The public policy recommendations described below are based on internationally agreed upon and accepted strategies.

Tobacco, weight, physical activity, diet, alcohol, and breastfeeding^1-8

• Implement tax policies, considering best practices, aimed at discouraging the use of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages.
• Implement health warning labels for the containers of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages. For foods and beverages, it is recommended to implement warning labels that include the PAHO nutrient profile model.
• Create healthy environments in the community, schools, educational centers and public buildings: ban the use of products that contain tobacco and generate emissions in shared environments, as well as the use of e-cigarettes, which are a gateway for tobacco use; prohibit alcohol use in these settings; decrease the availability of unhealthy foods and beverages and increase the availability of healthy foods and beverages; promote the creation of spaces for physical activity, as well as spaces to facilitate breastfeeding, and ensure access to drinking water.
• Include quality physical education classes in curricula, promote physical activity at recess, and encourage active transportation to and from school.
• Ban advertising, promotion, and sponsorship of tobacco, e-cigarettes, alcohol, and breastmilk substitutes; and ban the advertising of unhealthy foods and beverages to children.
• Implement communication, education, and counseling programs to encourage behavioral changes in the population regarding the use of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages, and to promote physical activity, healthy eating, and breastfeeding.
• Safeguard the design, implementation, and evaluation of these policies from potential conflicts of interest.
• Adopt the international codes and conventions related to the recommendations above, and ensure that they are correctly implemented:

WHO Framework Convention on Tobacco Control.

International Code of Marketing of Breast-milk Substitutes.

The WHO Technical package SAFER to prevent and reduce alcohol-related death and disability.

The International Labour Organization Maternity Protection Convention and related recommendations.

¹ Pan American Health Organization. PAHO Nutrient Profile Model. Washington, D.C.: PAHO; 2016.

² World Health Organization. Tackling NCDs: ‘best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases. Geneva: WHO; 2017.

³ 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. London: WCRF; 2018.

⁴ World Health Organization. WHO Framework Convention on Tobacco Control. Geneva: WHO; 2003.

⁵ World Health Organization. International Code of Marketing of Breast-Milk Substitutes. Geneva: WHO; 1981.

⁶ World Health Organization. The technical package SAFER. A world free from alcohol related harms. Washington, D.C.: PAHO; 2020.

⁷ United Nations Children’s Fund. Breastfeeding and Family-Friendly policies: an evidence brief. New York: UNICEF; 2019.

⁸ International Labour Organization. Maternity Protection Convention. Geneva: ILO; 1919.

The public policy recommendations described below are based on internationally agreed upon and accepted strategies.

Tobacco, weight, physical activity, diet, alcohol, and breastfeeding^1-8

• Implement tax policies, considering best practices, aimed at discouraging the use of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages.
• Implement health warning labels for the containers of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages. For foods and beverages, it is recommended to implement warning labels that include the PAHO nutrient profile model.
• Create healthy environments in the community, schools, educational centers and public buildings: ban the use of products that contain tobacco and generate emissions in shared environments, as well as the use of e-cigarettes, which are a gateway for tobacco use; prohibit alcohol use in these settings; decrease the availability of unhealthy foods and beverages and increase the availability of healthy foods and beverages; promote the creation of spaces for physical activity, as well as spaces to facilitate breastfeeding, and ensure access to drinking water.
• Include quality physical education classes in curricula, promote physical activity at recess, and encourage active transportation to and from school.
• Ban advertising, promotion, and sponsorship of tobacco, e-cigarettes, alcohol, and breastmilk substitutes; and ban the advertising of unhealthy foods and beverages to children.
• Implement communication, education, and counseling programs to encourage behavioral changes in the population regarding the use of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages, and to promote physical activity, healthy eating, and breastfeeding.
• Safeguard the design, implementation, and evaluation of these policies from potential conflicts of interest.
• Adopt the international codes and conventions related to the recommendations above, and ensure that they are correctly implemented:

– WHO Framework Convention on Tobacco Control.

– International Code of Marketing of Breast-milk Substitutes.

– The WHO Technical package SAFER to prevent and reduce alcohol-related death and disability.

– The International Labour Organization Maternity Protection Convention and related recommendations.

¹ Pan American Health Organization. PAHO Nutrient Profile Model. Washington, D.C.: PAHO; 2016.

² World Health Organization. Tackling NCDs: ‘best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases. Geneva: WHO; 2017.

³ 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. London: WCRF; 2018.

⁴ World Health Organization. WHO Framework Convention on Tobacco Control. Geneva: WHO; 2003.

⁵ World Health Organization. International Code of Marketing of Breast-Milk Substitutes. Geneva: WHO; 1981.

⁶ World Health Organization. The technical package SAFER. A world free from alcohol related harms. Washington, D.C.: PAHO; 2020.

⁷ United Nations Children’s Fund. Breastfeeding and Family-Friendly policies: an evidence brief. New York: UNICEF; 2019.

⁸ International Labour Organization. Maternity Protection Convention. Geneva: ILO; 1919.

The public policy recommendations described below are based on internationally agreed upon and accepted strategies.

Tobacco, weight, physical activity, diet, alcohol, and breastfeeding^1-8

• Implement tax policies, considering best practices, aimed at discouraging the use of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages.
• Implement health warning labels for the containers of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages. For foods and beverages, it is recommended to implement warning labels that include the PAHO nutrient profile model.
• Create healthy environments in the community, schools, educational centers and public buildings: ban the use of products that contain tobacco and generate emissions in shared environments, as well as the use of e-cigarettes, which are a gateway for tobacco use; prohibit alcohol use in these settings; decrease the availability of unhealthy foods and beverages and increase the availability of healthy foods and beverages; promote the creation of spaces for physical activity, as well as spaces to facilitate breastfeeding, and ensure access to drinking water.
• Include quality physical education classes in curricula, promote physical activity at recess, and encourage active transportation to and from school.
• Ban advertising, promotion, and sponsorship of tobacco, e-cigarettes, alcohol, and breastmilk substitutes; and ban the advertising of unhealthy foods and beverages to children.
• Implement communication, education, and counseling programs to encourage behavioral changes in the population regarding the use of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages, and to promote physical activity, healthy eating, and breastfeeding.
• Safeguard the design, implementation, and evaluation of these policies from potential conflicts of interest.
• Adopt the international codes and conventions related to the recommendations above, and ensure that they are correctly implemented:

– WHO Framework Convention on Tobacco Control.

– International Code of Marketing of Breast-milk Substitutes.

– The WHO Technical package SAFER to prevent and reduce alcohol-related death and disability.

– The International Labour Organization Maternity Protection Convention and related recommendations.

¹ Pan American Health Organization. PAHO Nutrient Profile Model. Washington, D.C.: PAHO; 2016.

² World Health Organization. Tackling NCDs: ‘best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases. Geneva: WHO; 2017.

³ 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. London: WCRF; 2018.

⁴ World Health Organization. WHO Framework Convention on Tobacco Control. Geneva: WHO; 2003.

⁵ World Health Organization. International Code of Marketing of Breast-Milk Substitutes. Geneva: WHO; 1981.

⁶ World Health Organization. The technical package SAFER. A world free from alcohol related harms. Washington, D.C.: PAHO; 2020.

⁷ United Nations Children’s Fund. Breastfeeding and Family-Friendly policies: an evidence brief. New York: UNICEF; 2019.

⁸ International Labour Organization. Maternity Protection Convention. Geneva: ILO; 1919.

The public policy recommendations described below are based on internationally agreed upon and accepted strategies.

Tobacco, weight, physical activity, diet, alcohol, and breastfeeding^1-8

• Implement tax policies, considering best practices, aimed at discouraging the use of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages.
• Implement health warning labels for the containers of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages. For foods and beverages, it is recommended to implement warning labels that include the PAHO nutrient profile model.
• Create healthy environments in the community, schools, educational centers and public buildings: ban the use of products that contain tobacco and generate emissions in shared environments, as well as the use of e-cigarettes, which are a gateway for tobacco use; prohibit alcohol use in these settings; decrease the availability of unhealthy foods and beverages and increase the availability of healthy foods and beverages; promote the creation of spaces for physical activity, as well as spaces to facilitate breastfeeding, and ensure access to drinking water.
• Include quality physical education classes in curricula, promote physical activity at recess, and encourage active transportation to and from school.
• Ban advertising, promotion, and sponsorship of tobacco, e-cigarettes, alcohol, and breastmilk substitutes; and ban the advertising of unhealthy foods and beverages to children.
• Implement communication, education, and counseling programs to encourage behavioral changes in the population regarding the use of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages, and to promote physical activity, healthy eating, and breastfeeding.
• Safeguard the design, implementation, and evaluation of these policies from potential conflicts of interest.
• Adopt the international codes and conventions related to the recommendations above, and ensure that they are correctly implemented:

– WHO Framework Convention on Tobacco Control.

– International Code of Marketing of Breast-milk Substitutes.

– The WHO Technical package SAFER to prevent and reduce alcohol-related death and disability.

– The International Labour Organization Maternity Protection Convention and related recommendations.

¹ Pan American Health Organization. PAHO Nutrient Profile Model. Washington, D.C.: PAHO; 2016.

² World Health Organization. Tackling NCDs: ‘best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases. Geneva: WHO; 2017.

³ 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. London: WCRF; 2018.

⁴ World Health Organization. WHO Framework Convention on Tobacco Control. Geneva: WHO; 2003.

⁵ World Health Organization. International Code of Marketing of Breast-Milk Substitutes. Geneva: WHO; 1981.

⁶ World Health Organization. The technical package SAFER. A world free from alcohol related harms. Washington, D.C.: PAHO; 2020.

⁷ United Nations Children’s Fund. Breastfeeding and Family-Friendly policies: an evidence brief. New York: UNICEF; 2019.

⁸ International Labour Organization. Maternity Protection Convention. Geneva: ILO; 1919.

The public policy recommendations described below are based on internationally agreed upon and accepted strategies.

Tobacco, weight, physical activity, diet, alcohol, and breastfeeding^1-8

• Implement tax policies, considering best practices, aimed at discouraging the use of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages.
• Implement health warning labels for the containers of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages. For foods and beverages, it is recommended to implement warning labels that include the PAHO nutrient profile model.
• Create healthy environments in the community, schools, educational centers and public buildings: ban the use of products that contain tobacco and generate emissions in shared environments, as well as the use of e-cigarettes, which are a gateway for tobacco use; prohibit alcohol use in these settings; decrease the availability of unhealthy foods and beverages and increase the availability of healthy foods and beverages; promote the creation of spaces for physical activity, as well as spaces to facilitate breastfeeding, and ensure access to drinking water.
• Include quality physical education classes in curricula, promote physical activity at recess, and encourage active transportation to and from school.
• Ban advertising, promotion, and sponsorship of tobacco, e-cigarettes, alcohol, and breastmilk substitutes; and ban the advertising of unhealthy foods and beverages to children.
• Implement communication, education, and counseling programs to encourage behavioral changes in the population regarding the use of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages, and to promote physical activity, healthy eating, and breastfeeding.
• Safeguard the design, implementation, and evaluation of these policies from potential conflicts of interest.
• Adopt the international codes and conventions related to the recommendations above, and ensure that they are correctly implemented:

– WHO Framework Convention on Tobacco Control.

– International Code of Marketing of Breast-milk Substitutes.

– The WHO Technical package SAFER to prevent and reduce alcohol-related death and disability.

– The International Labour Organization Maternity Protection Convention and related recommendations.

¹ Pan American Health Organization. PAHO Nutrient Profile Model. Washington, D.C.: PAHO; 2016.

² World Health Organization. Tackling NCDs: ‘best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases. Geneva: WHO; 2017.

³ 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. London: WCRF; 2018.

⁴ World Health Organization. WHO Framework Convention on Tobacco Control. Geneva: WHO; 2003.

⁵ World Health Organization. International Code of Marketing of Breast-Milk Substitutes. Geneva: WHO; 1981.

⁶ World Health Organization. The technical package SAFER. A world free from alcohol related harms. Washington, D.C.: PAHO; 2020.

⁷ United Nations Children’s Fund. Breastfeeding and Family-Friendly policies: an evidence brief. New York: UNICEF; 2019.

⁸ International Labour Organization. Maternity Protection Convention. Geneva: ILO; 1919.

The public policy recommendations described below are based on internationally agreed upon and accepted strategies.

Tobacco, weight, physical activity, diet, alcohol, and breastfeeding^1-8

• Implement tax policies, considering best practices, aimed at discouraging the use of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages.
• Implement health warning labels for the containers of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages. For foods and beverages, it is recommended to implement warning labels that include the PAHO nutrient profile model.
• Create healthy environments in the community, schools, educational centers and public buildings: ban the use of products that contain tobacco and generate emissions in shared environments, as well as the use of e-cigarettes, which are a gateway for tobacco use; prohibit alcohol use in these settings; decrease the availability of unhealthy foods and beverages and increase the availability of healthy foods and beverages; promote the creation of spaces for physical activity, as well as spaces to facilitate breastfeeding, and ensure access to drinking water.
• Include quality physical education classes in curricula, promote physical activity at recess, and encourage active transportation to and from school.
• Ban advertising, promotion, and sponsorship of tobacco, e-cigarettes, alcohol, and breastmilk substitutes; and ban the advertising of unhealthy foods and beverages to children.
• Implement communication, education, and counseling programs to encourage behavioral changes in the population regarding the use of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages, and to promote physical activity, healthy eating, and breastfeeding.
• Safeguard the design, implementation, and evaluation of these policies from potential conflicts of interest.
• Adopt the international codes and conventions related to the recommendations above, and ensure that they are correctly implemented:

– WHO Framework Convention on Tobacco Control.

– International Code of Marketing of Breast-milk Substitutes.

– The WHO Technical package SAFER to prevent and reduce alcohol-related death and disability.

– The International Labour Organization Maternity Protection Convention and related recommendations.

¹ Pan American Health Organization. PAHO Nutrient Profile Model. Washington, D.C.: PAHO; 2016.

² World Health Organization. Tackling NCDs: ‘best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases. Geneva: WHO; 2017.

³ 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. London: WCRF; 2018.

⁴ World Health Organization. WHO Framework Convention on Tobacco Control. Geneva: WHO; 2003.

⁵ World Health Organization. International Code of Marketing of Breast-Milk Substitutes. Geneva: WHO; 1981.

⁶ World Health Organization. The technical package SAFER. A world free from alcohol related harms. Washington, D.C.: PAHO; 2020.

⁷ United Nations Children’s Fund. Breastfeeding and Family-Friendly policies: an evidence brief. New York: UNICEF; 2019.

⁸ International Labour Organization. Maternity Protection Convention. Geneva: ILO; 1919.

The public policy recommendations described below are based on internationally agreed upon and accepted strategies.

Tobacco, weight, physical activity, diet, alcohol, and breastfeeding^1-8

• Implement tax policies, considering best practices, aimed at discouraging the use of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages.
• Implement health warning labels for the containers of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages. For foods and beverages, it is recommended to implement warning labels that include the PAHO nutrient profile model.
• Create healthy environments in the community, schools, educational centers and public buildings: ban the use of products that contain tobacco and generate emissions in shared environments, as well as the use of e-cigarettes, which are a gateway for tobacco use; prohibit alcohol use in these settings; decrease the availability of unhealthy foods and beverages and increase the availability of healthy foods and beverages; promote the creation of spaces for physical activity, as well as spaces to facilitate breastfeeding, and ensure access to drinking water.
• Include quality physical education classes in curricula, promote physical activity at recess, and encourage active transportation to and from school.
• Ban advertising, promotion, and sponsorship of tobacco, e-cigarettes, alcohol, and breastmilk substitutes; and ban the advertising of unhealthy foods and beverages to children.
• Implement communication, education, and counseling programs to encourage behavioral changes in the population regarding the use of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages, and to promote physical activity, healthy eating, and breastfeeding.
• Safeguard the design, implementation, and evaluation of these policies from potential conflicts of interest.
• Adopt the international codes and conventions related to the recommendations above, and ensure that they are correctly implemented:

– WHO Framework Convention on Tobacco Control.

– International Code of Marketing of Breast-milk Substitutes.

– The WHO Technical package SAFER to prevent and reduce alcohol-related death and disability.

– The International Labour Organization Maternity Protection Convention and related recommendations.

¹ Pan American Health Organization. PAHO Nutrient Profile Model. Washington, D.C.: PAHO; 2016.

² World Health Organization. Tackling NCDs: ‘best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases. Geneva: WHO; 2017.

³ 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. London: WCRF; 2018.

⁴ World Health Organization. WHO Framework Convention on Tobacco Control. Geneva: WHO; 2003.

⁵ World Health Organization. International Code of Marketing of Breast-Milk Substitutes. Geneva: WHO; 1981.

⁶ World Health Organization. The technical package SAFER. A world free from alcohol related harms. Washington, D.C.: PAHO; 2020.

⁷ United Nations Children’s Fund. Breastfeeding and Family-Friendly policies: an evidence brief. New York: UNICEF; 2019.

⁸ International Labour Organization. Maternity Protection Convention. Geneva: ILO; 1919.

The public policy recommendations described below are based on internationally agreed upon and accepted strategies.

Sun exposure⁹

• Promote public programs to reduce sun exposure, including the design of public spaces that protect the population.
• Regulate occupational exposure to the sun and monitor the implementation of programs to reduce sun exposure.

⁹ Pan American Health Organization. Climate Change for Health Professionals: A Pocket Book. Washington, D.C.: WHO; 2020.

The public policy recommendations described below are based on internationally agreed upon and accepted strategies.

Indoor air pollution¹⁰

• Implement actions and programs to progressively reduce the indoor use of coal and firewood, such as using updated stoves or switching to cleaner energies.

¹⁰ World Health Organization. WHO Guidelines for indoor air quality: Household fuel combustion. Executive summary. Geneva: WHO; 2014.

The public policy recommendations described below are based on internationally agreed upon and accepted strategies.

Outdoor air pollution¹¹

• Establish environmental air quality standards consistent with WHO guidelines or interim targets, and implement strategies to meet them in the short term.
• Increase the coverage of the air quality monitoring network in heavily populated areas.
• Establish communication and information systems to keep the community informed of air quality.

¹¹ World Health Organization. WHO global air quality guidelines. Particulate matter (‎PM2.5 and PM10)‎, ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide. Geneva: WHO; 2021.

The public policy recommendations described below are based on internationally agreed upon and accepted strategies.

Occupational hazards¹²

• Report, regulate, and monitor economic activities that expose workers––whether formal or informal––to type 1 carcinogens in the workplace.
• Ensure that both public and private companies eliminate or at least control the use of carcinogenic substances to reduce employees’ exposure.

¹² International Labour Organization. Promotional Framework for Occupational Safety and Health Convention. Geneva: ILO; 2006.

The public policy recommendations described below are based on internationally agreed upon and accepted strategies.

Helicobacter pylori¹³

• Define national policies on the screening and treatment of Helicobacter pylori infection according to the various at-risk population groups. Develop organized programs to implement these policies.
• Ensure the availability of the lab tests, treatment, follow-up, and diagnostic procedures required for these programs, and implement antibiotic resistance testing to ensure high eradication rates.

¹³ Malfertheiner P, Megraud F, Rokkas T, Gisbert JP, Liou J-M, Schulz C, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022;0:1-39.

The public policy recommendations described below are based on internationally agreed upon and accepted strategies.

Viral infections^14-21

• Ensure universal hepatitis B virus vaccination for boys and girls immediately after birth, and implement strategies to proactively find unvaccinated individuals in order to vaccinate them, preferably before they are sexually active (catch-up vaccination).
• Ensure access to diagnosis of hepatitis B and C, and availability of treatment for anyone diagnosed with these viral infections.
• Ensure the availability of HPV vaccines to sustain vaccination programs. Give one or two doses in vaccination programs, as recommended by WHO. Promote vaccination as a priority in girls 9–14 years of age and extend, if possible, to 18 years; include boys based on the availability of resources. Ensure WHO’s global goal of vaccinating 90% of girls by age 15 by 2030.
• Establish a program to promote and facilitate HIV testing in the general population. Ensure treatment of at least 95% of people with the infection. Ensure that at least 95% of patients have suppressed viral load.
• Make sure to use condoms consistently and correctly, especially with new or casual partners.

¹⁴ World Health Organization. Global health sector strategy on viral hepatitis 2016-2021. Towards ending viral hepatitis. Geneva: WHO; 2016.

¹⁵ World Health Organization. Preventing perinatal hepatitis B virus transmission: a guide for introducing and strengthening hepatitis B birth dose vaccination. Geneva: WHO; 2017.

¹⁶ Weng MK, Doshani M, Khan MA, Frey S, Ault K, Moore K, et al. Universal Hepatitis B Vaccination in Adults Aged 19-59 Years: Updated Recommendations of the Advisory Committee on Immunization Practices – United States, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(13):477-483.

¹⁷ World Health Organization. Meeting of the Strategic Advisory Group of Experts on Immunization, April 2022: conclusions and recommendations. Geneva: WHO; 2022.

¹⁸ World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. Geneva: WHO; 2022.

¹⁹ Pan American Health Organization. Plan of Action for the prevention and control of HIV and sexually transmitted infections 2016-2021. Washington, D.C.: PAHO; 2016.

²⁰ United Nations Population Fund, World Health Organization, Joint United Nations Programme on HIV/AIDS. Position statement on condoms and the prevention of HIV, other sexually transmitted infections and unintended pregnancy. Geneva: ONUSIDA; 2015.

²¹ World Health Organization. WHO guideline on self-care interventions for health and well-being, 2022 revision. Geneva: WHO; 2022.

The public policy recommendations described below are based on internationally agreed upon and accepted strategies.

Hormone replacement during menopause^22-24

• Develop consensus on national guidelines on the use of hormone replacement during menopause, as well as on customizing dose, regimen, and duration of treatment.
• Prohibit the over-the-counter sale (without medical prescription) of hormone replacement therapies for menopause.

²² American Cancer Society. Menopausal Hormone Therapy and Cancer Risk. American Cancer Society: Atlanta; 2015.

²³ Pan American Health Organization. Prevention: Breast Cancer Risk Factors and Prevention. Washington, D.C.: PAHO; 2016.

²⁴ Stuenkel CA, Davis SR, Gompel A, Lumsden MA, Murad MH, Pinkerton JV, et al. Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100(11):3975-4011.

The public policy recommendations described below are based on internationally agreed upon and accepted strategies.

Early detection of colon and rectal cancer²⁵

• Implement secondary prevention programs for colon and rectal cancer. According to current scientific evidence, mortality from colon and rectal cancer can be reduced by a fecal occult blood test every two years followed by colonoscopy for patients who have a positive result, and by at least one colonoscopy in a person’s lifetime between the ages of 50 and 74.
• Ensure a reasonable and regulated supply of fecal occult blood tests and colonoscopy services as needed for national programs.

²⁵ International Agency for Research on Cancer. Handbook of Cancer Prevention. Colorectal cancer screening. Volume 17. Lyon: IARC; 2019.

The public policy recommendations described below are based on internationally agreed upon and accepted strategies.

Early detection of breast cancer^{26, 27}

• Ensure the availability of quality mammograms and clinical breast examinations performed by health professionals with appropriate training, and discourage the use of breast self-examinations, as they have no benefit.
• Ensure timely diagnosis and treatment of patients with abnormal mammograms or clinical breast examinations. According to the WHO Global Breast Cancer Initiative, no more than 60 days should pass between first symptoms (or first interaction of the person with symptoms with the corresponding health system) (or detection of patients with abnormal results via screening) and complete diagnosis, including a comprehensive pathology report. Once cancer is confirmed, the best multimodal treatment available in the country should be offered.
• Adopt the recommendations for screening and early diagnosis in people at high risk of developing breast cancer.

²⁶ International Agency for Research on Cancer. Handbook of Cancer Prevention. Breast cancer screening. Volumen 15. Lyon: IARC; 2016.

²⁷ World Health Organization. The Global Breast Cancer Initiative (GBCI). Geneva: WHO; 2022.

The public policy recommendations described below are based on internationally agreed upon and accepted strategies.

Early detection of cervical cancer^28-30

• Following the WHO cervical cancer elimination initiative, ensure that at least 70% of women over 30 years of age are screened with a high-performance test (such as the HPV test) at least twice in their lifetime, once before age 35 and again before age 45. Where HPV molecular testing is not available, continue to use the available test (cytology or visual inspection with acetic acid) until HPV molecular testing is implemented.
• Ensure that 90% of patients with precancerous lesions or cervical cancer receive treatment, regardless of the screening algorithm offered (e.g., screening followed by colposcopy, biopsy, and treatment of confirmed lesions, or screening and treatment of patients with abnormal results).
• Ensure the availability of early detection tests, triage, diagnosis, treatment, and follow-up, according to the national program.

²⁸ World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. Geneva: WHO; 2022.

²⁹ World Health Organization. WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention, second edition. Geneva: WHO; 2021.

³⁰ International Agency for Research on Cancer. Handbook of Cancer Prevention. Cervical cancer screening. Volumen 18. Lyon: IARC; 2022.