NCDs have been identified as the leading cause of Years of Life Lost (YLL), Disability-Adjusted Life Years (DALYs), and mortality in countries by controlling communicable diseases, changing lifestyles, and growing risk factors for NCDs such as air pollution, low physical activity, and unhealthy nutrition. The share of NCDs from total deaths, both sexes, all ages increased between 1990 and 2019 in Iran (50.11% to 83.48%), the world (57.72% to 74.37%); a similar trend has occurred in the share of NCDs from total DALYs, Iran (45.33% to 78.09%), the world (43.19% to 63.82%); the global economic burden of NCDs is predicted to be USD47 trillion between 2010 and 2030 [1,2,3,4]. According to the Global Burden of Disease (GBD) 2019, about 16.5%, 4.5%, 18.8%, 30.6%, and 14.1% of all deaths in Iran in 2019 were attributable to dietary risk factors, insufficient physical activity (IPA), high BMI, high systolic blood pressure, and tobacco use respectively. The Iran STEPs 2016 survey revealed a high prevalence of IPA, approximately 54.7% of the total population, as defined by WHO recommendation, which is less than 600 Metabolic Equivalent of Task (MET) per week, and 9.6% of participants were current cigarette smokers, the majority of whom were aged 45–70 [5, 6]. Between 2011 and 2025, monetary losses to the low and middle-income countries (LMICs) that emerged from four main NCDs are predicted to exceed US$ 7 trillion, 70% of which will occur in the upper-middle-income countries (UMICs) [7]. It has been determined that 51% of this yearly loss will be linked to cardiovascular diseases, equal to around 4% of these countries’ current annual output [7]. Let alone that the COVID-19 pandemic might exacerbate NCDs' burden due to possible ignorance of NCDs’ priority [8].
NCDs’ prevention and control need global, national, multisectoral, and multistakeholder engagement. As a key strategy to achieve health systems’ goals and reduce health inequities, inter-sectoral collaboration is recommended by the “Global Action Plan” of the World Health Organization (WHO) for the prevention and control of NCDs, as well as by the “National Plan for Prevention and Control of NCDs” in Iran [3, 9, 10]. Nevertheless, the status of current inter-sectoral collaboration initiatives in Iran does not appear as meaningful as they are supposed to be for effective management of NCDs [11], e.g., in the field of urban and transport planning [12], food industry [13].
Meaningful prevention and control of NCDs need a comprehensive approach, which brings all sectors on board to work unitedly to reduce the risks associated with NCDs and to prevent and control NCDs' burden on communities. These include, but are not limited to, health, economics, diplomacy, foreign health policy, education system, agriculture, insurance organizations, markets, tax system, food industry, legislative system, etc. [14,15,16,17]. Intersectoral collaboration (ISC) is mentioned in Articles VII and VIII of the Alma Ata Declaration of 1978: “All governments should formulate national policies, strategies, and plans of action to launch, and sustain primary health care as part of a comprehensive national health system and in coordination with other sectors. To this end, it will be necessary to exercise political will, to mobilize the country's resources, and to use available external resources rationally” [18].
WHO also issued another statement, so-called Intersectoral Action for Health (IAH), which means “a recognized relationship between part or parts of the health sector with parts of another sector which has been formed to take action on an issue to achieve health outcomes (or intermediate health outcomes) in a way that is more effective, efficient or sustainable than could be achieved by the health sector acting alone” [19]. Other global statements, including Primary Health Care (PHC) [20], Millennium Development Goals (MDG) [21], and Sustainable Development Goals (SDGs) also consider ISC as one of the most necessary principles for the health system [22,23,24,25,26].
Stakeholder analysis facilitates the classification of stakeholders, valuing and comparing their particular sets of interests and powers, and examining and reviewing their relationships, including alliances, collaborations, and inherent conflicts [27]. It investigates “who these interested parties are, who has the power to influence what happens, how these parties interact and, based on this information, how they might be able to work more effectively together” [28]. Social network analysis (SNA) is a powerful technique for analyzing the relationship among different actors/stakeholders/parts of government and understanding possible ways to improve collaboration towards better outcomes. The insights gained from SNA can help coordinate ISC global and national efforts and interventions for more efficient prevention and control of NCDs [29], i.e., those recommended by the WHO’s PEN (Package of essential NCDs interventions) [9]. Social network theory and SNA help researchers explain the relationship between people, organizations, or even nations, which might enable them to explore the existing connections and draw a more realistic picture of underlying relationships among them [30]. Visualizing ISC as networks can also facilitate stakeholder network analysis techniques and network theories to discover how they can be more effective in tackling NCDs [29, 31].
Embedding collective decision-making mechanisms into the national administrative system is the key to successfully implementing policies in all settings [32]. Iran enjoys several collective decision-making bodies. So-called the “Councils” and the “Supreme Councils” support coordination, policymaking, and planning of joint decisions, taking which requires ISC among various entities, i.e., different ministries in different areas such as health, economy, welfare, the judicial system, and so on [33]. So-called the “cabinet committee”, such a mechanism exists in other countries; a group made up of cabinet ministers, which is formed to enable meaningful actions on a particular issue or general area of importance for the government [34]. Opportunities for ISC between the expert levels are also available in these councils.
The study’s objectives and questions are: What collective decision-making centers exist at the national level to progress IAH and ISC?; Which policies of identified stakeholders influence risk factors?; What interventions (at different levels) can be put on the agenda to control better the policies that have been approved?. Our findings will support, we envisage, national policymaking on NCDs and related risk factors for better knowledge translation and implementing laws and standards in Iran and perhaps similar settings.