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Content challenges
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Knowledge gap regarding NCDs
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Lack of access to correct information
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The need for stronger declarations of interests
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Structural challenges
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Organizational conflicts of interest (e.g. conflict of interest of some industries such as tobacco industry with health mission)
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Individual conflicts of interest (profitability of tobacco industry for certain individuals)
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Multisectoral nature of NCDs
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Growing trend of childhood obesity
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Lack of access to essential medicines and services for NCDs
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Financial burden of NCDs, both for individuals/families and for national/health budgets
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Lack of a unified management approach and management language
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Structural weaknesses in developing countries
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Heavy influence of developed nations on the United Nations (UN), which undermines efforts to achieve the ideals set forth by this organization
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Financial aspect of NCDs
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Power and business interests of private companies in the policy environment of NCDs, especially in low- and middle-income countries
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Impact of the private sector on the market and people’s preferences
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Policies made behind closed doors with little transparency
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Low investment by the Ministry of Health and Medical Education as the entity in charge of implementing the Tobacco Control Act compared to the capacity that has been built globally
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Lack of political will to engage all stakeholders in policy development
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Adverse economic conditions
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Food industries have the most complex conflicts of interest due to their special nature
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Process challenges
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Slow response of the country’s diplomatic apparatus in relation to international organizations
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Appointment of managers based on the wrong principles
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Difficulty in engaging certain agencies
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Failure of health sector outsiders to understand the problem of NCDs
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Different interpretations of the law in sectors other than healthcare
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Plans that are individual-based and are discarded with a change in management
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Weakness of the health sector in health policy-making, health economics and diplomacy
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Lack of transparency in food labelling
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Influence of industries and lobbying by unhealthy commodity industries in the parliament, WHO and other regulatory and legislative bodies
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Unawareness or inability to seize international opportunities
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Poor performance of the country in terms of tobacco control compared to 2030 targets
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Lack of strong NGO presence in actions against NCDs
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Lack of development in the country’s economy, and weak customs and border control
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Passive involvement of the Ministry of Foreign Affairs
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Shortage of financial resources nationwide
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Low priority of NCDs in the national policy agenda
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Lack of coordination between current processes
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Absence of physicians and specialists in the Ministry of Foreign Affairs
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Lack of proper procedure in policy-making nationwide
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Lack of R&D departments in organizations for better identification of best practices
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Governance challenges
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Global
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Soft and superficial approach of the Global Coordination Mechanism
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National
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Lack of transparency
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Difficulty deciding on the level of transparency of certain policies such as those related to tobacco use
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Lack of accountability and oversight
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Challenges related to inadequate funds, financing and mobilization of funds to address NCDs
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Disparity between budgets and development plans
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Dependence of the government on the private sector and taxes on unhealthy commodities
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Defects in the law dealing with individuals and organizations that ignore the ban on advertising unhealthy commodities
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Lack of attention to the Development Plan and macroeconomic policies in health policy-making
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Lack of clear mechanisms for identifying and resolving conflicts of interest
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Influence of tobacco companies in health policy
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Resistance of companies, the private sector and executive agencies to the implementation of some documents and laws
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Health sector
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Most governments are concerned with primary healthcare or treatment rather than health sector governance
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Lack of strong lobbying or negotiation teams at the level of the Ministry of Health and Medical Education
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Vertical, problem-oriented approach in the health system
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Abolition of the Community Affairs Department, which reduced the follow-up of NCDs and multisectoral action at the local level (provinces, cities and universities)
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Challenges to implementation of the pilot IraPEN [Iran’s Package of Essential NCDs] programme, including the deficiencies of the referral system, the problem of increasing public participation in cities, the high cost of the full package, and the problems caused by sanctions
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Priority of treatment over prevention across the health system
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Individual
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Lack of public participation in decision-making and the low public demand for NCD policies
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Democratic governments catering to the wishes of the populace
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Cultural challenges
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Lack of teamwork
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Low community involvement
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The prevalence of unhealthy diets and sedentary lifestyles
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Resistance to change
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Short-term orientation
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The need for culture-building in line with changes in laws
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