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Eisenkraft Klein D, Shawanda A. Bridging the commercial determinants of Indigenous health and the legacies of colonization: A critical analysis. Glob Health Promot 2024; 31:15-22. [PMID: 37522186 PMCID: PMC11363465 DOI: 10.1177/17579759231187614] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023]
Abstract
To date, there has been scarce effort to consider the intertwining of colonization and the commercial determinants of Indigenous health. This is a vital omission, and one that this paper proposes to address. We propose how four losses of tradition borne out of colonialism are intertwined with four respective commercial determinants of Indigenous health: 1) loss of traditional diets and the ultra-processed food industry; 2) loss of traditional ceremony and the tobacco industry; 3) loss of traditional knowledge and the infant formula industry; and 4) loss of traditional support networks and the alcohol industry. Building on Indigenous efforts to decolonize spaces and assert control over their own lives, we argue that analyzing the mechanisms through which industry activities intersect with colonial legacies will improve broader understandings of Indigenous health disparities.
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Affiliation(s)
| | - Amy Shawanda
- Waakebiness Institute for Indigenous Health, Dalla Lana School of Public Health, University of Toronto, Canada
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2
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Vasilescu CL, McKee M, Reeves A. Quantitative Textual Analysis as a means to explore corporate interests in food safety. Health (London) 2024; 28:372-389. [PMID: 37309822 DOI: 10.1177/13634593231173807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The growing body of scholarship on the commercial determinants of health has, so far, mostly employed qualitative methods but this is now being complemented by a small, yet growing, corpus of quantitative studies. We illustrate the use of one such method, quantitative text analysis (QTA), in a case study of submissions to a public consultation on a draft scientific opinion by the European Food Safety Authority on the chemical acrylamide, demonstrating how this method can be used and insights that might be drawn from it. We use Wordscores as one example of QTA to illuminate the diverse positions taken by actors submitting comments and then assess whether the final policy documents moved towards or away from the positions taken by different stakeholders. We find a broadly uniform position among the public health community, opposed to acrylamide, contrasting with industry positions that were not monolithic. Some firms recommended major amendments to the guidance, largely reflecting the impact on their practices, while policy innovators seeking ways to reduce acrylamide in foods aligned with the public health community. We also find no clear movement in the policy guidance, likely because most submissions supported the draft document. Many governments are required to conduct public consultations, some attracting enormous numbers of responses, with little guidance on how best to synthesise the responses so the default position is often a count of those for and against. We argue that QTA, primarily a research tool, might usefully be applied in analysing public consultation responses to understand better the positions taken by different actors.
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GÓMEZ EDUARDOJ, MAANI NASON, GALEA SANDRO. The Pitfalls of Ascribing Moral Agency to Corporations: Public Obligation and Political and Social Contexts in the Commercial Determinants of Health. Milbank Q 2024; 102:28-42. [PMID: 37880820 PMCID: PMC10938930 DOI: 10.1111/1468-0009.12678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/15/2023] [Accepted: 10/02/2023] [Indexed: 10/27/2023] Open
Abstract
Policy Points Government and civil society should be held more accountable for creating food and beverage regulatory policies rather than assigning moral agency to the food and beverage industry. Nutrition policymaking institutions should ensure civil society's ability to design regulatory policy. Government policymaking institutions should be isolated from industry interference.
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Crocetti AC, Cubillo (Larrakia) B, Hill (Torres Strait Islander) K, Carter (Yorta Yorta) M, Paradies (Wakaya) Y, Backholer K, Browne J. Media coverage of commercial industry activities impacting Aboriginal and Torres Strait Islander health, 2018-2022. Health Promot Int 2023; 38:daad157. [PMID: 38041808 PMCID: PMC10693320 DOI: 10.1093/heapro/daad157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023] Open
Abstract
This study aimed to examine the extent and nature of Australian news media coverage of commercial industry activities that explicitly speak to Aboriginal and Torres Strait Islander contexts. We undertook content and framing analysis of Australian newspaper and online media articles published between January 2018 and March 2022 that included terms related to 'Indigenous', 'commercial' and 'health'. Analysis focused on the nature of coverage, framing of responsibility, patterns over time and stakeholder representation. Forty-six media articles were included in the analysis. Half of these articles related to the actions of three companies (Woolworths, WAM Clothing and Rio Tinto). Most articles described negative health and well-being impacts of commercial activity, while four described positive impacts. The most common voice represented in media articles was from industry (n = 25). Aboriginal or Torres Strait Islander voices were represented in 21 articles. This analysis highlights how commercial activities in Australia are reported to negatively influence Aboriginal and Torres Strait Islander health and well-being, and that industry voices are more commonly represented in the media related to these issues.
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Affiliation(s)
- Alessandro Connor Crocetti
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, School of Health and Social Development, Faculty of Health, Geelong, VIC, Australia
| | - Beau Cubillo (Larrakia)
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, School of Health and Social Development, Faculty of Health, Geelong, VIC, Australia
| | - Karen Hill (Torres Strait Islander)
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, School of Health and Social Development, Faculty of Health, Geelong, VIC, Australia
| | - Morgan Carter (Yorta Yorta)
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Yin Paradies (Wakaya)
- Deakin University Alfred Deakin Institute for Citizenship and Globalisation, Burwood, VIC, Australia
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, School of Health and Social Development, Faculty of Health, Geelong, VIC, Australia
| | - Jennifer Browne
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, School of Health and Social Development, Faculty of Health, Geelong, VIC, Australia
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Maani N, CI van Schalkwyk M, Petticrew M. Under the influence: system-level effects of alcohol industry-funded health information organizations. Health Promot Int 2023; 38:daad167. [PMID: 38097395 PMCID: PMC10721437 DOI: 10.1093/heapro/daad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
There is now an established body of evidence that the alcohol industry seeks to obstruct public health policies that could affect the availability, affordability or marketing of alcohol. In parallel, the alcohol industry is active in funding corporate social responsibility initiatives, with a particular focus on 'responsible drinking' campaigns, often facilitated by national-level charities established and/or funded by the alcohol industry and associated organizations. While evidence continues to grow regarding biases in the content produced by such health information organizations, they remain active in partnerships with government health departments on national health promotion campaigns and provide a range of health-related information to the public, community organizations and schools. To understand the implications of such access for policymakers, researchers and the public, there is a need to consider the wider, system-level influences of such organizations and their place in wider alcohol industry strategies. In this article, we describe evolving evidence of the direct and indirect strategic effects of such organizations and demonstrate how they serve key roles in the alcohol industry through their existence, content, partnerships and public profiles. We end by considering the implications for how we conceptualize charities established or funded (entirely or partly) by harmful commodity industries, and to what extent current conflicts of interest guidelines are sufficiently effective.
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Affiliation(s)
- Nason Maani
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, 15a George Square, Edinburgh, EH8 9LD, UK
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - May CI van Schalkwyk
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Mark Petticrew
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
- UK PRP SPECTRUM Consortium, Usher Institute, Old Medical School, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
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Ralston R, Godziewski C, Brooks E. Reconceptualising the commercial determinants of health: bringing institutions in. BMJ Glob Health 2023; 8:e013698. [PMID: 38016709 PMCID: PMC10685945 DOI: 10.1136/bmjgh-2023-013698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/01/2023] [Indexed: 11/30/2023] Open
Abstract
The concept of the 'commercial determinants of health' (CDOH) has been developed by public health researchers as a way to describe the political economy of corporations and the impact of their practices on health, social inequalities and climate change. In this analysis, we assess the conceptual work that has developed this field and the influence of the more established 'social determinants of health' models. We highlight the dominance of epidemiologic and biomedical concepts on understandings of structure and agency in the CDOH literature and argue that the terminology of 'risk factors', 'drivers' and 'pathways' reflects an agent-centred approach. We suggest that, as a result, there is a tendency to overlook the importance of political institutions in shaping the exercise of corporate power. Our analysis seeks to 'bring institutions in' to CDOH research, using the empirical cases of Health in All Policies and Better Regulation in the European Union to highlight how institutional contexts shape political legitimacy and accountability, and in turn the strategies of corporate actors. Institutionalist approaches, we argue, have the potential to develop and expand understandings of CDOH by opening the black box between agency and structure.
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Affiliation(s)
- Rob Ralston
- Global Health Policy Unit, School of Social & Political Science, The University of Edinburgh, Edinburgh, UK
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), London, UK
| | | | - Eleanor Brooks
- Global Health Policy Unit, School of Social & Political Science, The University of Edinburgh, Edinburgh, UK
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Townsend B, Johnson TD, Ralston R, Cullerton K, Martin J, Collin J, Baum F, Arnanz L, Holmes R, Friel S. A framework of NGO inside and outside strategies in the commercial determinants of health: findings from a narrative review. Global Health 2023; 19:74. [PMID: 37817196 PMCID: PMC10565967 DOI: 10.1186/s12992-023-00978-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/02/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Public health scholarship has uncovered a wide range of strategies used by industry actors to promote their products and influence government regulation. Less is known about the strategies used by non-government organisations to attempt to influence commercial practices. This narrative review applies a political science typology to identify a suite of 'inside' and 'outside' strategies used by NGOs to attempt to influence the commercial determinants of health. METHODS We conducted a systematic search in Web of Science, ProQuest and Scopus. Articles were eligible for inclusion if they comprised an empirical study, explicitly sought to examine 'NGOs', were in English, and identified at least one NGO strategy aimed at commercial and/or government policy and practice. RESULTS One hundred forty-four studies met the inclusion criteria. Eight industry sectors were identified: extractive, tobacco, food, alcohol, pharmaceuticals, weapons, textiles and asbestos, and a small number of general studies. We identified 18 types of NGO strategies, categorised according to the target (i.e. commercial actor or government actor) and type of interaction with the target (i.e. inside or outside). Of these, five NGO 'inside' strategies targeted commercial actors directly: 1) participation in partnerships and multistakeholder initiatives; 2) private meetings and roundtables; 3) engaging with company AGMs and shareholders; 4) collaborations other than partnerships; and 5) litigation. 'Outside' strategies targeting commercial actors through the mobilisation of public opinion included 1) monitoring and reporting; 2) protests at industry sites; 3) boycotts; 4) directly engaging the public; and 5) creative use of alternative spaces. Four NGO 'inside' strategies directly targeting government actors included: 1) lobbying; 2) drafting legislation, policies and standards; 3) providing technical support and training; and 4) litigation. NGO 'outside' strategies targeting government included 1) protests and public campaigns; 2) monitoring and reporting; 3) forum shifting; and 4) proposing and initiating alternative solutions. We identified three types of NGO impact: substantive, procedural, and normative. CONCLUSION The analysis presents a matrix of NGO strategies used to target commercial and government actors across a range of industry sectors. This framework can be used to guide examination of which NGO strategies are effective and appropriate, and which conditions enable NGO influence.
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Affiliation(s)
- Belinda Townsend
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Australian National University, Canberra, Australia.
| | - Timothy D Johnson
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Australian National University, Canberra, Australia
| | - Rob Ralston
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | | | - Jane Martin
- Obesity Policy Coalition, Melbourne, Australia
| | - Jeff Collin
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Fran Baum
- Stretton Health Equity & School of Social Science, University of Adelaide, Adelaide, Australia
| | | | - Rodney Holmes
- Foundation for Alcohol Research and Education, Canberra, Australia
| | - Sharon Friel
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Australian National University, Canberra, Australia
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Lauber K, Brooks E. Why meta-regulation matters for public health: the case of the EU better regulation agenda. Global Health 2023; 19:70. [PMID: 37710336 PMCID: PMC10500858 DOI: 10.1186/s12992-023-00971-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023] Open
Abstract
Meta-regulation - the rules that govern how individual policies are developed and reviewed - has not received much attention in the study of health policy. We argue that these rules, far from value-free and objective, have significant potential to shape policy outputs and, as such, health outcomes. Channelling and operationalising wider paradigms like neoliberalism, they determine, for instance, what is considered 'good' policy, how decisions are made, based on which evidence, and whose voices matter. Exploring an archetypal example of meta-regulation, the European Union's Better Regulation agenda, we illustrate why meta-regulatory tools such as impact assessment, stakeholder consultation, and evaluation - and the norms that underlie their application - matter for health. In so doing, we concentrate especially on the ways in which Better Regulation may affect interest groups' ability to exert influence and, conversely, how actors have sought to shape Better Regulation. We argue that attention to meta-regulation contributes to counter-balancing the focus on agency within debates at the intersection of globalisation and health, and notably those on regulatory practices and coordination. Whilst research has noted, for instance, the origins of frameworks like Better Regulation and the increasing inclusion of 'good regulatory practice' provisions within trade and investment agreements, less attention is directed to the role that these frameworks play once institutionalised. Yet, as we illustrate, there is considerable scope for meta-regulation to enhance our understanding of the forces shaping health policy via, for instance, conceptualisations of the (social, economic, political, commercial) determinants of health. As such, we call for increased attention to the role of meta-regulation in research and practice aimed at improving human and planetary health.
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Affiliation(s)
- Kathrin Lauber
- Global Health Policy Unit, School of Social and Political Science, Chrystal Macmillan Building, 15a George Square, University of Edinburgh, Edinburgh, EH8 9LD, UK.
| | - Eleanor Brooks
- Global Health Policy Unit, School of Social and Political Science, Chrystal Macmillan Building, 15a George Square, University of Edinburgh, Edinburgh, EH8 9LD, UK
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Wood B, Lacy-Nichols J, Sacks G. Taking on the Corporate Determinants of Ill-health and Health Inequity: A Scoping Review of Actions to Address Excessive Corporate Power to Protect and Promote the Public's Health. Int J Health Policy Manag 2023; 12:7304. [PMID: 38618808 PMCID: PMC10590241 DOI: 10.34172/ijhpm.2023.7304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/18/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND In many sectors of the economy, for-profit business corporations hold excessive power relative to some governments and civil society. These power imbalances have been recognised as important contributors to many pressing and complex societal challenges, including unhealthy diets, climate change, and widening socio-economic inequalities, and thus pose a major barrier to efforts to improve public health and health equity. In this paper, we reviewed potential actions for addressing excessive corporate power. METHODS We conducted a scoping review of diverse literature (using Scopus, Web of Science, HeinOnline, and EBSCO databases), along with expanded searches, to identify state and collective actions with the potential to address excessive corporate power. Actions were thematically classified into overarching strategic objectives, guided by Meagher's '3Ds' heuristic, which classifies actions to curb corporate power into three groups: dispersion, democratisation, and dissolution. Based on the actions identified, we proposed two additional strategic objectives: reform and democratise the global governance of corporations, and strengthen countervailing power structures. RESULTS We identified 178 documents that collectively cover a broad range of actions to address excessive corporate power. In total, 18 interrelated strategies were identified, along with several examples in which aspects of these strategies have been implemented. CONCLUSION The proposed framework sheds light on how a diverse set of strategies and actions that seek to address excessive corporate power can work synergistically to change the regulatory context in which corporations operate, so that broader societal goals, including health and equity, are given much greater prominence and consideration vis-à-vis powerful corporate interests.
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Affiliation(s)
- Benjamin Wood
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Jennifer Lacy-Nichols
- Centre for Health Policy, The University of Melbourne School of Population and Global Health, Melbourne, VIC, Australia
| | - Gary Sacks
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
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Eisenkraft Klein D, Lexchin J, Sud A, Bavli I. Pharmaceutical company responses to Canadian opioid advertising restrictions: A framing analysis. PLoS One 2023; 18:e0287861. [PMID: 37384735 PMCID: PMC10310031 DOI: 10.1371/journal.pone.0287861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 06/14/2023] [Indexed: 07/01/2023] Open
Abstract
The pharmaceutical industry's promotion of opioids in North America has been well-documented. Yet despite the clear consequences of improperly classifying pharmaceutical company messaging and frequently permissive approaches that allow the pharmaceutical industry to self-regulate its own advertising, there has been scarce investigation to date of how pharmaceutical industry stakeholders interpret definitions of "advertising." This study explores how variations of "marketing" and "advertising" are strategically framed by the different actors involved in the manufacturing and distribution of pharmaceutical opioids. We employed a framing analysis of industry responses to Health Canada's letter to Canadian manufacturers and distributors of opioids requesting their commitment to voluntarily cease all marketing and advertising of opioids to health care professionals. Our findings highlight companies' continuing efforts to frame their messaging as "information" and "education" rather than "advertising" in ways that serve their interests. This study also calls attention to the industry's continual efforts to promote self-regulation and internal codes of conduct within a highly permissive federal regulatory framework with little concern for violations or serious consequences. While this framing often occurring out of public sight, this study highlights the subtle means through which the industry attempts to frame their promotion strategies away from "marketing". These framing strategies have significant consequences for the pharmaceutical industry's capacity to influence healthcare professionals, patients, and the general public.
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Affiliation(s)
| | - Joel Lexchin
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Abhimanyu Sud
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Humber River Hospital, Toronto, Ontario, Canada
| | - Itai Bavli
- Department of the History of Science, Faculty of Arts and Sciences, Harvard University, Cambridge, Massachusetts, United States of America
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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Ulucanlar S, Lauber K, Fabbri A, Hawkins B, Mialon M, Hancock L, Tangcharoensathien V, Gilmore AB. Corporate Political Activity: Taxonomies and Model of Corporate Influence on Public Policy. Int J Health Policy Manag 2023; 12:7292. [PMID: 37579378 PMCID: PMC10462073 DOI: 10.34172/ijhpm.2023.7292] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/19/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) kill 41 million people a year. The products and services of unhealthy commodity industries (UCIs) such as tobacco, alcohol, ultra-processed foods and beverages and gambling are responsible for much of this health burden. While effective public health policies are available to address this, UCIs have consistently sought to stop governments and global organisations adopting such policies through what is known as corporate political activity (CPA). We aimed to contribute to the study of CPA and development of effective counter-measures by formulating a model and evidence-informed taxonomies of UCI political activity. METHODS We used five complementary methods: critical interpretive synthesis of the conceptual CPA literature; brief interviews; expert co-author knowledge; stakeholder workshops; testing against the literature. RESULTS We found 11 original conceptualisations of CPA; four had been used by other researchers and reported in 24 additional review papers. Combining an interpretive synthesis of all these papers and feedback from users, we developed two taxonomies - one on framing strategies and one on action strategies. The former identified three frames (policy actors, problem, and solutions) and the latter six strategies (access and influence policy-making, use the law, manufacture support for industry, shape evidence to manufacture doubt, displace, and usurp public health, manage reputations to industry's advantage). We also offer an analysis of the strengths and weaknesses of UCI strategies and a model that situates industry CPA in the wider social, political, and economic context. CONCLUSION Our work confirms the similarity of CPA across UCIs and demonstrates its extensive and multi-faceted nature, the disproportionate power of corporations in policy spaces and the unacceptable conflicts of interest that characterise their engagement with policy-making. We suggest that industry CPA is recognised as a corruption of democracy, not an element of participatory democracy. Our taxonomies and model provide a starting point for developing effective solutions.
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Affiliation(s)
- Selda Ulucanlar
- Tobacco Control Research Group (TCRG), Department for Health, University of Bath, Bath, UK
| | - Kathrin Lauber
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Alice Fabbri
- Tobacco Control Research Group (TCRG), Department for Health, University of Bath, Bath, UK
| | - Ben Hawkins
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Melissa Mialon
- Trinity Business School, Trinity College Dublin, Dublin, Ireland
| | - Linda Hancock
- Alfred Deakin Institute, Deakin University, Melbourne, VIC, Australia
| | | | - Anna B. Gilmore
- Tobacco Control Research Group (TCRG), Department for Health, University of Bath, Bath, UK
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12
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de Lacy-Vawdon C, Vandenberg B, Livingstone C. Power and Other Commercial Determinants of Health: An Empirical Study of the Australian Food, Alcohol, and Gambling Industries. Int J Health Policy Manag 2023; 12:7723. [PMID: 37579379 PMCID: PMC10461899 DOI: 10.34172/ijhpm.2023.7723] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 04/19/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Commercial determinants of health (CDoH) represent a critical frame for exploring undue corporate and commercial influence over health. Power lenses are integral to understanding CDoH. Impacts of food, alcohol, and gambling industries are observable CDoH outcomes. This study aims to inform understanding of the systems and institutions of commercial and/or corporate forces working within the Australian food, alcohol, and gambling industries that influence health and well-being, including broader discourses materialised via these systems and institutions. METHODS Twenty semi-structured interviews were conducted with key-informants on Australian public policy processes. Interviewees were current and former politicians, political staff members, regulators and other public servants, industry representatives, lobbyists, journalists, and researchers with expertise and experience of the Australian food, alcohol, and/ or gambling industries. Interviews sought participants' perceptions of Australian food, alcohol, and gambling industries' similarities and differences, power and influence, relationships, and intervention opportunities and needs. RESULTS Strategies and tactics used by Australian food, alcohol and gambling industries are similar, and similar to those of the tobacco industry. They wield considerable soft (eg, persuasive, preference-shaping) and hard (eg, coercive, political, and legal/economic) power. Perceptions of this power differed considerably according to participants' backgrounds. Participants framed their understanding of necessary interventions using orthodox neoliberal discourses, including limiting the role of government, emphasising education, consumer freedom, and personal choice. CONCLUSION Food, alcohol, and gambling industries exercise powerful influences in Australian public policy processes, affecting population health and well-being. Per Wood and colleagues' framework, these manifest corporate, social, and ecological outcomes, and represent considerable instrumental, structural, and discursive power. We identify power as arising from discourse and material resources alike, along with relationships and complex industry networks. Addressing power is essential for reducing CDoH harms. Disrupting orthodox discourses and ideologies underpinning this should be a core focus of public health (PH) advocates and researchers alike.
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Affiliation(s)
- Cassandra de Lacy-Vawdon
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Brian Vandenberg
- School of Social Sciences, Monash University, Melbourne, VIC, Australia
| | - Charles Livingstone
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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13
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Lacy-Nichols J, Nandi S, Mialon M, McCambridge J, Lee K, Jones A, Gilmore AB, Galea S, de Lacy-Vawdon C, de Carvalho CMP, Baum F, Moodie R. Conceptualising commercial entities in public health: beyond unhealthy commodities and transnational corporations. Lancet 2023; 401:1214-1228. [PMID: 36966783 DOI: 10.1016/s0140-6736(23)00012-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 09/25/2022] [Accepted: 12/23/2022] [Indexed: 04/07/2023]
Abstract
Most public health research on the commercial determinants of health (CDOH) to date has focused on a narrow segment of commercial actors. These actors are generally the transnational corporations producing so-called unhealthy commodities such as tobacco, alcohol, and ultra-processed foods. Furthermore, as public health researchers, we often discuss the CDOH using sweeping terms such as private sector, industry, or business that lump together diverse entities whose only shared characteristic is their engagement in commerce. The absence of clear frameworks for differentiating among commercial entities, and for understanding how they might promote or harm health, hinders the governance of commercial interests in public health. Moving forward, it is necessary to develop a nuanced understanding of commercial entities that goes beyond this narrow focus, enabling the consideration of a fuller range of commercial entities and the features that characterise and distinguish them. In this paper, which is the second of three papers in a Series on commercial determinants of health, we develop a framework that enables meaningful distinctions among diverse commercial entities through consideration of their practices, portfolios, resources, organisation, and transparency. The framework that we develop permits fuller consideration of whether, how, and to what extent a commercial actor might influence health outcomes. We discuss possible applications for decision making about engagement; managing and mitigating conflicts of interest; investment and divestment; monitoring; and further research on the CDOH. Improved differentiation among commercial actors strengthens the capacity of practitioners, advocates, academics, regulators, and policy makers to make decisions about, to better understand, and to respond to the CDOH through research, engagement, disengagement, regulation, and strategic opposition.
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Affiliation(s)
- Jennifer Lacy-Nichols
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, VIC, Australia.
| | - Sulakshana Nandi
- Public Health Resource Network, Chhattisgarh, India; People's Health Movement, New Delhi, India
| | - Melissa Mialon
- Trinity Business School, Trinity College Dublin, Dublin, Ireland
| | | | - Kelley Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Anna B Gilmore
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
| | | | | | - Fran Baum
- Stretton Institute, University of Adelaide, Adelaide, SA, Australia
| | - Rob Moodie
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, VIC, Australia
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14
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Gilmore AB, Fabbri A, Baum F, Bertscher A, Bondy K, Chang HJ, Demaio S, Erzse A, Freudenberg N, Friel S, Hofman KJ, Johns P, Abdool Karim S, Lacy-Nichols J, de Carvalho CMP, Marten R, McKee M, Petticrew M, Robertson L, Tangcharoensathien V, Thow AM. Defining and conceptualising the commercial determinants of health. Lancet 2023; 401:1194-1213. [PMID: 36966782 DOI: 10.1016/s0140-6736(23)00013-2] [Citation(s) in RCA: 129] [Impact Index Per Article: 129.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 10/13/2022] [Accepted: 12/23/2022] [Indexed: 04/07/2023]
Abstract
Although commercial entities can contribute positively to health and society there is growing evidence that the products and practices of some commercial actors-notably the largest transnational corporations-are responsible for escalating rates of avoidable ill health, planetary damage, and social and health inequity; these problems are increasingly referred to as the commercial determinants of health. The climate emergency, the non-communicable disease epidemic, and that just four industry sectors (ie, tobacco, ultra-processed food, fossil fuel, and alcohol) already account for at least a third of global deaths illustrate the scale and huge economic cost of the problem. This paper, the first in a Series on the commercial determinants of health, explains how the shift towards market fundamentalism and increasingly powerful transnational corporations has created a pathological system in which commercial actors are increasingly enabled to cause harm and externalise the costs of doing so. Consequently, as harms to human and planetary health increase, commercial sector wealth and power increase, whereas the countervailing forces having to meet these costs (notably individuals, governments, and civil society organisations) become correspondingly impoverished and disempowered or captured by commercial interests. This power imbalance leads to policy inertia; although many policy solutions are available, they are not being implemented. Health harms are escalating, leaving health-care systems increasingly unable to cope. Governments can and must act to improve, rather than continue to threaten, the wellbeing of future generations, development, and economic growth.
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Affiliation(s)
| | - Alice Fabbri
- Department for Health, University of Bath, Bath, UK
| | - Fran Baum
- Stretton Health Institute, University of Adelaide, Adelaide, SA, Australia
| | | | - Krista Bondy
- Stirling Management School, University of Stirling, Stirling, UK
| | - Ha-Joon Chang
- Department of Economics, School of Oriental and African Studies University of London, London, UK
| | - Sandro Demaio
- Victorian Health Promotion Foundation, Melbourne, VIC, Australia
| | - Agnes Erzse
- South African Medical Research Council/Wits Centre for Health Economics and Decision Science, Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Nicholas Freudenberg
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Sharon Friel
- Menzies Centre for Health Governance, School of Regulation and Global Governance, The Australian National University, Acton, ACT, Australia
| | - Karen J Hofman
- South African Medical Research Council/Wits Centre for Health Economics and Decision Science, Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Paula Johns
- ACT Health Promotion, Rio de Janeiro, Brazil
| | - Safura Abdool Karim
- South African Medical Research Council/Wits Centre for Health Economics and Decision Science, Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Jennifer Lacy-Nichols
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | | | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Lindsay Robertson
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | | | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, University of Sydney, NSW, Australia
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15
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Bennett E, Topp SM, Moodie AR. National Public Health Surveillance of Corporations in Key Unhealthy Commodity Industries - A Scoping Review and Framework Synthesis. Int J Health Policy Manag 2023; 12:6876. [PMID: 37579395 PMCID: PMC10425693 DOI: 10.34172/ijhpm.2023.6876] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/02/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Corporations in unhealthy commodity industries (UCIs) have growing influence on the health of national populations through practices that lead to increased consumption of unhealthy products. The use of government-led public health surveillance is best practice to better understand any emerging public health threat. However, there is minimal systematic evidence, generated and monitored by national governments, regarding the scope of UCI corporate practices and their impacts. This study aims to synthesise current frameworks that exist to identify and monitor UCI influence on health to highlight the range of practices deployed by corporations and inform future surveillance efforts in key UCIs. METHODS Seven biomedical, business and scientific databases were searched to identify literature focused on corporate practices that impact human health and frameworks for monitoring or assessment of the way UCIs impact health. Content analysis occurred in three phases, involving (1) the identification of framework documents in the literature and extraction of all corporate practices from the frameworks; (2) initial inductive grouping and synthesis followed by deductive synthesis using Lima and Galea's 'vehicles of power' as a heuristic; and (3) scoping for potential indicators linked to each corporate practice and development of an integrated framework. RESULTS Fourteen frameworks were identified with 37 individual corporate practices which were coded into five different themes according the Lima and Galea 'Corporate Practices and Health' framework. We proposed a summary framework to inform the public health surveillance of UCIs which outlines key actors, corporate practices and outcomes that should be considered. The proposed framework draws from the health policy triangle framework and synthesises key features of existing frameworks. CONCLUSION Systematic monitoring of the practices of UCIs is likely to enable governments to mitigate the negative health impacts of corporate practices. The proposed synthesised framework highlights the range of practices deployed by corporations for public health surveillance at a national government level. We argue there is significant precedent and great need for monitoring of these practices and the operationalisation of a UCI monitoring system should be the object of future research.
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Affiliation(s)
- Elizabeth Bennett
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, VIC, Australia
| | - Stephanie M. Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, VIC, Australia
| | - Alan Rob Moodie
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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16
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Binagwaho A, Mathewos K. The WHO Foundation and conflicts of interest. BMJ 2023; 380:392. [PMID: 36804409 DOI: 10.1136/bmj.p392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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17
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Bacon MH, Vandelac L, Gagnon MA, Parent L. Poisoning Regulation, Research, Health, and the Environment: The Glyphosate-Based Herbicides Case in Canada. TOXICS 2023; 11:121. [PMID: 36850995 PMCID: PMC9965480 DOI: 10.3390/toxics11020121] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
Despite discourse advocating pesticide reduction, there has been an exponential increase in pesticide use worldwide in the agricultural sector over the last 30 years. Glyphosate-Based Herbicides (GBHs) are the most widely used pesticides on the planet as well as in Canada, where a total of almost 470 million kilograms of declared "active" ingredient glyphosate was sold between 2007 and 2018. GBHs accounted for 58% of pesticides used in the agriculture sector in Canada in 2017. While the independent scientific literature on the harmful health and environmental impacts of pesticides such as GBHs is overwhelming, Canada has only banned 32 "active" pesticide ingredients out of 531 banned in 168 countries, and reapproved GBHs in 2017 until 2032. This article, based on interdisciplinary and intersectoral research, will analyze how as a result of the scientific and regulatory captures of relevant Canadian agencies by the pesticide industry, the Canadian regulation and scientific assessment of pesticides are deficient and lagging behind other countries, using the GBH case as a basis for analysis. It will show how, by embracing industry narratives and biased evidence, by being receptive to industry demands, and by opaque decision making and lack of transparency, Health Canada's Pest Management Regulatory Agency (PMRA) promotes commercial interests over the imperatives of public health and environmental protection.
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Affiliation(s)
- Marie-Hélène Bacon
- Ecohealth Research Collective on Pesticides, Policies and Alternatives (CREPPA), Institute of Environmental Sciences, Université du Québec à Montréal (UQAM), Montréal, QC H3C 3P8, Canada
| | - Louise Vandelac
- Ecohealth Research Collective on Pesticides, Policies and Alternatives (CREPPA), Department of Sociology and Institute of Environmental Sciences, Université du Québec à Montréal (UQAM), Montréal, QC H3C 3P8, Canada
| | - Marc-André Gagnon
- School of Public Policy and Administration, Carleton University, Ottawa, ON K1S 5B6, Canada
| | - Lise Parent
- Ecohealth Research Collective on Pesticides, Policies and Alternatives (CREPPA), Science and Technology Department, Université TÉLUQ, Montréal, QC H2S 3L5, Canada
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18
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Barlow P, Allen LN. US and EU Free Trade Agreements and implementation of policies to control tobacco, alcohol, and unhealthy food and drinks: A quasi-experimental analysis. PLoS Med 2023; 20:e1004147. [PMID: 36602976 PMCID: PMC9815641 DOI: 10.1371/journal.pmed.1004147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/22/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Identifying and tackling the factors that undermine regulation of unhealthy commodities is an essential component of effective noncommunicable disease (NCD) prevention. Unhealthy commodity producers may use rules in US and EU Free Trade Agreements (FTAs) to challenge policies targeting their products. We aimed to test whether there was a statistical relationship between US and EU FTA participation and reduced implementation of WHO-recommended policies. METHODS AND FINDINGS We performed a statistical analysis assessing the probability of at least partially implementing 10 tobacco, alcohol, and unhealthy food and drink policies in 127 countries in 2014, 2016, and 2019. We assessed differences in implementation of these policies in countries with and without US/EU FTAs. We used matching to conduct 48 covariate-adjusted quasi-experimental comparisons across 27 matched US/EU FTA members (87 country-years) and performed additional analyses and robustness checks to assess alternative explanations for our results. Out of our 48 tests, 19% (9/48) identified a statistically significant decrease in the predicted probability of at least partially implementing the unhealthy commodity policy in question, while 2% (1/48) showed an increase. However, there was marked heterogeneity across policies. At the level of individual policies, US FTA participation was associated with a 37% reduction (95%CI: -0.51 to -0.22) in the probability of fully implementing graphic tobacco warning policies, and a 53% reduction (95%CI: -0.63 to -0.43) in the probability of at least partially implementing smoke-free place policies. EU FTA participation was associated with a 28% reduction (95%CI: -0.45 to -0.10) in the probability of fully implementing graphic tobacco warning policies, and a 25% reduction (95%CI: -0.47 to -0.03) in the probability of fully implementing restrictions on child marketing of unhealthy food and drinks. There was a positive association with implementing fat limits and bans, but this was not robust. Associations with other outcomes were not significant. The main limitations included residual confounding, limited ability to discern precise mechanisms of influence, and potentially limited generalisability to other FTAs. CONCLUSIONS US and EU FTA participation may reduce the probability of implementing WHO-recommended tobacco and child food marketing policies by between a quarter and a half-depending on the FTA and outcome in question. Governments negotiating or participating in US/EU FTAs may need to establish robust health protections and mitigation strategies to achieve their NCD mortality reduction targets.
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Affiliation(s)
- Pepita Barlow
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- * E-mail:
| | - Luke N. Allen
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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19
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A qualitative framing analysis of how firearm manufacturers and related bodies communicate to the public on gun-related harms and solutions. Prev Med 2023; 166:107346. [PMID: 36427567 DOI: 10.1016/j.ypmed.2022.107346] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022]
Abstract
There is a growing understanding that the producers and sellers of harmful products directly and indirectly affect population health and policy, including through seeking to influence public understanding about the nature of harms and their solutions. However, the firearm industry and related organisations have not to date been the subject of this type of enquiry. This study sought to address this evidential gap through examining the ways in which the firearm industry and industry-associated organisations frame firearms, firearm-related harms and possible solutions to gun violence. This was a thematic qualitative documentary analysis of materials from 7 of the largest firearm manufacturers and associated organisations. Two authors independently extracted textual material from web articles, press releases, annual reports and shareholder communications between 1st April 2019 to 1st April 2020 (302 documents). A hybrid approach combining both deductive and inductive coding was adopted, guided by the literature on the commercial determinants of health and using NVivo version 12. The firearm industry and firearm industry-funded organisations use framings about the safety and role of guns, evidence on associated harms and solutions that align with the industry's business interests, consistent with evidence on other harmful product manufacturers. This study identified framing strategies employed by the firearm industry and related organisations. These included attempts to undermine evidence, linking regulation to a dystopian future, minimising some of the most common harms, placing the responsibility for harms on individuals, and attempting to foster a heightened sense of risk to personal safety.
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20
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Casswell S. Development of Alcohol Control Policy in Vietnam: Transnational Corporate Interests at the Policy Table, Global Public Health Largely Absent. Int J Health Policy Manag 2022; 11:3032-3039. [PMID: 35942958 PMCID: PMC10105168 DOI: 10.34172/ijhpm.2022.6625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 06/01/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This paper analyses input from global interests in the policy process leading up to the passing of alcohol control legislation in Vietnam in 2019. The global alcohol industry now relies on growth in volume in emerging markets in middle-income countries such as Vietnam, a large, rapidly industrialising country with a youthful population and emerging middle class. The industry's role in the alcohol policy process is compared with that of global health interests. METHODS Document analysis of letters and English language media coverage was supplemented by and triangulated with data from key informants on changes in the content of draft alcohol legislation and participant observation. RESULTS The alcohol legislation was negotiated in the context of active engagement from the global alcohol industry and some input from global public health interests. The global alcohol industry established a partnership relationship with politicians using CSR and funded a local employee in Hanoi over the decade prior to the draft legislation being considered. Direct lobbying took place over the content of the legislation, which went through six published drafts. Trade and investment agreements provided a supportive environment and were referred to by both politicians and industry. In contrast public health resource was limited and lacked the support of a normative global policy to counter the economic imperatives. Vietnamese Ministry of Health proposals for cost effective alcohol policy were not enacted. CONCLUSION Global commercial interests employed their considerable resources to engage in corporate social responsibility (CSR) and build partnerships with policy-makers over a long period, contributing significantly to an environment unsupportive of enacting effective alcohol control policy. The absence of structural support from a global health treaty on alcohol and lack of an equivalent level of long-term sustained input from global health actors contributed to the legislative outcome, which excluded proposed cost-effective policies to reduce alcohol harm.
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Affiliation(s)
- Sally Casswell
- SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand
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21
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Allen LN. Trust, but Verify Comment on "'Part of the Solution': Food Corporation Strategies for Regulatory Capture and Legitimacy". Int J Health Policy Manag 2022; 11:2727-2731. [PMID: 35247935 PMCID: PMC9818090 DOI: 10.34172/ijhpm.2022.7008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/06/2022] [Indexed: 01/21/2023] Open
Abstract
According to Lacy-Nichols and Williams, the food industry is increasingly forestalling regulation with incremental concessions and co-option of policy-making discourses and processes; bolstering their legitimacy via partnerships with credible stakeholders; and disarming critics by amending their product portfolios whilst maintaining high sales volumes and profits. Their assessment raises a number of fundamental philosophical questions that we must address in order to form an appropriate public health response: is it appropriate to treat every act of corporate citizenship with cynicism? If voluntary action leads to better health outcomes, does it matter whether profits are preserved? How should we balance any short-term benefits from industry-led reforms against the longer-term risk stemming from corporate capture of policy-making networks? I argue for a nuanced approach, focused on carefully defined health outcomes; allowing corporations the benefit of the doubt, but implementing robust binding measures the moment voluntary actions fail to meet independently set objectives.
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Affiliation(s)
- Luke N. Allen
- London School of Hygiene and Tropical Medicine, London, UK
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22
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Silva KC, de Castro IRR, de Carvalho CMP, de Camargo KR. Baby food industry interference with infant feeding international regulation-A case study on the standard for follow-up formula. Front Public Health 2022; 10:984385. [PMID: 36483244 PMCID: PMC9723377 DOI: 10.3389/fpubh.2022.984385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/27/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Globally, first-food systems have changed and breastfeeding has decreased due to the increased growth in commercial breast milk substitute (BMS) consumption, which includes both follow-up and toddler formulas. These products are manufactured by a small number of corporate leaders in international BMS sales. Discussions for global regulation of these products take place in the Codex Alimentarius and are permeated by the strong participation of these corporations in the Codex committees. Objective In the present study, the participation of the baby food industry in the review of the follow-up formula standard in the Codex Committee on Nutrition and Foods for Special Dietary Uses (CCNFSDU) was analyzed. Methods The analysis of the CCNFSDU documents was based on the period from 2009 to 2019 and used quantitative and qualitative approaches. Compositional and participation data from country delegations and observer organizations on the representative profiles of the involved institutions and the baby food industry's involvement in this process were established systematically. Results In total, 134 out of the 189 Codex Alimentarius member countries engaged in the standard review process, of which 28% were involved in the entire process. The private sector was present in 81% of the most assiduous member state delegations to the meetings. Furthermore, ~60% of the observer organizations involved in the review process were business associations representing industry interests. Moreover, the International Special Dietary Foods Industries was the only business association with observer status in the CCNFSDU that was specifically dedicated to representing the baby food industryduring the review process. Conclusion These research results expand the body of evidence confirming the expressive and disproportionate participation of baby food industries and their representatives in the discussion processes within the scope of the CCNFSDU. However, studies investigating the Codex and the public documents of its respective committees are limited. Thus, this was the first study to analyze the influence of the baby food industry on BMS global regulatory compliance.
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Affiliation(s)
- Kimielle Cristina Silva
- Institute of Social Medicine, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil,*Correspondence: Kimielle Cristina Silva
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Crocetti AC, Cubillo (Larrakia) B, Lock (Ngiyampaa) M, Walker (Yorta Yorta) T, Hill (Torres Strait Islander) K, Mitchell (Mununjali) F, Paradies (Wakaya) Y, Backholer K, Browne J. The commercial determinants of Indigenous health and well-being: a systematic scoping review. BMJ Glob Health 2022; 7:bmjgh-2022-010366. [PMID: 36319033 PMCID: PMC9628540 DOI: 10.1136/bmjgh-2022-010366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/04/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Health inequity within Indigenous populations is widespread and underpinned by colonialism, dispossession and oppression. Social and cultural determinants of Indigenous health and well-being are well described. Despite emerging literature on the commercial determinants of health, the health and well-being impacts of commercial activities for Indigenous populations is not well understood. We aimed to identify, map and synthesise the available evidence on the commercial determinants of Indigenous health and well-being. METHODS Five academic databases (MEDLINE Complete, Global Health APAPsycInfo, Environment Complete and Business Source Complete) and grey literature (Australian Indigenous HealthInfoNet, Google Scholar, Google) were systematically searched for articles describing commercial industry activities that may influence health and well-being for Indigenous peoples in high-income countries. Data were extracted by Indigenous and non-Indigenous researchers and narratively synthesised. RESULTS 56 articles from the USA, Canada, Australia, New Zealand, Norway and Sweden were included, 11 of which were editorials/commentaries. The activities of the extractive (mining), tobacco, food and beverage, pharmaceutical, alcohol and gambling industries were reported to impact Indigenous populations. Forty-six articles reported health-harming commercial practices, including exploitation of Indigenous land, marketing, lobbying and corporate social responsibility activities. Eight articles reported positive commercial industry activities that may reinforce cultural expression, cultural continuity and Indigenous self-determination. Few articles reported Indigenous involvement across the study design and implementation. CONCLUSION Commercial industry activities contribute to health and well-being outcomes of Indigenous populations. Actions to reduce the harmful impacts of commercial activities on Indigenous health and well-being and future empirical research on the commercial determinants of Indigenous health, should be Indigenous led or designed in collaboration with Indigenous peoples.
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Affiliation(s)
- Alessandro Connor Crocetti
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Beau Cubillo (Larrakia)
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Mark Lock (Ngiyampaa)
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Troy Walker (Yorta Yorta)
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Karen Hill (Torres Strait Islander)
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | | | - Yin Paradies (Wakaya)
- Deakin University Alfred Deakin Institute for Citizenship and Globalisation, Burwood, Victoria, Australia
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Jennifer Browne
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Zaltz DA, Bisi LE, Ruskin G, Hoe C. How independent is the international food information council from the food and beverage industry? A content analysis of internal industry documents. Global Health 2022; 18:91. [PMID: 36309701 PMCID: PMC9618198 DOI: 10.1186/s12992-022-00884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 10/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The International Food Information Council (IFIC) and its partner foundation (IFIC Foundation) widely disseminate nutrition information and participate in relevant policymaking processes. Prior research has established a connection between IFIC and large food and beverage companies, representing a potential conflict of interest. The authors reviewed public records documents to investigate the connection between IFIC and industry, and to describe how IFIC communicates policy-relevant information about nutrition science to the public. METHODS The research team collected communications between IFIC and members of the research and policymaking communities by using state and federal transparency laws. The team analyzed the content of these documents with a commercial determinants of health framework while allowing for new themes to emerge, guided by the broad analytic questions of how and why does IFIC communicate nutrition information to policymakers and the broader public? RESULTS IFIC employs self-designed research and media outreach to disseminate nutrition information. Communications from IFIC and its affiliates related to nutrition information fell within major themes of manufacturing doubt and preference shaping. CONCLUSIONS IFIC uses media outlets to preemptively counter information about the negative health impacts of added sugars and ultra-processed foods, and promotes a personal-responsibility narrative about dietary intake and health. IFIC and its affiliates disseminate a narrow subset of nutrition and health information consistent with corporate interests and in opposition to public health policies associated with improved population health.
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Affiliation(s)
- Daniel A Zaltz
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
| | - Lauren E Bisi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Gary Ruskin
- U.S. Right To Know, 4096 Piedmont Ave. #963, Oakland, CA, 94611, USA
| | - Connie Hoe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
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25
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Zwierczyk U, Sowada C, Duplaga M. Eating Choices—The Roles of Motivation and Health Literacy: A Cross-Sectional Study. Nutrients 2022; 14:nu14194026. [PMID: 36235678 PMCID: PMC9573739 DOI: 10.3390/nu14194026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/17/2022] [Accepted: 09/24/2022] [Indexed: 11/29/2022] Open
Abstract
Food choices are determined by intrinsic and extrinsic product characteristics, biological and physiological features, psychological factors, and situational and socio-cultural factors. Self-determination theory offers the explanation of health behavior change identifying motivations located along a continuum of autonomy. Another approach to the motivations guiding health behaviors, including food choices, relies on distinguishing thematic categories. Health motivations seem to be an obvious determinant of health behaviors, but final decisions regarding health are also the effect of other types of motivations such as economic, cultural, or emotional. The role of marketing pressure in modern society is perceived to be an important source of motivation for purchasing food and other products. The Motivation–Opportunity–Ability (MOA) framework was initially proposed in order to explain the processing of brand information from advertisements and was later expanded to other areas, including health and nutritional behaviors. The aim of this study was the analysis of determinants of food choices. We have developed a common regression model including six categories of motivations addressed by the Eating Motivations Scale and three health literacy types corresponding with element of ability from the MOA framework, adjusted for socio-demographic factors, health status, and the use of the Internet and TV. The analysis was performed on data from a computer-assisted web-based interviewing (CAWI) survey among 2008 adult Internet users completed in May 2022. The uni- and multivariate linear regression models were developed with the Index of Unhealthy Food Choices (IUFC), calculated based on the responses to items asking about the frequency of the consumption of twelve food categories. Univariate modeling revealed that IUFC is significantly associated with health, food, and e-health literacies and with five out of six eating motivations. However, the multivariate regression model yielded significant associations only for eating motivations but not for the three literacy scores. Health motivation was negatively associated with IUFC (B, standard error (SE): 0.83, 0.07; 95% confidence interval (95% CI): 0.98–0.69), but positively with emotional (B, SE: 0.22, 0.04; 95% CI: 0.14–0.3), economic (B, SE: 0.41, 0.08; 95% CI: 0.25–0.56), and marketing (B, SE: 0.62, 0.08; 95% CI: 0.47–0.78) motivations. Our findings suggest that motivations guiding food choices may prevail over the element of ‘ability’ distinguished in the frameworks and models that explain people’s behaviors, including behaviors relating to health. Thus, it is essential to emphasize development of appropriate motivations and not only to provide knowledge and skills. Furthermore, one should also remember motivations other than health motivations when searching for the determinants of health behaviors.
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Affiliation(s)
- Urszula Zwierczyk
- Department of Health Promotion and e-Health, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Skawińska Str. 8, 31-066 Krakow, Poland
| | - Christoph Sowada
- Department of Health Economics and Social Security, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Skawińska Str. 8, 31-066 Krakow, Poland
| | - Mariusz Duplaga
- Department of Health Promotion and e-Health, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Skawińska Str. 8, 31-066 Krakow, Poland
- Correspondence:
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Maani N, McKee M. The commercial determinants of health: The mini-budget is a consequence of foundational forces medicine must bear witness to. BMJ 2022; 378:o2327. [PMID: 36167354 DOI: 10.1136/bmj.o2327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Nason Maani
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine
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Allen LN, Wigley S, Holmer H. Study protocol: assessing the association between corporate financial influence and implementation of policies to tackle commercial determinants of non-communicable diseases: a cross-sectional analysis of 172 countries. BMJ Open 2022; 12:e055656. [PMID: 36041766 PMCID: PMC9438081 DOI: 10.1136/bmjopen-2021-055656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION There are many case studies of corporations that have worked to undermine health policy implementation. It is unclear whether countries that are more exposed to corporate financial influence are systematically less likely to implement robust health policies that target firms' financial interests. We aim to assess the association between corporate financial influence and implementation of WHO-recommended policies to constrain sales, marketing and consumption of tobacco, alcohol and unhealthy foods. METHODS AND ANALYSIS We will perform a cross-sectional analysis of 172 WHO Member States using national datasets from 2015, 2017 and 2020. We will use random effects generalised least squares regression to test the association between implementation status of 12 WHO-recommended tobacco, alcohol and diet policies, and corporate financial influence, a metric that combines disclosure of campaign donations, public campaign finance, corporate campaign donations, legislature corrupt activities, disclosure by politicians and executive oversight. We will control for GDP per capita, population aged >65 years (%), urbanisation (%), level of democracy, continent, ethno-linguistic fractionalisation, legal origin, UN-defined 'Small Island Developing States' and Muslim population (%) (to capture alcohol policy differences). We will include year dummies to address the possibility of a spurious relationship between the outcome variable and the independent variables of interests. For example, there may be an upward global trend in policy implementation that coincides with an upward global trend in the regulation of lobbying and campaign finance. ETHICS AND DISSEMINATION As this study uses publicly available data, ethics approval is not required. The authors have no conflicts of interest to declare. Findings will be submitted to a peer-reviewed journal for publication in the academic literature. All data, code and syntax will be made publicly available on GitHub.
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Affiliation(s)
- Luke Nelson Allen
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Simon Wigley
- Department of Philosophy, Bilkent University, Ankara, Turkey
| | - Hampus Holmer
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Rinaldi C, van Schalkwyk MCI, Egan M, Petticrew M. A Framing Analysis of Consultation Submissions on the WHO Global Strategy to Reduce the Harmful Use of Alcohol: Values and Interests. Int J Health Policy Manag 2022; 11:1550-1561. [PMID: 34273930 PMCID: PMC9808336 DOI: 10.34172/ijhpm.2021.68] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/09/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In response to the magnitude of harms caused by alcohol, the World Health Organization (WHO) Global Strategy to Reduce the Harmful Use of Alcohol (GAS) was endorsed in 2010. We analysed submissions to the 2019 WHO consultation on the implementation of the GAS to identify how different stakeholders frame alcohol use and control; and to assess how stakeholders engage with the consultation process, with possibly harmful consequences for public health policy. METHODS All submissions from WHO Member States, international organisations, non-governmental organisations (NGOs), academic institutions and private sector entities were identified and used as data for an inductive framing analysis. This involved close reading and data familiarisation, thematic coding and identifying emergent framings. Through the analysis of texts, framing analysis can give insights into the values and interests of stakeholders. Because framing influences how issues are conceptualised and addressed, framing analysis is a useful tool to study policy-making processes. RESULTS We identified 161 unique submissions and seven attachments. Emerging frames were grouped according to their function: defining the problem, assigning causation, proposing solutions, or justifying and persuading. Submissions varied in terms of the framing they deployed and how this was presented, eg, how the problem was defined. Proposed policy solutions also varied. Targeted solutions emphasising individual responsibility tended to be supported by industry and some Member States. Calls for universal regulation and global mobilisation often came from NGOs and academia. Stakeholders drew on evidence and specific value systems to support the adoption of certain problem and solution ideas and to oppose competing framing. CONCLUSION Alcohol control is a contested policy field in which different stakeholders use framing to set the agenda and influence what policy solutions are considered legitimate. WHO should consider which interests are served by these different framings and how to weigh different stakeholders in the consultation process.
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Affiliation(s)
- Chiara Rinaldi
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - May CI van Schalkwyk
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
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Wood B, Baker P, Sacks G. Conceptualising the Commercial Determinants of Health Using a Power Lens: A Review and Synthesis of Existing Frameworks. Int J Health Policy Manag 2022; 11:1251-1261. [PMID: 33619932 PMCID: PMC9808328 DOI: 10.34172/ijhpm.2021.05] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 01/16/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There is increasing recognition that power imbalances that favour corporations, especially those active in unhealthy commodity industries, over other actors are central to the ways in which corporations influence population health. However, existing frameworks for analysing corporate strategies and practices that impact on health do not incorporate concepts of power in consistent ways. This paper aimed to review the ways in which corporate power has been incorporated into such frameworks, and to propose a revised framing of the commercial determinants of health (CDoH) that makes concepts of power explicit. METHODS We conducted a narrative review of frameworks that identify corporate strategies and practices and explain how these influence population health. Content analysis was conducted to identify explicit references to different qualities of power - its origins, nature, and manifestations. RESULTS Twenty-two frameworks were identified, five of which used theories of power. A wide range of contexts that shape, and are shaped by corporate power were discussed, as were a diversity of corporate, social and ecological outcomes. A variety of material and ideational sources of power was also covered. We proposed an integrated 'Corporate Power and Health' framework to inform analysis of the CDoH, organised around key questions on power set out by Foucault. The proposed framework draws from a number of well-established corporate power theories and synthesises key features of existing CDoH frameworks. CONCLUSION Public health advocates, researchers and policy-makers would likely be better placed to understand and address the CDoH by engaging with theories of power to a greater extent, and by explicitly incorporating concepts of corporate power in analyses of how the deployment of corporate strategies and practices influence population health.
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Affiliation(s)
- Benjamin Wood
- Global Obesity Centre, Deakin University, Geelong, VIC, Australia
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Gary Sacks
- Global Obesity Centre, Deakin University, Geelong, VIC, Australia
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Zaltz DA, Grossman ER, Lucas SA, Ruffin M, Benjamin-Neelon SE. University Pouring Rights Contracts: Provisions That May Protect Companies From Beverage Policies. Am J Prev Med 2022; 62:e367-e370. [PMID: 35065884 DOI: 10.1016/j.amepre.2021.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/25/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Daniel A Zaltz
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Elyse R Grossman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Martha Ruffin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Milsom P, Smith R, Walls H. Expanding Public Health Policy Analysis for Transformative Change: The Importance of Power and Ideas Comment on "What Generates Attention to Health in Trade Policy-Making? Lessons From Success in Tobacco Control and Access to Medicines: A Qualitative Study of Australia and the (Comprehensive and Progressive) Trans-Pacific Partnership". Int J Health Policy Manag 2022; 11:521-524. [PMID: 33105964 PMCID: PMC9309956 DOI: 10.34172/ijhpm.2020.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/04/2020] [Indexed: 11/24/2022] Open
Abstract
It is increasingly recognised within public health scholarship that policy change depends on the nature of the power relations surrounding and embedded within decision-making spaces. It is only through sustained shifts in power in all its forms (visible, hidden and invisible) that previously excluded perspectives have influence in policy decisions. Further, consideration of the underlying neoliberal paradigm is essential for understanding how existing power dynamics and relations have emerged and are sustained. In their analysis of political and governance factors, Townsend et al have provided critical insight into future potential strategies for increasing attention to health concerns in trade policy. In this commentary we explore how incorporating theories of power more rigorously into similar political analyses, as well as more explicit critical consideration of the neoliberal political paradigm, can assist in analysing if and how strategies can effectively challenge existing power relations in ways that are necessary for transformative policy change.
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Affiliation(s)
- Penelope Milsom
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine. London, UK
| | - Richard Smith
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Helen Walls
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine. London, UK
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Nisbett N, Harris J, Backholer K, Baker P, Jernigan VBB, Friel S. Holding no-one back: The Nutrition Equity Framework in theory and practice. GLOBAL FOOD SECURITY 2022; 32:100605. [PMID: 36873709 PMCID: PMC9983632 DOI: 10.1016/j.gfs.2021.100605] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Equity remains poorly conceptualised in current nutrition frameworks and policy approaches. We draw on existing literatures to present a novel Nutrition Equity Framework (NEF) that can be used to identify priorities for nutrition research and action. The framework illustrates how social and political processes structure the food, health and care environments most important to nutrition. Central to the framework are processes of unfairness, injustice and exclusion as the engine of nutrition inequity across place, time and generations, ultimately influencing both nutritional status and people's space to act. The NEF illustrates conceptually how action on the socio-political determinants of nutrition is the most fundamental and sustainable way of improving nutrition equity for everyone everywhere, through 'equity-sensitive nutrition'. Efforts must ensure, in the words of the Sustainable Development Goals, that not only is "no one left behind" but also that the inequities and injustices we describe do not hold anyone back from realising their right to healthy diets and good nutrition.
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Affiliation(s)
- Nicholas Nisbett
- Institute of Development Studies at the University of Sussex, UK
| | - Jody Harris
- Institute of Development Studies at the University of Sussex, UK.,World Vegetable Centre, Thailand
| | - Kathryn Backholer
- Deakin University, Geelong, Institute for Health Transformation, Victoria, Australia
| | - Philip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | | | - Sharon Friel
- School of Regulation and Global Governance, Australian National University, Australia
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Maani N, van Schalkwyk M, Filippidis F, Knai C, Petticrew M. Manufacturing doubt: Assessing the effects of independent vs industry-sponsored messaging about the harms of fossil fuels, smoking, alcohol, and sugar sweetened beverages. SSM Popul Health 2022; 17:101009. [PMID: 35036514 PMCID: PMC8749266 DOI: 10.1016/j.ssmph.2021.101009] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/06/2021] [Accepted: 12/15/2021] [Indexed: 01/16/2023] Open
Abstract
Background Manufacturers of harmful products engage in misinformation tactics long employed by the tobacco industry to emphasize uncertainty about scientific evidence and deflect negative attention from their products. This study assessed the effects of one type of tactic, the use of "alternative causation" arguments, on public understanding. Methods In five trials (one for each industry) anonymized Qualtrics panel respondents were randomized to receive a message on the risk in question from one of four industry sponsored organizations (exposure), or from one of four independent organizations (control), on risks related to alcohol, tobacco, fossil fuel and sugar sweetened beverages. Logistic regression models were used to evaluate the effect of industry arguments about uncertainty on the primary outcome of public certainty about product risk, adjusting for age, gender and education. The results from all five trials were pooled in a random-effects meta-analysis. Findings In total, n=3284 respondents were exposed to industry-sponsored messaging about product-related risks, compared to n=3297 exposed to non-industry messages. Across all industries, exposure to industry-sponsored messages led to greater reported uncertainty or false certainty about risk, compared to non-industry messages [Summary odds ratio (OR) 1·60, confidence interval (CI) 1·28-1·99]. The effect was greater among those who self-rated as not/slightly knowledgeable (OR 2·24, CI 1·61-3·12), or moderately knowledgeable (OR 1·85, CI 1·38-2·48) compared to those very/extremely knowledgeable (OR 1·28, CI 1·03-1·60). Conclusions This study demonstrates that exposure to industry sponsored messages which appear intended to downplay risk significantly increases uncertainty or false certainty, with the effect being greater in less knowledgeable participants.
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Affiliation(s)
- N. Maani
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, UK
- Rockefeller Foundation, Boston University Commission on Data, Determinants and Decision-making, Boston University School of Public Health, Boston, USA
- SPECTRUM Research Consortium, London School of Hygiene and Tropical Medicine, London, UK
| | - M.C.I. van Schalkwyk
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - F.T. Filippidis
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - C. Knai
- SPECTRUM Research Consortium, London School of Hygiene and Tropical Medicine, London, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - M. Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, UK
- SPECTRUM Research Consortium, London School of Hygiene and Tropical Medicine, London, UK
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Hoe C, Weiger C, Minosa MKR, Alonso F, Koon AD, Cohen JE. Strategies to expand corporate autonomy by the tobacco, alcohol and sugar-sweetened beverage industry: a scoping review of reviews. Global Health 2022; 18:17. [PMID: 35164801 PMCID: PMC8845406 DOI: 10.1186/s12992-022-00811-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/31/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Noncommunicable diseases contribute to over 70% of global deaths each year. Efforts to address this epidemic are complicated by the presence of powerful corporate actors. Despite this, few attempts have been made to synthesize existing evidence of the strategies used to advance corporate interests across industries. Given this, our study seeks to answer the questions: 1) Is there an emergent taxonomy of strategies used by the tobacco, alcohol and sugar-sweetened beverage (SSB) industries to expand corporate autonomy? 2) How are these strategies similar and how are they different? METHODS Under the guidance of a framework developed by Arksey and O'Malley, a scoping review was carried out whereby six databases were searched in June 2021 to identify relevant peer-reviewed literature. To be included in this review, studies had to explicitly discuss the strategies used by the tobacco, alcohol, and/or sugar-sweetened beverage multinational corporations and be considered review articles aimed to synthesize existing evidence from at least one of the three industries. Eight hundred and fifty-eight articles were selected for full review and 59 articles were retained for extraction, analysis, and categorization. RESULTS Results identified six key strategies the industries used: 1) influencing government policy making and implementation, 2) challenging unfavorable science, 3) creating a positive image, 4) manipulating markets, 5) mounting legal challenges, and 6) anticipating future scenarios. Despite these similarities, there are few but important differences. Under the strategy of influencing government policy making and implementation, for example, literature showed that the alcohol and SSB industries have been "privileged with high levels of participation" within international public health organizations. CONCLUSIONS Understanding how industries resist efforts to control them is important for public health advocates working to reduce consumption of and death and diseases resulting from harmful commodities. Moreover, there is a greater need for the public health community to generate consensus about how to ethically engage or not engage with industries that produce unhealthy commodities. More studies are also needed to build the evidence base of industry tactics to resist regulation, particularly in the case of SSB, and in low-and middle-income countries.
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Affiliation(s)
- Connie Hoe
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Caitlin Weiger
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Marela Kay R Minosa
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Fernanda Alonso
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Adam D Koon
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Joanna E Cohen
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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de Lacy-Vawdon C, Vandenberg B, Livingstone CH. Recognising the elephant in the room: the commercial determinants of health. BMJ Glob Health 2022; 7:bmjgh-2021-007156. [PMID: 35121643 PMCID: PMC8819800 DOI: 10.1136/bmjgh-2021-007156] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Cassandra de Lacy-Vawdon
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Brian Vandenberg
- School of Social Sciences, Monash University, Clayton, Victoria, Australia
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Assessing the association between corporate political influence and implementation of policies to tackle commercial determinants of non-communicable diseases: A cross-sectional analysis of 172 countries. Soc Sci Med 2022; 297:114825. [DOI: 10.1016/j.socscimed.2022.114825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/31/2022] [Accepted: 02/15/2022] [Indexed: 11/17/2022]
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van Schalkwyk MCI, Petticrew M, Maani N, Hawkins B, Bonell C, Katikireddi SV, Knai C. Distilling the curriculum: An analysis of alcohol industry-funded school-based youth education programmes. PLoS One 2022; 17:e0259560. [PMID: 35020741 PMCID: PMC8754310 DOI: 10.1371/journal.pone.0259560] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/22/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND AIM For decades, corporations such as the tobacco and fossil fuel industries have used youth education programmes and schools to disseminate discourses, ideas and values favourable to their positions, and to pre-empt regulation that threatens profits. However, there is no systematic research into alcohol industry-funded youth education programmes. This article serves to address this important gap in the literature. METHODS Using a discourse theoretical approach informed by poststructural discourse theory and critical discourse analysis, we analysed teaching materials from three school-based youth education initiatives which focus on alcohol consumption and health harms: Drinkaware for Education, The Smashed Project (funded by Diageo), and Talk About Alcohol (Alcohol Education Trust). These materials, some of which are disseminated internationally, are provided to schools through intermediary bodies in receipt of alcohol industry funding. FINDINGS The analysis found that these materials drew from and presented discourses of personal responsibility, moderate alcohol consumption, and involved a narrowing of the problem definition and causes. The locus of the problem is located by the discourses within individuals including youth, with causes of youth alcohol consumption repeatedly presented as peer pressure and 'poor choices', with little or no mention of alcohol industry marketing or other practices. All programmes promoted familiarisation and normalisation of alcohol as a 'normal' adult consumer product which children must learn about and master how to use responsibly when older. The discourses constructed in these materials closely align with those of other alcohol industry corporate social responsibility discourses which employ selective presentation of harms, including misinformation about cancer, and ambiguous terms such as "responsible drinking". Furthermore, the role of alcohol price, availability and access, and the impacts of alcohol and the industry on inequities were not articulated within the discourses. The research was limited to an analysis of teaching materials and further research is needed to explore their impact on youth, teachers and wider discourses and social norms. CONCLUSION Alcohol industry-sponsored youth education programmes serve industry interests and promote moderate consumption while purportedly educating children about harms and influences of alcohol use. There are considerable conflicts of interest in the delivery of alcohol education programmes funded by the alcohol industry and intermediary bodies in receipt of such funding. Alcohol education materials should be developed independent from industry, including funding, and should empower children and young people to understand and think critically about alcohol, including harms and drivers of consumption, and effective interventions needed to protect them and others from alcohol-related harms. Independent organisations can use this analysis to critique their materials to strengthen alignment with meeting student and public health interests. The ongoing exposure of children and young people to such conflicted and misleading materials needs urgent attention from policymakers, practitioners, teachers and parents, and resources dependent on industry support should cease being used in schools.
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Affiliation(s)
- May C. I. van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), London, United Kingdom
| | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), London, United Kingdom
| | - Ben Hawkins
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Chris Bonell
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Cécile Knai
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), London, United Kingdom
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Lee K, Freudenberg N. Public Health Roles in Addressing Commercial Determinants of Health. Annu Rev Public Health 2022; 43:375-395. [DOI: 10.1146/annurev-publhealth-052220-020447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The shared challenges posed by the production and distribution of health-harming products have led to growing recognition of the need for policy learning and transfer across problems, populations, and social contexts. The commercial determinants of health (CDoH) can serve as a unifying concept to describe the population health consequences arising from for-profit actors and activities, along with the social structures that sustain them. Strategies to mitigate harms from CDoH have focused on behavioral change, regulation, fiscal policies, consumer and citizen activism, and litigation. While there is evidence of effective measures for each strategy, approaches that combine strategies are generally more impactful. Filling gaps in evidence can inform ways of adapting these strategies to specific populations and social contexts. Overall, CDoH are addressed most effectively not through siloed efforts to reduce consumption of health-harming products, but instead as a set of integrated strategies to reduce exposures to health-harming commercial actors and activities. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Kelley Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Nicholas Freudenberg
- School of Public Health and Health Policy, City University of New York, New York, NY, USA
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Lee K, Freudenberg N, Zenone M, Smith J, Mialon M, Marten R, Lima JM, Friel S, Klein DE, Crosbie E, Buse K. Measuring the Commercial Determinants of Health and Disease: A Proposed Framework. INTERNATIONAL JOURNAL OF HEALTH SERVICES : PLANNING, ADMINISTRATION, EVALUATION 2022; 52:115-128. [PMID: 34723675 PMCID: PMC8592108 DOI: 10.1177/00207314211044992] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/27/2021] [Indexed: 01/03/2023]
Abstract
The commercial determinants of health (CDoH) describe the adverse health effects associated with for-profit actors and their actions. Despite efforts to advance the definition, conceptualization, and empirical analyses of CDoH, the term's practical application to mitigate these effects requires the capacity to measure the influences of specific components of CDoH and the cumulative impacts of CDoH on the health and well-being of specific populations. Building on the Global Burden of Disease Study, we begin by conceptualizing CDoH as risk factor exposures that span agency and structural influences. We identify 6 components of these influences and propose an initial set of indicators and datasets to rank exposures as high, medium, or low. These are combined into a commercial determinants of health index (CDoHi) and illustrated by 3 countries. Although now a proof of concept, comparative analysis of CDoH exposures by population, over time and space, and their associated health outcomes will become possible with further development of indicators and datasets. Expansion of the CDoHi and application to varied populations groups will enable finer targeting of interventions to reduce health harms. The measurement of improvements to health and wellness from such interventions will, in turn, inform overall efforts to address the CDoH.
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Affiliation(s)
- Kelley Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | | | - Marco Zenone
- London School of Hygiene & Tropical Medicine, London, UK
| | - Julia Smith
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Melissa Mialon
- Trinity Business School, Trinity College Dublin, Dublin, Ireland
| | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | | | - Sharon Friel
- School of Regulation and Global Governance, Australian National University, Canberra, Australia
| | | | - Eric Crosbie
- School of Public Health, University of Nevada Reno, Reno, USA
| | - Kent Buse
- George Institute for Global Health UK, Imperial College London, London, UK
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Klein DE, Lima JM. The Prison Industrial Complex as a Commercial Determinant of Health. Am J Public Health 2021; 111:1750-1752. [PMID: 34529500 PMCID: PMC8561192 DOI: 10.2105/ajph.2021.306467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Daniel Eisenkraft Klein
- Daniel Eisenkraft Klein is a PhD student at the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Joana Madureira Lima is with the World Health Organization, Bishkek, Kyrgyzstan
| | - Joana Madureira Lima
- Daniel Eisenkraft Klein is a PhD student at the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Joana Madureira Lima is with the World Health Organization, Bishkek, Kyrgyzstan
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Gómez EJ. The politics of ultra-processed foods and beverages regulatory policy in upper-middle-income countries: Industry and civil society in Mexico and Brazil. Glob Public Health 2021; 17:1883-1901. [PMID: 34555297 DOI: 10.1080/17441692.2021.1980600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ABSTRACTAddressing the politics of corporate political activity and policy interference in response to non-communicable diseases (NCDs) is a new area of scholarly research. The objective of this article is to explain how, in Mexico and Brazil, the ultra-processed foods and beverages industry succeeded in creating the political and social conditions conducive for their on-going regulatory policy influence and manipulation of scientific research. In addition to establishing partnerships within and outside of government, industry representatives have succeeded in hampering civic opposition by establishing allies within academia and society. Ministries of Health have simultaneously neglected to work closely with civil society, while legislative representatives have continued to benefit from industry campaign contributions. Findings from this article suggest that ultra-processed foods and beverages industries wield on-going regulatory policy influence in Mexico and Brazil, and that government is still not fully committed to working with civil society on these issues.
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van Schalkwyk MCI, Maani N, McKee M, Thomas S, Knai C, Petticrew M. "When the Fun Stops, Stop": An analysis of the provenance, framing and evidence of a 'responsible gambling' campaign. PLoS One 2021; 16:e0255145. [PMID: 34437561 PMCID: PMC8389453 DOI: 10.1371/journal.pone.0255145] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/17/2021] [Indexed: 11/25/2022] Open
Abstract
When the Fun Stops, Stop, is a prominent 'responsible gambling' campaign in the UK, originally funded and delivered by the industry-initiated and funded Senet Group. Since the Senet Group's dissolution in 2020, the campaign has been overseen by the Betting and Gambling Council (BGC), the main gambling industry trade body. There has been no prior analysis of the activities, ideas and framing adopted by the Senet Group, who claimed to be acting as an industry 'watchdog' and oversaw what they characterised as a major public education campaign. We collated written and image-based material related to the Senet Group and its When the Fun Stops, Stop campaign from multiple sources. Guided by Entman's four functions of framing, we analysed the Senet Group's framing of the issues it sought to address, particularly harmful gambling, as well as its causes, and the solutions, focusing on the group's main activity: the delivery of the When the Fun Stops, Stop campaign. We also critically appraised an evaluation of the campaign funded by the Senet Group, using the findings to interrogate the stated claims about the campaign's effectiveness. The analysis showed that the Senet Group's framing of the problem, its causes, and proposed responses resemble those adopted by other industries and industry-funded groups. This involves portraying any harms caused by their products as limited to an atypical minority, rejecting upstream determinants of harm, and promoting individually-targeted voluntary measures, all contrary to the evidence of what works in health promotion, and what would characterise a public health approach. Neither the existing evidence base nor the evidence presented by the Senet Group support their claims about the campaign's effectiveness. These findings add to concerns about industry-funded campaigns in other areas. To minimise conflicts of interest, interventions intended to address gambling-related harms, such as public education campaigns, should be evidence-based and developed, implemented and evaluated completely independent of the industry and industry-funded organisations.
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Affiliation(s)
- May CI van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
- School of Public Health, Boston University, Boston, MA, United States of America
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Samantha Thomas
- Faculty of Health, Institute for Health Transformation, School of Health and Soc. Dev., Deakin University, Geelong, Australia
| | - Cécile Knai
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
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Chavez‐Ugalde Y, Jago R, Toumpakari Z, Egan M, Cummins S, White M, Hulls P, De Vocht F. Conceptualizing the commercial determinants of dietary behaviors associated with obesity: A systematic review using principles from critical interpretative synthesis. Obes Sci Pract 2021; 7:473-486. [PMID: 34401205 PMCID: PMC8346378 DOI: 10.1002/osp4.507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/04/2021] [Accepted: 03/12/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Unhealthy diet is an important preventable risk factor for overweight and obesity. Identifying the key drivers of an unhealthy diet is an important public health aim. "Big Food" has been identified as an influential factor shaping dietary behavior and obesity, and their practices have broadly been labeled as the "commercial determinants of obesity," but there is a lack of definitions and conceptualizations for these terms. This review aimed to synthesize literature on the commercial determinants of dietary behavior associated with obesity. It presents the development of an integrative definition and a conceptual framework involving potential influences on dietary behavior, and it examines the prevalence of certain narratives within papers that focus on children and adolescents. METHODS Four electronic databases (Ovid MEDLINE, PubMed, Web of Science, and Scopus) were searched up to December 2020. Eighty-one articles met the inclusion criteria: they were published in a peer-reviewed academic journal, described a practice from the food/beverage industry in relation to dietary behavior or obesity. Data were integrated using critical interpretative synthesis. RESULTS The commercial determinants of dietary behavior are conceptualized in terms of three corporate spheres of action-political and legal; production, processing and design; and marketing and preference shaping-which enable powerful food industry to successfully pursue their business, market, and political objectives. The most frequently reported sphere of action targeting children and adolescents was marketing and preference shaping. CONCLUSIONS In the included literature, the commercial determinants of dietary behavior associated with obesity have been conceptualized as being part of a complex system where corporate practices are enabled by power structures. The proposed framework can facilitate a structured identification and systematic study of the impact of specific aspects of food industry's strategies and increase opportunities for primary prevention by anticipating industry responses and by discouraging corporate practices that harm health.
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Affiliation(s)
- Yanaina Chavez‐Ugalde
- National Institute for Health ResearchSchool for Public Health ResearchNewcastle upon TyneUK
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Russell Jago
- National Institute for Health ResearchSchool for Public Health ResearchNewcastle upon TyneUK
- Centre for Exercise, Nutrition & Health Sciences, School for Policy StudiesUniversity of BristolBristolUK
- National Institute for Health Research Collaboration for Leadership, Applied Health Research and Care West (NIHR CLAHRC West)BristolUK
| | - Zoi Toumpakari
- Centre for Exercise, Nutrition & Health Sciences, School for Policy StudiesUniversity of BristolBristolUK
| | - Matt Egan
- National Institute for Health ResearchSchool for Public Health ResearchNewcastle upon TyneUK
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Steven Cummins
- National Institute for Health ResearchSchool for Public Health ResearchNewcastle upon TyneUK
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Martin White
- National Institute for Health ResearchSchool for Public Health ResearchNewcastle upon TyneUK
- Centre for Diet and Activity Research (CEDAR) MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - Paige Hulls
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Frank De Vocht
- National Institute for Health ResearchSchool for Public Health ResearchNewcastle upon TyneUK
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- National Institute for Health Research Collaboration for Leadership, Applied Health Research and Care West (NIHR CLAHRC West)BristolUK
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Milsom P, Smith R, Baker P, Walls H. Corporate power and the international trade regime preventing progressive policy action on non-communicable diseases: a realist review. Health Policy Plan 2021; 36:493-508. [PMID: 33276385 PMCID: PMC8128013 DOI: 10.1093/heapol/czaa148] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2020] [Indexed: 12/21/2022] Open
Abstract
Transnational tobacco, alcohol and ultra-processed food corporations use the international trade regime to prevent policy action on non-communicable diseases (NCDs); i.e. to promote policy 'non-decisions'. Understanding policy non-decisions can be assisted by identifying power operating in relevant decision-making spaces, but trade and health research rarely explicitly engages with theories of power. This realist review aimed to synthesize evidence of different forms and mechanisms of power active in trade and health decision-making spaces to understand better why NCD policy non-decisions persist and the implications for future transformative action. We iteratively developed power-based theories explaining how transnational health-harmful commodity corporations (THCCs) utilize the international trade regime to encourage NCD policy non-decisions. To support theory development, we also developed a conceptual framework for analysing power in public health policymaking. We searched six databases and relevant grey literature and extracted, synthesized and mapped the evidence against the proposed theories. One hundred and four studies were included. Findings were presented for three key forms of power. Evidence indicates THCCs attempt to exercise instrumental power by extensive lobbying often via privileged access to trade and health decision-making spaces. When their legitimacy declines, THCCs have attempted to shift decision-making to more favourable international trade legal venues. THCCs benefit from structural power through the institutionalization of their involvement in health and trade agenda-setting processes. In terms of discursive power, THCCs effectively frame trade and health issues in ways that echo and amplify dominant neoliberal ideas. These processes may further entrench the individualization of NCDs, restrict conceivable policy solutions and perpetuate policymaking norms that privilege economic/trade interests over health. This review identifies different forms and mechanisms of power active in trade and health policy spaces that enable THCCs to prevent progressive action on NCDs. It also points to potential strategies for challenging these power dynamics and relations.
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Affiliation(s)
- Penelope Milsom
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, Kings Cross, London WC1H 9SH, UK
| | - Richard Smith
- College of Medicine and Health, University of Exeter, Magdalen Road, Exeter, EX1 2LU, UK
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, Victoria 3125 Australia
| | - Helen Walls
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, Kings Cross, London WC1H 9SH, UK
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How food companies use social media to influence policy debates: a framework of Australian ultra-processed food industry Twitter data. Public Health Nutr 2021; 24:3124-3135. [PMID: 33222709 PMCID: PMC9884788 DOI: 10.1017/s1368980020003353] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To understand if, and how, Australian ultra-processed food industry actors use Twitter to influence food and health policy debates and produce a conceptual framework to describe such influence. DESIGN Twitter data of prominent industry actors were defined through purposive sampling and inductively coded to investigate possible influence on food and health policy debates. These are described using descriptive statistics and coded extracts. SETTING Australia. PARTICIPANTS Twitter accounts of nine prominent ultra-processed food industry actors, including major trade associations. RESULTS Ultra-processed food industry actors actively used Twitter to influence food and health policy debates. Seven overarching strategies were identified: co-opting public health narratives; opposing regulation; supporting voluntary, co- or self-regulation; engaging policy processes and decision-makers; linking regulatory environments to the need for ongoing profitability; affecting public perceptions and value judgements; and using ignorance claims to distort policy narratives. Each lobbying strategy is underpinned with tactics described throughout and captured in a framework. CONCLUSIONS The current study creates a framework to monitor how food industry actors can use social media to influence food and health policy debates. As such, social media appears to be not only an important commercial determinant of health for brand marketing, but also an extension of lobbying practices to reshape public perceptions of corporate conduct and policy-making.
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Lacy-Nichols J, Marten R. Power and the commercial determinants of health: ideas for a research agenda. BMJ Glob Health 2021; 6:bmjgh-2020-003850. [PMID: 33593758 PMCID: PMC7888370 DOI: 10.1136/bmjgh-2020-003850] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/19/2020] [Accepted: 11/11/2020] [Indexed: 12/31/2022] Open
Affiliation(s)
- Jennifer Lacy-Nichols
- Centre for Health Policy, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Robert Marten
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
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Legg T, Hatchard J, Gilmore AB. The Science for Profit Model-How and why corporations influence science and the use of science in policy and practice. PLoS One 2021; 16:e0253272. [PMID: 34161371 PMCID: PMC8221522 DOI: 10.1371/journal.pone.0253272] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 06/01/2021] [Indexed: 12/15/2022] Open
Abstract
Science has been at the centre of attempts by major industries, including tobacco, chemical, and pharmaceutical, to delay progress in tackling threats to human and planetary health by, inter alia, obscuring industry harms, and opposing regulation. Some aspects of this influence are well documented, others remain poorly understood, and similarities between industries remain underexplored. This study, therefore, aims to synthesise the literature to develop an evidence-based typology and model of corporate influence on science in order to provide an overview of this multi-faceted phenomenon. We obtained literature examining corporate attempts to influence science and the use of science in policy and practice from: database searches, bibliographies, expert recommendations, and web alerts; using a modified scoping review methodology (n = 68). Through interpretive analysis we developed the Science for Profit Typology and Model. We identified eight corporate sectors repeatedly engaging in activities to influence science, including: manipulation of scientific methods; reshaping of criteria for establishing scientific "proof"; threats against scientists; and clandestine promotion of policy reforms that increase reliance on industry evidence. The typology identifies five macro-level strategies used consistently across the eight industries, comprising 19 meso-level strategies. The model shows how these strategies work to maximise the volume, credibility, reach, and use of industry-favourable science, while minimising these same aspects of industry-unfavourable science. This creates doubt about harms of industry products/practices or efficacy of policies affecting industry; promotes industry-favoured policy responses and industry products as solutions; and legitimises industry's role as scientific stakeholder. These efforts ultimately serve to weaken policy, prevent litigation, and maximise use of industry products/practices-maximising corporate profitability. We provide an accessible way to understand how and why corporations influence science, demonstrate the need for collective solutions, and discuss changes needed to ensure science works in the public interest.
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Affiliation(s)
- Tess Legg
- Department for Health, Tobacco Control Research Group, University of Bath, Bath, United Kingdom
| | - Jenny Hatchard
- Department for Health, Tobacco Control Research Group, University of Bath, Bath, United Kingdom
| | - Anna B. Gilmore
- Department for Health, Tobacco Control Research Group, University of Bath, Bath, United Kingdom
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VAN SCHALKWYK MAYCI, MAANI NASON, COHEN JONATHAN, MCKEE MARTIN, PETTICREW MARK. Our Postpandemic World: What Will It Take to Build a Better Future for People and Planet? Milbank Q 2021; 99:467-502. [PMID: 33783865 PMCID: PMC8241272 DOI: 10.1111/1468-0009.12508] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Policy Points Despite the pandemic's ongoing devastating impacts, it also offers the opportunity and lessons for building a better, fairer, and sustainable world. Transformational change will require new ways of working, challenging powerful individuals and industries who worsened the crisis, will act to exploit it for personal gain, and will work to ensure that the future aligns with their interests. A flourishing world needs strong and equitable structures and systems, including strengthened democratic, research, and educational institutions, supported by ideas and discourses that are free of opaque and conflicted influence and that challenge the status quo and inequitable distribution of power.
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Affiliation(s)
| | - NASON MAANI
- Faculty of Public Health and PolicyLondon School of Hygiene & Tropical Medicine
- School of Public HealthBoston University
| | | | - MARTIN MCKEE
- Faculty of Public Health and PolicyLondon School of Hygiene & Tropical Medicine
| | - MARK PETTICREW
- Faculty of Public Health and PolicyLondon School of Hygiene & Tropical Medicine
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Clapp J. The problem with growing corporate concentration and power in the global food system. NATURE FOOD 2021; 2:404-408. [PMID: 37118223 DOI: 10.1038/s43016-021-00297-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/29/2021] [Indexed: 04/30/2023]
Abstract
What are the potential consequences when a relatively small number of large firms come to dominate markets within the global food system? This Perspective examines the implications of corporate concentration and power in the global seed and agrochemical industry, a sector that has become more consolidated in recent years. It outlines the pathways via which concentrated firms in this sector have the potential to exert power in food systems more broadly-both directly and indirectly-in ways that matter for food system outcomes. Specifically, concentrated firms can shape markets, shape technology and innovation agendas, and shape policy and governance frameworks. This Perspective makes the case that a range of measures are needed to ensure that corporate concentration and power do not undermine key goals for food systems, such as equitable livelihoods, sustainability and broad-based participation in food system governance. These include measures to strengthen competition policies, to bolster public sector support for diverse food systems, and to curb corporate influence in the policy process.
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Affiliation(s)
- Jennifer Clapp
- School of Environment, Resources and Sustainability, University of Waterloo, Waterloo, Ontario, Canada.
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Baker P, Russ K, Kang M, Santos TM, Neves PAR, Smith J, Kingston G, Mialon M, Lawrence M, Wood B, Moodie R, Clark D, Sievert K, Boatwright M, McCoy D. Globalization, first-foods systems transformations and corporate power: a synthesis of literature and data on the market and political practices of the transnational baby food industry. Global Health 2021; 17:58. [PMID: 34020657 PMCID: PMC8139375 DOI: 10.1186/s12992-021-00708-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/29/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The global milk formula market has 'boomed' in recent decades, raising serious concerns for breastfeeding, and child and maternal health. Despite these developments, few studies have investigated the global expansion of the baby food industry, nor the market and political practices corporations have used to grow and sustain their markets. In this paper, our aim is to understand the strategies used by the baby food industry to shape 'first-foods systems' across its diverse markets, and in doing so, drive milk formula consumption on a global scale. We used a theoretically guided synthesis review method, which integrated diverse qualitative and quantitative data sources. RESULTS Global milk formula sales grew from ~US$1.5 billion in 1978 to US$55.6 billion in 2019. This remarkable expansion has occurred along two main historical axes. First, the widening geographical reach of the baby food industry and its marketing practices, both globally and within countries, as corporations have pursued new growth opportunities, especially in the Global South. Second, the broadening of product ranges beyond infant formula, to include an array of follow-up, toddler and specialized formulas for a wider range of age groups and conditions, thereby widening the scope of mother-child populations subject to commodification. Sophisticated marketing techniques have been used to grow and sustain milk formula consumption, including marketing through health systems, mass-media and digital advertising, and novel product innovations backed by corporate science. To enable and sustain this marketing, the industry has engaged in diverse political practices to foster favourable policy, regulatory and knowledge environments. This has included lobbying international and national policy-makers, generating and deploying favourable science, leveraging global trade rules and adopting corporate policies to counter regulatory action by governments. CONCLUSION The baby food industry uses integrated market and political strategies to shape first-foods systems in ways that drive and sustain milk formula market expansion, on a global scale. Such practices are a major impediment to global implementation of the International Code of Marketing of Breastmilk Substitutes, and other policy actions to protect, promote and support breastfeeding. New modalities of public health action are needed to negate the political practices of the industry in particular, and ultimately to constrain corporate power over the mother-child breastfeeding dyad.
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Affiliation(s)
- Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | | | | | - Thiago M. Santos
- International Centre for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Paulo A. R. Neves
- International Centre for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Julie Smith
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Gillian Kingston
- Centre for Primary Care and Public Health, Queen Mary University, London, UK
| | - Melissa Mialon
- Trinity Business School, Trinity College Dublin, Dublin, Ireland
| | - Mark Lawrence
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Benjamin Wood
- School of Health and Social Development, Deakin University, Geelong, Australia
| | - Rob Moodie
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - David Clark
- Independent Consultant on Public Health Law, New York, USA
| | - Katherine Sievert
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Monique Boatwright
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - David McCoy
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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