Abstract for: The role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases in Nepal

The objective of this paper was to describe the role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases (NCDs) in Nepal and identify leverages for action from a systems perspective. The study was a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n=63) and focus group discussions (n=12) at different levels (policy, district and/or community) and was informed by the adapted Social Determinants of Health Framework. The data analysis involved case study based thematic analysis, causal loop diagramming, sense making with stakeholders and leverage point analysis. Five key interacting themes emerged during the data analysis. These interacting themes were utilized to develop iterative causal loop diagrams and system archetypes showing the influence of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. A final comprehensive causal loop diagram facilitated in the identification and iteration of leverage points for action. The resulting themes and causal loop diagrams showed how socio-economic circumstances was influencing addiction and availability of tobacco and alcohol products in Nepal. A multi-sectoral response led by health system is urgently needed.