1
|
Vaillancourt C, Ahmed M, Kirk S, Labonté MÈ, Laar A, Mah CL, Minaker L, Olstad DL, Potvin Kent M, Provencher V, Prowse R, Raine KD, Schram A, Zavala-Mora D, Rancourt-Bouchard M, Vanderlee L. Food environment research in Canada: a rapid review of methodologies and measures deployed between 2010 and 2021. Int J Behav Nutr Phys Act 2024; 21:18. [PMID: 38373957 PMCID: PMC10875887 DOI: 10.1186/s12966-024-01558-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/03/2024] [Indexed: 02/21/2024] Open
Abstract
Numerous research methodologies have been used to examine food environments. Existing reviews synthesizing food environment measures have examined a limited number of domains or settings and none have specifically targeted Canada. This rapid review aimed to 1) map research methodologies and measures that have been used to assess food environments; 2) examine what food environment dimensions and equity related-factors have been assessed; and 3) identify research gaps and priorities to guide future research. A systematic search of primary articles evaluating the Canadian food environment in a real-world setting was conducted. Publications in English or French published in peer-reviewed journals between January 1 2010 and June 17 2021 and indexed in Web of Science, CAB Abstracts and Ovid MEDLINE were considered. The search strategy adapted an internationally-adopted food environment monitoring framework covering 7 domains (Food Marketing; Labelling; Prices; Provision; Composition; Retail; and Trade and Investment). The final sample included 220 articles. Overall, Trade and Investment (1%, n = 2), Labelling (7%, n = 15) and, to a lesser extent, Prices (14%, n = 30) were the least studied domains in Canada. Among Provision articles, healthcare (2%, n = 1) settings were underrepresented compared to school (67%, n = 28) and recreation and sport (24%, n = 10) settings, as was the food service industry (14%, n = 6) compared to grocery stores (86%, n = 36) in the Composition domain. The study identified a vast selection of measures employed in Canada overall and within single domains. Equity-related factors were only examined in half of articles (n = 108), mostly related to Retail (n = 81). A number of gaps remain that prevent a holistic and systems-level analysis of food environments in Canada. As Canada continues to implement policies to improve the quality of food environments in order to improve dietary patterns, targeted research to address identified gaps and harmonize methods across studies will help evaluate policy impact over time.
Collapse
Affiliation(s)
- Caroline Vaillancourt
- École de Nutrition, Centre de Nutrition, Santé et Société (NUTRISS), Université Laval, 2425 Rue de L'Agriculture, Québec, QC, G1V 0A6, Canada
| | - Mavra Ahmed
- Department of Nutritional Sciences, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Sara Kirk
- School of Health and Human Performance, Dalhousie University, 6230 South Street, Kjipuktuk (Halifax), NS, B3H 4R2, Canada
| | - Marie-Ève Labonté
- École de Nutrition, Centre de Nutrition, Santé et Société (NUTRISS), Université Laval, 2425 Rue de L'Agriculture, Québec, QC, G1V 0A6, Canada
| | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, P. O. Box LG 13, Legon, Accra, Ghana
| | - Catherine L Mah
- School of Health Administration, Dalhousie University, 5850 College Street, Halifax, NS, B3H 4R2, Canada
| | - Leia Minaker
- School of Planning, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3T1, Canada
| | - Dana Lee Olstad
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Véronique Provencher
- École de Nutrition, Centre de Nutrition, Santé et Société (NUTRISS), Université Laval, 2425 Rue de L'Agriculture, Québec, QC, G1V 0A6, Canada
| | - Rachel Prowse
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Kim D Raine
- School of Public Health, University of Alberta, 11405 87 Ave Northwest, Edmonton, AB, T6G 1C9, Canada
| | - Ashley Schram
- School of Regulation and Global Governance (RegNet), ANU College of Asia & the Pacific, The Australian National University, 8 Fellows Road, Canberra, Australian Capital Territory, 2600, Australia
| | - Daniela Zavala-Mora
- Science Library, Université Laval, 1045 Avenue de La Médecine, Québec, QC, G1V 0A6, Canada
| | - Maryka Rancourt-Bouchard
- École de Nutrition, Centre de Nutrition, Santé et Société (NUTRISS), Université Laval, 2425 Rue de L'Agriculture, Québec, QC, G1V 0A6, Canada
| | - Lana Vanderlee
- École de Nutrition, Centre de Nutrition, Santé et Société (NUTRISS), Université Laval, 2425 Rue de L'Agriculture, Québec, QC, G1V 0A6, Canada.
| |
Collapse
|
2
|
Shokr H, Rishworth A, Wilson K. Access to emergency care in Egypt: Tiered health care and manifestations of inequity. Soc Sci Med 2023; 336:116212. [PMID: 37783622 DOI: 10.1016/j.socscimed.2023.116212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/27/2023] [Accepted: 09/01/2023] [Indexed: 10/04/2023]
Abstract
Market-driven health care reforms and development strategies continue to drive the privatization of health care services across the world. When these measures are implemented, large disparities emerge and are maintained. Using a modified version of the access to care framework developed by Penchansky and Thomas, this paper examines the manifestations of inequity between private for-profit and public emergency care in the Greater Cairo Region and Asyut, Egypt. In-depth interviews with physicians working in both sectors reveals stark disparities in access between these two health care sectors in Egypt. Access issues identified include unaffordable care in the private sector, unavailable medical supplies and overcrowding in public hospitals, as well as a salary gap that drives health care workers from public to private practice, creating staffing shortages in public hospitals. The manifestations of these inequities are often severe, usually tangible, and according to health care providers, embodied in the experiences of service users.
Collapse
Affiliation(s)
- Hisham Shokr
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Andrea Rishworth
- Department of Geography, Geomatics, and Environment, University of Toronto Mississauga, Mississauga, Ontario, Canada.
| | - Kathi Wilson
- Department of Geography, Geomatics, and Environment, University of Toronto Mississauga, Mississauga, Ontario, Canada.
| |
Collapse
|
3
|
Townsend B, Tenni BF, Goldman S, Gleeson D. Public health advocacy strategies to influence policy agendas: lessons from a narrative review of success in trade policy. Global Health 2023; 19:60. [PMID: 37612767 PMCID: PMC10463651 DOI: 10.1186/s12992-023-00960-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/26/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Despite accumulating evidence of the implications of trade policy for public health, trade and health sectors continue to operate largely in silos. Numerous barriers to advancing health have been identified, including the dominance of a neoliberal paradigm, powerful private sector interests, and constraints associated with policymaking processes. Scholars and policy actors have recommended improved governance practices for trade policy, including: greater transparency and accountability; intersectoral collaboration; the use of health impact assessments; South-South networking; and mechanisms for civil society participation. These policy prescriptions have been generated from specific cases, such as the World Trade Organization's Doha Declaration on TRIPS and Public Health or specific instances of trade-related policymaking at the national level. There has not yet been a comprehensive analysis of what enables the elevation of health goals on trade policy agendas. This narrative review seeks to address this gap by collating and analysing known studies across different levels of policymaking and different health issues. RESULTS Sixty-five studies met the inclusion criteria and were included in the review. Health issues that received attention on trade policy agendas included: access to medicines, food nutrition and food security, tobacco control, non-communicable diseases, access to knowledge, and asbestos harm. This has occurred in instances of domestic and regional policymaking, and in bilateral, regional and global trade negotiations, as well as in trade disputes and challenges. We identified four enabling conditions for elevation of health in trade-related policymaking: favourable media attention; leadership by trade and health ministers; public support; and political party support. We identified six strategies successfully used by advocates to influence these conditions: using and translating multiple forms of evidence, acting in coalitions, strategic framing, leveraging exogenous factors, legal strategy, and shifting forums. CONCLUSION The analysis demonstrates that while technical evidence is important, political strategy is necessary for elevating health on trade agendas. The analysis provides lessons that can be explored in the wider commercial determinants of health where economic and health interests often collide.
Collapse
Affiliation(s)
- Belinda Townsend
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Australian National University, Canberra, Australia.
| | - Brigitte Frances Tenni
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
- Nossal Institute for Global Health, The School of Population and Global Health, The University of Melbourne, Carlton, VIC, 3010, Australia
| | - Sharni Goldman
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Australian National University, Canberra, Australia
| | - Deborah Gleeson
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
| |
Collapse
|
4
|
Barlow P, Allen LN. US and EU Free Trade Agreements and implementation of policies to control tobacco, alcohol, and unhealthy food and drinks: A quasi-experimental analysis. PLoS Med 2023; 20:e1004147. [PMID: 36602976 PMCID: PMC9815641 DOI: 10.1371/journal.pmed.1004147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/22/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Identifying and tackling the factors that undermine regulation of unhealthy commodities is an essential component of effective noncommunicable disease (NCD) prevention. Unhealthy commodity producers may use rules in US and EU Free Trade Agreements (FTAs) to challenge policies targeting their products. We aimed to test whether there was a statistical relationship between US and EU FTA participation and reduced implementation of WHO-recommended policies. METHODS AND FINDINGS We performed a statistical analysis assessing the probability of at least partially implementing 10 tobacco, alcohol, and unhealthy food and drink policies in 127 countries in 2014, 2016, and 2019. We assessed differences in implementation of these policies in countries with and without US/EU FTAs. We used matching to conduct 48 covariate-adjusted quasi-experimental comparisons across 27 matched US/EU FTA members (87 country-years) and performed additional analyses and robustness checks to assess alternative explanations for our results. Out of our 48 tests, 19% (9/48) identified a statistically significant decrease in the predicted probability of at least partially implementing the unhealthy commodity policy in question, while 2% (1/48) showed an increase. However, there was marked heterogeneity across policies. At the level of individual policies, US FTA participation was associated with a 37% reduction (95%CI: -0.51 to -0.22) in the probability of fully implementing graphic tobacco warning policies, and a 53% reduction (95%CI: -0.63 to -0.43) in the probability of at least partially implementing smoke-free place policies. EU FTA participation was associated with a 28% reduction (95%CI: -0.45 to -0.10) in the probability of fully implementing graphic tobacco warning policies, and a 25% reduction (95%CI: -0.47 to -0.03) in the probability of fully implementing restrictions on child marketing of unhealthy food and drinks. There was a positive association with implementing fat limits and bans, but this was not robust. Associations with other outcomes were not significant. The main limitations included residual confounding, limited ability to discern precise mechanisms of influence, and potentially limited generalisability to other FTAs. CONCLUSIONS US and EU FTA participation may reduce the probability of implementing WHO-recommended tobacco and child food marketing policies by between a quarter and a half-depending on the FTA and outcome in question. Governments negotiating or participating in US/EU FTAs may need to establish robust health protections and mitigation strategies to achieve their NCD mortality reduction targets.
Collapse
Affiliation(s)
- Pepita Barlow
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- * E-mail:
| | - Luke N. Allen
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
5
|
Baum F, Townsend B, Fisher M, Browne-Yung K, Freeman T, Ziersch A, Harris P, Friel S. Creating Political Will for Action on Health Equity: Practical Lessons for Public Health Policy Actors. Int J Health Policy Manag 2022; 11:947-960. [PMID: 33327689 PMCID: PMC9808180 DOI: 10.34172/ijhpm.2020.233] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/14/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite growing evidence on the social determinants of health and health equity, political action has not been commensurate. Little is known about how political will operates to enact pro-equity policies or not. This paper examines how political will for pro-health equity policies is created through analysis of public policy in multiple sectors. METHODS Eight case studies were undertaken of Australian policies where action was either taken or proposed on health equity or where the policy seemed contrary to such action. Telephone or face-to-face interviews were conducted with 192 state and non-state participants. Analysis of the cases was done through thematic analysis and triangulated with document analysis. RESULTS Our case studies covered: trade agreements, primary healthcare (PHC), work conditions, digital access, urban planning, social welfare and Indigenous health. The extent of political will for pro-equity policies depended on the strength of path dependency, electoral concerns, political philosophy, the strength of economic and biomedical framings, whether elite interests were threatened and the success or otherwise of civil society lobbying. CONCLUSION Public health policy actors may create political will through: determining how path dependency that exacerbates health inequities can be broken, working with sympathetic political forces committed to fairness; framing policy options in a way that makes them more likely to be adopted, outlining factors to consider in challenging the interests of elites, and considering the extent to which civil society will work in favour of equitable policies. A shift in norms is required to stress equity and the right to health.
Collapse
Affiliation(s)
- Fran Baum
- Southgate Institute for Health, Society & Equity, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Belinda Townsend
- Menzies Centre for Health Policy, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Matt Fisher
- Southgate Institute for Health, Society & Equity, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | | | - Toby Freeman
- Southgate Institute for Health, Society & Equity, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Anna Ziersch
- Southgate Institute for Health, Society & Equity, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Patrick Harris
- Menzies Centre for Health Governance, School of Regulation and Global Governance, College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
| | - Sharon Friel
- Menzies Centre for Health Policy, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
6
|
Moriguchi Watanabe L, Bernardes Pereira Delfino H, Augusta de Souza Pinhel M, Noronha NY, Maria Diani L, Cintra do Prado Assumpção L, Ferreira Nicoletti C, Barbosa Nonino C. Food and Nutrition Public Policies in Brazil: From Malnutrition to Obesity. Nutrients 2022; 14:nu14122472. [PMID: 35745202 PMCID: PMC9227558 DOI: 10.3390/nu14122472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023] Open
Abstract
“Nutrition transition” describes the shifts in dietary consumption and energy expenditure influenced by economic, demographic, and epidemiological changes at a population level. This phenomenon has been associated with rising obesity rates worldwide, especially in developed countries. In Brazil, the historical analysis of temporal trends between malnutrition and obesity characterized the nutrition transition in the country and interweaved it with the formulation and implementation of public food and nutrition policies. Such analysis is crucial for understanding certain principles in each context. Thus, this review contextualized the consolidation of obesity as a critical health and public policy issue in Brazil. Our review suggested that the country may still be at the initial stage of care for obesity, and more efforts are needed to contain the advance of the disease in Brazil.
Collapse
Affiliation(s)
- Ligia Moriguchi Watanabe
- Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto 14049-900, Brazil; (L.C.d.P.A.); (C.B.N.)
- Correspondence:
| | - Heitor Bernardes Pereira Delfino
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto 14049-900, Brazil; (H.B.P.D.); (M.A.d.S.P.); (N.Y.N.); (L.M.D.)
| | - Marcela Augusta de Souza Pinhel
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto 14049-900, Brazil; (H.B.P.D.); (M.A.d.S.P.); (N.Y.N.); (L.M.D.)
- Department of Molecular Biology, Sao Jose do Rio Preto Medical School, Sao Jose do Rio Preto 15090-000, Brazil
| | - Natália Yumi Noronha
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto 14049-900, Brazil; (H.B.P.D.); (M.A.d.S.P.); (N.Y.N.); (L.M.D.)
| | - Luisa Maria Diani
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto 14049-900, Brazil; (H.B.P.D.); (M.A.d.S.P.); (N.Y.N.); (L.M.D.)
| | - Lucca Cintra do Prado Assumpção
- Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto 14049-900, Brazil; (L.C.d.P.A.); (C.B.N.)
| | - Carolina Ferreira Nicoletti
- Applied Physiology & Nutrition Research Group, Rheumatology Division, Medical School FMUSP, University of Sao Paulo, Sao Paulo 01246-903, Brazil;
| | - Carla Barbosa Nonino
- Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto 14049-900, Brazil; (L.C.d.P.A.); (C.B.N.)
| |
Collapse
|
7
|
Barlow P, Sanap R, Garde A, Winters LA, Mabhala MA, Thow AM. Reassessing the health impacts of trade and investment agreements: a systematic review of quantitative studies, 2016-20. Lancet Planet Health 2022; 6:e431-e438. [PMID: 35550082 DOI: 10.1016/s2542-5196(22)00047-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 06/15/2023]
Abstract
To ensure a high level of health protection, governments must ensure that health and trade policy objectives are aligned. We conducted a systematic review of the health impacts of trade policies, including trade and investment agreements (TIAs), to provide a timely overview of this field. We systematically reviewed studies evaluating the health impacts of trade policies published between Jan 19, 2016, and July 10, 2020. Included studies were quantitative studies evaluating the impact of TIAs and trade policies on health determinants or outcomes. We evaluated methodological quality and performed a narrative synthesis. 21 of 28 067 articles identified via searches met our criteria. Methodologically strong studies found reduced child mortality, deteriorating worker health, rising supplies of sugar, ultra-processed food, tobacco, and alcohol supplies, and increased drug overdoses following trade reforms, compared with the time periods before trade reform. However, associations varied substantially across contexts and socioeconomic characteristics. Our findings show that trade policies, including TIAs, have diverse effects on health and health determinants. These effects vary substantially across contexts and socioeconomic groups. Governments seeking to adopt healthy trade policies should consider these updated findings to ensure that opportunities for health improvement are leveraged and widely shared, while harms are avoided, especially among vulnerable groups.
Collapse
Affiliation(s)
- Pepita Barlow
- Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - Rujuta Sanap
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Amandine Garde
- School of Law and Social Justice, University of Liverpool, Liverpool, UK
| | - L Alan Winters
- Department of Economics, University of Sussex Business School, Brighton, UK
| | - Mzwandile A Mabhala
- Department of Public Health and Wellbeing, University of Chester, Chester, UK
| | - Anne-Marie Thow
- Menzies Centre for Health Policy and Economics, School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
8
|
Industry influence over global alcohol policies via the World Trade Organization: a qualitative analysis of discussions on alcohol health warning labelling, 2010–19. Lancet Glob Health 2022; 10:e429-e437. [DOI: 10.1016/s2214-109x(21)00570-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/14/2021] [Accepted: 11/29/2021] [Indexed: 12/27/2022]
|
9
|
Townsend B, Friel S, Schram A, Baum F, Labonté R. What Generates Attention to Health in Trade Policy-Making? Lessons From Success in Tobacco Control and Access to Medicines: A Qualitative Study of Australia and the (Comprehensive and Progressive) Trans-Pacific Partnership. Int J Health Policy Manag 2021; 10:613-624. [PMID: 32610761 PMCID: PMC9278530 DOI: 10.34172/ijhpm.2020.80] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 05/27/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Despite greater attention to the nexus between trade and investment agreements and their potential impacts on public health, less is known regarding the political and governance conditions that enable or constrain attention to health issues on government trade agendas. Drawing on interviews with key stakeholders in the Australian trade domain, this article provides novel insights from policy actors into the range of factors that can enable or constrain attention to health in trade negotiations. METHODS A qualitative case study was chosen focused on Australia's participation in the Trans-Pacific Partnership (TPP) negotiations and the domestic agenda-setting processes that shaped the government's negotiating mandate. Process tracing via document analysis of media reporting, parliamentary records and government inquiries identified key events during Australia's participation in the TPP negotiations. Semi-structured interviews were undertaken with 25 key government and non-government policy actors including Federal politicians, public servants, representatives from public interest nongovernment organisations and industry associations, and academic experts. RESULTS Interviews revealed that domestic concerns for protecting regulatory space for access to generic medicines and tobacco control emerged onto the Australian government's trade agenda. This contrasted with other health issues like alcohol control and nutrition and food systems that did not appear to receive attention. The analysis suggests sixteen key factors that shaped attention to these different health issues, including the strength of exporter interests; extent of political will of Trade and Health Ministers; framing of health issues; support within the major political parties; exogenous influencing events; public support; the strength of available evidence and the presence of existing domestic legislation and international treaties, among others. CONCLUSION These findings aid understanding of the factors that can enable or constrain attention to health issues on government trade agendas, and offer insights for potential pathways to elevate greater attention to health in future. They provide a suite of conditions that appear to shape attention to health outside the biomedical health domain for further research in the commercial determinants of health.
Collapse
Affiliation(s)
- Belinda Townsend
- School of Regulation and Global Governance, College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
| | - Sharon Friel
- School of Regulation and Global Governance, College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
| | - Ashley Schram
- School of Regulation and Global Governance, College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
| | - Fran Baum
- Southgate Institute for Health, Society and Equity, Department of Public Health, Flinders University, Adelaide, SA, Australia
| | - Ronald Labonté
- Institute of Population Health, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
10
|
Papadopulos JS, Mentis AFA, Liapi C. Social Pharmacology as an Underappreciated Field in Medical Education: A Single Medical School's Experience. Front Pharmacol 2021; 12:714707. [PMID: 34531746 PMCID: PMC8438604 DOI: 10.3389/fphar.2021.714707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Alexios-Fotios A Mentis
- University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Charis Liapi
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
11
|
Burlandy L, Prado Alexandre-Weiss V, Silva Canella D, Feldenheimer da Silva AC, Maranha Paes de Carvalho C, Rugani Ribeiro de Castro I. Obesity agenda in Brazil, conflicts of interest and corporate activity. Health Promot Int 2021; 36:1186-1197. [PMID: 33169128 DOI: 10.1093/heapro/daaa085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Obesity is a social and health problem of global dimensions that demands coordinated solutions from different sectors as well as intersectoral efforts to overcome it. However, policies to overcome obesity affect the interests of the commercial private sector. In Brazil, the Intersectoral Strategy for Obesity Prevention and Control (EIPCO) is the result of participative public action and integrates a set of policies in the field of food and nutrition security. Based on the premise that EIPCO expresses public interests to be protected, promoted and guaranteed by the federal government, this article aims to analyze corporate political activity (CPA) and conflict of interest (COI) situations involving the private commercial sector in the food and nutrition field in Brazil, using EIPCO as a reference. The methods include document analysis and identification of cases reported by the Brazilian civil society organizations that are part of the National Council on Food and Nutrition Security. The results highlighted the actors, actions, ideas and interests addressed by EIPCO and also indicated that EIPCO does not question the private commercial sector's practices in regard to obesity and some of its recommended actions reflect disputes about the concept of healthy eating. All cases analyzed involved CPA to promote ultra-processed food consumption, including lobbying and funding researchers. Those practices and goals are in the opposite direction from the objectives of EIPCO to overcome obesity which indicates potential COI once these representatives of the private sector are directly influencing the governmental political process and policies.
Collapse
Affiliation(s)
- Luciene Burlandy
- Graduate Program in Nutritional Science, Faculty of Nutrition and Graduate Program in Social Policy, Fluminense Federal University (UFF), Reference Centre for Food and Nutrition Sovereignty and Security (CERESAN), Rua Mário Santos Braga 30/405 Centro Niterói CEP 24020-150, Niterói-RJ, Brazil
| | - Veruska Prado Alexandre-Weiss
- Faculty of Nutrition, Federal University of Goiás (UFG), CERESAN, Rua 227, Qd. 68 s/n°, Setor Leste Universitário, Goiânia-GO, CEP 74605-080, Brazil
| | - Daniela Silva Canella
- Department of Applied Nutrition and Graduate program in Food, Nutrition and Health, Nutrition Institute, State University of Rio de Janeiro (UERJ), Rua São Francisco Xavier 524- Pavilhão João Lyra Filho 12 andar, Bloco D - Maracanã, Rio de Janeiro, RJ - CEP 20550-900, Brazil
| | - Ana Carolina Feldenheimer da Silva
- Department of Social Nutrition, Nutrition Institute, State University of Rio de Janeiro (UERJ), Rua São Francisco Xavier 524- Pavilhão João Lyra Filho 12 andar, Bloco D - Maracanã, Rio de Janeiro, RJ - CEP 20550-900, Brazil
| | - Camila Maranha Paes de Carvalho
- Faculty of Nutrition, Fluminense Federal University (UFF), Rua Mário Santos Braga 30/405 Centro Niterói CEP 24020-150, Niterói-RJ, Brazil.,Centre of Reference on Food and Nutrition Sovereignty and Security (CERESAN), Rua Mário Santos Braga 30/413 Centro, Niteroi, RJ, Brasil. CEP 24020-150.,Alliance for Tobacco Control and Health Promotion (ACT), Av N. Sa. Copacabana 330/1107, Rio de Janeiro, RJ, Brasil. CEP - 22020-001
| | - Inês Rugani Ribeiro de Castro
- Department of Social Nutrition and Graduate program in Food, Nutrition and Health, Nutrition Institute, State University of Rio de Janeiro (UERJ), Rua São Francisco Xavier 524- Pavilhão João Lyra Filho 12 andar, Bloco D - Maracanã, Rio de Janeiro, RJ - CEP 20550-900, Brazil
| |
Collapse
|
12
|
Milsom P, Smith R, Baker P, Walls H. Corporate power and the international trade regime preventing progressive policy action on non-communicable diseases: a realist review. Health Policy Plan 2021; 36:493-508. [PMID: 33276385 PMCID: PMC8128013 DOI: 10.1093/heapol/czaa148] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2020] [Indexed: 12/21/2022] Open
Abstract
Transnational tobacco, alcohol and ultra-processed food corporations use the international trade regime to prevent policy action on non-communicable diseases (NCDs); i.e. to promote policy 'non-decisions'. Understanding policy non-decisions can be assisted by identifying power operating in relevant decision-making spaces, but trade and health research rarely explicitly engages with theories of power. This realist review aimed to synthesize evidence of different forms and mechanisms of power active in trade and health decision-making spaces to understand better why NCD policy non-decisions persist and the implications for future transformative action. We iteratively developed power-based theories explaining how transnational health-harmful commodity corporations (THCCs) utilize the international trade regime to encourage NCD policy non-decisions. To support theory development, we also developed a conceptual framework for analysing power in public health policymaking. We searched six databases and relevant grey literature and extracted, synthesized and mapped the evidence against the proposed theories. One hundred and four studies were included. Findings were presented for three key forms of power. Evidence indicates THCCs attempt to exercise instrumental power by extensive lobbying often via privileged access to trade and health decision-making spaces. When their legitimacy declines, THCCs have attempted to shift decision-making to more favourable international trade legal venues. THCCs benefit from structural power through the institutionalization of their involvement in health and trade agenda-setting processes. In terms of discursive power, THCCs effectively frame trade and health issues in ways that echo and amplify dominant neoliberal ideas. These processes may further entrench the individualization of NCDs, restrict conceivable policy solutions and perpetuate policymaking norms that privilege economic/trade interests over health. This review identifies different forms and mechanisms of power active in trade and health policy spaces that enable THCCs to prevent progressive action on NCDs. It also points to potential strategies for challenging these power dynamics and relations.
Collapse
Affiliation(s)
- Penelope Milsom
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, Kings Cross, London WC1H 9SH, UK
| | - Richard Smith
- College of Medicine and Health, University of Exeter, Magdalen Road, Exeter, EX1 2LU, UK
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, Victoria 3125 Australia
| | - Helen Walls
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, Kings Cross, London WC1H 9SH, UK
| |
Collapse
|
13
|
Townsend B. Defending access to medicines in regional trade agreements: lessons from the Regional Comprehensive Economic Partnership - a qualitative study of policy actors' views. Global Health 2021; 17:78. [PMID: 34238347 PMCID: PMC8264472 DOI: 10.1186/s12992-021-00721-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background The Regional Economic Partnership Agreement (RCEP) is a mega regional trade agreement signed by fifteen countries on 15 November 2020 after 8 years of negotiation. Signatories include the ten members of the Association of South East Asian Nations (ASEAN) plus China, New Zealand, Japan, South Korea and Australia. India was a negotiating party until it withdrew from the negotiations in November 2019. The RCEP negotiations were initially framed as focused on the needs of low income countries. Public health concerns emerged however when draft negotiating chapters were leaked online, revealing pressures on countries to agree to intellectual property and investment measures that could exacerbate issues of access to medicines and seeds, and protecting regulatory space for public health. A concerted Asia Pacific civil society campaign emerged in response to these concerns, and in 2019, media and government reporting suggested that several of these measures had been taken off the table, which was subsequently confirmed in the release of the signed text in November 2020. Results This paper examines civil society and health actors’ views of the conditions that successfully contributed to the removal of these measures in RCEP, with a focus on intellectual property and access to medicines. Drawing on twenty semi-structured qualitative interviews with civil society, government and legal and health experts from nine countries participating in the RCEP negotiations, the paper reports a matrix of ten conditions related to actor power, ideas, political context and specific health issues that appeared to support prioritisation of some public health concerns in the RCEP negotiations. Conclusions Conditions identified included strong low and middle income country leadership; strong civil society mobilisation, increased technical capacity of civil society and low and middle income negotiators; supportive public health norms; processes that somewhat opened up the negotiations to hear public health views; the use of evidence; domestic support for health issues; and supportive international public health legislation. Lessons from the RCEP can inform prioritisation of public health in future trade agreement negotiations.
Collapse
Affiliation(s)
- Belinda Townsend
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australia.
| |
Collapse
|
14
|
Kidgell D, Hills D, Griffiths D, Endacott R. Trade agreements and the risks for the nursing workforce, nursing practice and public health: A scoping review. Int J Nurs Stud 2020; 109:103676. [PMID: 32603925 DOI: 10.1016/j.ijnurstu.2020.103676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 05/31/2020] [Accepted: 05/31/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Trade agreements in the 21st century have evolved to include provisions that affect domestic public policy and public health in signatory countries. There are growing calls for health professionals and public health advocates to pursue an active advisory role in trade negotiations in order to anticipate and prevent negative outcomes for health services and public health. AIM This scoping review explored current literature to identify existing knowledge of the implications of trade agreements for the nursing workforce, nursing practice and public health using as an example the 2018 'Comprehensive and Progressive Agreement for Trans-Pacific Partnership'. DESIGN Scoping review DATA SOURCES: Emerald Insight, Informit, Ovid MEDLINE, PubMed, ProQuest, Scopus, and a number of specialist Economics, International Trade and Business, and International Relations databases. Grey literature included national and international policy documents. REVIEW METHOD Literature was selected according to extraction field criteria, supplemented by hand searching of relevant grey literature and snowballing references from the selected literature reference lists. Analysis was undertaken to identify key themes emerging from the literature. REVIEW RESULTS Six key themes relevant to nursing workforce, nursing practice or public health were 1. Lack of consultation with public health and health professionals in trade negotiations; 2. Implications of strengthened intellectual property provisions for equitable access to medicines (including biologics) and medical devices; 3. Threats to government capacity to regulate domestic policy for public health and health services through 'Investor State Dispute Settlement' provisions 4. Threats to government capacity to regulate domestic policy for public health and health services through 'Regulatory Coherence' 5. Potential limited benefits to communities and increased health inequities 6. Potential implications of increased temporary migration. Gaps were identified in the literature for implications for nursing practice and the nursing workforce from regulatory and labour provisions of trade agreements. CONCLUSIONS The analysis of the literature reviewed is of international importance for the nursing workforce, nursing practice and public health. Policymakers must anticipate and respond to how the inclusion of labour or regulatory provisions in trade agreements will affect nursing practice and the nursing workforce, and how this may subsequently impact on the health of communities globally.
Collapse
Affiliation(s)
- Dianna Kidgell
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Road, Clayton, Victoria 3800, Australia.
| | - Danny Hills
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Road, Clayton, Victoria 3800, Australia; School of Nursing and Healthcare Professions, Federation University Australia, P.O. Box 663, Ballarat, Victoria 3353, Australia
| | - Debra Griffiths
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Road, Clayton, Victoria 3800, Australia
| | - Ruth Endacott
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Road, Clayton, Victoria 3800, Australia; School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth PL48AA, United Kingdom
| |
Collapse
|
15
|
Kittelsen SK, Fukuda-Parr S, Storeng KT. Editorial: the political determinants of health inequities and universal health coverage. Global Health 2019; 15:73. [PMID: 31775774 PMCID: PMC6881907 DOI: 10.1186/s12992-019-0514-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Sakiko Fukuda-Parr
- Centre for Development and the Environment (SUM), University of Oslo, Oslo, Norway.,Julien J. Studley Graduate Programs in International Affairs, The New School, New York City, NY, USA
| | - Katerini Tagmatarchi Storeng
- Centre for Development and the Environment (SUM), University of Oslo, Oslo, Norway.,Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
16
|
Kentikelenis A, Rochford C. Power asymmetries in global governance for health: a conceptual framework for analyzing the political-economic determinants of health inequities. Global Health 2019; 15:70. [PMID: 31775894 PMCID: PMC6881908 DOI: 10.1186/s12992-019-0516-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background Recent scholarship has increasingly identified global power asymmetries as the root cause of health inequities. This article examines how such asymmetries manifest in global governance for health, and how this impacts health outcomes. Results We focus on the political-economic determinants of global health inequities, and how these determinants operate at different levels of social action (micro, meso, and macro) through distinct but interacting mechanisms. To clarify how these mechanisms operate, we develop an integrative framework for examining the links between global neoliberalism—the currently dominant policy paradigm premised on advancing the reach of markets and promoting ever-growing international economic integration—and global health inequities, and show how these mechanisms have macro–macro, macro–meso–macro, and macro–micro–macro manifestations. Conclusions Our approach enables the design of theoretically-nuanced empirical strategies to document the multiple ways in which the political economy entrenches or, alternatively, might ameliorate global health inequities.
Collapse
Affiliation(s)
- Alexander Kentikelenis
- Department of Social and Political Sciences, Bocconi University, Milan, Italy. .,Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology, Trondheim, Norway.
| | - Connor Rochford
- Blavatnik School of Government, University of Oxford, Oxford, UK
| |
Collapse
|
17
|
Plamondon KM, Bisung E. The CCGHR Principles for Global Health Research: Centering equity in research, knowledge translation, and practice. Soc Sci Med 2019; 239:112530. [PMID: 31539786 DOI: 10.1016/j.socscimed.2019.112530] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/24/2019] [Accepted: 08/29/2019] [Indexed: 11/26/2022]
Abstract
Medical geography and global health share a fundamental concern for health equity. Both fields operate within similar multiple intersecting funding, academic, health systems, and development landscapes to produce scholarship. Both reflect complex interactions and partnerships between people, communities and institutions of unequal power. The Canadian Coalition of Global Health Research Principles for Global Health Research evolved from deep concern about the absence of standards for how Canadians engage in this field. They can serve as a broadly relevant framework to guide how to integrate equity considerations into everyday research, knowledge translation, and practice activities. Comprised of six principles (authentic partnering, inclusion, shared benefits, commitment to the future, responsiveness to causes of inequities, and humility), they are an aspirational and reflective frame that can elevate equity as a central procedural goal and outcome. In this commentary, we describe each of the six principles and offer examples of how they are being applied to guide research practices, inform knowledge translation science and build capacity. We invite collective reflection about moving our field toward more meaningful health equity research and action, using the CCGHR Principles for Global Health Research to spark dialogue about how to align our practices with desire for a more equitable world.
Collapse
Affiliation(s)
- Katrina M Plamondon
- Faculty of Health & Social Development, School of Nursing, University of British Columbia; and Regional Practice Leader, Research & Knowledge Translation, Interior Health, Canada.
| | - Elijah Bisung
- School of Kinesiology & Health Studies, Queens University, Canada
| |
Collapse
|
18
|
Plamondon KM, Pemberton J. Blending integrated knowledge translation with global health governance: an approach for advancing action on a wicked problem. Health Res Policy Syst 2019; 17:24. [PMID: 30832660 PMCID: PMC6399857 DOI: 10.1186/s12961-019-0424-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The persistence of health inequities is a wicked problem for which there is strong evidence of causal roots in the maldistribution of power, resources and money within and between countries. Though the evidence is clear, the solutions are far from straightforward. Integrated knowledge translation (IKT) ought to be well suited for designing evidence-informed solutions, yet current frameworks are limited in their capacity to navigate complexity. Global health governance (GHG) also ought to be well suited to advance action, but a lack of accountability, inclusion and integration of evidence gives rise to politically driven action. Recognising a persistent struggle for meaningful action, we invite contemplation about how blending IKT with GHG could leverage the strengths of both processes to advance health equity. DISCUSSION Action on root causes of health inequities implicates disruption of structures and systems that shape how society is organised. This infinitely complex work demands sophisticated examination of drivers and disrupters of inequities and a vast imagination for who (and what) should be engaged. Yet, underlying tendencies toward reductionism seem to drive superficial responses. Where IKT models lack consideration of issues of power and provide little direction for how to support cohesive efforts toward a common goal, recent calls from the field of GHG may provide insight into these issues. Additionally, though GHG is criticised for its lack of attention to using evidence, IKT offers approaches and strategies for collaborative processes of generating and refining knowledge. Contemplating the inclusion of governance in IKT requires re-examining roles, responsibilities, power and voice in processes of connecting knowledge with action. We argue for expanding IKT models to include GHG as a means of considering the complexity of issues and opening new possibilities for evidence-informed action on wicked problems. CONCLUSION Integrated learning between these two fields, adopting principles of GHG alongside the strategies of IKT, is a promising opportunity to strengthen leadership for health equity action.
Collapse
Affiliation(s)
- Katrina Marie Plamondon
- University of British Columbia, 3333 University Way, Kelowna, BC Canada
- Interior Health, 505 Doyle Avenue, Kelowna, BC Canada
| | - Julia Pemberton
- McMaster University, 1280 Main Street West, Hamilton, ON Canada
| |
Collapse
|
19
|
Delgado BMG, Silva AP, de Rodriguez JM. [Concept Map on Health and Intellectual Property in Central America and the Dominican RepublicMapa conceitual de saúde e propriedade intelectual na América Central e na República Dominicana]. Rev Panam Salud Publica 2019; 43:e4. [PMID: 31093228 PMCID: PMC6393721 DOI: 10.26633/rpsp.2019.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 09/10/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of this study is to prepare a "Concept Map on Health and Intellectual Property in Central America and the Dominican Republic" in order to help identify the main access barriers to health, especially medicines, and to guide state authorities toward actions to improve the efficiency and effectiveness of policies. METHODS The report "Concept Map on Public Health and Intellectual Property, Regional Perspective: Central America and the Dominican Republic" was analyzed. Then the knowledge generation and management methodology was applied and a search strategy was identified to recover the information for preparation of the concept maps. RESULTS The legal framework and institutional structure, as well as policies, programs, plans, and strategies for health and intellectual property, were identified. A set of barriers that hinder access to medicines was also identified, as well as solutions to overcome them. CONCLUSIONS In Central America and the Dominican Republic, health strategies, policies, programs, and plans are in place, but unfortunately their scope and degree of dissemination is uneven. This, together with social and economic factors, explains why health inequity persists between and within countries. The identified barriers to access to medicines included the expansion and strengthening of the rights of pharmaceutical patent-holders, problems with implementing the flexibilities of the Agreement on Trade-related Aspects of Intellectual Property Rights, pricing policies, and strict regulatory standards.
Collapse
Affiliation(s)
| | - Ana Paula Silva
- Sistemas y Servicios de Salud, Organización Panamericana de la Salud, Washington, DC; Estados Unidos de América
| | | |
Collapse
|
20
|
Townsend B, Schram A, Baum F, Labonté R, Friel S. How does policy framing enable or constrain inclusion of social determinants of health and health equity on trade policy agendas? CRITICAL PUBLIC HEALTH 2018. [DOI: 10.1080/09581596.2018.1509059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Belinda Townsend
- School of Regulation and Global Governance, Australian National University, Canberra, Australia
| | - Ashley Schram
- School of Regulation and Global Governance, Australian National University, Canberra, Australia
| | - Fran Baum
- Department of Public Health, Flinders University of South Australia, Adelaide, Australia
| | - Ronald Labonté
- Institute of Population Health, University of Ottawa, Ottawa, Canada
| | - Sharon Friel
- School of Regulation and Global Governance, Australian National University, Canberra, Australia
| |
Collapse
|
21
|
Barlow P, Labonte R, McKee M, Stuckler D. Trade challenges at the World Trade Organization to national noncommunicable disease prevention policies: A thematic document analysis of trade and health policy space. PLoS Med 2018; 15:e1002590. [PMID: 29944652 PMCID: PMC6019096 DOI: 10.1371/journal.pmed.1002590] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/17/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND It has long been contested that trade rules and agreements are used to dispute regulations aimed at preventing noncommunicable diseases (NCDs). Yet most analyses of trade rules and agreements focus on trade disputes, potentially overlooking how a challenge to a regulation's consistency with trade rules may lead to 'policy or regulatory chill' effects whereby countries delay, alter, or repeal regulations in order to avoid the costs of a dispute. Systematic empirical analysis of this pathway to impact was previously prevented by a dearth of systematically coded data. METHODS AND FINDINGS Here, we analyse a newly created dataset of trade challenges about food, beverage, and tobacco regulations among 122 World Trade Organization (WTO) members from January 1, 1995 to December 31, 2016. We thematically describe the scope and frequency of trade challenges, analyse economic asymmetries between countries raising and defending them, and summarise 4 cases of their possible influence. Between 1995 and 2016, 93 food, beverage, and tobacco regulations were challenged at the WTO. 'Unnecessary' trade costs were the focus of 16.4% of the challenges. Only one (1.1%) challenge remained unresolved and escalated to a trade dispute. Thirty-nine (41.9%) challenges focussed on labelling regulations, and 18 (19.4%) focussed on quality standards and restrictions on certain products like processed meats and cigarette flavourings. High-income countries raised 77.4% (n = 72) of all challenges raised against low- and lower-middle-income countries. We further identified 4 cases in Indonesia, Chile, Colombia, and Saudi Arabia in which challenges were associated with changes to food and beverage regulations. Data limitations precluded a comprehensive evaluation of policy impact and challenge validity. CONCLUSIONS Policy makers appear to face significant pressure to design food, beverage, and tobacco regulations that other countries will deem consistent with trade rules. Trade-related influence on public health policy is likely to be understated by analyses limited to formal trade disputes.
Collapse
Affiliation(s)
- Pepita Barlow
- Department of Sociology, University of Oxford, Oxford, United Kingdom
| | - Ronald Labonte
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Martin McKee
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David Stuckler
- Department of Policy Analysis and Public Management, Italy
| |
Collapse
|
22
|
Delany L, Signal L, Thomson G. International trade and investment law: a new framework for public health and the common good. BMC Public Health 2018; 18:602. [PMID: 29739460 PMCID: PMC5941687 DOI: 10.1186/s12889-018-5486-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 04/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND International trade and investment agreements can have positive outcomes, but also have negative consequences that affect global health and influence fundamental health determinants: poverty, inequality and the environment. This article proposes principles and strategies for designing future international law to attain health and common good objectives. ARGUMENT Basic principles are needed for international trade and investment agreements that are consistent with the common good, public health, and human rights. These principles should reflect the importance of reducing inequalities, along with social and environmental sustainability. Economic growth should be recognised as a means to common good objectives, rather than an end in itself. Our favoured approach is both radical and comprehensive: we describe what this approach would include and outline the strategies for its implementation, the processes and capacity building necessary for its achievement, and related governance and corporate issues. The comprehensive approach includes significant changes to current models for trade and investment agreements, in particular (i) health, social and environmental objectives would be recognised as legitimate in their own right and implemented accordingly; (ii) changes to dispute-resolution processes, both state-to-state and investor-state; (iii) greater deference to international legal frameworks for health, environmental protection, and human rights; (iv) greater coherence across the international law framework; (v) limitations on investor privileges, and (vi) enforceable corporate responsibilities for contributing to health, environmental, human rights and other common good objectives. We also identify some limited changes that could be considered as an alternative to the proposed comprehensive approach. Future research is needed to develop a range of model treaties, and on the means by which such treaties and reforms might be achieved. Such research would focus also on complementary institutional reforms relevant to the United Nations and other international agencies. Advocacy by a range of communities is needed for effective change. Reform will require informed debate, determined engagement with decision-makers and stakeholders, and some agreement across health, social and environmental sectors on alternatives. CONCLUSIONS Current frameworks of international law that govern trade and economic development need radical change, in relation to treaty processes, content, and contexts, to better attain public health objectives.
Collapse
|
23
|
Nikogosian H, Kickbusch I. Interface of health and trade: a view point from health diplomacy. BMJ Glob Health 2018; 3:e000491. [PMID: 29379646 PMCID: PMC5759719 DOI: 10.1136/bmjgh-2017-000491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/17/2017] [Accepted: 10/22/2017] [Indexed: 11/21/2022] Open
Affiliation(s)
- Haik Nikogosian
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Ilona Kickbusch
- Global Health Center, Graduate Institute of International and Development Studies, Geneva, Switzerland
| |
Collapse
|
24
|
Stevens H, Huys I. Innovative Approaches to Increase Access to Medicines in Developing Countries. Front Med (Lausanne) 2017. [PMID: 29270407 DOI: 10.3389/fmed.2017.00218/full] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Access to essential medicines is problematic for one third of all persons worldwide. The price of many medicines (i.e., drugs, vaccines, and diagnostics) is unaffordable to the majority of the population in need, especially in least-developed countries, but also increasingly in middle-income countries. Several innovative approaches, based on partnerships, intellectual property, and pricing, are used to stimulate innovation, promote healthcare delivery, and reduce global health disparities. No single approach suffices, and therefore stakeholders need to further engage in partnerships promoting knowledge and technology transfer in assuring essential medicines to be manufactured, authorized, and distributed in low- and middle-income countries (LMICs) in an effort of making them available at affordable and acceptable conditions.
Collapse
Affiliation(s)
- Hilde Stevens
- Institute for Interdisciplinary Innovation in healthcare (I3h), Unversité libre de Bruxelles (ULB), Brussels, Belgium
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| |
Collapse
|
25
|
Stevens H, Huys I. Innovative Approaches to Increase Access to Medicines in Developing Countries. Front Med (Lausanne) 2017; 4:218. [PMID: 29270407 PMCID: PMC5725781 DOI: 10.3389/fmed.2017.00218] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/20/2017] [Indexed: 11/13/2022] Open
Abstract
Access to essential medicines is problematic for one third of all persons worldwide. The price of many medicines (i.e., drugs, vaccines, and diagnostics) is unaffordable to the majority of the population in need, especially in least-developed countries, but also increasingly in middle-income countries. Several innovative approaches, based on partnerships, intellectual property, and pricing, are used to stimulate innovation, promote healthcare delivery, and reduce global health disparities. No single approach suffices, and therefore stakeholders need to further engage in partnerships promoting knowledge and technology transfer in assuring essential medicines to be manufactured, authorized, and distributed in low- and middle-income countries (LMICs) in an effort of making them available at affordable and acceptable conditions.
Collapse
Affiliation(s)
- Hilde Stevens
- Institute for Interdisciplinary Innovation in healthcare (I3h), Unversité libre de Bruxelles (ULB), Brussels, Belgium
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| |
Collapse
|
26
|
Hanefeld J, Khan M, Tomson G, Smith R. Trade is central to achieving the sustainable development goals: a case study of antimicrobial resistance. BMJ 2017; 358:j3505. [PMID: 28739673 PMCID: PMC5523143 DOI: 10.1136/bmj.j3505] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Johanna Hanefeld and colleagues highlight the links between trade and health and argue for greater consideration of trade agreements in actions to meet the sustainable development goals
Collapse
Affiliation(s)
- Johanna Hanefeld
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine London, London, UK
| | - Mishal Khan
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine London, London, UK
| | - Göran Tomson
- Public Health-Global Health/IHCAR, Karolinska Institutet, Stockholm, Sweden
- Swedish Institute for Global Health Transformation (SIGHT), Stockholm
| | - Richard Smith
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine London, London, UK
| |
Collapse
|