Alcohol, ideological schisms and a science of corporate behaviours on health

Quantitative Textual Analysis as a means to explore corporate interests in food safety

The growing body of scholarship on the commercial determinants of health has, so far, mostly employed qualitative methods but this is now being complemented by a small, yet growing, corpus of quantitative studies. We illustrate the use of one such method, quantitative text analysis (QTA), in a case study of submissions to a public consultation on a draft scientific opinion by the European Food Safety Authority on the chemical acrylamide, demonstrating how this method can be used and insights that might be drawn from it. We use Wordscores as one example of QTA to illuminate the diverse positions taken by actors submitting comments and then assess whether the final policy documents moved towards or away from the positions taken by different stakeholders. We find a broadly uniform position among the public health community, opposed to acrylamide, contrasting with industry positions that were not monolithic. Some firms recommended major amendments to the guidance, largely reflecting the impact on their practices, while policy innovators seeking ways to reduce acrylamide in foods aligned with the public health community. We also find no clear movement in the policy guidance, likely because most submissions supported the draft document. Many governments are required to conduct public consultations, some attracting enormous numbers of responses, with little guidance on how best to synthesise the responses so the default position is often a count of those for and against. We argue that QTA, primarily a research tool, might usefully be applied in analysing public consultation responses to understand better the positions taken by different actors.

The policy implications of 'thinking problematically': problematizing Big Food's role in obesity policymaking

Practitioners need to engage with the contested nature of public health policymaking. This study, stemming from a concern that the involvement of Big Food is not widely problematized in health promotion practice, used 'What's the Problem Represented to Be?' discourse analysis to examine how Big Food, as a discursive actor, reacted to and shaped a problem representation of childhood obesity. Analysis of Big Food documents, including Coca-Cola and Burger King, developed during the regulation of broadcast advertising to children in Ireland found that Big Food constructs the problem of childhood obesity in a way which privileges its role as policy actor; it draws on and undermines public health discourses of obesity; and it negates the impact of corporate practices on obesity and on related policymaking. An in-depth analysis of Big Food's own documents provides access to the processes of knowledge production and governing undertaken by Big Food. The study offers two tools of resistance for health promotion practitioners to interrogate and challenge Big Food-problematization as a policy tool and 'corporate influence' as a critical public health discourse.

Defining the commercial determinants of health: a systematic review

Background

Despite increasing attention to the social determinants of health in recent decades, globally there is an unprecedented burden from non-communicable diseases (NCDs). Recently, the corporate and commercial conditions associated with these, commercial determinants of health (CDoH), have also begun to receive attention. This research aims to articulate the CDoH as described in the literature, summarize substantive findings, and assess strengths and limitations of current literature.

Methods

Systematic review of formal (Medline, EMBASE, Scopus, Global Health) and grey literature (database, Google Advanced, targeted website, citation searching). Searching identified 125 texts for full-text review, with 33 included for final review. Data extracted were analyzed thematically.

Results

The dynamics constituting CDoH include broad facilitators such as globalization of trade, corporate structures, and regulatory systems, articulation of social and economic power, neoliberal and capitalist ideologies; additional elements include corporate activities such as marketing, corporate political activities, corporate social responsibility, extensive supply chains, harmful products and production, and issues of accessibility. These contribute significantly to worsened global health outcomes.

Conclusions

Literature describing effects of macro conditions and corporate activities on health could usefully utilize CDoH terminology. Facilitation via revised, consistent and operational definition of CDoH would assist. Social, political, commercial and economic structures and relations of CDoH are under-theorized. Systematic approaches to identifying, describing, and disrupting these are required to improve global health.

Health, environment and colonial legacies: Situating the science of pesticides, bananas and bodies in Ecuador

Pesticide-related health impacts in Ecuador's banana industry illustrate the need to understand science's social production in the context of major North-South inequities. This paper explores colonialism's ongoing context-specific relationships to science, and what these imply for population health inquiry and praxis. Themes in postcolonial science and technology studies and critical Latin American scholarship guide this exploration, oriented around an ethnographic case study of bananas, pesticides and health in Ecuador. The challenge of explaining these impacts prompts us to explore discursive and contextual dynamics of pesticide toxicology and phytopathology, two disciplines integral to understanding pesticide-health linkages. The evolution of banana phytopathology reflects patterns of banana production and plant science in settings made accessible to scientists by European colonialism and American military interventions. Similarly, American foreign policy in Cold War-era Latin America created conditions for widespread pesticide exposures and accompanying health science research. Neocolonial representations of the global South interacted with these material realities in fostering generation of scientific knowledge. Implications for health praxis include troubling celebratory portrayals of global interconnectedness in the field of global health, motivating critical political economy and radical community-based approaches in their place. Another implication is a challenge to conciliatory corporate engagement approaches in health research, given banana production's symbiosis of scientifically 'productive' military and corporate initiatives. Similarly, the origins and evolution of toxicology should promote humility and precautionary approaches in addressing environmental injustices such as pesticide toxicity, given the role of corporate actors in promoting systematic underestimation of risk to vulnerable populations. Perhaps most unsettlingly, the very structures and processes that drive health inequities in Ecuador's banana industry simultaneously shape production of knowledge about those inequities. Public health scholars should thus move beyond simply carrying out more, or better, studies, and pursue the structural changes needed to redress historical and ongoing injustices.

Mapping discourse coalitions in the minimum unit pricing for alcohol debate: a discourse network analysis of UK newspaper coverage

BACKGROUND AND AIMS

Minimum unit pricing (MUP) for alcohol was introduced in Scotland on 1 May 2018, and is now on the policy agenda in other devolved administrations and at Westminster. Previous research has explored the arguments deployed for and against MUP, but the congruence between actors in the MUP debate has not been sufficiently examined. This study identified and mapped the discourse coalitions that emerged in the UK MUP debate through an analysis of actors' use of arguments in media coverage of the policy debates.

DESIGN

A sample of print media coverage of MUP was obtained from the LexisNexis newspaper database. The resulting sample was imported into discourse network analysis (DNA) software for coding and subsequent visualization of actor networks.

SETTING

United Kingdom.

OBSERVATIONS

A total of 348 articles from eight UK-wide and three Scottish newspapers from an 18-month period, ending in November 2012, were analysed.

MEASUREMENTS

Actors' arguments were coded to generate structured data for conversion into a weighted actor network where ties represent similarities among actors in terms of arguments in support of or opposition to MUP.

FINDINGS

Two polarized discourse coalitions, Opponents and Proponents of MUP, emerged in media coverage. The Proponents coalition consisted mainly of health advocacy groups, charities, political parties and academic institutions. In the Opponents coalition, the networks were formed of key alcohol manufacturers and economic think-tanks. While producer organizations were central to the Opponents coalition, some commercial actors were more favourable to MUP, highlighting divisions within the industry overall.

CONCLUSIONS

Media coverage of minimum unit pricing (MUP) in Scotland from June 2011 to November 2012 showed alignment between the policy positions of (1) alcohol producers and think-tanks opposed to MUP; and (2) public health advocates and health charities in favour of the policy. Some alcohol industry actors were supportive of MUP indicating divisions among the industry. Discourse network analysis may be usefully applied to study other highly contested policy issues in health and beyond.

The post-2015 landscape: vested interests, corporate social responsibility and public health advocacy

This paper explores the tensions between UN calls for private sector engagement in the post-2015 landscape and public health opposition to those 'harm industries' that are 'corporate vectors of disease' for the mounting global non-communicable disease burden. The UN's support for public-private partnership has provided industries with 'vested interests' in the propagation of unhealthy behaviours with new opportunities for the strategic alignment of their corporate social responsibility (CSR) endeavours with the post-2015 sustainable development agenda. This has galvanised public health advocates to place pressure on the World Health Organisation to formalise their ambiguous stance towards private sector involvement in public policy formation and the resultant 'conflicts of interest'. This paper critically examines the 'gathering storm' between this 'anti-corporate movement' and the alcohol industry in the increasingly politicised domain of CSR. Drawing on the example of SABMiller's Tavern Intervention Program, the paper argues that CSR represents a profound threat to the sanctity and moral authority of the public health worldview. Questions therefore need to be asked about whether the public health-led path of industry non-association will necessarily result in health improvements or just a further retrenchment of the ideological faultlines explored in the paper.