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Hanefeld J, Modisenyane M, Vearey J, Lunt N, Smith R, Walls H. Bilateral health agreements of South Africa: an analysis of issues covered. Health Policy Plan 2024; 39:722-730. [PMID: 38795056 PMCID: PMC11308612 DOI: 10.1093/heapol/czae038] [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: 07/30/2023] [Revised: 04/04/2024] [Accepted: 05/24/2024] [Indexed: 05/27/2024] Open
Abstract
The bilateral agreements signed between South Africa and countries in Southern and Eastern Africa are a rare example of efforts to regulate health-related issues in a world region. As far as we know, there are no comparable bilateral health governance mechanisms in regions elsewhere. Furthermore, the rapidly growing literature on global health governance and governance for global health has to date not addressed the issue of patient mobility and how to govern it. In this study, we examine the issues included in these agreements, highlight key issues that they address, identify areas of omission and provide recommendations for improvement. This analysis should inform the development of such governance agreements both in Southern Africa and in regions elsewhere. We obtained 13 bilateral health agreements between South Africa and 11 neighbouring African countries as part of a broader research project examining the impact on health systems of patient mobility in South Africa, and thematically analysed their content and the governance mechanisms described. The agreements appear to be solidarity mechanisms between neighbouring countries. They contain considerable content on health diplomacy, with little on health governance, management and delivery. Nonetheless, given what they do and do not address, and how, they provide a rare insight into mechanisms of global health diplomacy and attempts to address patient mobility and other health-related issues in practice. The agreements appear to be global health diplomacy mechanisms expressing solidarity, emerging from a post-apartheid period, but with little detail of issues covered, and a range of important issues not addressed. Further empirical work is required to understand what these documents mean, particularly in the Covid-19 context, and to understand challenges with their implementation. The documents also raise the need for particular study of bilateral flows and experience of patients and health workers, and how this relates to health system strengthening.
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Affiliation(s)
- Johanna Hanefeld
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H9SH, UK
| | - Moeketsi Modisenyane
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H9SH, UK
- African Centre of Migration and Society, University of Witwatersrand, Johannesburg 2050, South Africa
| | - Jo Vearey
- African Centre of Migration and Society, University of Witwatersrand, Johannesburg 2050, South Africa
| | - Neil Lunt
- Department of Social Policy and Social Work, University of York, York YO10 5DD, UK
| | - Richard Smith
- College of Medicine and Health, University of Exeter, Exeter EX1 2HZ, UK
| | - Helen Walls
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H9SH, UK
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2
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Legg T, Clift B, Gilmore AB. Document analysis of the Foundation for a Smoke-Free World's scientific outputs and activities: a case study in contemporary tobacco industry agnogenesis. Tob Control 2024; 33:525-534. [PMID: 37137700 PMCID: PMC11228203 DOI: 10.1136/tc-2022-057667] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 04/05/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Tobacco corporation Philip Morris International launched the Foundation for a Smoke-Free World (FSFW), a purportedly independent scientific organisation, in 2017. We aimed to systematically investigate FSFW's activities and outputs, comparing these with previous industry attempts to influence science, as identified in the recently developed typology of corporate influence on science, the Science for Profit Model (SPM). DESIGN We prospectively collected data on FSFW over a 4-year period, 2017-2021, and used document analysis to assess whether FSFW's activities mirror practices tobacco and other industries have historically used to shape science in their own interests. We used the SPM as an analytical framework, working deductively to search for use of the strategies it identifies, and inductively to search for any additional strategies. RESULTS Marked similarities between FSFW's practices and previous corporate attempts to influence science were observed, including: producing tobacco industry-friendly research and opinion; obscuring industry involvement in science; funding third parties which denigrate science and scientists that may threaten industry profitability; and promoting tobacco industry credibility. CONCLUSIONS Our paper identifies FSFW as a new vehicle for agnogenesis, indicating that, over 70 years since the tobacco industry began to manipulate science, efforts to protect science from its interference remain inadequate. This, combined with growing evidence that other industries are engaging in similar practices, illustrates the urgent need to develop more robust systems to protect scientific integrity.
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Affiliation(s)
- Tess Legg
- Department for Health, University of Bath, Bath, UK
| | - Bryan Clift
- Department for Health, University of Bath, Bath, UK
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3
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Small R, Nugent R, Webb D, Hutchinson B, Spencer G, Ngongo C, Chestnov R, Tarlton D. Advancing progress on tobacco control in low-income and middle-income countries through economic analysis. Tob Control 2024; 33:s3-s9. [PMID: 38697661 PMCID: PMC11103286 DOI: 10.1136/tc-2023-058335] [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: 08/15/2023] [Accepted: 01/29/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND More than 80% of the world's 1.3 billion tobacco users live in low-income and middle-income countries (LMICs), where progress to address tobacco and its harms has been slow. The perception that tobacco control detracts from economic priorities has impeded progress. The Secretariat of the WHO Framework Convention on Tobacco Control (FCTC) is leading the FCTC 2030 project, which includes technical assistance to LMICs to analyse the economic costs of tobacco use and the benefits of tobacco control. METHODS The Secretariat of the WHO FCTC, United Nations Development Programme and WHO supported 21 LMICs between 2017 and 2022 to complete national investment cases to guide country implementation of the WHO FCTC, with analytical support provided by RTI International. These country-level cases combine customised estimates of tobacco's economic impact with qualitative analysis of socio-political factors influencing tobacco control. This paper overviews the approach, observed tobacco control advancements and learnings from 21 countries: Armenia, Cabo Verde, Cambodia, Chad, Colombia, Costa Rica, El Salvador, Eswatini, Georgia, Ghana, Jordan, Laos, Madagascar, Myanmar, Nepal, Samoa, Sierra Leone, Sri Lanka, Suriname, Tunisia and Zambia. RESULTS Tobacco control advancements in line with investment case findings and recommendations have been observed in 17 of the 21 countries, and many have improved collaboration and policy coherence between health and economic stakeholders. CONCLUSIONS Tobacco control must be seen as more than a health concern. Tobacco control leads to economic benefits and contributes to sustainable development. National investment cases can support country ownership and leadership to advance tobacco control.
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Affiliation(s)
- Roy Small
- HIV, Health and Development Group, United Nations Development Programme, New York, New York, USA
| | - Rachel Nugent
- Department of Global Health, University of Washington, Seattle, Washington, USA
- RTI International, Research Triangle Park, North Carolina, USA
| | - Douglas Webb
- United Nations Development Programme, Tbilsi, Georgia
| | | | | | - Carrie Ngongo
- RTI International, Research Triangle Park, North Carolina, USA
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4
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Ralston R, Wagner-Rizvi T, van Schalkwyk MC, Maani N, Collin J. The WHO Foundation in global health governance: Depoliticizing corporate philanthropy. Soc Sci Med 2024; 344:116515. [PMID: 38412806 DOI: 10.1016/j.socscimed.2023.116515] [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: 07/04/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 02/29/2024]
Abstract
The creation of the WHO Foundation during the COVID-19 pandemic represents a significant institutional development in the politics of financing the World Health Organization (WHO). In the context of longstanding acute financial pressures, the objective of the WHO Foundation is to widen WHO's resource base by attracting philanthropic donations from the commercial sector. In placing funding decisions 'at one remove' from WHO, the stated expectation is that the WHO Foundation will act as an intermediary, insulating the WHO from potential conflicts of interest and reputational risk through a combination of strategic distance from WHO and proximity with its norms and rules of engagement with non-state actors. Yet, whether this model has translated into practice remains understudied. In this article, we focus on emerging institutional practices within the WHO Foundation, highlighting a drift from its stated governance model. Based on analysis of WHO Foundation documents, we demonstrate how due diligence and transparency practices within the Foundation have been redesigned in ways that contradict or subvert its claims to applying alignment with WHO's governance norms, notably relating to its engagement with health harming industries such as alcohol and petrochemical companies. While this situation may seem paradoxical, we argue that, in placing funding decisions 'at one remove' from the formal institutions and structures of WHO, the creation of the Foundation has served to displace this issue to a more secluded arena where drifts in practice are less exposed to political oversight and scrutiny. Focusing on the discursive aspects of this process of depoliticisation, we contend that the Foundation has strategically managed 'fictional expectations' of accountable and transparent governance in order to mitigate concerns about its mandate and functions. This assessment provides new and important insights into the depoliticizing functions of the WHO Foundation and the significant implications this may have for global health governance.
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Affiliation(s)
- Rob Ralston
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, UK; SPECTRUM Consortium, UK.
| | - Tracey Wagner-Rizvi
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, UK; SPECTRUM Consortium, UK
| | - May Ci van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK
| | - Nason Maani
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, UK
| | - Jeff Collin
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, UK; SPECTRUM Consortium, UK
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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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Watts C, Burton S, Freeman B. Conducting tobacco industry informant interviews: lessons and implications for commercial determinants of health research. Health Promot Int 2022; 37:daab169. [PMID: 34634798 DOI: 10.1093/heapro/daab169] [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: 11/13/2022] Open
Abstract
Investigating and exposing tobacco industry tactics to oppose and interfere with tobacco control policymaking is crucial to advancing public health. Whilst past investigations of tobacco industry activities have largely focused on secondary sources of information, such as publicly available tobacco industry documents, the collection of first-hand evidence from key informants has been an under-utilized method in tobacco industry monitoring. This article provides a detailed account of a methodological approach to systematically recruit former tobacco company employees as key informants for a study that aimed to gather information on the marketing tactics tobacco companies use in the Australian retail channel. Given the success of our study methodology in uncovering new information about tobacco company practices, we propose that key informant interviews with former industry employees should be a priority method for research investigating the role of commercial actors in influencing public health outcomes. To offer guidance to researchers who may wish to undertake a similar methodological approach, we also provide a reflective account of the elements of success and the lessons learned from this research.
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Affiliation(s)
- Christina Watts
- Faculty of Medicine and Health, The Daffodil Centre, The University of Sydney, A joint venture with Cancer Council NSW, Sydney, Australia
| | - Suzan Burton
- School of Business, Western Sydney University, Sydney, Australia
| | - Becky Freeman
- Faculty of Medicine and Health, Sydney School of Public Health, Prevention Research Collaboration, The University of Sydney, Sydney, Australia
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7
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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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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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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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Lauber K, Rutter H, Gilmore AB. Big food and the World Health Organization: a qualitative study of industry attempts to influence global-level non-communicable disease policy. BMJ Glob Health 2021; 6:e005216. [PMID: 34117011 PMCID: PMC8202098 DOI: 10.1136/bmjgh-2021-005216] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/08/2021] [Accepted: 04/25/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION There is an urgent need for effective action to address the over 10 million annual deaths attributable to unhealthy diets. Food industry interference with policies aimed at reducing non-communicable diseases (NCDs) is widely documented at the national level but remains under-researched at the global level. Thus, this study explores how ultra-processed food industry actors have attempted to influence NCD policy at WHO. METHODS A combination of inductive and deductive thematic coding of internal industry documents, academic literature and interviews with key informants from international organisations and global civil society was used to identify action-based strategies ultra-processed food industry actors employ to influence global-level policy. RESULTS Ultra-processed food industry actors have attempted to influence WHO and its policies through three main action-based strategies: coalition management, involvement in policy formulation, and information management. Coalition management includes the creation and use of overt alliances between corporations-business associations-and more covert science-focused and policy-focused intermediaries, the hiring of former WHO staff and attempted co-option of civil society organisations. Industry involvement in policy formulation is operationalised largely through the lobbying of Member States to support industry positions, and business associations gaining access to WHO through formal consultations and hearings. Information management involves funding and disseminating research favourable to commercial interests, and challenging unfavourable evidence. CONCLUSION We provide novel insights into how ultra-processed food industry actors shape global-level NCD policy and identify a clear need to guard against commercial interference to advance NCD policy. In their approach, the political behaviour of multinational food corporations bears similarities to that of the tobacco industry. Increased awareness of, and safeguarding against, commercial interference at the national as well as the global level have the potential to strengthen the crucial work of WHO.
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Affiliation(s)
- Kathrin Lauber
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Anna B Gilmore
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
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11
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Ikegwuonu T, Hilton S, Smith KE, Buckton CH, Wong M, Weishaar HB. Understanding commercial actors' engagement in policy debates on proposed e-cigarette regulation in Scotland. Tob Control 2021; 31:511-519. [PMID: 33771932 DOI: 10.1136/tobaccocontrol-2020-056084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/05/2020] [Accepted: 11/13/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION There is growing concern about transnational tobacco corporations' (TTCs) and other commercial actors' involvement in e-cigarette policy development. Previous analyses suggest that TTCs used e-cigarette debates to demonstrate alignment with public health and re-gain policy influence. Less is known about the engagement of other types of commercial actors in e-cigarette policy debates. METHODS This paper is the first to empirically analyse commercial actors' engagement in an e-cigarette policy consultation process and to examine their views on proposed regulation. It applies mixed methods, drawing on policy consultation submissions (n=32), semi-structured interviews (n=9) and a social network analysis of website links among 32 commercial actors. RESULTS The results show that commercial actors' positions on e-cigarette regulation aligned with business interests. TTCs, independent e-cigarette manufacturers and other non-licensed commercial actors were opposed to most aspects of potential e-cigarette regulation (except for age of sale restrictions), whereas licensed commercial actors, including pharmaceutical companies, supported more stringent regulation. While collaboration was viewed as strategically important to gain policy influence, distinct commercial interests and concerns about TTC credibility led to strategic distancing and to collaboration being largely confined to sector boundaries. In addition to reiterating arguments employed by TTCs in previous regulatory debates, commercial actors focused on highlighting the technical complexity and harm reduction potential of e-cigarettes. CONCLUSION Awareness of the various commercial interests and strategic positioning of commercial actors in e-cigarette policy should inform public health advocacy and policy development, including managing conflicts of interest in the context of Framework Convention on Tobacco Control Article 5.3.
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Affiliation(s)
- Theresa Ikegwuonu
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Katherine E Smith
- Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Christina H Buckton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Mark Wong
- Urban Studies, School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Heide B Weishaar
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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12
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Bhatta DN, Crosbie E, Bialous SA, Glantz S. Defending Comprehensive Tobacco Control Policy Implementation in Nepal From Tobacco Industry Interference (2011-2018). Nicotine Tob Res 2021; 22:2203-2212. [PMID: 32309853 DOI: 10.1093/ntr/ntaa067] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 04/16/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Nepal passed a comprehensive tobacco control law in 2011. Tobacco control advocates successfully countered tobacco industry (TI) interference to force implementation of law. AIMS AND METHODS Policy documents, news stories, and key informant interviews were triangulated and interpreted using the Policy Dystopia Model (PDM). RESULTS The TI tried to block and weaken the law after Parliament passed it. Tobacco control advocates used litigation to force implementation of the law while the TI used litigation in an effort to block implementation. The TI argued that tobacco was socially and economically important, and used front groups to weaken the law. Tobacco control advocates mobilized the media, launched public awareness campaigns, educated the legislature, utilized lawsuits, and monitored TI activities to successfully counter TI opposition. CONCLUSIONS Both tobacco control advocates and the industry used the discursive and instrumental strategies described in the PDM. The model was helpful for understanding TI activities in Nepal and could be applied to other low- and middle-income countries. Civil society, with the help of international health groups, should continue to track TI interference and learn the lessons from other countries to proactively to counter it. IMPLICATIONS The PDM provides an effective framework to understand battles over implementation of a strong tobacco control law in Nepal, a low- and middle-income country. The TI applied discursive and instrumental strategies in Nepal in its efforts to weaken and delay the implementation of the law at every stage of implementation. It is important to continuously monitor TI activities and learn lessons from other countries, as the industry often employ the same strategies globally. Tobacco control advocates utilized domestic litigation, media advocacy, and engaged with legislators, politicians, and other stakeholders to implement a strong tobacco control law. Other low- and middle-income countries can adapt these lessons from Nepal to achieve effective implementation of their laws.
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Affiliation(s)
- Dharma N Bhatta
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA.,Global Cancer Program, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - Eric Crosbie
- School of Community Health Sciences, University of Nevada, Reno, NV
| | - Stella A Bialous
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA.,Global Cancer Program, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA.,Social and Behavioral Sciences Department, School of Nursing, University of California, San Francisco, CA
| | - Stanton Glantz
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA.,Global Cancer Program, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA.,Department of Medicine, Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, CA
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Bhatta DN, Bialous S, Crosbie E, Glantz S. Exceeding WHO Framework Convention on Tobacco Control (FCTC) Obligations: Nepal Overcoming Tobacco Industry Interference to Enact a Comprehensive Tobacco Control Policy. Nicotine Tob Res 2020; 22:2213-2223. [PMID: 31535694 PMCID: PMC7733065 DOI: 10.1093/ntr/ntz177] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/11/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND The tobacco industry works to block, delay, and weaken national tobacco control legislation to implement the WHO Framework Convention on Tobacco Control (FCTC). This article reviews how Nepal overcame industry opposition and to a comprehensive tobacco control law implementing the FCTC. METHODS We triangulated newspaper articles and policy documents with key informant interviews. RESULTS With the support of international health groups, local tobacco control advocates worked with policymakers in Nepal to pass a comprehensive tobacco control law that exceeded FCTC obligations. The tobacco industry exploited a time of political transition to block consideration by Parliament, arranged and sponsored foreign tours for legislators, made death threats to tobacco control advocates and their families, and argued for the economic importance of tobacco farms. Despite strong interference from Health, and Law and Justice ministers, a 2009 Supreme Court ruling helped tobacco control advocates secure a comprehensive tobacco control law in 2011 that included rotating pictorial health warning labels covering 75% of both sides of cigarette packages, 100% smoke free public places and workplaces, private homes and vehicles, and a tobacco advertising, promotion, and sponsorship ban. CONCLUSIONS Advocates in developing countries should utilize Nepal's experience to reject tobacco industry offers of compromise and continue educating politicians and legislators to generate political support to pass a comprehensive tobacco control law. Technical and financial support from international agencies, and effective collaboration and coordination of civil societies, and utilization of domestic litigation are helpful in LMICs where governance is weak (the abstract in Nepali is available as a Supplementary Material). IMPLICATIONS The tobacco industry exploited a time of political transition in Nepal in its effort to block comprehensive tobacco control policy in Parliament by sponsoring foreign tours of legislatures, making death threats to tobacco control advocates and their families, and arguing for the economic importance of tobacco farms. Tobacco control advocates used litigation to raise awareness and educate legislators and promote strong legislation with the involvement of international health groups. Technical and financial support from international agencies, and effective collaboration and coordination of civil societies, and utilization of domestic litigation are helpful in LMICs where governance is weak.
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Affiliation(s)
- Dharma N Bhatta
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA
- Global Cancer Program, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - Stella Bialous
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA
- Global Cancer Program, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
- Social and Behavioral Sciences Department, School of Nursing, University of California, San Francisco, CA
| | - Eric Crosbie
- School of Community Health Sciences, University of Nevada, Reno, NV
| | - Stanton Glantz
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA
- Global Cancer Program, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
- Department of Medicine, Philip R Lee Institute for Health Policy Studies, Cardiovascular Research Institute, University of California, San Francisco, CA
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Watts C, Burton S, Freeman B. Creating a market for IQOS: analysis of Philip Morris' strategy to introduce heated tobacco products to the Australian consumer market. Tob Control 2020; 31:458-463. [PMID: 33191270 DOI: 10.1136/tobaccocontrol-2020-056057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Philip Morris International has made efforts to expand the sale of its heated tobacco product, IQOS, into new domestic markets globally. In Australia, where heated tobacco products are prohibited, the company recently attempted to overturn Australian legislation in order to permit their sale. In light of this recent move, this study presents a case study of the company's strategies to legalise and distribute IQOS in the Australian market. METHODS To assess Philip Morris' lobbying activities and corporate strategies, a case study approach was used by triangulating data from three sources: interviews with former Philip Morris employees, news articles reporting Philip Morris' lobbying activities or plans for IQOS in Australia, and submissions to relevant government inquiries and reviews from 2015 to 2020. RESULTS Philip Morris has actively lobbied Australian policy-makers to overturn bans on nicotine-containing products. Information obtained from key informants and Philip Morris' government submissions indicates that the company's goal is for heated tobacco products in Australia to be regulated in a new product category, exempt from tobacco control laws. Informants revealed that Philip Morris was also working to establish a network of upmarket pubs, clubs and bars where they could sell IQOS once legalisation was achieved. CONCLUSIONS Philip Morris has strongly lobbied the Australian government to legalise heated tobacco products, while simultaneously making plans to sell IQOS at young adult-friendly premises such as bars, clubs and pubs if its proposed legislative changes are made. This case study provides valuable insights for other countries where Philip Morris may be replicating similar strategies to weaken tobacco control legislation.
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Affiliation(s)
- Christina Watts
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia .,Cancer Prevention and Advocacy Division, Cancer Council New South Wales, Sydney, New South Wales, Australia
| | - Suzan Burton
- School of Business, Western Sydney University, Sydney, New South Wales, Australia
| | - Becky Freeman
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Thow AM, Lencucha RA, Rooney K, Colagiuri S, Lenzen M. Implications for farmers of measures to reduce sugars consumption. Bull World Health Organ 2020; 99:41-49. [PMID: 33658733 DOI: 10.2471/blt.19.249177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 09/25/2020] [Accepted: 10/01/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To estimate the impact of reduced consumption of free sugars in line with World Health Organization recommendations, on sugar farmers globally. Methods Using multiregion input-output analysis, we estimated the proportional impact on production volumes of a 1% reduction in free sugars consumption by the public. We extracted data on sugar production from the Food and Agriculture Organization of the United Nations database for the top 15 sugar-cane- and beet-producing countries globally, and created a custom multiregion input-output database to assess the proportions of production going to human consumption, drawing on household expenditure surveys and national input-output databases (data valid for years 2000-2015). We also considered the impact on production volumes in relation to countries' gross domestic product. Findings A high proportion of current sugar production from these countries goes to human consumption, and would thus be impacted by reduced consumption of sugars. The largest impacts on cane sugar production, and thus on farmers, would likely occur in Brazil, China, India and Thailand and on beet production in Belarus, Germany, Russian Federation and United States of America. Conclusion A global opportunity exists for public health leadership to bring together the health, economic, environmental and agriculture sectors to collaborate and build capacity for promotion of alternative livelihoods for sugar farmers. Lessons regarding strategy and the importance of political economy factors can be learnt from tobacco control measures. Further research to quantify the impact of reductions in sugars consumption would provide useful insights for designing policies to complement and strengthen efforts to improve diets and health.
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Affiliation(s)
- Anne Marie Thow
- Charles Perkins Centre, Faculty of Medicine and Health, D17, University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Raphael A Lencucha
- School of Physical and Occupational Therapy, McGill University, Quebec, Canada
| | - Kieron Rooney
- Charles Perkins Centre, Faculty of Medicine and Health, D17, University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Stephen Colagiuri
- Charles Perkins Centre, Faculty of Medicine and Health, D17, University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Manfred Lenzen
- School of Physics, University of Sydney, Sydney, Australia
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16
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Lauber K, Ralston R, Mialon M, Carriedo A, Gilmore AB. Non-communicable disease governance in the era of the sustainable development goals: a qualitative analysis of food industry framing in WHO consultations. Global Health 2020; 16:76. [PMID: 32847604 PMCID: PMC7448499 DOI: 10.1186/s12992-020-00611-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/19/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The UN system's shift towards multistakeholder governance, now embedded in the Sustainable Development Goals (SDGs), invites a broad range of actors, including the private sector, to the policymaking table. Although the tobacco industry is formally excluded from engagement, this approach provides opportunities for other unhealthy commodity industries to influence the World Health Organization's (WHO's) non-communicable disease (NCD) agenda. Focusing on the food industry, this research maps which actors engaged with WHO consultations, and critically examines actors' policy and governance preferences as well as the framing they employ to promote these preferences in the global context. METHODS All written responses from food industry actors to publicly available NCD-relevant WHO consultations held between September 2015 and September 2018 were identified, totalling forty-five responses across five consultations. A qualitative frame analysis was conducted to identify policy positions expressed by respondents, as well as arguments and frames used to do so. RESULTS Though no individual companies responded to the consultations, the majority of participating business associations had some of the largest multinational food corporations as members. Respondents overarchingly promoted non-statutory approaches and opposed statutory regulation and conflict of interest safeguards. To this purpose, they framed the food industry as a legitimate and necessary partner in policymaking, differentiating themselves from the tobacco industry and referencing a history of successful collaboration, while also invoking multistakeholder norms and good governance principles to portray collaboration as required. Respondents contrasted this with the limits of WHO's mandate, portraying it as out of step with the SDGs and framing NCD decision-making as a matter of national sovereignty. CONCLUSION We observed that the UN's call for partnerships to support the SDGs is invoked to defend corporate access to NCD policy. This highlights the need for more cautious approaches which are mindful of the commercial determinants of health. Systematic opposition to regulation and to governance approaches which may compromise commercial actors' insider role in global health by food industry actors shown here, and the strategic use of the Sustainable Development agenda to this purpose, raises questions about the value of collaboration from the perspective of international health agencies such as WHO.
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Affiliation(s)
- Kathrin Lauber
- Tobacco Control Research Group, University of Bath, Bath, UK.
- SPECTRUM Consortium, Edinburgh, UK.
| | - Rob Ralston
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Mélissa Mialon
- School of Public Health, University of São Paulo, São Paulo, Brazil
| | | | - Anna B Gilmore
- Tobacco Control Research Group, University of Bath, Bath, UK
- SPECTRUM Consortium, Edinburgh, UK
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17
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Stoeva P. International norm development and change: can international law play a meaningful role in curbing the lifestyle disease pandemic? BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2020; 20:18. [PMID: 32703214 PMCID: PMC7376856 DOI: 10.1186/s12914-020-00239-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The magnitude of the noncommunicable epidemic is difficult to overstate. The projected cost of the epidemic is substantial. It disproportionately affects people in low- and middle-income countries as well as poorer and marginalised communities in high-income countries. The international community has taken various steps to address the four modifiable risk factors causing the majority of noncommunicable diseases (NCDs), however, action has so far fallen short of expectations. Both analysts and international institutions are advocating the adoption of a new international legal norm to address the NCD crisis. MAIN TEXT Drawing on existing knowledge from international relations and international legal studies, this article argues that a new international treaty is not only currently improbable, but also not strictly desirable. In-depth critical analysis and reflection is needed regarding the strengths and weaknesses of a legal approach to addressing the NCD pandemic. The argument is set out in three sections - the first reviews contributions of agentic constructivism, which focus on the process of normative emergence and change, and draws on empirical examples to highlight overlooked aspects of normative development and how they relate to NCD politics. The second engages with the critique of legal principles. Critical approaches to law seek to expose the myths that legal principles are neutral, objective, good. The third section discusses the characteristics of practice in the NCD field and its implications on process and principles for the pursuit of a legal solution to the NCD crisis. CONCLUSIONS Any advocacy for an international norm to address NCDs needs to be nuanced and demonstrate awareness of the nature and character of both the norm development process and resulting international legal principles. As analysts, we are responsible for advocating inclusive and ethical norms, but also for highlighting the implications of inequalities and differences between and within states and societies. There may be a viable international legal instrument that would support dedicated policies to curb the NCD epidemic, but such an instrument needs to be actively advocated for and negotiated with a wide range of stakeholders, navigating a complex international framework of existing norms and conflicting, powerful interests.
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Affiliation(s)
- Preslava Stoeva
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
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18
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Valente TW, Pitts S, Wipfli H, Vega Yon GG. Network influences on policy implementation: Evidence from a global health treaty. Soc Sci Med 2019; 222:188-197. [PMID: 30739870 DOI: 10.1016/j.socscimed.2019.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 12/12/2018] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
Abstract
This paper examines whether country implementation of a public health treaty is influenced by the implementation behaviors of other countries to which they have network ties. We examine implementation of the Framework Convention on Tobacco Control (FCTC) adopted by the World Health Organization in 2003 and ratified by approximately 94% of countries as of 2016. We constructed five networks: (1) geographic distance, (2) general trade, (3) tobacco trade, (4) GLOBALink referrals, and (5) GLOBALink co-subscriptions. Network exposure terms were constructed from these networks based on the implementation scores for six articles of the FCTC treaty. We estimate effects using a lagged Type 1 Tobit model. Results show that network effects were significant: (a) across all networks for article 6 (pricing and taxation), (b) distance, general trade, GL referrals, and GL co-subscriptions for article 8 (second hand smoke), (c) distance, general trade, and GL co-subscriptions for article 11 (packaging and labeling), and (d) distance and GL co-subscription for article 13 (promotion and advertising), (e) tobacco trade and GL co-subscriptions for article 14 (cessation). These results indicate that diffusion effects were more prevalent for pricing and taxation as well as restrictions on smoking in public places and packaging and labeling. These results suggest that network influences are possible in domains that are amenable to control by national governments but unlikely to occur in domains established by existing regulatory systems. Implications for future studies of policy implementation are discussed.
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Affiliation(s)
- Thomas W Valente
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Applied Physics Laboratory, Johns Hopkins University, USA.
| | - Stephanie Pitts
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Applied Physics Laboratory, Johns Hopkins University, USA
| | - Heather Wipfli
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Applied Physics Laboratory, Johns Hopkins University, USA
| | - George G Vega Yon
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Applied Physics Laboratory, Johns Hopkins University, USA
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19
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van der Eijk Y, Bialous SA, Glantz S. The Tobacco Industry and Children's Rights. Pediatrics 2018; 141:peds.2017-4106. [PMID: 29712762 PMCID: PMC5914496 DOI: 10.1542/peds.2017-4106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 11/24/2022] Open
Abstract
The manufacture, use, and marketing of tobacco present a serious threat to children's right to health. This makes the Convention on the Rights of the Child a potentially powerful tobacco-control tool and the United Nations Children's Fund (UNICEF), which oversees the convention's implementation, a potential leader in tobacco control. UNICEF actively supported tobacco control initiatives in the late 1990s, but since the early 2000s UNICEF's role in tobacco control has been minimal. Using the Truth Tobacco Industry Documents library, an online collection of previously secret tobacco industry documents, we sought to uncover information on the tobacco industry's ties with UNICEF. We found that from 1997 to 2000, when UNICEF was actively promoting tobacco control to support children's rights, the tobacco industry saw children's rights and UNICEF as potentially powerful threats to business that needed to be closely monitored and neutralized. The industry then positioned itself as a partner with UNICEF on youth smoking prevention initiatives as a way to avoid meaningful tobacco control measures that could save children's lives. After UNICEF's corporate engagement guidelines were loosened in 2003, tobacco companies successfully engaged with UNICEF directly and via front groups, including the Eliminating Child Labour in Tobacco Growing Foundation. This was part of an overall tobacco industry strategy to improve its corporate image, infiltrate the United Nations, and weaken global tobacco-control efforts. As part of its mission to protect children's rights, UNICEF should end all partnerships with the tobacco industry and its front groups.
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Affiliation(s)
| | - Stella A. Bialous
- Center for Tobacco Control Research and Education,,Department of Social and Behavioral Sciences, School of Nursing, and
| | - Stanton Glantz
- Center for Tobacco Control Research and Education, .,Department of Medicine (Cardiology), Cardiovascular Research Institute and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
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20
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Watts C, Hefler M, Freeman B. ‘We have a rich heritage and, we believe, a bright future’: how transnational tobacco companies are using Twitter to oppose policy and shape their public identity. Tob Control 2018; 28:227-232. [DOI: 10.1136/tobaccocontrol-2017-054188] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 11/04/2022]
Abstract
BackgroundThe tobacco industry has a long history of opposing tobacco control policy and promoting socially responsible business practices. With the rise of social media platforms, like Twitter, the tobacco industry is enabled to readily and easily communicate these messages.MethodsAll tweets published by the primary corporate Twitter accounts of British American Tobacco (BAT), Imperial Brands PLC (Imperial), Philip Morris International (PMI) and Japan Tobacco International (JTI) were downloaded in May 2017 and manually coded under 30 topic categories.ResultsA total of 3301 tweets across the four accounts were analysed. Overall, the most prominent categories of tweets were topics that opposed or critiqued tobacco control policies (36.3% of BAT’s tweets, 35.1% of Imperial’s tweets, 34.0% of JTI’s tweets and 9.6% of PMI’s tweets). All companies consistently tweeted to promote an image of being socially and environmentally responsible. Tweets of this nature comprised 29.1% of PMI’s tweets, 20.9% of JTI’s tweets, 18.4% of Imperial’s tweets and 18.4% of BAT’s tweets. BAT, Imperial, JTI and PMI also frequently used Twitter to advertise career opportunities, highlight employee benefits, promote positive working environments and bring attention to awards and certifications that the company had received (11.6%, 11.1%, 19.3% and 45.7% of the total tweets published by each account, respectively).ConclusionsTransnational tobacco companies are using Twitter to oppose tobacco control policy and shape their public identity by promoting corporate social responsibility initiatives in violation of WHO Framework Convention on Tobacco Control. Regulation of the tobacco industry’s global online activities is required.
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MacKenzie R, Eckhardt J, Widyati Prastyani A. Japan Tobacco International: To 'be the most successful and respected tobacco company in the world'. Glob Public Health 2017; 12:281-299. [PMID: 28139966 PMCID: PMC5553429 DOI: 10.1080/17441692.2016.1273368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Japan Tobacco International (JTI) is the international division of Japan Tobacco Incorporated, and the world’s third largest transnational tobacco company. Founded in 1999, JTI’s rapid growth has been the result of a global business strategy that potentially serves as a model for other Asian tobacco companies. This paper analyses Japan Tobacco Incorporated’s global expansion since the 1980s in response to market opening, foreign competition, and declining share of a contracting domestic market. Key features of its global strategy include the on-going central role and investment by the Japanese government, and an expansion agenda based on mergers and acquisitions. The paper also discusses the challenges this global business strategy poses for global tobacco control and public health. This paper is part of the special issue ‘The Emergence of Asian Tobacco Companies: Implications for Global Health Governance’.
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Affiliation(s)
- Ross MacKenzie
- a Department of Psychology , Macquarie University , Sydney , Australia
| | - Jappe Eckhardt
- b Department of Politics , University of York , Heslington, York , UK
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22
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Russell A. SMOG IN A TIME OF TOBACCO CONTROL. ANTHROPOLOGY TODAY 2017. [DOI: 10.1111/1467-8322.12395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Andrew Russell
- Associate Professor (Reader) in the Department of Anthropology, Durham University. His research interests are tobacco and breathlessness
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Petticrew M, Katikireddi SV, Knai C, Cassidy R, Maani Hessari N, Thomas J, Weishaar H. 'Nothing can be done until everything is done': the use of complexity arguments by food, beverage, alcohol and gambling industries. J Epidemiol Community Health 2017; 71:1078-1083. [PMID: 28978619 PMCID: PMC5847098 DOI: 10.1136/jech-2017-209710] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/04/2017] [Accepted: 08/10/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Corporations use a range of strategies to dispute their role in causing public health harms and to limit the scope of effective public health interventions. This is well documented in relation to the activities of the tobacco industry, but research on other industries is less well developed. We therefore analysed public statements and documents from four unhealthy commodity industries to investigate whether and how they used arguments about complexity in this way. METHODS We analysed alcohol, food, soda and gambling industry documents and websites and minutes of reports of relevant health select committees, using standard document analysis methods. RESULTS Two main framings were identified: (i) these industries argue that aetiology is complex, so individual products cannot be blamed; and (ii) they argue that population health measures are 'too simple' to address complex public health problems. However, in this second framing, there are inherent contradictions in how industry used 'complexity', as their alternative solutions are generally not, in themselves, complex. CONCLUSION The concept of complexity, as commonly used in public health, is also widely employed by unhealthy commodity industries to influence how the public and policymakers understand health issues. It is frequently used in response to policy announcements and in response to new scientific evidence (particularly evidence on obesity and alcohol harms). The arguments and language may reflect the existence of a cross-industry 'playbook', whose use results in the undermining of effective public health policies - in particular the undermining of effective regulation of profitable industry activities that are harmful to the public's health.
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Affiliation(s)
- Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Cécile Knai
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Cassidy
- Department of Anthropology, Goldsmiths University of London, London, UK
| | - Nason Maani Hessari
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - James Thomas
- EPPI-Centre, SSRU, Department of Social Science, UCL Institute of Education, University College London, London, UK
| | - Heide Weishaar
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Hertie School of Governance, Berlin, Germany
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Bain J, Weishaar H, Semple S, Duffy S, Hilton S. Vulnerable children, stigmatised smokers: The social construction of target audiences in media debates on policies regulating smoking in vehicles. Health (London) 2017; 21:633-649. [PMID: 27457688 PMCID: PMC5639949 DOI: 10.1177/1363459316633279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Following restrictions on smoking in vehicles carrying children in several countries, legislation to safeguard minors from second-hand smoke exposure in vehicles is under-consideration or has been implemented across the United Kingdom. This article presents the first investigation into social constructions of children, smokers and smoking parents in newsprint media and coverage of debates about protecting children from exposure to second-hand smoke in vehicles. Using Scotland as an example, articles on children's exposure to second-hand smoke published between 1 January 2004 and 16 February 2014 in three Scottish newspapers were identified using Nexis UK. In all, 131 articles were thematically coded and analysed. Children were portrayed as vulnerable and requiring protection, with few articles highlighting children's ability to voice concerns about the dangers of smoking. Smokers and smoking parents were mainly portrayed in a factual manner, but also frequently as irresponsible and, in some cases, intentionally imposing harm. Individual smokers were blamed for their recklessness, with only a small number of articles mentioning the need to assist smokers in quitting. Supporters of legislation focused on corresponding discourse, whereas critics directed debates towards established arguments against policy, including individual freedom, privacy and problems of enforcement. Focusing on children's vulnerability to second-hand smoke might have increased support for legislation but risked a side effect of smokers being stigmatised. The media and supporters of public health policy are encouraged to consider appropriate approaches to raise awareness of the health harms of second-hand smoke to children while avoiding unintended stigmatisation of those in which they want to encourage behaviour change.
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Fooks GJ, Smith J, Lee K, Holden C. Controlling corporate influence in health policy making? An assessment of the implementation of article 5.3 of the World Health Organization framework convention on tobacco control. Global Health 2017; 13:12. [PMID: 28274267 PMCID: PMC5343400 DOI: 10.1186/s12992-017-0234-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 02/03/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) stands to significantly reduce tobacco-related mortality by accelerating the introduction of evidence-based tobacco control measures. However, the extent to which States Parties have implemented the Convention varies considerably. Article 5.3 of the FCTC, is intended to insulate policy-making from the tobacco industry's political influence, and aims to address barriers to strong implementation of the Convention associated with tobacco industry political activity. This paper quantitatively assesses implementation of Article 5.3's Guidelines for Implementation, evaluates the strength of Parties' efforts to implement specific recommendations, and explores how different approaches to implementation expose the policy process to continuing industry influence. METHODS We cross-referenced a broad range of documentary data (including FCTC Party reports and World Bank data on the governance of conflicts of interest in public administration) against Article 5.3 implementation guidelines (n = 24) for 155 Parties, and performed an in-depth thematic analysis to examine the strength of implementation for specific recommendations. RESULTS Across all Parties, 16% of guideline recommendations reviewed have been implemented. Eighty-three percent of Parties that have taken some action under Article 5.3 have introduced less than a third of the guidelines. Most compliance with the guidelines is achieved through pre-existing policy instruments introduced independently of the FCTC, which rarely cover all relevant policy actors and fall short of the guideline recommendations. Measures introduced in response to the FCTC are typically restricted to health ministries and not explicit about third parties acting on behalf of the industry. Parties systematically overlook recommendations that facilitate industry monitoring. CONCLUSION Highly selective and incomplete implementation of specific guideline recommendations facilitates extensive ongoing opportunities for industry policy influence. Stronger commitment to implementation is required to ensure consistently strong compliance with the FCTC internationally.
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Affiliation(s)
- Gary Jonas Fooks
- School of Languages and Social Sciences, Aston University, Birmingham, UK
| | - Julia Smith
- Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Kelley Lee
- Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Chris Holden
- Department of Social Policy and Social Work, University of York, York, UK
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Ulucanlar S, Fooks GJ, Gilmore AB. The Policy Dystopia Model: An Interpretive Analysis of Tobacco Industry Political Activity. PLoS Med 2016; 13:e1002125. [PMID: 27649386 PMCID: PMC5029800 DOI: 10.1371/journal.pmed.1002125] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/08/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tobacco industry interference has been identified as the greatest obstacle to the implementation of evidence-based measures to reduce tobacco use. Understanding and addressing industry interference in public health policy-making is therefore crucial. Existing conceptualisations of corporate political activity (CPA) are embedded in a business perspective and do not attend to CPA's social and public health costs; most have not drawn on the unique resource represented by internal tobacco industry documents. Building on this literature, including systematic reviews, we develop a critically informed conceptual model of tobacco industry political activity. METHODS AND FINDINGS We thematically analysed published papers included in two systematic reviews examining tobacco industry influence on taxation and marketing of tobacco; we included 45 of 46 papers in the former category and 20 of 48 papers in the latter (n = 65). We used a grounded theory approach to build taxonomies of "discursive" (argument-based) and "instrumental" (action-based) industry strategies and from these devised the Policy Dystopia Model, which shows that the industry, working through different constituencies, constructs a metanarrative to argue that proposed policies will lead to a dysfunctional future of policy failure and widely dispersed adverse social and economic consequences. Simultaneously, it uses diverse, interlocking insider and outsider instrumental strategies to disseminate this narrative and enhance its persuasiveness in order to secure its preferred policy outcomes. Limitations are that many papers were historical (some dating back to the 1970s) and focused on high-income regions. CONCLUSIONS The model provides an evidence-based, accessible way of understanding diverse corporate political strategies. It should enable public health actors and officials to preempt these strategies and develop realistic assessments of the industry's claims.
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Affiliation(s)
- Selda Ulucanlar
- Department for Health and UK Centre for Tobacco and Alcohol Studies (UKCTAS), University of Bath, Bath, United Kingdom
| | - Gary J. Fooks
- School of Languages and Social Sciences, Aston University, Birmingham, United Kingdom
| | - Anna B. Gilmore
- Department for Health and UK Centre for Tobacco and Alcohol Studies (UKCTAS), University of Bath, Bath, United Kingdom
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Lee K, Eckhardt J, Holden C. Tobacco industry globalization and global health governance: towards an interdisciplinary research agenda. PALGRAVE COMMUNICATIONS 2016; 2:16037. [PMID: 28458910 PMCID: PMC5409523 DOI: 10.1057/palcomms.2016.37] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 05/17/2016] [Indexed: 05/02/2023]
Abstract
Shifting patterns of tobacco production and consumption, and the resultant disease burden worldwide since the late twentieth century, prompted efforts to strengthen global health governance through adoption of the Framework Convention on Tobacco Control. While the treaty is rightfully considered an important achievement, to address a neglected public health issue through collective action, evidence suggests that tobacco industry globalization continues apace. In this article, we provide a systematic review of the public health literature and reveal definitional and measurement imprecision, ahistorical timeframes, transnational tobacco companies and the state as the primary units and levels of analysis, and a strong emphasis on agency as opposed to structural power. Drawing on the study of globalization in international political economy and business studies, we identify opportunities to expand analysis along each of these dimensions. We conclude that this expanded and interdisciplinary research agenda provides the potential for fuller understanding of the dual and dynamic relationship between the tobacco industry and globalization. Deeper analysis of how the industry has adapted to globalization over time, as well as how the industry has influenced the nature and trajectory of globalization, is essential for building effective global governance responses. This article is published as part of a thematic collection dedicated to global governance.
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Affiliation(s)
- Kelley Lee
- Simon Fraser University, Burnaby, Canada
| | | | - Chris Holden
- Department of Social Policy and Social Work, University of York, York, UK
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Viacava KR, Weydmann GJ, de Vasconcelos MF, Jaboinski J, Batista GD, de Almeida RMM, Bizarro L. It is pleasant and heavy: convergence of visual contents in tobacco, alcohol and food marketing in Brazil. Health Promot Int 2015; 31:674-83. [DOI: 10.1093/heapro/dav057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Petticrew M, Lee K, Ali H, Nakkash R. "Fighting a hurricane": tobacco industry efforts to counter the perceived threat of Islam. Am J Public Health 2015; 105:1086-93. [PMID: 25880961 DOI: 10.2105/ajph.2014.302494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Islamic countries are of key importance to transnational tobacco companies as growing markets with increasing smoking rates. We analyzed internal tobacco industry documents to assess the industry's response to rising concerns about tobacco use within Islamic countries. The tobacco industry perceived Islam as a significant threat to its expansion into these emerging markets. To counter these concerns, the industry framed antismoking views in Islamic countries as fundamentalist and fanatical and attempted to recruit Islamic consultants to portray smoking as acceptable. Tobacco industry lawyers also helped develop theological arguments in favor of smoking. These findings are valuable to researchers and policymakers seeking to implement culturally appropriate measures in Islamic countries under the World Health Organization Framework Convention on Tobacco Control.
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Affiliation(s)
- Mark Petticrew
- At the time of the study, Mark Petticrew was with the Social and Environmental Health Research Department, and Kelley Lee was with the Global Health Department, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK. Kelley Lee is also with the Faculty of Health Sciences, Simon Fraser University, Burnaby British Columbia, Canada. Rima Nakkash is with the Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon. Haider Ali is with the Department for Strategy and Marketing, Open University Business School, Milton Keynes, England
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Russell A, Wainwright M, Mamudu H. A Chilling Example? Uruguay, Philip Morris International, and WHO's Framework Convention on Tobacco Control. Med Anthropol Q 2014; 29:256-77. [DOI: 10.1111/maq.12141] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Hadii Mamudu
- Department of Health Services Management and Policy East Tennessee State University
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Katikireddi SV, Bond L, Hilton S. Changing policy framing as a deliberate strategy for public health advocacy: a qualitative policy case study of minimum unit pricing of alcohol. Milbank Q 2014; 92:250-83. [PMID: 24890247 PMCID: PMC4089371 DOI: 10.1111/1468-0009.12057] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
CONTEXT Scotland is the first country in the world to pass legislation introducing a minimum unit price (MUP) for alcohol in an attempt to reduce consumption and associated harms by increasing the price of the cheapest alcohol. We investigated the competing ways in which policy stakeholders presented the debate. We then established whether a change in framing helped explain the policy's emergence. METHODS We conducted a detailed policy case study through analysis of evidence submitted to the Scottish parliament, and in-depth, one-to-one interviews (n = 36) with politicians, civil servants, advocates, researchers, and industry representatives. FINDINGS Public- and voluntary-sector stakeholders tended to support MUP, while industry representatives were more divided. Two markedly different ways of presenting alcohol as a policy problem were evident. Critics of MUP (all of whom were related to industry) emphasized social disorder issues, particularly among young people, and hence argued for targeted approaches. In contrast, advocates for MUP (with the exception of those in industry) focused on alcohol as a health issue arising from overconsumption at a population level, thus suggesting that population-based interventions were necessary. Industry stakeholders favoring MUP adopted a hybrid framing, maintaining several aspects of the critical framing. Our interview data showed that public health advocates worked hard to redefine the policy issue by deliberately presenting a consistent alternative framing. CONCLUSIONS Framing alcohol policy as a broad, multisectoral, public health issue that requires a whole-population approach has been crucial to enabling policymakers to seriously consider MUP, and public health advocates intentionally presented alcohol policy in this way. This reframing helped prioritize public health considerations in the policy debate and represents a deliberate strategy for consideration by those advocating for policy change around the world and in other public health areas.
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Abstract
Ischemic heart disease (IHD) is the greatest single cause of mortality and loss of disability-adjusted life years worldwide, and a substantial portion of this burden falls on low- and middle-income countries (LMICs). Deaths from IHD and acute coronary syndrome (ACS) occur, on average, at younger ages in LMICs than in high-income countries, often at economically productive ages, and likewise frequently affect the poor within LMICs. Although data about ACS in LMICs are limited, there is a growing literature in this area and the research gaps are being steadily filled. In high-income countries, decades of investigation into the risk factors for ACS and development of behavioral programs, medications, interventional procedures, and guidelines have provided us with the tools to prevent and treat events. Although similar tools can be, and in fact have been, implemented in many LMICs, challenges remain in the development and implementation of cardiovascular health promotion activities across the entire life course, as well as in access to treatment for ACS and IHD. Intersectoral policy initiatives and global coordination are critical elements of ACS and IHD control strategies. Addressing the hurdles and scaling successful health promotion, clinical and policy efforts in LMICs are necessary to adequately address the global burden of ACS and IHD.
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Affiliation(s)
- Rajesh Vedanthan
- From the Department of Medicine, Division of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY (R.V., V.F.); Department of Biology and School of Medicine, Stanford University, Palo Alto, CA (B.S.); and Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.)
| | - Benjamin Seligman
- From the Department of Medicine, Division of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY (R.V., V.F.); Department of Biology and School of Medicine, Stanford University, Palo Alto, CA (B.S.); and Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.)
| | - Valentin Fuster
- From the Department of Medicine, Division of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY (R.V., V.F.); Department of Biology and School of Medicine, Stanford University, Palo Alto, CA (B.S.); and Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.).
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Lee K, Kamradt-Scott A. The multiple meanings of global health governance: a call for conceptual clarity. Global Health 2014; 10:28. [PMID: 24775919 PMCID: PMC4036464 DOI: 10.1186/1744-8603-10-28] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 02/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The term global health governance (GHG) is now widely used, with over one thousand works published in the scholarly literature, almost all since 2002. Amid this rapid growth there is considerable variation in how the term is defined and applied, generating confusion as to the boundaries of the subject, the perceived problems in practice, and the goals to be achieved through institutional reform. METHODOLOGY This paper is based on the results of a separate scoping study of peer reviewed GHG research from 1990 onwards which undertook keyword searches of public health and social science databases. Additional works, notably books, book chapters and scholarly articles, not currently indexed, were identified through Web of Science citation searches. After removing duplicates, book reviews, commentaries and editorials, we reviewed the remaining 250 scholarly works in terms of how the concept of GHG is applied. More specifically, we identify what is claimed as constituting GHG, how it is problematised, the institutional features of GHG, and what forms and functions are deemed ideal. RESULTS After examining the broader notion of global governance and increasingly ubiquitous term "global health", the paper identifies three ontological variations in GHG scholarship - the scope of institutional arrangements, strengths and weaknesses of existing institutions, and the ideal form and function of GHG. This has produced three common, yet distinct, meanings of GHG that have emerged - globalisation and health governance, global governance and health, and governance for global health. CONCLUSIONS There is a need to clarify ontological and definitional distinctions in GHG scholarship and practice, and be critically reflexive of their normative underpinnings. This will enable greater precision in describing existing institutional arrangements, as well as serve as a prerequisite for a fuller debate about the desired nature of GHG.
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Affiliation(s)
- Kelley Lee
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC V5S 1S6, Canada
| | - Adam Kamradt-Scott
- Centre for International Security Studies, Department of Government and International Relations, University of Sydney, Room 384, H04 Merewether Building, Sydney, NSW 2006, Australia
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A systematic review of barriers to and facilitators of the use of evidence by policymakers. BMC Health Serv Res 2014; 14:2. [PMID: 24383766 PMCID: PMC3909454 DOI: 10.1186/1472-6963-14-2] [Citation(s) in RCA: 545] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 12/20/2013] [Indexed: 11/29/2022] Open
Abstract
Background The gap between research and practice or policy is often described as a problem. To identify new barriers of and facilitators to the use of evidence by policymakers, and assess the state of research in this area, we updated a systematic review. Methods Systematic review. We searched online databases including Medline, Embase, SocSci Abstracts, CDS, DARE, Psychlit, Cochrane Library, NHSEED, HTA, PAIS, IBSS (Search dates: July 2000 - September 2012). Studies were included if they were primary research or systematic reviews about factors affecting the use of evidence in policy. Studies were coded to extract data on methods, topic, focus, results and population. Results 145 new studies were identified, of which over half were published after 2010. Thirteen systematic reviews were included. Compared with the original review, a much wider range of policy topics was found. Although still primarily in the health field, studies were also drawn from criminal justice, traffic policy, drug policy, and partnership working. The most frequently reported barriers to evidence uptake were poor access to good quality relevant research, and lack of timely research output. The most frequently reported facilitators were collaboration between researchers and policymakers, and improved relationships and skills. There is an increasing amount of research into new models of knowledge transfer, and evaluations of interventions such as knowledge brokerage. Conclusions Timely access to good quality and relevant research evidence, collaborations with policymakers and relationship- and skills-building with policymakers are reported to be the most important factors in influencing the use of evidence. Although investigations into the use of evidence have spread beyond the health field and into more countries, the main barriers and facilitators remained the same as in the earlier review. Few studies provide clear definitions of policy, evidence or policymaker. Nor are empirical data about policy processes or implementation of policy widely available. It is therefore difficult to describe the role of evidence and other factors influencing policy. Future research and policy priorities should aim to illuminate these concepts and processes, target the factors identified in this review, and consider new methods of overcoming the barriers described.
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35
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Oliver K, Innvar S, Lorenc T, Woodman J, Thomas J. A systematic review of barriers to and facilitators of the use of evidence by policymakers. BMC Health Serv Res 2014; 14:2. [PMID: 24383766 PMCID: PMC3909454 DOI: 10.1186/1472-6963-14-2#citeas] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 12/20/2013] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The gap between research and practice or policy is often described as a problem. To identify new barriers of and facilitators to the use of evidence by policymakers, and assess the state of research in this area, we updated a systematic review. METHODS Systematic review. We searched online databases including Medline, Embase, SocSci Abstracts, CDS, DARE, Psychlit, Cochrane Library, NHSEED, HTA, PAIS, IBSS (Search dates: July 2000 - September 2012). Studies were included if they were primary research or systematic reviews about factors affecting the use of evidence in policy. Studies were coded to extract data on methods, topic, focus, results and population. RESULTS 145 new studies were identified, of which over half were published after 2010. Thirteen systematic reviews were included. Compared with the original review, a much wider range of policy topics was found. Although still primarily in the health field, studies were also drawn from criminal justice, traffic policy, drug policy, and partnership working. The most frequently reported barriers to evidence uptake were poor access to good quality relevant research, and lack of timely research output. The most frequently reported facilitators were collaboration between researchers and policymakers, and improved relationships and skills. There is an increasing amount of research into new models of knowledge transfer, and evaluations of interventions such as knowledge brokerage. CONCLUSIONS Timely access to good quality and relevant research evidence, collaborations with policymakers and relationship- and skills-building with policymakers are reported to be the most important factors in influencing the use of evidence. Although investigations into the use of evidence have spread beyond the health field and into more countries, the main barriers and facilitators remained the same as in the earlier review. Few studies provide clear definitions of policy, evidence or policymaker. Nor are empirical data about policy processes or implementation of policy widely available. It is therefore difficult to describe the role of evidence and other factors influencing policy. Future research and policy priorities should aim to illuminate these concepts and processes, target the factors identified in this review, and consider new methods of overcoming the barriers described.
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Affiliation(s)
- Kathryn Oliver
- School of Social Sciences, University of Manchester, Bridgeford Street, M13 9PL Manchester, UK
| | - Simon Innvar
- Faculty of Social Sciences, Oslo University College, P.B. 4, St. Olavs Plass, NO-0130 Oslo, Norway
| | - Theo Lorenc
- Department of Science, Technology, Engineering, and Public Policy (UCL STEaPP), University College London, 66-72 Gower Street, London WC1E 6EA, UK
| | - Jenny Woodman
- MRC Centre of Epidemiology for Child Health, Institute of Child Health, London WC1N 1EH, UK
| | - James Thomas
- University of London, Institute of Education, 20 Bedford Way, London WC1H 0AL, UK
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Fooks GJ, Gilmore AB. Corporate philanthropy, political influence, and health policy. PLoS One 2013; 8:e80864. [PMID: 24312249 PMCID: PMC3842338 DOI: 10.1371/journal.pone.0080864] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 10/15/2013] [Indexed: 11/23/2022] Open
Abstract
Background The Framework Convention of Tobacco Control (FCTC) provides a basis for nation states to limit the political effects of tobacco industry philanthropy, yet progress in this area is limited. This paper aims to integrate the findings of previous studies on tobacco industry philanthropy with a new analysis of British American Tobacco's (BAT) record of charitable giving to develop a general model of corporate political philanthropy that can be used to facilitate implementation of the FCTC. Method Analysis of previously confidential industry documents, BAT social and stakeholder dialogue reports, and existing tobacco industry document studies on philanthropy. Results The analysis identified six broad ways in which tobacco companies have used philanthropy politically: developing constituencies to build support for policy positions and generate third party advocacy; weakening opposing political constituencies; facilitating access and building relationships with policymakers; creating direct leverage with policymakers by providing financial subsidies to specific projects; enhancing the donor's status as a source of credible information; and shaping the tobacco control agenda by shifting thinking on the importance of regulating the market environment for tobacco and the relative risks of smoking for population health. Contemporary BAT social and stakeholder reports contain numerous examples of charitable donations that are likely to be designed to shape the tobacco control agenda, secure access and build constituencies. Conclusions and Recommendations Tobacco companies' political use of charitable donations underlines the need for tobacco industry philanthropy to be restricted via full implementation of Articles 5.3 and 13 of the FCTC. The model of tobacco industry philanthropy developed in this study can be used by public health advocates to press for implementation of the FCTC and provides a basis for analysing the political effects of charitable giving in other industry sectors which have an impact on public health such as alcohol and food.
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Affiliation(s)
- Gary J. Fooks
- Department for Health, University of Bath, Bath, United Kingdom
- * E-mail:
| | - Anna B. Gilmore
- Department for Health, University of Bath, Bath, United Kingdom
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Fooks G, Gilmore A, Collin J, Holden C, Lee K. The Limits of Corporate Social Responsibility: Techniques of Neutralization, Stakeholder Management and Political CSR. JOURNAL OF BUSINESS ETHICS : JBE 2013; 112:283-299. [PMID: 23997379 PMCID: PMC3755635 DOI: 10.1007/s10551-012-1250-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 02/15/2012] [Indexed: 05/21/2023]
Abstract
Since scholarly interest in corporate social responsibility (CSR) has primarily focused on the synergies between social and economic performance, our understanding of how (and the conditions under which) companies use CSR to produce policy outcomes that work against public welfare has remained comparatively under-developed. In particular, little is known about how corporate decision-makers privately reconcile the conflicts between public and private interests, even though this is likely to be relevant to understanding the limitations of CSR as a means of aligning business activity with the broader public interest. This study addresses this issue using internal tobacco industry documents to explore British-American Tobacco's (BAT) thinking on CSR and its effects on the company's CSR Programme. The article presents a three-stage model of CSR development, based on Sykes and Matza's theory of techniques of neutralization, which links together: how BAT managers made sense of the company's declining political authority in the mid-1990s; how they subsequently justified the use of CSR as a tool of stakeholder management aimed at diffusing the political impact of public health advocates by breaking up political constituencies working towards evidence-based tobacco regulation; and how CSR works ideologically to shape stakeholders' perceptions of the relative merits of competing approaches to tobacco control. Our analysis has three implications for research and practice. First, it underlines the importance of approaching corporate managers' public comments on CSR critically and situating them in their economic, political and historical contexts. Second, it illustrates the importance of focusing on the political aims and effects of CSR. Third, by showing how CSR practices are used to stymie evidence-based government regulation, the article underlines the importance of highlighting and developing matrices to assess the negative social impacts of CSR.
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Affiliation(s)
- Gary Fooks
- Department of Health, University of Bath, Claverton Down, Bath, BA2 7AY UK
| | - Anna Gilmore
- Department of Health, University of Bath, Claverton Down, Bath, BA2 7AY UK
| | - Jeff Collin
- Global Health Policy, Centre for International Public Health Policy, School of Health in Social Science, University of Edinburgh, Medical Buildings, Teviot Place, Edinburgh, EH8 9AG UK
| | - Chris Holden
- Social Policy and Social Work, University of York, Heslington, York, YO10 5DD UK
| | - Kelley Lee
- Faculty of Health Sciences, Simon Fraser University, Room 11322, Blusson Hall, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
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