Obesity framing for health policy development in Australia, France and Switzerland

A Critical Analysis of Representations of Inequalities in Childhood Obesity in Australian Health Policy Documents

BACKGROUND

In Australia, childhood obesity follows a socioeconomic gradient whereby children with lower socioeconomic position are disproportionately burdened. To reduce these inequalities in childhood obesity requires a multi-component policy-driven response. Action to address health issues is underpinned by the ways in which they are represented as 'problems' in public policy. This study critically examines representations of inequalities in childhood obesity within Australian health policy documents published between 2000-2019.

METHODS

Australia's federal, state and territory government health department websites were searched for health policy documents including healthy weight, obesity, healthy eating, food and nutrition strategies; child and youth health strategies; and broader health and wellbeing, prevention and health promotion policies that proposed objectives or strategies for childhood obesity prevention. Thematic analysis of eligible documents was guided by a theoretical framework informed by problematization theory, ecological systems theory, and theoretical principles for equity in health policy.

RESULTS

Eighteen policy documents were eligible for inclusion. The dominant representation of inequalities in childhood obesity was one of individual responsibility. The social determinants of inequalities in childhood obesity were acknowledged, yet policy actions predominantly focused on individual determinants. Equity was positioned as a principle of policy documents but was seldom mentioned in policy actions.

CONCLUSION

Current representations of inequalities in childhood obesity in Australian health policy documents do not adequately address the underlying causes of health inequities. In order to reduce inequalities in childhood obesity future policies will need greater focus on health equity and the social determinants of health (SDoH).

Management of the Sports Industry for Ensuring the Public Health: Prospect of Implementing the Innovations

The article is devoted to studying the relationship between sports management and ensuring the population’s health. The study of current trends in the development of sports industry management was carried out with the help of bibliometric analysis. The results proved that the modern sports management system should consider the quality of the provision of sports services and the opportunities for their commercialization, the impact of the dispute on people’s lives and health, the role of sports in ensuring sustainable development, and the financial support of the sports industry. In order to assess the impact of the sports industry on public health and the quality of life, a set of statistical indicators was formed. These indicators characterize the functioning of the sports industry (the number of sports facilities, the involvement of the population in sports and recreational activities) and the state of the population’s health (parameters of life expectancy, morbidity, and mortality) of Ukraine for 2000-2021. Calculations were made by regression modeling using the Prais-Winsten method, including a time lag from 0 to 4 years. The obtained results proved that, at the current stage, the development of the sports industry has a limited impact on the health indicators of the population. In particular, it was found that engaging in the population’s physical culture and health activities contributes to reducing its mortality rate. Besides, engaging the population in such activity at enterprises, institutions, and organizations contributes to reducing the overweight population. On the other hand, a direct connection was also recorded between the growth of the population’s sports activity and the deterioration of certain public health parameters (in particular, the incidence of tuberculosis, hypertension, and mortality from certain diseases). At the same time, it was confirmed that the population’s activity in sports largely depends on the number of sports facilities. It made it possible to assess the transmission effects of the presence of sports facilities on the population’s health. Calculations have shown that the growth of the number of sports facilities for professional sports mostly has a negative impact on the health and life indicators of the population. In contrast, the impact of playgrounds with exercise equipment is mostly positive. That makes it possible to substantiate the areas on which the management of the sports industry should be focused to ensure the maximization of its positive impact on public health.

Whose rights deserve protection? Framing analysis of responses to the 2016 Committee of Advertising Practice consultation on the non-broadcast advertising of foods and soft drinks to children

Exposure to advertising of food and beverages high in fat sugar and salt (HFSS) is considered a factor in the development of childhood obesity. This paper uses framing analysis to examine the strategic discursive practices employed by non-industry and industry responders to the Committee of Advertising Practice's consultation responses (n = 86) on UK regulation of non-broadcast advertising of foods and soft drinks to children. Our analysis demonstrates non-industry and industry responders engaged in a moral framing battle centred on whose rights were deemed as being of greatest importance to protect: children or industry. Both industry and non-industry responders acknowledged that childhood obesity and non-broadcast advertising were complex issues but diverged on how they morally framed their arguments. Non-industry responders employed a moral framework that aligned with the values represented in social justice approaches to public health policy, where children were identified as vulnerable, in need of protection from harmful HFSS product advertising and childhood obesity was a societal problem to solve. In contrast, industry responders emphasised industry rights, portraying themselves as a responsible industry that is victim to perceived disproportionate policymaking, and values more closely aligned with a market justice approach to public health policy. Our analysis provides detailed insights into the framing strategies used in the policy debate surrounding the non-broadcast advertising of HFSS foods to children. This has relevance as to how advocacy organisations can develop counter-framing to industry frames which seek to limit effective regulation.

The Good and Evil of Health Policy: Medicaid Expansion, Republican Governors, and Moral Intuitions

Using moral foundations theory (MFT), this study analyzes how Republican governors employed moral concepts to either build support or opposition to Medicaid expansion. The study examined statements about Medicaid expansion made by all Republican governors as reported in two large newspapers in each governor's state from 28 June 2012 to 31 December 2018. A slight majority of the statements (183 or 58.5%) used moral arguments in support of Medicaid expansion. Governors from both policy camps most frequently used the moral foundations shared by liberals and conservatives: care/harm and fairness/cheating. Those supporting expansion also used loyalty/betrayal, authority/subversion, and sanctity/degradation. Those opposing expansion used liberty/oppression. Policymakers recognize that activating the public's moral intuitions can be an effective way to advance a policy of interest. Those interested in advancing health policies would do well to better understand the kind of moral arguments that are used with potential supporters and arguments that may be used by opponents.

Shifting threats and rhetoric: how Republican governors framed Medicaid expansion

The 2012 Supreme Court decision in National Federation of Independent Business v Sebelius gave states the option to adopt the Medicaid expansion as part of the Affordable Care Act. Many states, especially those under Republican control, have since grappled with their decision to implement the expansion. We conduct a comparative analysis of how Republican governors framed their stance on the Medicaid expansion. We analyze public statements on the Medicaid expansion published in two major in-state newspapers from all Republican governors from June 2012 through June 2018. In total we collected, coded and analyzed 3277 statements from 66 newspapers. Several key themes emerge from our analysis. While every Republican governor used oppositional framing as part of their rhetorical response to the Medicaid expansion, the policy had a destabilizing effect on the previously unified opposition to health reform. We find that Republican framing split after the results of the 2012 election and that overall Republican governors shifted towards more supportive framing prior to the 2016 presidential election. Republican governors transformed how they framed their stance towards Medicaid expansion after Donald Trump was elected in 2016, with both supportive and oppositional moral-based framing of expansion increasing. These findings inform how policymakers use rhetoric to support their stance on controversial policies in a hyper-partisan and polarized political environment.