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Uddin S, Lu H, Alschner W, Patay D, Frank N, Gomes FS, Thow AM. An NLP-based novel approach for assessing national influence in clause dissemination across bilateral investment treaties. PLoS One 2024; 19:e0298380. [PMID: 38470902 PMCID: PMC10931470 DOI: 10.1371/journal.pone.0298380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/24/2024] [Indexed: 03/14/2024] Open
Abstract
International investment agreements (IIAs) promote foreign investment. However, they can undermine crucial health programs, creating a dilemma for governments between corporate and public health interests. For this reason, including clauses that safeguard health has become an essential practice in IIAs. According to the current literature, some countries have played a pivotal role in leading this inclusion, while others follow the former ones. However, the existing literature needs a unique approach that can quantify the influence strength of a country in disseminating clauses that explicitly mention health provisions to others. Following an NLP (Natural Language Processing)-based text similarity analysis of Bilateral Investment Treaties (BITs), this study proposes a metric, 'Influence' (INF), which provides insights into the role of different countries or regions in the propagation of IIA texts among BITs. We demonstrate a comprehensive application of this metric using a large agreement dataset. Our findings from this application corroborate the evidence in the current literature, supporting the validity of the proposed metric. According to the INF, Germany, Canada, and Brazil emerged as the most influential players in defensive, neutral, and offensive health mentions, respectively. These countries wield substantial bargaining power in international investment law and policy, and their innovative approaches to BITs set a path for others to follow. These countries provide crucial insights into the direction and sources of influence of international investment regulations to safeguard health. The proposed metric holds substantial usage for policymakers and investors. This can help them identify vital global countries in IIA text dissemination and create new policy guidelines to safeguard health while balancing economic development and public health protection. A software tool based on the proposed INF measure can be found at https://inftool.com/.
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Affiliation(s)
- Shahadat Uddin
- School of Project Management, Faculty of Engineering, The University of Sydney, Forest Lodge, Australia
| | - Haohui Lu
- School of Project Management, Faculty of Engineering, The University of Sydney, Forest Lodge, Australia
| | - Wolfgang Alschner
- Common Law Section, Faculty of Law, University of Ottawa, Ottawa, Canada
| | - Dori Patay
- Sydney School of Public Health, Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, The University of Sydney, Forest Lodge, Australia
| | - Nicholas Frank
- School of Regulation and Global Governance, Australian National University, Canberra, Australia
| | - Fabio S. Gomes
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization/World Health Organization, Washington DC, United States of America
| | - Anne Marie Thow
- Sydney School of Public Health, Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, The University of Sydney, Forest Lodge, Australia
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Ngqangashe Y, Phulkerd S, Schram A, Collin J, Schneider CH, Thow AM, Friel S. Inhibitors and Supporters of Policy Change in the Regulation of Unhealthy Food Marketing in Australia. Int J Health Policy Manag 2024. [PMID: 38618852 DOI: 10.34172/ijhpm.2024.7405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 02/12/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Evidence on the impact of policies that regulate unhealthy food marketing demonstrates a need for a shift from pure industry self-regulation toward statutory regulation. Institutional rules, decision-making procedures, actor practices and institutional norms influence the regulatory choices made by policymakers. This study examined institutional processes that sustain, support, or inhibit change in the food marketing regulation in Australia using the three pillars of institutions framework - regulatory, normative and cultural cognitive pillars. METHODS This was a qualitative study. Twenty-four in-depth semi-structured interviews were conducted with industry, government, civil society, and academic actors who are involved in nutrition policy in Australia. RESULTS The regulatory pillar was perceived to inhibit policy change through the co-regulation and self-regulation frameworks that assign rulemaking, monitoring and enforcement to industry bodies with minimal oversight by regulatory agencies and no involvement of health actors. The normative pillar was perceived to provide pathways for comprehensive statutory regulation through institutional goals and norms for collaboration that centre on a whole-of-government approach. The framing of food marketing policies to highlight the vulnerability of children is a cultural cognitive element that was perceived to be essential for getting support for policy change; however, there was a lack of shared understanding of food marketing as a policy issue. In addition, government ideologies that are perceived to be reluctant to regulate commercial actors and values that prioritize economic interest over public health make it difficult for health advocates to argue for statutory regulation of food marketing. CONCLUSION Elements of all three pillars (regulatory, normative and cultural-cognitive) were identified as either inhibitors or pathways that support policy change. This study contributes to the understanding of factors that inhibit policy change and potential pathways for implementing comprehensive statutory regulation of unhealthy food marketing.
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Affiliation(s)
- Yandisa Ngqangashe
- School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
| | - Sirinya Phulkerd
- Institute for Population and Social Research, Mahidol University, Salaya, Thailand
| | - Ashley Schram
- School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
| | - Jeff Collin
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Carmen Huckel Schneider
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Sharon Friel
- School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
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Reeve E, Bell C, Sacks G, Mounsey S, Waqa G, Peeters A, Thow AM. Lessons for strengthening policymaking for obesity and diet-related noncommunicable disease prevention: A narrative synthesis of policy literature from the Western Pacific Region. Obes Rev 2024; 25:e13651. [PMID: 37905309 DOI: 10.1111/obr.13651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/28/2023] [Accepted: 09/09/2023] [Indexed: 11/02/2023]
Abstract
Obesity and diet-related noncommunicable diseases (NCDs) have a profound impact on individuals, households, health care systems, and economies in low- and middle- income countries (LMICs), with the Western Pacific Region experiencing some of the highest impacts. Governments have committed to improving population diets; however, implementation challenges limit effective policy action. We undertook meta-narrative synthesis of the academic literature and used theories of policymaking and implementation to synthesize current knowledge of issues affecting the adoption and implementation of policies to prevent obesity and diet-related NCDs in LMICs in the Western Pacific Region. We found that political leadership and management of food and nutrition policies often diluted following policy adoption, and that nutrition and health advocates find it difficult to enforce policy compliance from actors outside their sectors. Opportunities for strengthening implementation of food and nutrition policies in the Western Pacific include (1) improved and earlier engagement between health policymakers and implementing agencies; (2) focusing on the need for increased accountability from governments, including through effective engagement and organization of actor networks, knowledge sharing, and in highlighting where stronger action is required; and (3) identifying and building the strategic capacities of policy actors in framing, advocacy, coalition-building, knowledge translation, and leadership.
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Affiliation(s)
- Erica Reeve
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Colin Bell
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Gary Sacks
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Sarah Mounsey
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Gade Waqa
- Pacific Research Centre for Prevention of Obesity and Non-Communicable Disease (C-POND), Fiji National University, Suva, Fiji
| | - Anna Peeters
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Tissaoui T, Davis T, Trevena H, Thow AM. Health policy implications of corporate social responsibility provisions in international investment agreements. Bull World Health Organ 2024; 102:94-104D. [PMID: 38313154 PMCID: PMC10835630 DOI: 10.2471/blt.23.290419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 02/06/2024] Open
Abstract
Objective To analyse and classify inclusions of corporate social responsibility in international investment agreements, especially inclusions with reference to public health. Method We extracted the text of international investment agreements containing corporate social responsibility inclusions from the Electronic Database of Investment Treaties. We conducted a documentary analysis of the corporate social responsibility inclusions, and we developed a typology categorizing inclusions based on level of detail and reference to international commitments. Findings Of the 3816 agreements signed as of October 2023, 127 agreements contain corporate social responsibility inclusions. Since the first inclusion of corporate social responsibility in 2008, the percentage of agreements containing such inclusion signed each year has steadily increased from 4.6% (4/86) in 2008 to 42.8% (21/49) in 2018 and 33.3% (3/9) in 2023. Using the typology we developed, we categorized the level of detail as follows: nine were minimal, 27 were low, 35 were low-medium, 107 were medium, 11 were medium-high and seven were high. Health is mentioned in 36 of these inclusions. Conclusion This analysis indicates that international investment agreements increasingly incorporate a high level of detail on expectations regarding investors' corporate social responsibility. Such provisions offer a potential tool to increase government guidance and accountability of global corporations, including with respect to governments' public health objectives.
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Affiliation(s)
- Takwa Tissaoui
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, The University of Sydney, Camperdown 2050, New South Wales, Australia
| | - Teresa Davis
- Discipline of Marketing, University of Sydney Business School, Sydney, Australia
| | - Helen Trevena
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, The University of Sydney, Camperdown 2050, New South Wales, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, The University of Sydney, Camperdown 2050, New South Wales, Australia
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Annan RA, Agyapong NAF, Thow AM, Swart EC. Background commentary on the Researching the Obesogenic Food Environment (ROFE) project. Public Health Nutr 2024; 27:e56. [PMID: 38229559 PMCID: PMC10882530 DOI: 10.1017/s136898002300280x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
OBJECTIVE The objective of this commentary is to provide an overview of the rationale and objectives of the Researching the Obesogenic Food Environment (ROFE) project that was conducted in Ghana and South Africa. DESIGN Narration has been used to describe the main objectives, phases as well as the methods used for the conduct of this project. SETTING The project described in this commentary was conducted in Khayelitsha and Mount Frere in South Africa and Ahodwo and Ejuratia for Ghana. PARTICIPANT Participants of the study described here include households in South Africa and Ghana, stakeholders and policymakers, and various actors within the food chain in both countries. RESULTS The ROFE findings provide a good understanding of the extent of the impact of the food environment on consumption, characteristics of value chains of healthy and unhealthy foods, as well as the potential for improved governance and policy that is relevant to the region. The supplement provides the opportunity to share the extensive findings of the ROFE project. Nine papers that describe the process and findings of the three phases of the ROFE project have been presented. Some of the papers focus on phases of the ROFE, while others cut across different phases and explore the linkages between the phases. Briefly descriptions of key findings of some of the papers in the supplement are provided. CONCLUSION Together, the findings of the ROFE study presented in this supplement have increased understanding of how communities in SA and Ghana interact with their food supplies and have led to identification of specific opportunities to improve food supply policies, in ways that create incentives for the production and consumption of healthy, relative to unhealthy foods.
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Affiliation(s)
- Reginald Adjetey Annan
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Nana Ama Frimpomaa Agyapong
- Department of Clinical Nutrition and Dietetics, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Anne Marie Thow
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW2006, Australia
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Madurawala S, Kiringoda K, Thow AM, Arunatilake N. Fiscal policies and regulations for healthy diets in Sri Lanka: an analysis of the political economy of taxation and traffic light labelling for sugar-sweetened beverages. Glob Health Action 2023; 16:2280339. [PMID: 38018465 PMCID: PMC10795608 DOI: 10.1080/16549716.2023.2280339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Unhealthy dietary patterns significantly contribute to rising non-communicable diseases (NCDs) in Sri Lanka. The government has implemented policy measures to promote healthy dietary patterns, including the traffic light labelling (TLL) system for sugar-sweetened beverages (SSBs) in 2016 and taxation on SSBs in 2017. OBJECTIVES To analyse how ideas, institutions, and power dynamics influence the formulation and implementation of these two interventions, and to identify strategies for public health actors to advocate for more effective food environment policies in Sri Lanka. METHODS This study drew on Kingdon's theory of agenda-setting and Campbell's institutionalist approach to develop the theoretical framework. We examined the political economy at the policy development and implementation stages, adopting a deductive framework approach for data collection and analysis. Data were collected from documents and key informants. RESULTS NCDs and nutrition are recognised and framed as important policy issues in health-sector policy documents, and the SSB tax and TLL system are seen as means of improving diets and health. Sri Lanka's commitment to addressing NCDs and nutrition-related issues is evident through these policies. The Ministry of Health led policy development, and key stakeholders were involved. However, there are opportunities to learn and strengthen policy in Sri Lanka and elsewhere. Limited involvement and commitment of some stakeholders in developing national policies, industry interferences, and other gaps resulted in weaker policy design. Gender considerations were also given minimal attention in policy formulation and implementation. CONCLUSIONS To enhance the effectiveness of the policies and regulations to promote healthy diets in Sri Lanka, comprehensive policy coverage, multistakeholder involvement and commitment to national policies, balanced power dynamics, technical feasibility, government commitment backed with high-level political support, awareness, and knowledge creation, managing industry interferences, integrating gender considerations are crucial factors.
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Affiliation(s)
- Sunimalee Madurawala
- Health, Education & Labour Department, Institute of Policy Studies of Sri Lanka, Colombo, Sri Lanka
| | - Kimuthu Kiringoda
- Health, Education & Labour Department, Institute of Policy Studies of Sri Lanka, Colombo, Sri Lanka
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, Australia
| | - Nisha Arunatilake
- Health, Education & Labour Department, Institute of Policy Studies of Sri Lanka, Colombo, Sri Lanka
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Thow AM, Phulkerd S, Ngqangashe Y, Ravuvu A, Zaruba L, Huckel Schneider C, Collin J, Schram A, Friel S. Protecting children from unhealthy food marketing: a comparative policy analysis in Australia, Fiji and Thailand. Health Promot Int 2023; 38:daad136. [PMID: 38011397 PMCID: PMC10681351 DOI: 10.1093/heapro/daad136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Restrictions on marketing of unhealthy foods and beverages to children is a globally recommended policy measure to improve diets and health. The aim of the analysis was to identify opportunities to enable policy learning and shift beliefs of relevant actors, to engender policy progress on restrictions on marketing of unhealthy foods to children. We drew on the Advocacy Coalition Framework to thematically analyse data from qualitative policy interviews conducted Australia (n = 24), Fiji (n = 10) and Thailand (n = 20). In all three countries two clear and opposing advocacy coalitions were evident within the policy subsystem related to regulation of unhealthy food marketing, which we termed the 'strengthen regulation' and 'minimal/self regulation' coalitions. Contributors to policy stasis on this issue were identified as tensions between public health and economic objectives of government, and limited formal and informal spaces for productive dialogue. The analysis also identified opportunities for policy learning that could enable policy progress on restrictions on marketing of unhealthy foods to children as: taking an incremental approach to policy change, defining permitted (rather than restricted) foods, investing in new public health expertise related to emerging marketing approaches and scaling up of monitoring of impacts. The insights from this study are likely to be relevant to many countries seeking to strengthen regulation of marketing to children, in response to recent global recommendations.
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Affiliation(s)
- Anne Marie Thow
- Faculty of Medicine and Health, Sydney School of Public Health, Menzies Centre for Health Policy and Economics, Charles Perkins Centre (D17), The University of Sydney, Sydney, NSW, 2006, Australia
| | - Sirinya Phulkerd
- Institute for Population and Social Research, Mahidol University, Phutthamonthon, Nakhon Pathom, Thailand
| | - Yandisa Ngqangashe
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Fellows Road, Australian National University, Canberra, ACT, 2600, Australia
| | - Amerita Ravuvu
- Non-Communicable Disease (NCD) Prevention and Control Programme, Public Health Division, Pacific Community (SPC), Private Mail Bag, Suva, Fiji
| | | | - Carmen Huckel Schneider
- Faculty of Medicine and Health, Sydney School of Public Health, Menzies Centre for Health Policy and Economics, Charles Perkins Centre (D17), The University of Sydney, Sydney, NSW, 2006, Australia
| | - Jeff Collin
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, Edinburgh, EH8 9YL, UK
| | - Ashley Schram
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Fellows Road, Australian National University, Canberra, ACT, 2600, Australia
| | - Sharon Friel
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Fellows Road, Australian National University, Canberra, ACT, 2600, Australia
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Farrell P, Bogard J, Thow AM, Boylan S, Johnson E, Tutuo J. Food price and availability in Solomon Islands during COVID-19: A food environment survey. Nutr Health 2023; 29:611-619. [PMID: 37365874 PMCID: PMC10293874 DOI: 10.1177/02601060231183592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Background: In Solomon Islands, the retail food environment is an important food source, for instance, the dominant source of fresh fruit and vegetables for urban consumers is open markets. The effects of COVID-19 mitigation measures (such as restriction of human movement and border closures) in early 2020 placed food security at risk in many parts of the community. Of particular concern was the risk of price gouging in an already price-sensitive market. Aims: The study aimed to provide rapid and policy-relevant information on the pricing of foods in the urban food environment in Solomon Islands in the context of the unfolding COVID-19 pandemic. Methods: A vendor survey was conducted in July to August 2020 and repeated in July 2021 using a survey tool that collected information on type, quantity, and price of food on offer. Findings: We found price reductions among the majority of fresh fruit and non-starchy vegetables available. A trend of rising prices was reported for some other commodities, such as fresh locally caught fish. Conclusion: Our findings highlight the impact of 'schocks to the system' on food prices as a potential barrier or enabler to consumption of fresh foods purchased from urban areas - an important finding in a price sensitive market. The survey design was successful in collecting pricing data from the retail food environment during a time of external 'shock to the system'. Our approach is applicable to other settings needing a rapid survey of the external food environment.
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Affiliation(s)
- Penny Farrell
- Menzies Centre for Health Policy and Economics, Charles Perkins Centre (D17), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Jessica Bogard
- Agriculture and Food, Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, Charles Perkins Centre (D17), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Sinead Boylan
- Agriculture and Food, Commonwealth Scientific and Industrial Research Organisation, Eveleigh, NSW, Australia
| | - Ellen Johnson
- Menzies Centre for Health Policy and Economics, Charles Perkins Centre (D17), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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Sackar SA, Apprey C, Aduku LNE, Thow AM, Annan R. Operationalising multi-sectoral food- and nutrition-related policies to curb the rise in obesity in Ghana. Public Health Nutr 2023; 26:3230-3238. [PMID: 36847129 PMCID: PMC10755410 DOI: 10.1017/s136898002300037x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 01/14/2023] [Accepted: 02/10/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To examine the governance of the food and nutrition policy space with particular reference to interests and power among stakeholders. DESIGN We followed a case study research design to conduct a nutrition policy analysis. We triangulated three sources of data: key-informant interviews, learning journey and relevant policy documents (2010-2020). This study is grounded in a conceptual framework focused on power. SETTING Ghana. PARTICIPANTS Key informants (n 28) drawn from policy stakeholders from government (Health, Agriculture, Trade and Industry), academia, civil society, development partners, civil society organisation (CSO) and private sector in Accra and Kumasi. RESULTS Power relations generated tensions, leading to weak multi-sectoral coordination among actors within the nutrition policy space. Governance and funding issues were identified as reasons for the weak multi-sectoral coordination. Formal power rested with government institutions while the private sector and CSO pushed to be invited during policy formulation. Visible stakeholders from industry were trade oriented and held a common interest of profit-making; they sought to receive support from government in order to be more competitive. There were no observed structures at the subnational levels for effective link with the national level. CONCLUSION Formal responsibility for decision making within the nutrition and food policy space rested with the health sector and bringing on board nutrition-related sectors remained a challenge due to power tensions. Establishing a National Nutrition Council, with structures at the subnational level, will strengthen policy coordination and implementation. Taxation of sugar-sweetened beverages could provide a fund generation avenue for coordination of programmes to curb obesity.
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Affiliation(s)
- Samuel Akwei Sackar
- Department of Dietetics, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, P.O. Box KB143, Accra, Ghana
| | - Charles Apprey
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Linda Nana Esi Aduku
- College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Reginald Annan
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Mukanu MM, Thow AM, Delobelle P, Mchiza ZJR. Mapping of food environment policies in Zambia: a qualitative document analysis. BMC Nutr 2023; 9:112. [PMID: 37784146 PMCID: PMC10544488 DOI: 10.1186/s40795-023-00766-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/08/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The food environment in which people exercise food choices significantly impacts their dietary patterns. Policies that limit the availability, affordability, and access to unhealthy food while increasing that of healthier alternatives help build healthy food environments, which are required to address the double burden of malnutrition. This study aimed to assess the availability of food environment policies in Zambia. METHOD We applied a two-step qualitative document analysis to identify policy content relating to healthy food environments from global and Zambia-specific nutrition-related policy documents. In the first step, global policy documents were analyzed to develop a reference point for globally recommended policies for healthy food environments. In the second step, Zambia's nutrition-related policies were analyzed to identify content relating to healthy food environments. The identified policy content was then mapped against the global reference point to identify food environment policy gaps. RESULTS Our analysis of global policy recommendations identified five broad categories of policy provisions: information and education based; regulatory and legislative tools; strategies to promote production and access to healthy food production; social protection-based strategies and guiding principles for governments relating to multisectoral collaboration and governance. Our analysis found that Zambian Government policy documents in the health, agriculture, education, and national planning and development sectors have policy provisions for healthy food environments. While these policy provisions generally covered all five reference categories, we found policy gaps in the regulatory and legislative tools category relative to global recommendations. CONCLUSION Zambia's food environment policy landscape must include globally recommended regulatory and legislative policy measures like restricting the marketing of unhealthy foods and non-alcoholic beverages to children. Nutrition policy reforms are required to facilitate the introduction of regulatory and legislative policy measures that effectively address the double burden of malnutrition in Zambia.
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Affiliation(s)
- Mulenga Mary Mukanu
- School of Public Health, University of the Western Cape, Bellville, 7535, South Africa.
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Peter Delobelle
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, 7700, South Africa
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Zandile June-Rose Mchiza
- School of Public Health, University of the Western Cape, Bellville, 7535, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, 7505, South Africa
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Reeve E, Ravuvu A, Johnson E, Nasiga S, Brewer T, Mounsey S, Thow AM. Scaling up food pricing policies in the Pacific: a guide to action. BMJ Glob Health 2023; 8:e012041. [PMID: 37813442 PMCID: PMC10565307 DOI: 10.1136/bmjgh-2023-012041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/21/2023] [Indexed: 10/13/2023] Open
Abstract
There are calls for governments around the world to adopt pricing policies, including taxes, subsidies and price controls that ensure all people have access to, and can afford, healthy diets. Despite the strong potential of pricing policies to promote healthy diets and to support a post-COVID-19 recovery, there are gaps in evidence with regard to 'how' to design and apply effective food taxes in practice, and countries report challenges in navigating the different policy options.In this practice piece, we examine the global evidence for food taxes with a view to identifying practical lessons for policy design, adoption and implementation, using the Pacific Islands Region as a case study. We present a systematic resource that draws on locally generated evidence, and a Pacific conceptualisation of healthy diets, to address considerations in setting the tax base, rate and mechanisms, and to ensure tax targets are clearly identifiable within national tax and administrative systems. Health and Finance collaboration at the country level could ensure tax design addresses concerns for the impacts of food taxes on employment, economics and equity, as well as position food taxes as an opportunity to fund revenue shortfalls faced by governments following the COVID-19 pandemic. We demonstrate a need to review other policies for consistency with national health objectives to ensure that countries avoid inadvertently undermining health taxes, for example, by ensuring that foods with known non-communicable disease risk are not being price protected or promoted.
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Affiliation(s)
- Erica Reeve
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Amerita Ravuvu
- Non-Communicable Disease (NCD) Prevention and Control Programme, Public Health Division, Pacific Community, Suva, Fiji
| | - Ellen Johnson
- Sydney School of Public Health, The University of Sydney Menzies Centre for Health Policy, Sydney, New South Wales, Australia
| | - Selai Nasiga
- Independent consultant, Commonwealth Secretariat, London, UK
| | - Tom Brewer
- Australian National Centre for Ocean Resources and Security, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sarah Mounsey
- Sydney School of Public Health, The University of Sydney Menzies Centre for Health Policy, Sydney, New South Wales, Australia
| | - Anne Marie Thow
- Sydney School of Public Health, The University of Sydney Menzies Centre for Health Policy, Sydney, New South Wales, Australia
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Mukanu MM, Mchiza ZJR, Delobelle P, Thow AM. Nutrition policy reforms to address the double burden of malnutrition in Zambia: a prospective policy analysis. Health Policy Plan 2023; 38:926-938. [PMID: 37452507 PMCID: PMC10506529 DOI: 10.1093/heapol/czad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 05/31/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023] Open
Abstract
The evolution of nutrition patterns in Zambia has resulted in the coexistence of undernutrition and overnutrition in the same population, the double burden of malnutrition. While Zambia has strong policies addressing undernutrition and stunting, these do not adequately address food environment drivers of the double burden of malnutrition and the adolescent age group and hence the need for nutrition policy reforms. We conducted a theory-based qualitative prospective policy analysis involving in-depth interviews with nutrition policy stakeholders and policy document review to examine the feasibility of introducing nutrition policy options that address the double burden of malnutrition among adolescents to identify barriers and facilitators to such policy reforms. Using the multiple streams theory, we categorized the barriers and facilitators to prospective policy reforms into those related to the problem, policy solutions and politics stream. The use of a life-course approach in nutrition programming could facilitate policy reforms, as adolescence is one of the critical invention points in a person's lifecycle. Another key facilitator of policy reform was the availability of institutional infrastructure that could be leveraged to deliver adolescent-focused policies. However, the lack of evidence on the burden and long-term impacts of adolescent nutrition problems, the food industry's strong influence over governments' policy agenda setting and the lack of public awareness to demand better nutrition were perceived as critical barriers to policy reforms. In addition, the use of the individual responsibility framing for nutrition problems was dominant among stakeholders. As a result, stakeholders did not perceive legislative nutrition policy options that effectively address food environment drivers of the double burden of malnutrition to be feasible for the Zambian context. Policy entrepreneurs are required to broker policy reforms that will get legislative policy options on the government's agenda as they can help raise public support and re-engineer the framing of nutrition problems and their solutions in Zambia.
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Affiliation(s)
- Mulenga Mary Mukanu
- School of Public Health, University of the Western Cape, Bellville, Cape Town 7535, South Africa
| | - Zandile June-Rose Mchiza
- School of Public Health, University of the Western Cape, Bellville, Cape Town 7535, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
| | - Peter Delobelle
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town 7700, South Africa
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, University of Sydney, Camperdown, NSW 2006, Australia
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Gilmore AB, Fabbri A, Baum F, Bertscher A, Bondy K, Chang HJ, Demaio S, Erzse A, Freudenberg N, Friel S, Hofman KJ, Johns P, Abdool Karim S, Lacy-Nichols J, de Carvalho CMP, Marten R, McKee M, Petticrew M, Robertson L, Tangcharoensathien V, Thow AM. Defining and conceptualising the commercial determinants of health. Lancet 2023; 401:1194-1213. [PMID: 36966782 DOI: 10.1016/s0140-6736(23)00013-2] [Citation(s) in RCA: 103] [Impact Index Per Article: 103.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 10/13/2022] [Accepted: 12/23/2022] [Indexed: 04/07/2023]
Abstract
Although commercial entities can contribute positively to health and society there is growing evidence that the products and practices of some commercial actors-notably the largest transnational corporations-are responsible for escalating rates of avoidable ill health, planetary damage, and social and health inequity; these problems are increasingly referred to as the commercial determinants of health. The climate emergency, the non-communicable disease epidemic, and that just four industry sectors (ie, tobacco, ultra-processed food, fossil fuel, and alcohol) already account for at least a third of global deaths illustrate the scale and huge economic cost of the problem. This paper, the first in a Series on the commercial determinants of health, explains how the shift towards market fundamentalism and increasingly powerful transnational corporations has created a pathological system in which commercial actors are increasingly enabled to cause harm and externalise the costs of doing so. Consequently, as harms to human and planetary health increase, commercial sector wealth and power increase, whereas the countervailing forces having to meet these costs (notably individuals, governments, and civil society organisations) become correspondingly impoverished and disempowered or captured by commercial interests. This power imbalance leads to policy inertia; although many policy solutions are available, they are not being implemented. Health harms are escalating, leaving health-care systems increasingly unable to cope. Governments can and must act to improve, rather than continue to threaten, the wellbeing of future generations, development, and economic growth.
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Affiliation(s)
| | - Alice Fabbri
- Department for Health, University of Bath, Bath, UK
| | - Fran Baum
- Stretton Health Institute, University of Adelaide, Adelaide, SA, Australia
| | | | - Krista Bondy
- Stirling Management School, University of Stirling, Stirling, UK
| | - Ha-Joon Chang
- Department of Economics, School of Oriental and African Studies University of London, London, UK
| | - Sandro Demaio
- Victorian Health Promotion Foundation, Melbourne, VIC, Australia
| | - Agnes Erzse
- South African Medical Research Council/Wits Centre for Health Economics and Decision Science, Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Nicholas Freudenberg
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Sharon Friel
- Menzies Centre for Health Governance, School of Regulation and Global Governance, The Australian National University, Acton, ACT, Australia
| | - Karen J Hofman
- South African Medical Research Council/Wits Centre for Health Economics and Decision Science, Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Paula Johns
- ACT Health Promotion, Rio de Janeiro, Brazil
| | - Safura Abdool Karim
- South African Medical Research Council/Wits Centre for Health Economics and Decision Science, Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Jennifer Lacy-Nichols
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | | | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Lindsay Robertson
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | | | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, University of Sydney, NSW, Australia
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Tekle DY, Rosewarne E, Santos JA, Trieu K, Buse K, Palu A, Thow AM, Jan S, Webster J. Do Food and Nutrition Policies in Ethiopia Support the Prevention of Non-Communicable Diseases through Population-Level Salt Reduction Measures? A Policy Content Analysis. Nutrients 2023; 15:nu15071745. [PMID: 37049585 PMCID: PMC10096844 DOI: 10.3390/nu15071745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
Introduction: Despite the importance of salt reduction to health outcomes, relevant policy adoption in Ethiopia has been slow, and dietary consumption of sodium remains relatively high. Aim: This analysis aims to understand the content and context of existing food-related policy, strategy, and guideline documents to identify gaps and potential opportunities for salt reduction in Ethiopia in the wider context of global evidence-informed best practice nutrition policy. Methods: Policy documents relevant to food and noncommunicable diseases (NCDs), published between 2010 and December 2021, were identified through searches of government websites supplemented with experts’ advice. Documentary analysis was conducted drawing on the ‘policy cube’ which incorporates three dimensions: (i) comprehensiveness of policy measures, which for this study included the extent to which the policy addressed the food-related WHO “Best Buys” for the prevention of NCDs; (ii) policy salience and implementation potential; and (iii) equity (including gender) and human rights orientation. Results: Thirty-two policy documents were retrieved from government ministries, of which 18 were deemed eligible for inclusion. A quarter of these documents address diet-related “Best Buys” through the promotion of healthy nutrition and decreasing consumption of excess sodium, sugar, saturated fat, and trans-fats. The remainder focuses on maternal and child health and micronutrient deficiencies. All documents lack detail relating to budget, monitoring and evaluation, equity, and rights. Conclusions: This review demonstrates that the Government of Ethiopia has established policy frameworks highlighting its intention to address NCDs, but that there is an opportunity to strengthen these frameworks to improve the implementation of salt reduction programs. This includes a more holistic approach, enhanced clarification of implementation responsibilities, stipulation of budgetary allocations, and promoting a greater focus on inequities in exposure to nutrition interventions across population groups. While the analysis has identified gaps in the policy frameworks, further qualitative research is needed to understand why these gaps exist and to identify ways to fill these gaps.
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Affiliation(s)
- Dejen Yemane Tekle
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
- School of Public Health, Mekelle University, Mekelle 1871, Ethiopia
| | - Emalie Rosewarne
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
| | - Joseph Alvin Santos
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
| | - Kathy Trieu
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
| | - Kent Buse
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
- The George Institute for Global Health, Imperial College London, London NW9 7PA, UK
| | - Aliyah Palu
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Stephen Jan
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
| | - Jacqui Webster
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
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Lencucha R, Kulenova A, Thow AM. Framing policy objectives in the sustainable development goals: hierarchy, balance, or transformation? Global Health 2023; 19:5. [PMID: 36691068 PMCID: PMC9869817 DOI: 10.1186/s12992-023-00909-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 01/19/2023] [Indexed: 01/25/2023] Open
Abstract
Society continues to be confronted with the deep inadequacies of the current global order. Rampant income inequality between and within countries, dramatic disparities in access to resources, as seen during the COVID pandemic, persistent degradation of the environment, and numerous other problems are tied to existing systems of economy and government. Current global economic systems are implicated in perpetuating these problems. The Sustainable Development Goals (SDGs) were born out of the recognition that dramatic changes were needed to address these intersecting challenges. There is general recognition that transformation of global systems and the relationship between sectors is needed. We conduct a structured, theoretically-informed analysis of SDG documents produced by United Nations agencies with the aim of examining the framing of economic policy goals, a historically dominant domain of consideration in development policy, in relation to health, social and environmental goals. We apply a novel typology to categorize the framing of policy goals. This analysis identified that the formal discourse associated with the SDGs marks a notable change from the pre-SDG development discourse. The 'transformational' agenda issued in the SDG documents is in part situated in relation to a critique of previous and existing approaches to development that privilege economic goals over health, social and environmental goals, and position economic policy as the solution to societal concerns. At the same time, we find that there is tension between the aspiration of transformation and an overwhelming focus on economic goals. This work has implications for health governance, where we find that health goals are still often framed as a means to achieve economic policy goals. Health scholars and advocates can draw from our analysis to critically examine how health fits within the transformational development agenda and how sectoral policy goals can move beyond a crude emphasis on economic growth.
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Affiliation(s)
- Raphael Lencucha
- grid.14709.3b0000 0004 1936 8649Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Hosmer House, 3654 prom Sir-William-Osler, Montréal, Québec H3G 1Y5 Canada
| | - Alua Kulenova
- grid.14709.3b0000 0004 1936 8649Faculty of Medicine and Health Sciences, Family Medicine, McGill University, Montreal, Canada
| | - Anne Marie Thow
- grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, Australia
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Chiu K, Thow AM, Bero L. Understanding the Dynamics of More Restrictive Medicines Policy: A Case Study of Codeine Up-Scheduling in Australia. Int J Health Policy Manag 2022; 12:6872. [PMID: 37579455 PMCID: PMC10125097 DOI: 10.34172/ijhpm.2022.6872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/19/2022] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND There has been increasing concern over opioid-related harms across the world. In Australia in 2018, codeine-containing products were up-scheduled from over-the-counter access at pharmacies, to requiring a prescription. The drug regulator's decision to up-schedule was contentious and widely debated, due to the potentially large impact on consumers and healthcare professionals. This study aimed to analyse influences on the codeine up-scheduling policy. METHODS This retrospective policy analysis used the Advocacy Coalition Framework (ACF) to understand how policy actors with shared beliefs formed adversarial coalitions to shape policy. Data were drawn from documents (regulator policy documents, public submissions, news reports, organisational media releases and position statements) and semi-structured interviews with 15 key policy actors. Codes were generated relating to policy processes and actor beliefs; broad themes included the role of health professionals, perceptions of opioids, impact on consumers, and the role of government in healthcare. RESULTS Two coalitions in this policy subsystem were identified: (1) supportive [with respect to the up-scheduling], and (2) opposing. The key evident beliefs of the supportive coalition were that the harms of codeine outweighed the benefits, and that government regulation was the best pathway for protecting consumers. The opposing coalition believed that the benefits of codeine accessible through pharmacists outweighed any harms, and consumers should manage their health without any more intervention than necessary. The policy decision reflected the influence of the supportive coalition, and this analysis highlighted the importance of their public health framing of the issue, the acceptability of their experts and supporting evidence, and the perceived legitimacy of the up-scheduling process. CONCLUSION Understanding these coalitions, their beliefs, and how they are translated through existing policy processes and institutions provides insight for those interested in influencing future health policy. Specific lessons include the importance of strategic frames and advocacy, and engagement with formal policy processes.
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Affiliation(s)
- Kellia Chiu
- School of Pharmacy, Faculty of Medicine and Health & Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health & Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Lisa Bero
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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17
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McKenzie BL, Waqa G, Mounsey S, Johnson C, Woodward M, Buse K, Thow AM, McLean R, Webster J. Incorporating a gender lens into nutrition and health-related policies in Fiji: analysis of policies and stakeholder perspectives. Int J Equity Health 2022; 21:148. [PMID: 36242079 PMCID: PMC9569111 DOI: 10.1186/s12939-022-01745-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 09/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background Gender equality, zero hunger and healthy lives and well-being for all, are three of the Sustainable Development Goals (SDGs) that underpin Fiji’s National Development Plan. Work towards each of these goals contributes to the reduction of non-communicable diseases (NCDs). There are gender differences in NCD burden in Fiji. It is, however, unclear whether a gender lens could be more effectively included in nutrition and health-related policies. Methods This study consisted of three components: (i) a policy content analysis of gender inclusion in nutrition and health-related policies (n = 11); (ii) policy analysis using the WHO Gender Analysis tool to identify opportunities for strengthening future policy; and (iii) informant interviews (n = 18), to understand perceptions of the prospects for gender considerations in future policies. Results Gender equality was a goal in seven policies (64%); however, most focused on women of reproductive age. One of the policies was ranked as gender responsive. Main themes from key informant interviews were: 1) a needs-based approach for the focus on specific population groups in policies; 2) gender-related roles and responsibilities around nutrition and health; 3) what is considered “equitable” when it comes to gender, nutrition, and health; 4) current considerations of gender in policies and ideas for further gender inclusion; and 5) barriers and enablers to the inclusion of gender considerations in policies. Informants acknowledged gender differences in the burden of nutrition-related NCDs, yet most did not identify a need for stronger inclusion of gender considerations within policies. Conclusions There is considerable scope for greater inclusion of gender in nutrition and health-related policies in Fiji. This could be done by: 1) framing gender considerations in ways that are actionable and inclusive of a range of gender identities; 2) undertaking advocacy through actor networks to highlight the need for gender-responsive nutrition and health-related policies for key stakeholder groups; 3) ensuring that data collected to monitor policy implementation is disaggregated by sex and genders; and 4) promoting equitable participation in nutrition related issues in communities and governance processes. Action on these four areas are likely critical enablers to more gender equitable NCD reduction in Fiji.
Supplementary Information The online version contains supplementary material available at 10.1186/s12939-022-01745-x.
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Affiliation(s)
- Briar L McKenzie
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, NSW, 2042, Australia.
| | - Gade Waqa
- C-POND, Fiji National University, Suva, Fiji
| | - Sarah Mounsey
- Menzies Centre for Health Policy and Economics, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Claire Johnson
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, NSW, 2042, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, NSW, 2042, Australia.,The George Institute for Global Health, Imperial College London, London, UK
| | - Kent Buse
- The George Institute for Global Health, Imperial College London, London, UK
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Rachael McLean
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, NSW, 2042, Australia
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Phulkerd S, Collin J, Ngqangashe Y, Thow AM, Schram A, Huckel Schneider C, Friel S. How commercial actors used different types of power to influence policy on restricting food marketing: a qualitative study with policy actors in Thailand. BMJ Open 2022; 12:e063539. [PMID: 36229148 PMCID: PMC9562312 DOI: 10.1136/bmjopen-2022-063539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES There is limited research focused explicitly on understanding how commercial actors use different forms of power to influence policy decision making in Thailand. This study aimed to identify how the food industry has used structural, instrumental and discursive power to influence policy on restricting food marketing in Thailand. STUDY DESIGN Qualitative study using in-depth semistructured interviews SETTINGS: Thailand. PARTICIPANTS The interviews were conducted with 20 participants (of a total of 29 invited actors) from government, civil society, technical experts, international organisation and the food and advertising industry. Interview data were identified in the transcripts and analysed using abductive methods. RESULTS Non-commercial actors perceived the commercial actors' structural power (its economic influence and structurally privileged position) as central to understanding the government having not implemented policy to restrict food marketing. The commercial actors' instrumental power was observed through sponsorship, campaign and lobbying activities. Discursive power was used by the industry to shift responsibility away from the food companies and onto their customers, by focusing their messaging on freedom of consumer choice and consumer health literacy. CONCLUSIONS This study examined different types of power that commercial actors were perceived to use to influence policy to restrict food marketing in Thailand. The study showed arguments and institutional processes used to enhance commercial actors' ability to shape the policy decision for nutrition, public opinion and the broader regulatory environment. The findings help governments and other stakeholders to anticipate industry efforts to counter policy. The findings also suggest the need for governance structures that counter industry power, including comprehensive monitoring and enforcement in policy implementation.
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Affiliation(s)
- Sirinya Phulkerd
- Institute for Population and Social Research, Mahidol University, Salaya, Thailand
| | - Jeff Collin
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Yandisa Ngqangashe
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ashley Schram
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Carmen Huckel Schneider
- Menzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sharon Friel
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
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Siu E, Thow AM. Linking health and finance ministries to improve taxes on unhealthy products. Bull World Health Organ 2022; 100:570-577. [PMID: 36062244 PMCID: PMC9421554 DOI: 10.2471/blt.22.288104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 11/27/2022] Open
Abstract
The World Health Organization recommends economic measures such as taxes on tobacco, alcohol and unhealthy foods and beverages as part of a comprehensive strategy for prevention of noncommunicable diseases. However, progress in adopting these so-called health taxes has been hampered, in part, by different approaches and perceptions of key issues in different sectors of government. Health promotion is the responsibility of health policy-makers, while taxation is the mandate of finance ministries. Thus, strengthening cooperation between health and finance policy-makers is central to the successful adoption and implementation of effective health taxes. In this paper we identify the shared concerns of finance and health policy-makers about health taxes with the aim of enabling more effective cross-sector cooperation towards both additional financing for health systems and changes in unhealthy behaviours. For example, new approaches to supporting health taxation include the growing priority for health-system financing due to the growing burden of noncommunicable diseases, and the need to address the health and economic damage due to the coronavirus disease 2019 pandemic. As a result, high-level efforts to achieve progress on health taxes are gaining momentum and represent important progress towards using the combined expertise of health and finance policy-makers.
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Affiliation(s)
- Erika Siu
- Institute for Health Research and Policy, University of Illinois Chicago, 1747 West Roosevelt Road, Chicago, Illinois, 60608, United States of America
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, Australia
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Mounsey S, Waqa G, McKenzie B, Reeve E, Webster J, Bell C, Thow AM. Strengthening implementation of diet-related non-communicable disease prevention strategies in Fiji: a qualitative policy landscape analysis. Global Health 2022; 18:79. [PMID: 36050736 PMCID: PMC9434519 DOI: 10.1186/s12992-022-00859-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Noncommunicable diseases (NCDs) are the leading cause of death globally, and the World Health Organization (WHO) has recommended a comprehensive policy package for their prevention and control. However, implementing robust, best-practice policies remains a global challenge. In Fiji, despite political commitment to reducing the health and economic costs of NCDs, prevalence of diabetes and cardiovascular disease remain the highest in the region. The objective of this study was to describe the political and policy context for preventing diet-related NCDs in Fiji and policy alignment with WHO recommendations and global targets. We used a case study methodology and conducted (1) semi-structured key informant interviews with stakeholders relevant to diet-related NCD policy in Fiji (n = 18), (2) documentary policy analysis using policy theoretical frameworks (n = 11), (3) documentary stakeholder analysis (n = 7), and (4) corporate political activity analysis of Fiji’s food and beverage industry (n = 12). Data were sourced through publicly available documents on government websites, internet searches and via in-country colleagues and analysed thematically. Results Opportunities to strengthen and scale-up NCD policies in Fiji in line with WHO recommendations included (1) strengthening multisectoral policy engagement, (2) ensuring a nutrition- and health-in-all policy approach, (3) using a whole-of-society approach to tighten political action across sectors, and (4) identifying and countering food industry influence. Conclusion Diet-related NCD policy in Fiji will be strengthened with clearly defined partner roles, responsibilities and accountability mechanisms, clear budget allocation and strong institutional governance structures that can support and counter industry influence. Such initiatives will be needed to reduce the NCD burden in Fiji. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-022-00859-9.
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Affiliation(s)
- Sarah Mounsey
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, City Road, Sydney, NSW, 2006, Australia.
| | - Gade Waqa
- Fiji National University, Suva, Fiji
| | - Briar McKenzie
- The George Institute, City Road, Newtown, NSW, Australia
| | | | - Jacqui Webster
- The George Institute, City Road, Newtown, NSW, Australia
| | - Colin Bell
- School of Medicine and Global Obesity Centre, Geelong Waurn Ponds Campus, Deakin University, Melbourne, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, City Road, Sydney, NSW, 2006, Australia
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21
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Mukanu MM, Delobelle P, Thow AM, Mchiza ZJR. Determinants of dietary patterns in school going adolescents in Urban Zambia. Front Nutr 2022; 9:956109. [PMID: 36091242 PMCID: PMC9452662 DOI: 10.3389/fnut.2022.956109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Understanding dietary patterns in a population is critical for decision making. This study aimed to identify the prevailing dietary patterns and their associated individual and school environment factors among school going adolescents in Lusaka, Zambia. Method A cross-sectional study involving 404 Grade 10 pupils from 10 secondary schools in Lusaka district was conducted. A 108-item unquantified Food Frequency Questionnaire (FFQ) was used to assess the learner's food intake practices. Principal component analysis (PCA) was used to derive dietary patterns from the 108 food items. In addition, a mapping of food vendors and types of food sold was conducted in the same 10 schools using a semi-structured observation checklist. Bivariate and multivariate multilevel regression was used to analyse the individual and school level determinants of the adolescent dietary patterns. Results The average age of learners was 16.1 years (SD 1.4 years); 234 (58%) were female while 170 (42%) male. “Snacking,” “vegetarian,” “health conscious,” and “traditional” dietary patterns accounting for 54.5% of variability in learner's diets were identified using PCA. At individual level, having weekly pocket money was significantly associated with snacking (p ≤ 0.0001). Self-identified poverty was associated with snacking (p ≤ 0.0001), vegetarian (p = 0.009) and traditional (p = 0.009) dietary patterns. School level factors like a school tuckshop (similar to canteen) that sells fast foods or a kantemba (semi-permanent makeshift store) within the school vicinity (p = 0.023) were significantly associated with a snacking dietary pattern. School tuckshop selling nshima (a thick maize based porridge) was significantly associated with vegetarian (p = 0.007), health conscious (p = 0.02) and traditional dietary patterns (p=0.01) while a tuckshop with fruit significantly predicted traditional (p ≤ 0.0001), vegetarian (p = 0.041), and snacking (p = 0.002), dietary patterns. Having a supermarket or fast food restaurants in the school vicinity did not significantly influence any dietary pattern. Conclusion Both individual behavioral and school environment level factors were found to be significant determinants of the four dietary patterns identified in this study.
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Affiliation(s)
- Mulenga Mary Mukanu
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- *Correspondence: Mulenga Mary Mukanu
| | - Peter Delobelle
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
- Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, University of Sydney, Camperdown, NSW, Australia
| | - Zandile June-Rose Mchiza
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
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Chiu K, Thow AM, Bero L. The tension between national consistency and jurisdictional professional expansion: The case of pharmacist-administered vaccinations. Res Social Adm Pharm 2022; 18:3782-3791. [PMID: 35537904 PMCID: PMC9057933 DOI: 10.1016/j.sapharm.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
Abstract
Background The COVID-19 pandemic has highlighted the importance of coordinating policies on vaccinations at the national level. In Australia, the regulation and management of pharmacist-administered vaccination programs are the responsibility of each of the eight jurisdictions (six states and two territories), and have been developed independently of each other, leading to substantial variation. Consequently, there are variations regarding which vaccines pharmacists can administer, the minimum age, and whether these vaccines are publicly funded. Objective(s) To identify opportunities for a nationally consistent approach to pharmacist-administered vaccinations in Australia. Methods This policy analysis used the Multiple Streams Framework to identify barriers and enablers within the three “streams” of problem, policy, and politics, and how they affected the development of a national approach. Data were drawn from semi-structured interviews with 13 key policy actors and documents (pre-budget submissions and parliamentary inquiry reports). Themes were generated around actor interests, current and proposed pharmacist vaccination programs, and policymaking processes. Results From the pharmacy sector, there was little clarity around the need for a nationally consistent approach. This issue was linked to their ultimate goal of expanding pharmacist vaccination programs; it was seen as a means for states/territories with smaller programs to ‘catch up’ to other jurisdictions. There was also no unified policy approach from this sector; additionally, decision-makers within jurisdictional health departments faced different service delivery models, policy priorities, agendas, and policy actor relationships. Lastly, there was no federal body that had the capacity to coordinate a national approach. Possible enablers include refining the problem definition and re-framing it to a patient-centric model. Conclusions Coordination of vaccination policies is an ongoing policy issue with implications for pharmacist vaccination programs and other health policy areas in which a national approach is being considered. This analysis provides insight into how this may be developed in the future.
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Thow AM, Garde A, Winters LA, Johnson E, Mabhala A, Kingston P, Barlow P. Protecting noncommunicable disease prevention policy in trade and investment agreements. Bull World Health Organ 2022; 100:268-275. [PMID: 35386551 PMCID: PMC8958824 DOI: 10.2471/blt.21.287395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 11/27/2022] Open
Abstract
Preventing noncommunicable diseases is a global priority, for which the World Health Organization has recommended policies to reduce the consumption of tobacco products, alcohol and unhealthy foods. However, regulation has been strongly opposed by affected industries, who have invoked the provisions of legally binding trade and investment agreements. The aim of this analysis of the legal, economic and public health literature was to present a short primer on the relationship between noncommunicable disease prevention policy and trade and investment agreements to help public health policy-makers safeguard public health policies. The analysis identified opportunities for protecting, and even promoting, public health in trade and investment agreements, including: (i) ensuring exceptions for public health measures are included in agreements; (ii) committing to good regulatory practice that balances transparency and cooperation with the need for governments to limit the influence of vested interests; (iii) ensuring trade and investment agreement preambles acknowledge the importance of public health; (iv) excluding investor-state dispute settlement mechanisms from agreements; and (v) limiting the scope and definition of key provisions on investor protection to reduce the risk of investment disputes. This synthesis of the multidisciplinary literature also provides support for greater strategic and informed engagement between the health and trade policy sectors. In addition, ensuring a high level of health protection in trade and investment agreements requires cooperation between disciplines, engagement with experts in law, economics and public health policy, and fully transparent policy processes and governance structures.
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Affiliation(s)
- Anne Marie Thow
- Menzies Centre for Health Policy and Economics, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW 2006, Australia
| | - Amandine Garde
- School of Law and Social Justice, University of Liverpool, Liverpool, England
| | - L Alan Winters
- Department of Economics, University of Sussex, Sussex, England
| | - Ellen Johnson
- Menzies Centre for Health Policy and Economics, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW 2006, Australia
| | - Andi Mabhala
- Faculty of Health and Social Care, University of Chester, Chester, England
| | - Paul Kingston
- Faculty of Health and Social Care, University of Chester, Chester, England
| | - Pepita Barlow
- Department of Health Policy, London School of Economics and Political Science, London, England
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Chiu K, Thow AM, Bero L. “Never waste a good crisis”: Opportunities and constraints from the COVID-19 pandemic on pharmacists’ scope of practice. Res Social Adm Pharm 2022; 18:3638-3648. [PMID: 35414485 PMCID: PMC8985421 DOI: 10.1016/j.sapharm.2022.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/13/2022] [Accepted: 03/31/2022] [Indexed: 12/02/2022]
Abstract
Background In response to the COVID-19 pandemic, many pharmacy-based or pharmacist-delivered services were introduced or amended to mitigate the pandemic's health and social impact. This happened within the context of pharmacists seeking more opportunities to increase their clinical responsibilities and play a larger role in primary care. Objective(s): To analyse the policymaking context and pharmacy responses to COVID-19 that enable or constrain the expansion of pharmacists’ scope of practice. Methods This study is a policy analysis of documentary data detailing changes in pharmacy policy in Australia, drawing on a “policy space analysis” framework to identify opportunities and constraints to policy reform. Data were collected from news for health professionals; federal/jurisdictional legislation and media releases; and guidelines and directives from government health departments and agencies. Changes to pharmacy practice were identified and classified according to type. For each change, potential opportunities and constraints for expanding pharmacists’ scope of practice were identified. Results Four categories of changes were identified: medicines limits/restrictions; alternatives to paper prescriptions; public health measures; and community pharmacist-delivered services. Opportunities from the pandemic response that could expand scope of practice include the potential permanence of temporary measures that increase pharmacists' responsibilities; remuneration to legitimise services; political acknowledgement of medicines safety and access as a priority; and government need to quickly address crises. Constraints include the potential permanence of temporary measures that restrict pharmacists’ practice; negative perceptions of pharmacists from other clinicians; intra-professional disagreements regarding pharmacy-based services; and lack of pharmacist representation in institutional structures. Conclusions This analysis demonstrates that the pandemic responses and policy context may facilitate expansion of pharmacists’ scope of practice, and identifies possible avenues to do so; it also highlights constraints that need to be further addressed to achieve this goal.
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Affiliation(s)
- Kellia Chiu
- School of Pharmacy, Faculty of Medicine and Health & Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health & Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Lisa Bero
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Mounsey S, Vaka AK, Cama T, Waqa G, McKenzie B, Thow AM. Strengthening Sugar-Sweetened Beverage Taxation for Non-Communicable Disease Prevention: A Comparative Political Economy Analysis Case Study of Fiji and Tonga. Nutrients 2022; 14:nu14061212. [PMID: 35334867 PMCID: PMC8949109 DOI: 10.3390/nu14061212] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 01/27/2023] Open
Abstract
Diet-related fiscal policy is an effective NCD prevention strategy. However, current sugar-sweetened beverage (SSB) taxes in Fiji and Tonga have not had the desired effect; SSB consumption in Fiji, for example, contributes to mortality more than double the global rates and is highest in the WHO Western Pacific Region. We therefore aimed to better understand the perceived underlying political economy drivers that have and continue to affect change in each country. Our study design utilised a comparative case study that triangulated documentary policy and stakeholder analysis with semi-structured stakeholder interviews in both countries and an in-depth corporate political activity analysis in Fiji. We drew on theoretical frameworks relevant to political economy to collect and analyse policy and stakeholder data, and utilised established corporate political activity frameworks to analyse industry activity. Common findings to both Fiji and Tonga suggested that the SSB tax impact could be increased through multisectoral engagement, embracing a whole-of-society approach, strengthened institutional structures and leveraging off competing priorities across sectors towards more common goals. These findings provide opportunities and lessons for Fiji and Tonga as well as other similar settings seeking to strengthen or upscale the impact of diet-related fiscal policy.
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Affiliation(s)
- Sarah Mounsey
- Menzies Centre for Health Policy and Economics, School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia;
- Correspondence: ; Tel.: +44-741-598-1365
| | - Aspasia Katrina Vaka
- Queen Salote Institute of Nursing and Allied Health, Ministry of Health, Vaiola Hospital, Nuku’alofa, Tonga; (A.K.V.); (T.C.)
| | - Tilema Cama
- Queen Salote Institute of Nursing and Allied Health, Ministry of Health, Vaiola Hospital, Nuku’alofa, Tonga; (A.K.V.); (T.C.)
| | - Gade Waqa
- Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases (C-POND), Fiji National University, Tamavua Campus, Suva, Fiji;
| | - Briar McKenzie
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia;
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia;
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26
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Mulcahy G, Boelsen-Robinson T, Hart AC, Pesantes MA, Sameeha MJ, Phulkerd S, Alsukait RF, Thow AM. A Comparative Policy Analysis of the Adoption and Implementation of Sugar-Sweetened Beverage Taxes (2016-2019) in 16 Countries. Health Policy Plan 2022; 37:543-564. [PMID: 35244693 PMCID: PMC9113088 DOI: 10.1093/heapol/czac004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 12/23/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
Taxes on sugar-sweetened beverages (SSBs) are recommended as part of comprehensive policy action to prevent diet-related non-communicable diseases (NCDs), but have been adopted by only one quarter of World Health Organization (WHO) Member States. This paper presents a comparative policy analysis of recent SSB taxes (2016–19) in 16 countries. This study aimed to analyse the characteristics and patterns of factors influencing adoption and implementation of SSB taxes and policy learning between countries, to draw lessons for future SSB taxes. The data collection and analysis were informed by an analytical framework that drew on ‘diffusion of innovation’ and theories of policy learning. Qualitative data were collected from policy documents and media, in addition to national statistics. Qualitative data were thematically analysed and a narrative synthesis approach was used for integrated case study analysis. We found adaptation and heterogeneity in the approaches used for SSB taxation with a majority of countries adopting excise taxes, and consistent health framing in media and policy documents. Common public frames supporting the taxes included reducing obesity/NCDs and raising revenue (government actors) and subsequent health system savings (non-government actors). Opposing frames focused on regressivity and incoherence with other economic policy (government actors) and posited that taxes have limited health benefits and negative economic impacts on the food industry (industry). Evident ‘diffusion networks’ included the WHO, predominantly in middle-income countries, and some regional economic bodies. We found indications of policy learning in the form of reference to other countries’ taxes, particularly countries with membership in the same economic bodies and with shared borders. The study suggests that adoption of SSB taxation could be enhanced through strategic engagement by health actors with the policy-making process, consideration of the economic context, use of consistent health frames by cross-sector coalitions, and robust evaluation and reporting of SSB taxation.
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Affiliation(s)
- Georgina Mulcahy
- Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Australia
| | - Tara Boelsen-Robinson
- Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Australia.,Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | | | - Maria Amalia Pesantes
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Peru.,Department of Anthropology and Archaeology, Dickinson College, USA
| | - Mohd Jamil Sameeha
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Sirinya Phulkerd
- Institute for Population and Social Research, Mahidol University, Thailand
| | - Reem F Alsukait
- Department of Community Health Sciences, King Saud University, Saudi Arabia
| | - Anne Marie Thow
- Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Australia
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27
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Andrew NL, Allison EH, Brewer T, Connell J, Eriksson H, Eurich JG, Farmery A, Gephart JA, Golden CD, Herrero M, Mapusua K, Seto KL, Sharp MK, Thornton P, Thow AM, Tutuo J. Continuity and change in the contemporary Pacific food system. Global Food Security 2022. [DOI: 10.1016/j.gfs.2021.100608] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Background Sugar-sweetened beverage (SSB) taxes are recommended globally as part of measures to prevent diet-related NCDs. However, their uptake in the World Health Organization (WHO) European Region has been limited. The aim of this study was to inform strategic, cross-sectoral, public health policy engagement to support the uptake and effective implementation of SSB taxation. Methods We conducted a policy analysis of SSB taxes in the WHO European Region, drawing on theories of policy making and diffusion of innovation. Data were collected from policy documents and media, secondary contextual sources and qualitative interview data (n = 20) to analyze factors influencing the adoption of taxes in 10 countries. Results Belgium, Finland, France, Hungary, Ireland, Latvia, Monaco, Norway, Portugal and the UK had current SSB taxes, but Monaco was excluded from the findings due to its unique taxation context. All countries were characterized by policy priority for NCD prevention, and in many there was a fiscal imperative to raise revenue. The taxes took the form of excises or levies, and the tax base and rate varied between countries. SSB taxation was fostered by constructive engagement between health and fiscal policy makers, but also influenced by external industry and public health stakeholders. Policy learning from national and international experience was evident in all countries. Conclusions This study points to the value of ongoing policy learning for improving tax design, and the importance of constructive collaboration between finance and health policy makers. It also suggests regional bodies could play a greater role in supporting SSB taxation.
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Affiliation(s)
- Anne Marie Thow
- Menzies Centre for Health Policy and Economics, School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Holly L Rippin
- WHO European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
| | - Georgina Mulcahy
- Menzies Centre for Health Policy and Economics, School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Keeva Duffey
- WHO European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
| | - Kremlin Wickramasinghe
- WHO European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
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29
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Garton K, Swinburn B, Thow AM. Who influences nutrition policy space using international trade and investment agreements? A global stakeholder analysis. Global Health 2021; 17:118. [PMID: 34600556 PMCID: PMC8487514 DOI: 10.1186/s12992-021-00764-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/09/2021] [Indexed: 01/22/2023] Open
Abstract
Background Regulation of food environments is needed to address the global challenge of poor nutrition, yet policy inertia has been a problem. A common argument against regulation is potential conflict with binding commitments under international trade and investment agreements (TIAs). This study aimed to identify which actors and institutions, in different contexts, influence how TIAs are used to constrain policy space for improving food environments, and to describe their core beliefs, interests, resources and strategies, with the objective of informing strategic global action to preserve nutrition policy space. Methods We conducted a global stakeholder analysis applying the Advocacy Coalition Framework, based on existing academic literature and key informant interviews with international experts in trade and investment law and public health nutrition policy. Results We identified 12 types of actors who influence policy space in the food environment policy subsystem, relevant to TIAs. These actors hold various beliefs regarding the economic policy paradigm, the nature of obesity and dietary diseases as health problems, the role of government, and the role of industry in solving the health problem. We identified two primary competing coalitions: 1) a ‘public health nutrition’ coalition, which is overall supportive of and actively working to enact comprehensive food environment regulation; and 2) an ‘industry and economic growth’ focussed coalition, which places a higher priority on deregulation and is overall not supportive of comprehensive food environment regulation. The industry and economic growth coalition appears to be dominant, based on its relative power, resources and coordination. However, the public health nutrition coalition maintains influence through individual activism, collective lobbying and government pressure (e.g. by civil society), and expert knowledge generation. Conclusions Our analysis suggests that industry and economic growth-focussed coalitions are highly capable of leveraging networks, institutional structures and ideologies to their advantage, and are a formidable source of opposition acting to constrain nutrition policy space globally, including through TIAs. Opportunities for global public health nutrition coalitions to strengthen their influence in the support of nutrition policy space include strategic evidence generation and coalition-building through broader engagement and capacity-building. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-021-00764-7.
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Affiliation(s)
- Kelly Garton
- School of Population Health, The University of Auckland, Auckland, New Zealand.
| | - Boyd Swinburn
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Anne Marie Thow
- Menzies Centre for Health Policy, The University of Sydney, Sydney, NSW, Australia
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30
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Lencucha R, Thow AM. Intersectoral policy on industries that produce unhealthy commodities: governing in a new era of the global economy? BMJ Glob Health 2021; 5:bmjgh-2019-002246. [PMID: 32816826 PMCID: PMC7430321 DOI: 10.1136/bmjgh-2019-002246] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/04/2020] [Accepted: 05/28/2020] [Indexed: 12/21/2022] Open
Abstract
Tobacco, alcohol and unhealthy foods are key contributors to non-communicable diseases globally. Public health advocates have been proactive in recent years, developing systems to monitor and mitigate both health harms and influence by these industries. However, establishing and implementating strong government regulation of these unhealthy product-producing industries remains challenging. The relevant regulatory instruments lie not only with ministries of health but with agriculture, finance, industry and trade, largely driven by economic concerns. These policy sectors are often unreceptive to public health imperatives for restrictions on industry, including policies regarding labelling, marketing and excise taxes. Heavily influenced by traditional economic paradigms, they have been more receptive to industry calls for (unfettered) market competition, the rights of consumers to choose and the need for government to allow industry free rein; at most to establish voluntary standards of consumer protection, and certainly not to directly regulate industry products and practices. In recent years, the status quo of a narrow economic rationality that places economic growth above health, environment or other social goals is being re-evaluated by some governments and key international economic agencies, leading to windows of opportunity with the potential to transform how governments approach food, tobacco and alcohol as major, industry-driven risk factors. To take advantage of this window of opportunity, the public health community must work with different sectors of government to(1) reimagine policy mandates, drawing on whole-of-government imperatives for sustainable development, and (2) closely examine the institutional structures and governance processes, in order to create points of leverage for economic policies that also support improved health outcomes.
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Affiliation(s)
- Raphael Lencucha
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Anne Marie Thow
- School of Public Health, Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia
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31
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Constantinides S, Blake C, Frongillo E, Thow AM, Avula R, Liese A. The Role of Stakeholder Framing in Nutrition Agenda-Setting to Address the Double Burden of Malnutrition in Tamil Nadu, India. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab045_019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Addressing the double burden of malnutrition in many low- and middle-income countries through double duty strategies requires understanding of how stakeholder framing influences nutrition agenda-setting at the subnational level where policies are translated to address local context. We aimed to identify differences in frames of undernutrition and nutrition-related non-communicable diseases (NCDs) in Tamil Nadu, India and to show how the frames reflect stakeholder intention and action regarding nutrition actions.
Methods
Tamil Nadu is experiencing chronic undernutrition and increasing NCDs and has a history of commitment to addressing undernutrition. We conducted in-depth interviews with stakeholders from nutrition-sensitive disciplines using semi-structured questionnaires (n = 28). Stakeholder responses and established policy process frameworks guided interview coding and thematic analysis.
Results
The frames of undernutrition and NCDs comprised five domains: problem identification, risk factors, target populations, roles for stakeholders, and policy and program response. To address undernutrition, stakeholders consistently identified problems, risk factors, and target populations. Roles and responsibilities for stakeholders were defined, resulting in multisectoral strategies. For NCDs, stakeholders inconsistently identified the same domains, resulting in lack of convergence and bottlenecks to implementing double duty actions.
Conclusions
Nutrition-related NCDs have not reached a critical level of priority and coherence among state-level stakeholders regarding problem identification, risk factors, target populations, responsibility, and solutions, preventing political commitment to addressing them through inclusion in the policy agenda, dedicated resources, and convergence of multisectoral efforts. Development and implementation of multisectoral double duty strategies likely to be effective at the subnational level will require stakeholders to address three challenges in agenda-setting: adequate priority given to the problem, coherence of the policy community, and convergence of actions by multisectoral stakeholders.
Funding Sources
The Bill & Melinda Gates Foundation through POSHAN, led by the International Food Policy Research Institute.
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Affiliation(s)
| | | | | | | | - Rasmi Avula
- International Food Policy Research Institute
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32
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Thow AM, Abdool Karim S, Mukanu MM, Ahaibwe G, Wanjohi M, Gaogane L, Amukugo HJ, Ruhara CM, Ngoma T, Asiki G, Erzse A, Hofman K. The political economy of sugar-sweetened beverage taxation: an analysis from seven countries in sub-Saharan Africa. Glob Health Action 2021; 14:1909267. [PMID: 33877032 PMCID: PMC8078959 DOI: 10.1080/16549716.2021.1909267] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Non-communicable diseases are on the rise across sub-Saharan Africa. The region has become a targeted growth market for sugar-sweetened beverages, which are associated with weight gain, cardiovascular diseases and diabetes.Objective: To identify politico-economic factors relevant to nutrition-related fiscal policies, and to draw lessons regarding strategies to strengthen sugar-sweetened beverages taxation in the region and globally.Methods: We collected documentary data on policy content, stakeholders and corporate political activity from seven countries in east and southern Africa augmented by qualitative interviews in Botswana, Namibia, Kenya and Zambia, and stakeholder consultations in Rwanda, Tanzania and Uganda. Data were analysed using a political economy framework, focusing on ideas, institutions, interests and power, and a 'bricolage' approach was employed to identify strategies for future action.Results: Non-communicable diseases were recognised as a priority in all countries. Kenya, Zambia, Rwanda, Tanzania and Uganda had taxes on non-alcoholic beverages, which varied in rate and tax base, but appeared to be motivated by revenue rather than health concerns. Botswana and Namibia indicated intention to adopt sugar-sweetened beverage taxes. Health-oriented sugar-sweetened beverage taxation faced challenges from entrenched economic policy paradigms for industry-led economic growth and was actively opposed by sugar-sweetened beverage-related industries. Strategies identified to support stronger sugar-sweetened beverage taxation included shifting the economic discourse to strengthen health considerations, developing positive public opinion, forging links with the agriculture sector for shared benefit, and leadership by a central government agency.Conclusions: There are opportunities for more strategic public health engagement with the economic sector to foster strong nutrition-related fiscal policy for non-communicable disease prevention in the region.
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Affiliation(s)
- Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Safura Abdool Karim
- SAMRC/Centre for Health Economics and Decision Science - Priority Cost Effective Lessons for Systems Strengthening (PRICELESS SA), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mulenga M Mukanu
- Health Policy and Management Unit, University of Zambia School of Public Health, Lusaka, Zambia
| | - Gemma Ahaibwe
- Economic Policy Research Centre (EPRC), Makerere University, Kampala, Uganda
| | | | - Lebogang Gaogane
- Department of Health Promotion & Education, Boitekanelo College, Gaborone, Botswana
| | - Hans Justus Amukugo
- Community Health Department, School of Nursing, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | | | - Twalib Ngoma
- Economic Social Research Foundation (ESFR), Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Agnes Erzse
- SAMRC/Centre for Health Economics and Decision Science - Priority Cost Effective Lessons for Systems Strengthening (PRICELESS SA), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC/Centre for Health Economics and Decision Science - Priority Cost Effective Lessons for Systems Strengthening (PRICELESS SA), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Amukugo HJ, Abdool Karim S, Thow AM, Erzse A, Kruger P, Karera A, Hofman K. Barriers to, and facilitators of, the adoption of a sugar sweetened beverage tax to prevent non-communicable diseases in Namibia: a policy landscape analysis. Glob Health Action 2021; 14:1903213. [PMID: 33876708 PMCID: PMC8079035 DOI: 10.1080/16549716.2021.1903213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Nutrition-related non-communicable diseases contribute to approximately half of the premature deaths in Namibia. Westernisation and urbanisation of communities have resulted in changing dietary patterns that see people eating more refined and high sugar content foods that are a risk for nutrition-related non-communicable diseases. Sugar-sweetened beverage taxation has been found to influence consumer purchasing behaviour and to raise revenue for health-promoting activity in other low- and middle-income countries. Objectives: To analyse Namibia’s non-communicable diseases prevention policy landscape and assess the readiness of the Government to adopt sugar-sweetened beverage taxation policies for public health. Methods: Government policy documents relating to nutrition-related non-communicable diseases were analysed, utilising predetermined variables based on policy theory. Thirteen key informant interviews were conducted with stakeholders from Government, non-governmental organisations and academic institutions. Data sets were analysed utilising Kingdon’s analytical theory for agenda setting. Results: Nutrition-related non-communicable diseases are an increasing problem that requires immediate action. Diet and lifestyle are recognised as major contributors to non-communicable diseases. The Government has adopted a multisectoral approach to the control and prevention of non-communicable diseases in Namibia. A sugar-sweetened beverage tax is envisaged in policy, but there is no progress towards its enactment. At the highest level of Government, the Ministry of Finance has ruled out immediate action towards sugar-sweetened beverage taxation. There is little publicly available information about the Namibian beverages industry, but it is closely tied to the South African drinking industry and is influenced by policy action in that country. Conclusion: The Government of Namibia has taken positive steps and the policy environment is friendly towards an SSB tax. The proximity of trade and the competitive nature of the Namibian drinks industry with South Africa suggest that a regional perspective to advocacy would be of value.
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Affiliation(s)
- Hans Justus Amukugo
- Community Health Department, School of Nursing, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Safura Abdool Karim
- University of the Witwatersrand, School of Public Health, Johannesburg, South Africa
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Director of Academic Titles, School of Public Health, the University of Sydney, Australia
| | - Agnes Erzse
- University of the Witwatersrand, School of Public Health, Johannesburg, South Africa
| | - Petronell Kruger
- University of the Witwatersrand, School of Public Health, Johannesburg, South Africa
| | - Abel Karera
- Allied Health Department, School of Nursing, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Karen Hofman
- University of the Witwatersrand, School of Public Health, Johannesburg, South Africa
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Abstract
OBJECTIVE The objective of this review is to examine and map the reported forms, process functions, and objectives associated with private food safety standards to draw conclusions for public health nutrition. INTRODUCTION One pressing public health nutrition issue is the need for a healthier food supply to reduce diet-related risk factors for non-communicable diseases. Many organizations are involved in private food safety and/or nutrition standards that govern their food supply. With few published data on private nutrition standards, understanding the motivations behind enacting private food safety standards as a means of gaining authority may elucidate strategic opportunities of interest for the public health nutrition audience. This could positively affect the use of private standards and nutritional quality of packaged foods. INCLUSION CRITERIA Articles to be considered must focus on private food safety standards, which principally relate to the supply chain of packaged food for retail sale, in any country. In this group, the standard is largely invisible to consumers, and the dominant actors are private firms. Concepts of interest are the evolution, key drivers, regulatory form, function, objective and incentive for involvement in standard setting, adoption, implementation, conformity and enforcement of private food safety standards. METHODS An extensive search of multiple databases and official websites to source gray literature will be undertaken to identify articles of any design, reports and conference proceedings in English from 2008 to present. Selection, screening and data synthesis will follow JBI methodology. Data extraction will be undertaken using an extraction tool developed for this scoping review.
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Affiliation(s)
- Helen Trevena
- Sydney School of Public Health, Faculty of Medicine and Health, Menzies Centre for Health Policy, The University of Sydney, Sydney, Australia.,Food Policy Division, The George Institute for Global Health, The University of New South Wales, Sydney, Australia
| | - Belinda Reeve
- The University of Sydney Law School, New Law Building, The University of Sydney, Sydney, Australia
| | - Lisa Bero
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Anne Marie Thow
- Sydney School of Public Health, Faculty of Medicine and Health, Menzies Centre for Health Policy, The University of Sydney, Sydney, Australia
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Reeve E, Thow AM, Namohunu S, Bell C, Lal A, Sacks G. Action-oriented prospective policy analysis to inform the adoption of a fiscal policy to reduce diet-related disease in the Solomon Islands. Health Policy Plan 2021; 36:1257-1268. [PMID: 33826719 PMCID: PMC8428604 DOI: 10.1093/heapol/czab031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 11/23/2022] Open
Abstract
Fiscal tools are recommended as a part of a comprehensive approach to diet-related disease prevention, however, widespread adoption has been hampered by political and economic resistance. The aim of this study was to support an advocacy coalition in the Solomon Islands with evidence-based consideration of the development and implementation of a tax on sugar-sweetened beverages (SSBs), sensitive to local contextual factors and constraints. In 2017–19, we conducted a prospective policy analysis, including document analysis and qualitative interviews with key stakeholders to elicit policy-relevant data, a quantitative analysis to frame the policy problem and examine appropriate implementation mechanisms, and economic modelling to outline the potential benefits associated with different proposed policy solutions. Applying an action-oriented approach to prospective policy analysis enabled us as researchers to engage in the needs of a ‘pro-SSB tax’ advocacy coalition and prepare them to exploit policy opportunities created by the meeting of policy ‘streams’. Our analysis demonstrated that SSBs were being consumed in relatively large amounts, especially by children, and that there were likely to be substantial health and economic benefits associated with a SSB tax. Increasing fiscal uncertainty for key sectors had created an environment prime for the advocacy coalition to pursue the adoption of an SSB tax. However, we found that policymakers face a number of practical challenges in securing effective adoption and implementation of global food policy recommendations, including that it is difficult to demonstrate the potential efficacy of interventions in the local context. The development of a policy package based on local factors resulted in a policy product that was likely to be more persuasive for local policymakers and policy leaders. We suggest that there is substantial scope for researchers to more effectively engage with policy advocates to inform and shape real-world health policy improvements.
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Affiliation(s)
- Erica Reeve
- Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, 1 Gheringhap Street, Geelong, VIC 3220, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Level 2, Charles Perkins Centre, University of Sydney, NSW 2006, Australia
| | - Salome Namohunu
- Solomon Island Government, Ministry of Health and Medical Services, Honiara, Solomon Islands and UNICEF Pacific Islands
| | - Colin Bell
- Deakin University, School of Medicine, Faculty of Health, Geelong, Global Obesity Centre, School of Health and Social Development, 1 Gheringhap Street, Geelong, VIC 3220, Australia
| | - Anita Lal
- Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, 1 Gheringhap Street, Geelong, VIC 3220, Australia
| | - Gary Sacks
- Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, 1 Gheringhap Street, Geelong, VIC 3220, Australia
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Barlow P, Thow AM. Neoliberal discourse, actor power, and the politics of nutrition policy: A qualitative analysis of informal challenges to nutrition labelling regulations at the World Trade Organization, 2007-2019. Soc Sci Med 2021; 273:113761. [PMID: 33621752 DOI: 10.1016/j.socscimed.2021.113761] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/22/2021] [Accepted: 02/05/2021] [Indexed: 01/28/2023]
Abstract
Unhealthy diets are increasing contributors to poor health and mortality in low- and middle-income countries (LMICs). Government interventions targeting the structural drivers of unhealthy diets are needed to prevent these illnesses, including nutrition labelling regulations that create healthier food environments. Yet, implementation remains slow and uneven. One explanation for slow implementation highlights the role of politics, including powerful ideological discourse and its strategic deployment by economically powerful actors. In this article, we advance research on the politics of nutrition policies by analysing political discourse on nutrition labelling regulations within an influential and under-studied global institution: the World Trade Organization (WTO). We identified WTO Technical Barriers to Trade (TBT) Committee meeting minutes with reference to nutrition labelling policies proposed by Thailand, Chile, Indonesia, Peru, Ecuador, Bolivia, and Uruguay (2007-2019; n = 47). We analysed the frames, narratives, and normative claims that feature in inter-country discourse within TBT meetings and examined how actors mobilize ideological and material sources of power via these statements. We find that informal government challenges to nutrition labelling proposals within the Committee featured a narrative that individualized the causes of and solutions to poor diet, downplayed harms from industrialised food products, and framed state regulation as harmful and unjust. These non-technical claims mobilised neoliberal ideology and rhetoric to contest the normative legitimacy of members' proposals and to de-socialize and de-politicize poor diets. Furthermore, high-income countries (HICs) re-framed policy goals to focus on individual determinants of poor nutrition whilst calling for their preferred policies to be adopted. Patterns of discourse within TBT meetings also had striking similarities with arguments raised by multi-national food corporations elsewhere. Our findings suggest that non-technical and ideological arguments raised during TBT meetings serve as inconspicuous tools through which nutrition labelling policies in LMICs are undermined by HICs, industry, and the powerful ideology of neoliberalism.
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Affiliation(s)
- P Barlow
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, United Kingdom.
| | - A M Thow
- Menzies Centre for Health Policy, School of Public Health, Charles Perkins Centre (D17), The University of Sydney, NSW, 2006 Australia
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Farrell P, Thow AM, Rimon M, Roosen A, Vizintin P, Negin J. An Analysis of Healthy Food Access Amongst Women in Peri-urban Honiara. Hawaii J Health Soc Welf 2021; 80:33-40. [PMID: 33575663 PMCID: PMC7871453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Highly processed and energy-dense foods are contributing to the high and rising rates of non-communicable diseases and nutrient deficiencies in Solomon Islands. Non-communicable diseases currently cause 69% of deaths in Solomon Islands, and the rate is rising, fuelled in part by limited health system capacity to treat these conditions. Solomon Islands also has the highest reported undernourishment rate in the Pacific. Recent decades have seen several factors change the food and economic environment in Solomon Islands. Importantly, rural-to-urban migration has caused a disconnect between urban residents and access to land and home gardens. This study aimed to examine the complexities of nutritious food access in urban Solomon Islands. Data were collected from 32 women in Honiara, the islands' capital, using a novel survey instrument. There were 3 important findings: (1) the dominant influencers of the diet patterns described by participants in this study were food affordability and access to land on which to grow it, (2) all participants experienced food insecurity, and (3) reported diet patterns reflected unhealthy diets which were particularly high in processed and sugary foods. These findings suggest a need for improvements in the food environment in Honiara.
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Affiliation(s)
- Penny Farrell
- Sydney School of Public Health, Edward Ford Building A27, The University of Sydney, NSW, 2006, Australia (PF, PV, JN)
| | - Anne Marie Thow
- Menzies Centre for Health Policy, Charles Perkins Centre D17, The University of Sydney, NSW, 2006, Australia (AMT)
| | - Mia Rimon
- Pacific Community (SPC). Port Vila, Vanuatu and Honiara, Solomon Islands (MR)
| | - Andy Roosen
- Synergies Ltd, Ngossi Ridge, Honiara, Solomon Islands (AR)
| | - Pavle Vizintin
- Sydney School of Public Health, Edward Ford Building A27, The University of Sydney, NSW, 2006, Australia (PF, PV, JN)
| | - Joel Negin
- Sydney School of Public Health, Edward Ford Building A27, The University of Sydney, NSW, 2006, Australia (PF, PV, JN)
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Erzse A, Abdool Karim S, Thow AM, Ahaibwe G, Amukugo HJ, Asiki G, Gaogane L, Mukanu MM, Ngoma T, Ruhara CM, Wanjohi MN, Hofman K. The data availability landscape in seven sub-Saharan African countries and its role in strengthening sugar-sweetened beverage taxation. Glob Health Action 2021; 14:1871189. [PMID: 33876702 PMCID: PMC8079050 DOI: 10.1080/16549716.2020.1871189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/29/2020] [Indexed: 12/05/2022] Open
Abstract
Background: Credible data and indicators are necessary for country-specific evidence to support the design, implementation, monitoring and evaluation of sugar-sweetened beverage (SSB) taxation.Objective: A cross-country analysis was undertaken in seven Sub-Saharan African countries to describe the potential role of available data in strengthening SSB taxation. The objectives were to: document currently available data sources; report on public access; discuss strengths and limitations for use in monitoring SSB taxation; describe policy maker's data needs, and propose improvements in data collection.Methods: The study used a mixed-methods approach involving a secondary data analysis of publicly available documents, and a qualitative exploration of the data needs of policy makers' using primary data. Findings were synthesised and assessed for data strengths and weaknesses, including usability and availability. SSB taxation-related data availability was critically assessed with respect to adequacy in strengthening taxation policy on SSBs.Results: Findings showed a paucity of SSB taxation-related data in all seven countries. National survey data are inadequate regarding the intake of SSBs and household expenditure on SSBs. Fiscal data from SSB tax revenue, value added tax from SSB sales, corporate income tax from SSB companies and SSB custom duty revenues, are lacking. Accurate information on the soft drink industry is not easily accessed.Conclusion: Timely, easily understood, concise, and locally relevant evidence is needed in order to inform policy development on SSBs. The relevant data are drawn from multiple sectors. Cross- sector collaboration is therefore needed. Indicators for SSBs should be developed and included in current data collection tools to ensure monitoring and evaluation for SSB taxation.
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Affiliation(s)
- Agnes Erzse
- Faculty of Health Sciences, SAMRC/Centre for Health Economics and Decision Science, PRICELESS, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Safura Abdool Karim
- Faculty of Health Sciences, SAMRC/Centre for Health Economics and Decision Science, PRICELESS, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, The University of Sydney, Sydney, Australia
| | - Gemma Ahaibwe
- Economic Policy Research Centre (EPRC), Makerere University, Makerere, Uganda
| | | | - Gershim Asiki
- African Population and Health Research Center, Health and Systems for Health Unit, Kenya
| | - Lebogang Gaogane
- Boitekanelo College, Department of Health Promotion & Education, University of Botswana, Gaborone, Botswana
| | - Mulenga M. Mukanu
- Health Policy and Management Unit, University of Zambia School of Public Health, Lusaka, Zambia
| | - Twalib Ngoma
- Economic and Social Research Foundation, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | | | - Milkah N Wanjohi
- African Population and Health Research Center, Health and Systems for Health Unit, Kenya
| | - Karen Hofman
- Faculty of Health Sciences, SAMRC/Centre for Health Economics and Decision Science, PRICELESS, University of Witwatersrand School of Public Health, Johannesburg, South Africa
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Lencucha R, Thow AM. Developing a Research Agenda for the Analysis of Product Supply: A Response to the Recent Commentaries. Int J Health Policy Manag 2020; 9:539-541. [PMID: 32610829 PMCID: PMC7947652 DOI: 10.34172/ijhpm.2020.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/15/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Raphael Lencucha
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Anne Marie Thow
- Menzies Centre for Health Policy, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
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Thow AM, Apprey C, Winters J, Stellmach D, Alders R, Aduku LNE, Mulcahy G, Annan R. Understanding the Impact of Historical Policy Legacies on Nutrition Policy Space: Economic Policy Agendas and Current Food Policy Paradigms in Ghana. Int J Health Policy Manag 2020; 10:909-922. [PMID: 33201655 PMCID: PMC9309960 DOI: 10.34172/ijhpm.2020.203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/07/2020] [Indexed: 11/17/2022] Open
Abstract
Background: The global food system is not delivering affordable, healthy, diverse diets, which are needed to address malnutrition in all its forms for sustainable development. This will require policy change across the economic sectors that govern food systems, including agriculture, trade, finance, commerce and industry – a goal that has been beset by political challenges. These sectors have been strongly influenced by entrenched policy agendas and paradigms supported by influential global actors such as the World Bank and International Monetary Fund (IMF).
Methods: This study draws on the concept of path dependency to examine how historical economic policy agendas and paradigms have influenced current food and nutrition policy and politics in Ghana. Qualitative data were collected through interviews with 29 relevant policy actors, and documentary data were collected from current policies, academic and grey literature, historical budget statements and World Bank Group Archives (1950-present).
Results: Despite increased political priority for nutrition in Ghana, its integration into food policy remains limited. Food policy agendas are strongly focused on production, employment and economic returns, and existing market-based incentives do not support a nutrition-sensitive food supply. This policy focus appears to be rooted in a liberal economic approach to food policy arising from structural adjustment in the 1980s and trade liberalization in the 1990s, combined with historical experience of ‘failure’ of food policy intervention and an entrenched narrowly economic conception of food security.
Conclusion: This study suggests that attention to policy paradigms, in addition to specific points of policy change, will be essential for improving the outcomes of food systems for nutrition. An historical perspective can provide food and health policy-makers with insights to foster the revisioning of food policy to address multiple national policy objectives, including nutrition.
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Affiliation(s)
- Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Charles Apprey
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Janelle Winters
- Global Health Governance Group, Usher Institute of Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Robyn Alders
- Centre for Universal Health, Chatham House, London, UK.,Development Policy Centre, Australian National University, Canberra, ACT, Australia
| | | | - Georgina Mulcahy
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Reginald Annan
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Trevena H, Neal B, Downs SM, Davis T, Sacks G, Crino M, Thow AM. Drawing on Strategic Management Approaches to Inform Nutrition Policy Design: An Applied Policy Analysis for Salt Reduction in Packaged Foods. Int J Health Policy Manag 2020; 10:896-908. [PMID: 33160294 PMCID: PMC9309969 DOI: 10.34172/ijhpm.2020.204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/07/2020] [Indexed: 12/05/2022] Open
Abstract
Background: Nutrition policies to improve the food environment frequently rely on voluntary business action for implementation, many have had mixed success. The aims of this study were to identify key food system drivers influencing the Australian packaged food sector and analyse how these might impact the willingness of food companies to voluntarily reduce salt in packaged foods.
Methods: Business methods formed the basis of this retrospective applied policy analysis of voluntary salt reduction for the period 2013-2016 where the focal policy was the Australian Food and Health Dialogue (2009-2015). The analytical framework included political-legal, economic, social, technological (PEST) external drivers of the food system, and Porter’s Five Forces for the competitive drivers of the food system. Documentary data identifying food system drivers affecting the Australian packaged food sector (comprised of the food processing and supermarket industries) were identified through a comprehensive search of the grey and academic literatures.
Results: The interplay between external and competitive food system drivers created an environment in which voluntary salt reduction was found to be an uneasy fit. A high cost of doing business, soft growth, intense competition, asymmetry of power in favour of supermarkets, and marginal consumer interest in less salty food were found likely to create commercial disincentives to invest in voluntary salt reduction above more pressing commercial imperatives. Analysis of food manufacturing industries highlighted the highly contextual nature of food system drivers. Opportunities for nutrition policy included: support for ‘shared value’ in economic discourse; and, leveraging investor, supermarket, and the largely unrealised bargaining power of consumers.
Conclusion: Business frameworks can provide meaningful insights for nutrition policy on how food system drivers can thwart policy goals. Our analysis highlighted areas to incentivise voluntary action and illustrated the importance of political-legal, economic and consumer strategies for salt reduction.
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Affiliation(s)
- Helen Trevena
- Menzies Centre for Health Policy, University of Sydney School of Public Health, Sydney, NSW, Australia.,Food Policy Division, The George Institute for Global Health, The University of New South Wales, Sydney, NSW, Australia
| | - Bruce Neal
- Food Policy Division, The George Institute for Global Health, The University of New South Wales, Sydney, NSW, Australia.,The School of Public Health, Faculty of Medicine, Epidemiology and Biostatistics, Imperial College of Science, Technology and Medicine, London, UK.,Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.,The Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Shauna M Downs
- Department of Urban-Global Public Health, Rutgers School of Public Health, Newark, NJ, USA
| | - Teresa Davis
- Discipline of Marketing, University of Sydney Business School, Sydney, NSW, Australia
| | - Gary Sacks
- Global Obesity Centre, Deakin University, Geelong, VIC, Australia
| | - Michelle Crino
- Menzies Centre for Health Policy, University of Sydney School of Public Health, Sydney, NSW, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy, University of Sydney School of Public Health, Sydney, NSW, Australia
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Garton K, Thow AM, Swinburn B. International Trade and Investment Agreements as Barriers to Food Environment Regulation for Public Health Nutrition: A Realist Review. Int J Health Policy Manag 2020; 10:745-765. [PMID: 33105969 PMCID: PMC9309975 DOI: 10.34172/ijhpm.2020.189] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/28/2020] [Indexed: 11/09/2022] Open
Abstract
Background: Achieving healthy food systems will require regulation across the supply chain; however, binding international economic agreements may be constraining policy space for regulatory intervention in a way that limits uptake of ‘best-practice’ nutrition policy. A deeper understanding of the mechanisms through which this occurs, and under which conditions, can inform public health engagement with the economic policy sector.
Methods: We conducted a realist review of nutrition, policy and legal literature to identify mechanisms through which international trade and investment agreements (TIAs) constrain policy space for priority food environment regulations to prevent non-communicable diseases (NCDs). Recommended regulations explored include fiscal policies, product bans, nutrition labelling, advertising restrictions, nutrient composition regulations, and procurement policies. The process involved 5 steps: initial conceptual framework development; search for relevant empirical literature; study selection and appraisal; data extraction; analysis and synthesis, and framework revision.
Results: Twenty-six studies and 30 institutional records of formal trade/investment disputes or specific trade concerns (STCs) raised were included. We identified 13 cases in which TIA constraints on nutrition policy space could be observed. Significant constraints on nutrition policy space were documented with respect to fiscal policies, product bans, and labelling policies in 4 middle-income country jurisdictions, via 3 different TIAs. In 7 cases, trade-related concerns were raised but policies were ultimately preserved. Two of the included cases were ongoing at the time of analysis. TIAs constrained policy space through 1) TIA rules and principles (non- discrimination, necessity, international standards, transparency, intellectual property rights, expropriation, and fair and equitable treatment), and 2) interaction with policy design (objectives framed, products/services affected, nutrient thresholds chosen, formats, and time given to comment or implement). Contextual factors of importance included: actors/institutions, and political/regulatory context.
Conclusion: Available evidence suggests that there are potential TIA contributors to policy inertia on nutrition. Strategic policy design can avoid most substantive constraints. However, process constraints in the name of good regulatory practice (investor-state dispute settlement (ISDS), transparency, regulatory coherence, and harmonisation) pose a more serious threat of reducing government policy space to enact healthy food policies.
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Affiliation(s)
- Kelly Garton
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Anne Marie Thow
- Menzies Centre for Health Policy, The University of Sydney, Sydney, NSW, Australia
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
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Thow AM. Trade, standards and politics: global pressures on front-of-pack nutrition labelling interventions. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Although interpretive front-of-pack (FOP) nutrition labelling is rightly considered a national health policy decision, it is also influenced by global trade agreements and international standards. Over the past decade, Specific Trade Concerns have been repeatedly raised at the World Trade Organization (WTO) regarding potential impacts of FOP nutrition labelling initiatives on trade. One of the common concerns raised was regarding the consistency of the measures with international standards. The Codex Alimentarius Commission (Codex), which makes global food standards, is currently developing global guidance for FoP nutrition labelling, which will almost certainly influence national policy making. This presentation draws on qualitative policy analysis research on trade concerns and international standards work regarding FOP nutrition labelling. Two challenges are evident at the global policy level. The first is the potential for constraints on policy space for innovative FOP nutrition labelling due to binding trade agreements. The second is the potential for significant industry input into standard development at Codex, which then constitute the reference point for WTO discussions on labelling. Historically, Codex standards have focussed primarily on acute risks, for example, from foodborne disease. This shift in Codex's activities towards standards to address NCDs presents new risks for achievement of public health goals, as a result of the high level of industry involvement in this forum and thus potential commercial conflict of interest. It is imperative that public health actors engage with Codex processes to ensure policy space for national governments to implement strong and effective regulation and allow scope for innovation. At the national policy level, strategic framing of nutrition labelling policy objectives and proactive policy engagement between trade and health can also minimise trade issues.
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Affiliation(s)
- A M Thow
- Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
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45
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Farrell P, Thow AM, Wate JT, Nonga N, Vatucawaqa P, Brewer T, Sharp MK, Farmery A, Trevena H, Reeve E, Eriksson H, Gonzalez I, Mulcahy G, Eurich JG, Andrew NL. COVID-19 and Pacific food system resilience: opportunities to build a robust response. Food Secur 2020; 12:783-791. [PMID: 32837656 PMCID: PMC7369468 DOI: 10.1007/s12571-020-01087-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/09/2020] [Indexed: 11/30/2022]
Abstract
The unfolding COVID-19 pandemic has exposed the vulnerability of the Pacific food system to externalities and has had far-reaching impacts, despite the small number of COVID-19 cases recorded thus far. Measures adopted to mitigate risk from the pandemic have had severe impacts on tourism, remittances, and international trade, among other aspects of the political economy of the region, and are thus impacting on food systems, food security and livelihoods. Of particular concern will be the interplay between loss of incomes and the availability and affordability of local and imported foods. In this paper, we examine some of the key pathways of impact on food systems, and identify opportunities to strengthen Pacific food systems during these challenging times. The great diversity among Pacific Island Countries and Territories in their economies, societies, and agricultural potential will be an important guide to planning interventions and developing scenarios of alternative futures. Bolstering regional production and intraregional trade in a currently import-dependent region could strengthen the regional economy, and provide the health benefits of consuming locally produced and harvested fresh foods - as well as decreasing reliance on global supply chains. However, significant production, processing, and storage challenges remain and would need to be consistently overcome to influence a move away from shelf-stable foods, particularly during periods when human movement is restricted and during post-disaster recovery.
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Affiliation(s)
- Penny Farrell
- Menzies Centre for Health Policy, Level 2, Charles Perkins Centre (D17), Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006 Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy, Level 2, Charles Perkins Centre (D17), Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006 Australia
| | | | - Nichol Nonga
- Food and Agriculture Organization of the United Nations (FAO), Honiara, Solomon Islands
| | - Penina Vatucawaqa
- Food and Agriculture Organization of the United Nations (FAO), Suva, Fiji
| | - Tom Brewer
- Australian National Centre for Ocean Resources and Security, University of Wollongong, Wollongong, Australia
| | - Michael K Sharp
- Australian National Centre for Ocean Resources and Security, University of Wollongong, Wollongong, Australia.,Pacific Community, Noumea, New Caledonia
| | - Anna Farmery
- Australian National Centre for Ocean Resources and Security, University of Wollongong, Wollongong, Australia
| | - Helen Trevena
- Menzies Centre for Health Policy, Level 2, Charles Perkins Centre (D17), Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006 Australia
| | - Erica Reeve
- Global Obesity Centre, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Hampus Eriksson
- WorldFish, Honiara, Solomon Islands.,Australian National Centre for Ocean Resources and Security, University of Wollongong, Wollongong, Australia
| | - Itziar Gonzalez
- Food and Agriculture Organization of the United Nations (FAO), Suva, Fiji
| | - Georgina Mulcahy
- Menzies Centre for Health Policy, Level 2, Charles Perkins Centre (D17), Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006 Australia
| | - Jacob G Eurich
- Marine Science Institute, University of California Santa Barbara, Santa Barbara, CA USA.,Department of Ecology, Evolution and Marine Biology, University of California, Santa Barbara, Santa Barbara, CA USA
| | - Neil L Andrew
- Australian National Centre for Ocean Resources and Security, University of Wollongong, Wollongong, Australia
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Abstract
Growing evidence confirms a link between consumption of ultra-processed food and drinks and non-communicable diseases. Jean Adams and colleagues explore the implications for public health action
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Affiliation(s)
- Jean Adams
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Karen Hofman
- South Africa MRC/Wits Centre for Health Economics and Decision Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Jean-Claude Moubarac
- Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney Australia
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Mounsey S, Veerman L, Jan S, Thow AM. The macroeconomic impacts of diet-related fiscal policy for NCD prevention: A systematic review. Econ Hum Biol 2020; 37:100854. [PMID: 32062400 DOI: 10.1016/j.ehb.2020.100854] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Diet-related fiscal policies are effective interventions to address non-communicable disease. However, despite these being economic policy instruments, there is little public health attention given to the evidence of macroeconomic impacts. This review aims to assess the global evidence for the macroeconomic impact of diet-related fiscal policies for non-communicable disease prevention on industry revenue, government revenue and employment. METHODS For this systematic review we comprehensively searched the bibliographic databases MEDLINE, OvidSP, EMBASE, Global Health, SCOPUS, CINAHL and ECONLIT, and Google Scholar for English peer-reviewed studies or grey literature, with no date cut-off. Global interventions with a focus on diet-related fiscal strategies were assessed for the outcomes of industry revenue, gross domestic product, government revenue and employment. We excluded non-English papers. FINDINGS Eleven studies met the inclusion criteria. All studies were on sugar sweetened beverage taxation and one also included an energy-dense food tax. Nine were modelling studies and two used interrupted time series analysis based on empirical evidence. One study found potential employment increases because of taxation; two found no significant job losses and eight found reduced employment. Taxes reduced sales volume and revenue within the sugar/beverage industry. Government revenue generation was positive in all studies. One study considered redistribution of consumer and government spending to other goods and services; INTERPRETATION: We found no robust evidence for negative macroeconomic impacts of diet-related fiscal policies, likely a reflection of the limited methodology used in the analyses. This review suggests that there is a need for more high-quality research into the macroeconomic impacts of diet related fiscal measures and similar to tobacco taxation, government should consider directing revenue generated towards complementary measures to generate employment and/or provide livelihood training for those affected.
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Affiliation(s)
- Sarah Mounsey
- Menzies Centre for Health Policy, University of Sydney Australia.
| | | | - Stephen Jan
- The George Institute for Global Health Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy, University of Sydney Australia
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48
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Reeve B, Thow AM, Baker P, Hresc J, May S. The role of Australian local governments in creating a healthy food environment: an analysis of policy documents from six Sydney local governments. Aust N Z J Public Health 2020; 44:137-144. [DOI: 10.1111/1753-6405.12968] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 11/01/2019] [Accepted: 11/01/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Anne Marie Thow
- Menzies Centre for Health PolicyThe University of Sydney New South Wales
| | - Phil Baker
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition Sciences, Deakin University Victoria
| | - Jessica Hresc
- Charles Perkins CentreThe University of Sydney New South Wales
| | - Serena May
- The University of Sydney Law SchoolNew South Wales
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49
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Thow AM, Jones A, Huckel Schneider C, Labonté R. Increasing the public health voice in global decision-making on nutrition labelling. Global Health 2020; 16:3. [PMID: 31900178 PMCID: PMC6942308 DOI: 10.1186/s12992-019-0533-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/06/2019] [Indexed: 11/10/2022] Open
Abstract
To respond to the global noncommunicable disease (NCD) crisis, the Codex Alimentarius Commission (Codex), a multilateral United Nations body responsible for work on food standards, is developing global guidance for front of pack (FoP) nutrition labelling. Guidance from Codex regarding FoP nutrition labelling at the global level will almost certainly influence national policy making. This shift in Codex’s activities towards standards to address NCDs presents new risks for achievement of public health goals, as a result of the high level of industry involvement in this forum; there is a potential commercial conflict of interest held by manufacturers of products whose consumption could be discouraged by such guidance. In this Commentary, we examine the implications of Codex processes for developing robust global guidance on FoP nutrition labelling and identify opportunities to increase consideration of public health objectives. To date, there has been significantly higher representation of food industry compared to public health actors in Codex discussions on FoP nutrition labelling. Without a strong public health voice in Codex, the industry voice could dominate discussions on FoP nutrition labelling, such that subsequent global guidance prioritises future trade and profits over potential risks to public health. There is currently a critical window of opportunity for public health interests to be prioritised in this multisectoral international forum. The key public health priority for global guidance on FoP nutrition labelling is to ensure protection of policy space for national governments to implement strong and effective regulation, and allow scope for innovation. Public health actors can engage directly with Codex processes, at both the national and global level, and also need to raise awareness among domestic policy makers – including with Ministries of Agriculture and Industry, which often represent countries at Codex – regarding the importance and effectiveness of FoP labelling in NCD prevention. Increased engagement with Codex processes represents a tangible new opportunity to strengthen global governance for public health, and move towards improved coherence between trade policy and health protection goals.
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Affiliation(s)
- Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, Charles Perkins Centre, The University of Sydney, Sydney, Australia.
| | | | - Carmen Huckel Schneider
- Menzies Centre for Health Policy, School of Public Health, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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Jones A, Neal B, Reeve B, Ni Mhurchu C, Thow AM. Front-of-pack nutrition labelling to promote healthier diets: current practice and opportunities to strengthen regulation worldwide. BMJ Glob Health 2019; 4:e001882. [PMID: 31908864 PMCID: PMC6936575 DOI: 10.1136/bmjgh-2019-001882] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/28/2019] [Indexed: 01/24/2023] Open
Abstract
Unhealthy diets are a leading cause of death and disability globally. The WHO recommends Member States implement front-of-pack (FOP) nutrition labels to guide consumers towards healthier food choices, as part of comprehensive strategies to prevent diet-related non-communicable diseases. Interest in FOP nutrition labelling is increasing, but there is limited guidance for policymakers developing regulations necessary for effective implementation. A rapidly evolving evidence base, limited regulatory capacity and possibility of legal challenge by affected food industry stakeholders can create 'regulatory chill', whereby governments are dissuaded from progressive public health policymaking. We use a framework for analysing public health law and available best-practice guidance to evaluate key components of 31 FOP nutrition labelling regulations endorsed by governments up to June 2019. Analysis of regulatory form shows recent rapid uptake of label formats that are easier for consumers to understand and increasing use of mandatory legislation. However, policymakers must decide much more than whether to apply 'stars', 'traffic lights' or 'stop signs'. The substance of effective regulation must contain strategic regulatory objectives, clear specifications for displaying the label on pack, a valid scoring mechanism and a justified scope for including foods. While there are limited data on current practice, good governance of FOP nutrition labelling regulation also requires transparency and accountability in processes of label development, implementation, evaluation and enforcement to promote continuous improvement and withstand undue commercial interference. Whether developing new FOP nutrition labels or reforming existing ones, our findings support policymakers to design and implement best-practice, evidence-informed regulation.
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Affiliation(s)
- Alexandra Jones
- Food Policy, The George Institute for Global Health, UNSW, Sydney, NSW, Australia.,Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Bruce Neal
- Food Policy, The George Institute for Global Health, UNSW, Sydney, NSW, Australia.,Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Belinda Reeve
- Sydney Law School, University of Sydney, Sydney, NSW, Australia
| | - Cliona Ni Mhurchu
- Food Policy, The George Institute for Global Health, UNSW, Sydney, NSW, Australia.,National Centre for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, The University of Sydney, Sydney, NSW, Australia
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