inform people	Establishing public education campaigns on healthy lifestyles	Ministry of Health
		Establishing public education campaigns on gastrointestinal cancers prevention and screening	Ministry of Health
	Counseling in healthcare	Promoting efficiency in primary health care (e.g. delivering Fecal-Immunochemical Test by mail for all target populations).	Ministry of Health
		Promoting active care provision in oral health	Ministry of Health
		Helicobacter pylori screening for individuals under 40 years old	Ministry of Health
		Integrating physical activity promotion programs in primary health care services	Ministry of Health
		Giving more priority to evidence-based screening programs in strategic purchasing of services	Ministry of Health
	Education and skills	Educating and enhancing knowledge and awareness of health managers and policymakers at different levels of the decision-making process	Ministry of Health
		Including content related to the consumption of healthy foods in the educational curriculum of schools	Health Commission in the Parliament of Iran, Ministry of Health, Ministry of Education

World Cancer Research Fund International. Driving action to prevent cancer and other non-communicable diseases, a new policy framework for promoting healthy diets, physical activity, breastfeeding and reducing alcohol consumption; 2018.

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