The trend toward decentralising health governance holds implications not only for health systems design and financing, but also for policy innovation and implementation. In particular, asymmetric federalism emphasizes the benefits and drawbacks of decentralized policymaking both for sub-national units and at national levels. This paper takes a structural-functionalist approach to analysing the effects of asymmetrical federalism on the process, political, and programmatic success of policies aimed at addressing non-communicable diseases (NCDs). As defined by the World Health Organization (WHO), the main behavioural contributors to NCDs are tobacco use, excessive alcohol use, unhealthy diet, and lack of physical activity. Across a number of countries, the policies designed to address these factors share common themes, which can be characterised in terms of distribution (e.g., limits on vending machine or in-school sales); regulation on advertising, labelling, marketing, and packaging; and taxation on products deemed harmful. Using public records and legislative databases, the paper presents the UK as a case study by delineating the powers devolved to England, Northern Ireland, Scotland, and Wales in terms of distribution, regulation, and taxation, along with their implications for the ability of each region to design and implement policies preventing against NCDs. The results are then compared with data from existing literature on the impact of asymmetric federalism on health-related policymaking in Spain and Switzerland. It is argued that a higher degree of selective regional autonomy better allows for policy innovation, supporting the idea of the "policy crucible" at sub-national levels. Nonetheless, asymmetric federalism poses several challenges for health policymaking at the national level in terms of both coordination and equity. Further study is recommended into the effects of the "West Lothian question" on health-related policymaking not only within federal states, but also in proposed "quasi-federal" regions such as the European Union.
