Monitoring progress toward United Nations commitments: characteristics of Canadian legislation to promote tobacco control, physical activity and healthy eating. A descriptive study

Katerina Maximova; Kim D. Raine; Christine Czoli; Jennifer O’Loughlin; John Minkley; Kendall Tisdale; Tania Bubela

doi:10.9778/cmajo.20190049

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Figure 1:
Flow chart showing selection of Prevention Policy Directory (PPD) legislation for analysis. *Criteria applied by study investigators. Note: CanLII = Canadian Legal Information Institute.
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Figure 2:
Levels of legislation coerciveness by targeted risk factor and period (based on the Nuffield Council on Bioethics policy framework34).

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Table 1:

Classification of tools used to accomplish the legislation purpose32

Tool	Description
Tax and spend	Impose taxes, provide tax credits or exemptions
Direct regulation	Directly impose restrictions such as prohibitions and licensing on individuals and businesses
Indirect regulation through tort system	Grant of causes of action in tort to government or others
Deregulation	Repeal of legislative provisions that disincentivize desired public health behaviours
Delegation of regulation to public administrative body	Grant legal authority to public or administrative body (e.g., school board) empowering it to act and set its duties
Alter informational environment	Mandate product labelling, instructions for safe use, disclosure of ingredients or health warnings, limits on harmful or misleading advertising
Alter built environment	Grant ability to alter or regulate built environment or what people can do with built environment
Alter socioeconomic environment	Improve health by targeting social or economic resources to benefit of disadvantaged populations

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Table 2:

Legislation type by targeted risk factor

Legislation type	Risk factor; no. (%) of documents
Legislation type	Tobacco control n = 190	Physical activity n = 215	Healthy eating n = 101	Multiple factors^* n = 100	Total^† n = 718
Statute	75 (39.5)	116 (54.0)	42 (41.6)	19 (19.0)	335 (46.7)
Regulation	84 (44.2)	80 (37.2)	47 (46.5)	74 (74.0)	303 (42.2)
Code	0 (0.0)	1 (0.5)	0 (0.0)	2 (2.0)	3 (0.4)
Bill	31 (16.3)	18 (8.4)	12 (11.9)	5 (5.0)	77 (10.7)

↵* Legislation targeting more than 1 risk factor.
↵† Includes general legislation (e.g., provincial public health act).

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Table 3:

Legislation purpose and tools to accomplish its purpose by targeted risk factor

Variable	Risk factor; no. (%) of documents
Variable	Tobacco control n = 190	Physical activity n = 215	Healthy eating n = 101	Multiple factors^* n = 100	Total^† n = 718
Purpose
Primary — explicit	10 (5.3)	19 (8.8)	0 (0.0)	5 (5.0)	35 (4.9)
Primary — implicit	119 (62.6)	39 (18.1)	7 (6.9)	7 (7.0)	175 (24.4)
Secondary	56 (29.5)	114 (53.0)	24 (23.8)	75 (75.0)	307 (42.8)
No purpose	4 (2.1)	43 (20.0)	70 (69.3)	12 (12.0)	199 (27.7)
Missing	1 (0.1)	0 (0.0)	0 (0.0)	1 (1.0)	2 (0.3)
Tools to accomplish purpose
Tax and spend	33 (17.4)	44 (20.5)	6 (5.9)	13 (13.0)	100 (13.9)
Direct regulation	148 (77.9)	30 (14.0)	18 (17.8)	67 (67.0)	269 (37.5)
Indirect regulation	17 (8.9)	0 (0.0)	0 (0.0)	0 (0.0)	17 (2.4)
Regulation through public body	15 (7.9)	64 (29.8)	8 (7.9)	8 (8.0)	128 (17.8)
Alter informational environment	32 (16.8)	2 (0.9)	4 (4.0)	2 (2.0)	42 (5.8)
Alter built environment	3 (1.6)	124 (57.7)	0 (0.0)	39 (39.0)	185 (25.8)
Alter socioeconomic environment	1 (0.5)	4 (1.9)	3 (3.0)	2 (2.0)	10 (1.4)

↵* Legislation targeting more than 1 risk factor.
↵† Includes general legislation (e.g., provincial public health act).

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Table 4:

Ministry responsible for legislation and target location by targeted risk factor

Variable	Risk factor; no. (%) of documents
Variable	Tobacco control n = 190	Physical activity n = 215	Healthy eating n = 101	Multiple factors^* n = 100	Total^† n = 718
Ministry responsible
Health	85 (44.7)	1 (0.5)	10 (9.9)	27 (27.0)	131 (18.2)
Finance	54 (28.4)	13 (6.0)	4 (4.0)	7 (7.0)	78 (10.9)
Municipal	0 (0.0)	42 (19.5)	0 (0.0)	5 (5.0)	63 (8.8)
Environment	0 (0.0)	53 (24.6)	0 (0.0)	3 (3.0)	56 (7.8)
Education	2 (1.0)	14 (6.5)	6 (5.9)	5 (5.0)	32 (4.5)
Social services	0 (0.0)	5 (2.3)	7 (6.9)	16 (16.0)	32 (4.5)
Justice	24 (12.6)	1 (0.5)	1 (1.0)	1 (1.0)	28 (3.9)
Culture	0 (0.0)	19 (8.8)	0 (0.0)	7 (7.0)	26 (3.6)
Transportation	10 (5.3)	8 (3.7)	0 (0.0)	1 (1.0)	20 (2.8)
Agriculture	2 (1.0)	1 (0.5)	3 (3.0)	14 (14.0)	20 (2.8)
Development	1 (0.5)	12 (5.6)	0 (0.0)	1 (1.0)	14 (1.9)
Employment/labour	9 (4.7)	0 (0.0)	0 (0.0)	2 (2.0)	11 (1.5)
Other	3 (1.6)	46 (21.4)	70 (69.3)	11 (11.0)	207 (28.8)
Target location
Municipalities	8 (4.2)	60 (27.9)	0 (0.0)	9 (9.0)	94 (13.1)
Public transit	39 (20.5)	13 (6.0)	0 (0.0)	4 (4.0)	58 (8.1)
Schools	31 (16.3)	12 (5.6)	7 (6.9)	2 (2.0)	56 (7.8)
Food establishments	25 (13.2)	0 (0.0)	5 (5.0)	24 (24.0)	54 (7.5)
Outdoor nonurban spaces	1 (0.5)	48 (22.3)	0 (0.0)	4 (4.0)	53 (7.4)
Long-term care facilities	23 (12.1)	0 (0.0)	5 (5.0)	15 (15.0)	45 (6.3)
Child care facilities	15 (7.9)	1 (0.5)	6 (5.9)	19 (19.0)	44 (6.1)
Workplaces	41 (21.6)	1 (0.5)	0 (0.0)	2 (2.0)	44 (6.1)
Recreation and sport facilities	23 (12.1)	9 (4.2)	0 (0.0)	3 (3.0)	36 (5.0)
Enclosed public spaces	35 (18.4)	0 (0.0)	0 (0.0)	0 (0.0)	36 (5.0)
Hospitals	28 (14.7)	0 (0.0)	0 (0.0)	0 (0.0)	29 (4.0)
Universities	18 (9.5)	5 (2.3)	1 (1.0)	1 (1.0)	25 (3.5)
Pharmacies	14 (7.4)	0 (0.0)	0 (0.0)	0 (0.0)	16 (2.2)

↵* Legislation targeting more than 1 risk factor.
↵† Includes general legislation (e.g., provincial public health act).

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Table 5:

Legislation enforcement by targeted risk factor

Variable	Risk factor; no. (%) of documents
Variable	Tobacco control n = 190	Physical activity n = 215	Healthy eating n = 101	Multiple factors^* n = 100	Total^† n = 718
Provision for enforcement specified
In legislation itself	66 (34.7)	67 (31.2)	12 (11.9)	21 (21.0)	189 (26.3)
In enacting or other legislation	97 (51.0)	35 (16.3)	13 (12.9)	46 (46.0)	195 (27.2)
None specified	27 (14.2)	113 (52.6)	76 (75.2)	33 (33.0)	334 (46.5)
Offence or penalty specified
In legislation itself	73 (38.4)	71 (33.0)	14 (13.9)	7 (7.0)	185 (25.8)
In enacting or other legislation	92 (48.4)	35 (16.3)	12 (11.9)	60 (60.0)	203 (28.3)
None specified	25 (13.2)	109 (50.7)	75 (74.3)	33 (33.0)	330 (46.0)