Setting the agenda for a healthy retail environment: content analysis of US newspaper coverage of tobacco control policies affecting the point of sale, 2007-2014

BACKGROUND

Tobacco control policies affecting the point of sale (POS) are an emerging intervention, yet POS-related news media content has not been studied.

PURPOSE

We describe news coverage of POS tobacco control efforts and assess relationships between article characteristics, including policy domains, frames, sources, localisation and evidence present, and slant towards tobacco control efforts.

METHODS

High circulation state (n=268) and national (n=5) newspapers comprised the sampling frame. We retrieved 917 relevant POS-focused articles in newspapers from 1 January 2007 to 31 December 2014. 5 raters screened and coded articles, 10% of articles were double coded, and mean inter-rater reliability (IRR) was 0.74.

RESULTS

POS coverage emphasised tobacco retailer licensing (49.1% of articles) and the most common frame present was regulation (71.3%). Government officials (52.3%), followed by tobacco retailers (39.6%), were the most frequent sources. Half of articles (51.3%) had a mixed, neutral or antitobacco control slant. Articles presenting a health frame, a greater number of protobacco control sources, and statistical evidence were significantly more likely to also have a protobacco control slant. Articles presenting a political/rights or regulation frame, a greater number of antitobacco control sources, or government, tobacco industry, tobacco retailers, or tobacco users as sources were significantly less likely to also have a protobacco control slant.

CONCLUSIONS

Stories that feature procontrol sources, research evidence and a health frame also tend to support tobacco control objectives. Future research should investigate how to use data, stories and localisation to encourage a protobacco control slant, and should test relationships between content characteristics and policy progression.

Civil society advocacy in Nigeria: promoting democratic norms or donor demands?

Background

Civil society organizations (CSOs) are often assumed to be institutions that facilitate communication between citizens and policymakers. However, CSO advocacy is only as effective as the space allowed by government, the resources available from funders, and their own internal capacity. This article presents findings from a study in Nigeria that explores the advocacy and service delivery roles of CSOs working in Human Immunodeficiency Virus (HIV) prevention and mitigation. We will argue that donor and government treatment of civil society as service delivery organizations, rather than as organizations that participate in democratic norms, have shaped how civil society organizations work to mitigate and prevent HIV.

Methods

From February to April 2012, a team of Health Systems 20/20 staff and one consultant conducted 48 in-depth interviews with civil society organizations, State AIDS Control Agencies (SACAs), donors, international organizations, and networks of people living with HIV to examine a wide range of advocacy efforts by CSOs. For quantitative data collection, sampling frames were assembled from lists of HIV-oriented or involved CSOs. This sampling frame consisted of 2548 CSOs from all 36 states and the Federal Capital Territory. A random sample was then taken from the sampling frame, and we contacted 665 CSOs to arrange interviews. With a response rate of 80.2 %, the project conducted 533 surveys in February 2012.

Results

These surveys showed that CSOs advocacy efforts focused on community mobilization related to behavior change, such as peer education (54.9 % of CSOs) and rallies (58.2 % of CSOs), and not on changing government policies. In-depth interviews highlighted the role of donors and government in shaping a purely apolitical role for most CSOs through funding constraints, regulations, and capacity development choices.

Conclusions

In light of these findings, we present key points for considering the influence of donors and government on civil society advocacy for HIV services and rights. We present evidence that donors, and international organizations, conceive of civil society as apolitical, and not as independent actors that compete for political space. More democratic and rights-based views of civil society’s role, such as holding government accountable for providing services or promoting policy change, are not emphasized.

Who thinks what about e-cigarette regulation? A content analysis of UK newspapers

AIMS

To establish how frequently different types of stakeholders were cited in the UK media debate about e-cigarette regulation, their stances towards different forms of e-cigarette regulation, and what rationales they employed in justifying those stances.

METHODS

Quantitative and qualitative content analyses of 104 articles about e-cigarette regulation published in eight UK and three Scottish national newspapers between 1 January 2013 and 31 December 2014.

RESULTS

Reporting on e-cigarette regulation grew significantly (P < 0.001) throughout the sample period. Governments and regulatory bodies were the most frequently cited stakeholders and uniformly supported regulation, while other stakeholders did not always support regulation. Arguments for e-cigarette regulation greatly outnumbered arguments against regulation. Regulating purchasing age, restricting marketing and regulating e-cigarettes as medicine were broadly supported, while stakeholders disagreed about prohibiting e-cigarette use in enclosed public spaces. In rationalizing their stances, supporters of regulation cited child protection and concerns about the safety of e-cigarette products, while opponents highlighted the potential of e-cigarettes in tobacco cessation and questioned the evidence base associating e-cigarette use with health harms.

CONCLUSIONS

In the UK between 2013 and 2014, governments and tobacco control advocates frequently commented on e-cigarettes in UK-wide and Scottish national newspapers. Almost all commentators supported e-cigarette regulation, but there was disagreement about whether e-cigarette use should be allowed in enclosed public spaces. This appeared to be linked to whether commentators emphasized the harms of vapour and concerns about renormalizing smoking or emphasized the role of e-cigarettes as a smoking cessation aid.

Promoting Youth Agency Through Dimensions of Gay-Straight Alliance Involvement and Conditions that Maximize Associations

Gay-Straight Alliances (GSAs) may promote wellbeing for sexual minority youth (e.g., lesbian, gay, bisexual, or questioning youth) and heterosexual youth. We considered this potential benefit of GSAs in the current study by examining whether three GSA functions-support/socializing, information/resource provision, and advocacy-contributed to sense of agency among GSA members while controlling for two major covariates, family support and the broader school LGBT climate. The sample included 295 youth in 33 Massachusetts GSAs (69 % LGBQ, 68 % cisgender female, 68 % white; M age = 16.06 years). Based on multilevel models, as hypothesized, youth who received more support/socializing, information/resources, and did more advocacy in their GSA reported greater agency. Support/socializing and advocacy distinctly contributed to agency even while accounting for the contribution of family support and positive LGBT school climate. Further, advocacy was associated with agency for sexual minority youth but not heterosexual youth. Greater organizational structure enhanced the association between support/socializing and agency; it also enhanced the association between advocacy and agency for sexual minority youth. These findings begin to provide empirical support for specific functions of GSAs that could promote wellbeing and suggest conditions under which their effects may be enhanced.

Peer-engagement and its role in reducing the risky behavior among crack and methamphetamine smokers of the Downtown Eastside community of Vancouver, Canada

Background

The role of peers (former or current drug users) in reducing risky behavior within methamphetamine and crack smokers has not been well described or researched. The current study not only explores the role of peers in reducing risk factors for morbidity within the illicit drug smoking population in the Downtown Eastside (DTES) community of Vancouver but it also investigates the changes in the nature of drug use after the closure of an unsanctioned smoking facility.

Methods

The data pertain to qualitative interviews with 10 peers and 10 illicit drug smokers. The semi-structured interviews were conducted through community-based research, and the digital transcripts were analyzed via NVivo 10 software.

Results

The results indicate that peers (former and current drug users who are employed as educators) are instrumental in transferring risk reduction knowledge within crack and methamphetamine smokers. For example, these peers have been able to teach users about the risk of sharing pipes, using brillo, and using public drug. Furthermore, the Vancouver Area Network of Drug Users provides employment for crack and methamphetamine users in Vancouver who tend to have scarce sources of employment. However, since the closure of the unsanctioned inhalation facility, there has been significantly more public drug use and pipe sharing in the vicinity of the facility, placing drug smokers at significant risk of arrest, violence, and blood-borne infections.

Conclusions

The current study recommends expanding the harm reduction peer network for people who smoke illicit drugs in the DTES community of Vancouver who have historically been underserved.

Assessment of the European Union's illicit trade agreements with the four major Transnational Tobacco Companies

To address the illicit cigarette trade, the European Union (EU) has signed agreements with the four major Transnational Tobacco Companies (TTCs) that involve establishing extensive systems of cooperation. All agreements foresee two types of payments: annual payments (totalling US$ 1.9 billion over 20 years) and supplementary seizure payments, equivalent to 100% of the evaded taxes in the event of seizures of their products. While limited by the fundamental lack of transparency in this area, our analysis suggests that these agreements have served largely to secure the TTCs' interests and are threatening progress in tobacco control. The seizure payments are paltry and a wholly inadequate deterrent to TTC involvement in illicit trade. Despite the agreements, growing evidence indicates the TTCs remain involved in the illicit trade or are at best failing to secure their supply chains as required by the agreements. The intention of the seizure-based payments to deter the tobacco industry from further involvement in the illicit cigarette trade has failed because the agreements contain too many loopholes that provide TTCs with both the incentive and opportunity to classify seized cigarettes as counterfeit. In addition, the shifting nature of cigarette smuggling from larger to smaller consignments often results in seizures that are too small to qualify for the payments. Consequently, the seizure payments represent a tiny fraction of the revenue lost from cigarette smuggling, between 2004 and 2012, 0.08% of the estimated losses due to illicit cigarette trade in the EU. Our evidence suggests the EU should end these agreements.

SEATCA Tobacco Industry Interference Index: a tool for measuring implementation of WHO Framework Convention on Tobacco Control Article 5.3

OBJECTIVE

To measure the implementation of WHO Framework Convention on Tobacco Control (FCTC) Article 5.3 at country level using a new Tobacco Industry Interference Index and to report initial results using this index in seven Southeast Asian countries.

METHODS

Score sheet based on WHO FCTC Article 5.3 Guidelines sent to correspondents in seven Southeast Asian countries, using a scoring system designed with the help of tobacco control experts and validated through focused group discussions.

RESULTS

The seven countries ranked from the lowest level of interference to the highest are Brunei, Thailand, Lao PDR, Cambodia, Philippines, Malaysia and Indonesia. Countries that face high levels of unnecessary interaction with the tobacco industry also face high levels of tobacco industry influence in policy development. Most governments do not allow any tobacco industry representatives on their delegation to sessions of the Conference of the Parties or its subsidiary bodies nor accept their sponsorship for delegates, but most governments still accept or endorse offers of assistance from the tobacco industry in implementing tobacco control policies. Most governments also receive tobacco industry contributions (monetary or in kind) or endorse industry corporate social responsibility activities. Governments do not have a procedure for disclosing interactions with the tobacco industry, but Lao PDR, Philippines and Thailand have instituted measures to prevent or reduce industry interference.

CONCLUSIONS

This Tobacco Industry Interference Index, based on the WHO FCTC Article 5.3 Guidelines, is a useful advocacy tool for identifying both progress and gaps in national efforts at implementing WHO FCTC Article 5.3.

Support mothers in poverty need: Lessons learned from Mom2Mom

Childhood stress leads to adverse developmental and health outcomes in adulthood, and childhood poverty is perhaps the most significant source of stress that exists today for Canadian children. Previously, three key factors were identified that are important in improving developmental outcomes in children: reducing the stress of poverty; connecting the mother to the child's education; and connecting the mother to social support. The Mom2Mom Child Poverty Initiative was established as a model to improve developmental outcomes for vulnerable children. Mom2Mom combines current evidence regarding the social and biological determinants of child health with direct advocacy. It provides mentorship, and financial and practical support to families, with the goal of improving outcomes for children living in poverty.

How a housing advocacy coalition adds health: A culture of claims-making

Organizations that pursue health advocacy often tackle other issues too. How do these multi-issue organizations articulate and combine health with other issues? We examine how a Los Angeles coalition focused primarily on housing took up health in its 2008-2011 campaign against a residential development. Participant observation and archival data reveal that cultural context influenced how the coalition made claims about health, in two ways. First, advocates shared two major symbolic categories, which oriented the great bulk of their appeals regarding health. Second, advocates crafted rhetorical appeals that reflected their shared sense of social identity and obligation as spokespersons for a distinctive kind of community. These two kinds of cultural context influenced advocates' claims in public, formal settings as well more internal communication. These distinct, cultural influences on claims-making create challenges for socioeconomically diverse coalitions collaborating on health problems.

Georgia Maternal and Infant Health Research Group (GMIHRG): Mobilizing Allied Health Students and Community Partners to Put Data into Action

Purpose Despite having an obstetrician/gynecologist (ob/gyn) workforce comparable to the national average, Georgia is ranked 50th in maternal mortality and 40th in infant mortality. The Georgia Maternal and Infant Health Research Group (GMIHRG) was founded in 2010 to evaluate and address this paradox. Description In the several years since GMIHRG's inception, its graduate allied health student researchers and advisors have collaborated with community partners to complete several requisite research initiatives. Their initial work demonstrated that over half the Georgia areas outside metropolitan Atlanta lack adequate access to obstetric services, and their subsequent research evaluated the reasons for and the consequences of this maldistribution of obstetric providers. Assessment In order to translate their workforce and outcomes data for use in policymaking and programming, GMIHRG created reader-friendly reports for distribution to a wide variety of stakeholders and prepared concise, compelling presentations with targeted recommendations for change. This commitment to advocacy ultimately enabled them to: (a) inspire the Georgia Study Committees on Medicaid Reform and Medical Education, (b) influence Georgia General Assembly abortion bills, medical scholarship/loan legislation, and appropriations, and (c) motivate programming initiatives to improve midwifery education and perinatal regionalization in Georgia. Conclusion GMIHRG members have employed inventive research methods and maximized collaborative partnerships to enable their data on Georgia's maternal and infant outcomes and obstetric workforce to effectively inform state organizations and policymakers. With this unique approach, GMIHRG serves as a cost-efficient and valuable model for student engagement in the translation of research into advocacy efforts, policy change, and innovative programming.

FDA's misplaced priorities: premarket review under the Family Smoking Prevention and Tobacco Control Act

Among other key objectives, the 2009 Family Smoking Prevention and Tobacco Control Act was designed to end an era of constant product manipulation by the tobacco industry that had led to more addictive and attractive products. The law requires new tobacco products to undergo premarket review by the US Food and Drug Administration (FDA) before they can be sold. To assess FDA's implementation of its premarket review authorities, we reviewed FDA actions on new product applications, publicly available data on industry applications to market new products, and related FDA guidance documents and public statements. We conclude that FDA has not implemented the premarket review process in a manner that prioritises the protection of public health. In particular, FDA has (1) prioritised the review of premarket applications that allow for the introduction of new tobacco products over the review of potentially non-compliant products that are already on the market; (2) misallocated resources by accommodating the industry's repeated submissions of deficient premarket applications and (3) weakened the premarket review process by allowing the tobacco industry to market new and modified products that have not completed the required review process.

Playing the policy game: a review of the barriers to and enablers of nutrition policy change

OBJECTIVE

To progress nutrition policy change and develop more effective advocates, it is useful to consider real-world factors and practical experiences of past advocacy efforts to determine the key barriers to and enablers of nutrition policy change. The present review aimed to identify and synthesize the enablers of and barriers to public policy change within the field of nutrition.

DESIGN

Electronic databases were searched systematically for studies examining policy making in public health nutrition. An interpretive synthesis was undertaken.

SETTING

International, national, state and local government jurisdictions within high-income, democratic countries.

RESULTS

Sixty-three studies were selected for inclusion. Numerous themes were identified explaining the barriers to and enablers of policy change, all of which fell under the overarching category of 'political will', underpinned by a second major category, 'public will'. Sub-themes, including pressure from industry, neoliberal ideology, use of emotions and values, and being visible, were prevalent in describing links between public will, political will and policy change.

CONCLUSIONS

The frustration around lack of public policy change in nutrition frequently stems from a belief that policy making is a rational process in which evidence is used to assess the relative costs and benefits of options. The findings from the present review confirm that evidence is only one component of influencing policy change. For policy change to occur there needs to be the political will, and often the public will, for the proposed policy problem and solution. The review presents a suite of enablers which can assist health professionals to influence political and public will in future advocacy efforts.

The closure of rural and remote maternity services: Where are the midwives?

Decisions to close small maternity units in rural and remote communities have often precipitated a community response as women and families rally to save local services. But where are the midwives? We argue here that professional bodies such as colleges of midwives have a responsibility to advocate more strongly at a political level for evidence-based decisionmaking regarding the allocation of rural services. We suggest that adopting a comprehensive definition of maternity services risk that considers both social and health services risks and their impact on clinical risk, could provide a solid basis for effective advocacy by professional bodies.

Taking forward the World TB Day 2016 theme 'Unite to End Tuberculosis' for the WHO Africa Region

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Tuberculosis (TB) has remained a global emergency ever since it was declared as such by the World Health Organization (WHO) in 1993.

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Of the 9.6 million people who developed TB in 2014, 28% were in the WHO Africa Region, where the case rate was 281 per 100 000 population.

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An estimated 1.2 million (12%) TB cases were HIV-positive and the Africa Region accounted for 74% of these cases.

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The global spread of multidrug-resistant TB (MDR-TB) is now a major public health challenge.

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Scientific, political, and funder communities seriously need to ‘Unite to End TB’, the theme of the 2016 World TB Day.

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TB control programs in Africa can only succeed if mechanisms for close engagement of developing country scientists, healthcare workers, patient groups, governments, and policy-makers are ensured by funding and donor agencies.

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Several funder, political, and community initiatives provide hope for achieving the goals of the WHO post-2015 TB strategy.

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TB activities and funder investments in Africa need to be aligned in parallel with international efforts at improving social and living conditions and with the ‘one health’ initiative.

Tuberculosis (TB) remains a global emergency, with an estimated 9.6 million new TB cases worldwide reported in 2014. Twenty-eight percent of these cases were in the World Health Organization (WHO) Africa Region, where the annual case detection rate was 281 per 100 000 population—more than double the global average of 133 per 100 000. Of the 9.6 million people who developed TB, an estimated 1.2 million (12%) were HIV-positive, and the Africa Region accounted for 74% of these cases. Three million people with TB remain undiagnosed and untreated. Globally, an estimated 480 000 had multidrug-resistant TB (MDR-TB). Whilst of the African countries, only South Africa has reported a high prevalence of MDR-TB, it is likely that all of Sub-Saharan Africa has an unreported high load of drug-resistant TB. Tragically, in 2014, only 48% of individuals diagnosed with MDR-TB had successful treatment and an estimated 190 000 people died of MDR-TB. Of the global TB funding gap of US$ 0.8 billion, the largest funding gap was in the Africa Region, amounting to US$ 0.4 billion in 2015. The MDR-TB pandemic in particular now threatens to devastate entire regions and may fundamentally alter the life-expectancy and demographic profile of many countries in Sub-Saharan Africa. The theme designated for this year's World TB Day, March 24, 2016, is ‘Unite to End TB’. From the Africa Region, there is an urgent need to seriously address the political, economic, and social factors that influence host–Mycobacterium tuberculosis interactions and result in disease. Recent political and funder initiatives that provide renewed hope for the alleviation of Africa's TB and TB/HIV problems are discussed.

Advocacy communication, vaccines and the role of scientific societies

In 1986 the Ottawa Charter underlined the importance of advocacy in health. This article analyzes the role of advocacy in Public Health making the case of immunization, whose coverage rates are decreasing in many countries. An effective advocacy action could counteract the growing phenomenon of the vaccine hesitancy within both the general population and an increasing share of healthcare providers as well as contrast antivax movements' action. We identify who are the advocates focusing on Italy and on the crucial role of scientific societies which share the responsibility of making the latest scientific evidence and most effective infectious diseases' control strategies available to health policy makers. The Italian Society of Hygiene (SItI) has been actively engaged for several years in a number of initiatives of advocacy communication and vaccines including research, training, media exposure and a dedicated website portal (vaccinarSì).

"Am I Doing the Right Thing?": Pathways to Parenting a Gender Variant Child

Gender variant (GV) children have a subjective sense of gender identity and/or preferences regarding clothing, activities, and/or playmates that are different from what is culturally normative for their biological sex. Despite increases in rates of GV children and their families presenting at clinics, there is little research on how raising a GV child affects the family as a whole or how families make decisions regarding their care. This study took an ecological-transactional framework to explore the question, "what is the experience of parents who raise a GV or transgender child?" Eight mothers and three fathers of GV male and female children (ages 5-13) referred through a GV support group participated in interviews. Transcripts were analyzed using an adaptation of grounded theory analysis. These parents attempted to pave the way to a nonstigmatized childhood for their GV child, typically through two pathways: rescuing the child from fear of stigma and hurt or accepting GV and advocating for a more tolerant world. Many participants used both pathways to different degrees or shifted paths over time, and the paths selected were related to parents' own understanding of GV and their experiences and backgrounds as well as characteristics of the children they were parenting and the communities they inhabited. Limitations, clinical implications, and future directions are discussed.

Road Traffic and Other Unintentional Injuries Among Travelers to Developing Countries

Injuries result in nearly 6 million deaths and incur 52 million disability-adjusted life-years annually, making up 15% of the global disease burden. More than 90% of this burden occurs in low- and middle-income countries. Given this burden, it is not unexpected that injuries are the leading cause of death among travelers to low- and middle-income countries, namely, from road traffic crashes and drowning. Therefore, pretravel advice regarding foreseeable dangers and how to avoid them may significantly mitigate injury risk, such as wearing seatbelts, helmets, and personal flotation devices when appropriate; responsibly consuming alcohol; and closely supervising children.

Schistosomiasis elimination by 2020 or 2030?

Schistosomiasis has been a public health burden in a number of countries across the globe for centuries and probably beyond. The World Health Organization and partners are currently preparing to move towards elimination of this disease. However, given the historical challenges and barriers to ridding areas of this water-borne parasite infection, we question whether the current targets for eliminating schistosomiasis as a global health problem can be achieved.

Advocacy for the Provision of Dental Hygiene Services Within the Hospital Setting: Development of a Dental Hygiene Student Rotation

Educational preparation of dental hygiene students for hospital-based practice, and advocacy efforts promote inclusion of dental hygienists within hospital-based interdisciplinary health care teams.

BACKGROUND AND PURPOSE

Although the value of attending to the oral care needs of patients in critical care units has been recognized, the potential impact of optimal oral health care for the general hospital population is now gaining attention. This article describes a hospital-based educational experience for dental hygiene students and provides advocacy strategies for inclusion of dental hygienists within the hospital interdisciplinary team.

METHODS

The dental hygienist authors, both educators committed to evidence-based oral health care and the profession of dental hygiene, studied hospital health care and recognized a critical void in oral health care provision within that setting. They collaboratively developed and implemented a hospital-based rotation within the curriculum of a dental hygiene educational program and used advocacy skills to encourage hospital administrators to include a dental hygiene presence within hospital-based care teams.

CONCLUSIONS

Hospital-based dental hygiene practice, as part of interprofessional health care delivery, has the potential to improve patient well-being, shorten hospital stays, and provide fiscal savings for patients, institutions, and third party payers. Advocacy efforts can promote dental hygienists as members of hospital-based health care teams. Further research is needed to document: (1) patient outcomes resulting from optimal oral care provision in hospitals; (2) best ways to prepare dental hygienists for career opportunities within hospitals and other similar health care settings; and (3) most effective advocacy strategies to promote inclusion of dental hygienists within care teams.

Patterns of bird-window collisions inform mitigation on a university campus

Bird-window collisions cause an estimated one billion bird deaths annually in the United States. Building characteristics and surrounding habitat affect collision frequency. Given the importance of collisions as an anthropogenic threat to birds, mitigation is essential. Patterned glass and UV-reflective films have been proven to prevent collisions. At Duke University’s West campus in Durham, North Carolina, we set out to identify the buildings and building characteristics associated with the highest frequencies of collisions in order to propose a mitigation strategy. We surveyed six buildings, stratified by size, and measured architectural characteristics and surrounding area variables. During 21 consecutive days in spring and fall 2014, and spring 2015, we conducted carcass surveys to document collisions. In addition, we also collected ad hoc collision data year-round and recorded the data using the app iNaturalist. Consistent with previous studies, we found a positive relationship between glass area and collisions. Fitzpatrick, the building with the most window area, caused the most collisions. Schwartz and the Perk, the two small buildings with small window areas, had the lowest collision frequencies. Penn, the only building with bird deterrent pattern, caused just two collisions, despite being almost completely made out of glass. Unlike many research projects, our data collection led to mitigation action. A resolution supported by the student government, including news stories in the local media, resulted in the application of a bird deterrent film to the building with the most collisions: Fitzpatrick. We present our collision data and mitigation result to inspire other researchers and organizations to prevent bird-window collisions.

Caring for Children in Immigrant Families: Vulnerabilities, Resilience, and Opportunities

Demographics indicate that pediatricians increasingly care for children in immigrant families in routine practice. Although these children may be at risk for health disparities relating to socioeconomic disadvantage and cultural or linguistic challenges, immigrant families have unique strengths and potential for resilience. Adaptive and acculturation processes concerning health and well-being can be mediated by cultural media. Pediatricians have a professional responsibility to address the medical, mental health, and social needs of immigrant families. Advocacy and research at the practice level and beyond can further explore the unique needs of this population and evidence-based strategies for health promotion.

Comparing global alcohol and tobacco control efforts: network formation and evolution in international health governance

Smoking and drinking constitute two risk factors contributing to the rising burden of non-communicable diseases in low- and middle-income countries. Both issues have gained increased international attention, but tobacco control has made more sustained progress in terms of international and domestic policy commitments, resources dedicated to reducing harm, and reduction of tobacco use in many high-income countries. The research presented here offers insights into why risk factors with comparable levels of harm experience different trajectories of global attention. The analysis focuses particular attention on the role of dedicated global health networks composed of individuals and organizations producing research and engaging in advocacy on a given health problem. Variation in issue characteristics and the policy environment shape the opportunities and challenges of global health networks focused on reducing the burden of disease. What sets the tobacco case apart was the ability of tobacco control advocates to create and maintain a consensus on policy solutions, expand their reach in low- and middle-income countries and combine evidence-based research with advocacy reaching beyond the public health-centered focus of the core network. In contrast, a similar network in the alcohol case struggled with expanding its reach and has yet to overcome divisions based on competing problem definitions and solutions to alcohol harm. The tobacco control network evolved from a group of dedicated individuals to a global coalition of membership-based organizations, whereas the alcohol control network remains at the stage of a collection of dedicated and like-minded individuals.

The Implications of Meno's Paradox for the Mental Capacity Act 2005

Meno's paradox-which asks 'how will you know it is the thing you didn't know?'-appears in Plato's dialogue of the same name. This article suggests that a similar question arises in some supportive relationships. Attention to this question clarifies one condition necessary to justify making a best interests decisions against someone's will: the decided-for person must be unable to recognise that they have failed to recognise a need. From this condition, two duties are derived: a duty to ensure that someone cannot recognise that they have failed to recognise a need before making a decision against their will; and a duty to provide consensual support to those who have had decisions made against their will, in order to help them to avoid such second-order failures of recognition in the future. The article assesses the Mental Capacity Act 2005 against each of these duties. For each duty, it finds that the Act allows compliance, but does not robustly require it.

Barriers to genuine consumer and carer participation from the perspectives of Australian systemic mental health advocates

BACKGROUND

Consumer and carer participation in mental health service development and evaluation has widespread nominal support. However, genuine and consistent participation remains elusive due to systemic barriers.

AIMS

This paper explores barriers to reform for mental health services from the perspectives of consumers and carers actively engaged in advocating for improvements in the mental health system.

METHOD

Qualitative research with two mental health systemic advocacy organisations analysed 17 strategic communication documents and nine interviews to examine barriers to reform and participation identified by consumer and carer advocates and staff.

RESULTS

A number of individual-level barriers were described, however advocates gave more focus to systemic barriers, for which five themes emerged. These reflected lack of awareness, limited participation opportunities, slow progress for change, policy issues and mental health culture including stigma.

CONCLUSIONS

Findings highlight systemic barriers to participation for consumer and carer advocates as a whole and the influence of these barriers on the individual experiences of those engaged in advocacy and representation work. Participants also emphasised the need for leadership to overcome some of these obstacles and move towards genuine consumer and carer participation and reform. Findings are discussed in the context of power within mental health systems.