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Minaker LM, Menko P, Olona D. Development and testing of two tools to assess point-of-sale food and beverage marketing to children in restaurants. Public Health Nutr 2024; 27:e128. [PMID: 38705591 PMCID: PMC11112432 DOI: 10.1017/s1368980024000983] [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: 04/24/2023] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To describe the development and testing of two assessment tools designed to assess exterior (including drive-thru) and interior food and beverage marketing in restaurants with a focus on marketing to children and teens. DESIGN A scoping review on restaurant marketing to children was undertaken, followed by expert and government consultations to produce a draft assessment tool. The draft tool was mounted online and further refined into two separate tools: the Canadian Marketing Assessment Tool for Restaurants (CMAT-R) and the CMAT-Photo Coding Tool (CMAT-PCT). The tools were tested to assess inter-rater reliability using Cohen's Kappa and per cent agreement for dichotomous variables, and intra-class correlation coefficients (ICCs) for continuous or rank-order variables. SETTING Waterloo, Ontario, Canada. PARTICIPANTS Restaurants of all types were assessed using the CMAT-R (n 57), and thirty randomly selected photos were coded using the CMAT-PCT. RESULTS The CMAT-R collected data on general promotions and restaurant features, drive-thru features, the children's menu and the dollar/value menu. The CMAT-PCT collected data on advertisement features, features considered appealing to children and teens, and characters. The inter-rater reliability of the CMAT-R tool was strong (mean per cent agreement was 92·4 %, mean Cohen's κ = 0·82 for all dichotomous variables and mean ICC = 0·961 for continuous/count variables). The mean per cent agreement for the CMAT-PCT across items was 97·3 %, and mean Cohen's κ across items was 0·91, indicating very strong inter-rater reliability. CONCLUSIONS The tools assess restaurant food and beverage marketing. Both showed high inter-rater reliability and can be adapted to better suit other contexts.
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Affiliation(s)
- Leia M Minaker
- School of Planning, Faculty of Environment, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Patrycia Menko
- School of Planning, Faculty of Environment, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - David Olona
- School of Planning, Faculty of Environment, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Blankenship J, Nguyen T, White JM, Badham J, Zambrano P, Vu D, Nguyen H, Cashin J, Kupka R. Overpromoted and underregulated: National binding legal measures related to commercially produced complementary foods in seven Southeast Asian countries are not fully aligned with available guidance. MATERNAL & CHILD NUTRITION 2023; 19 Suppl 2:e13588. [PMID: 38092379 PMCID: PMC10719056 DOI: 10.1111/mcn.13588] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/11/2023] [Accepted: 10/26/2023] [Indexed: 12/17/2023]
Abstract
The market for commercially produced complementary foods (CPCF) is rapidly expanding in Southeast Asia; however, the existence and content of mandatory national policies, standards and legislation (binding legal measures) for CPCF in the region is unclear. To assess the status of national binding legal measures for CPCF in Southeast Asia, a legal and policy desk review was conducted in seven countries (Cambodia, Laos People's Democratic Republic, Indonesia, Malaysia, Philippines, Thailand and Viet Nam). The alignment of the national binding legal measures relevant to CPCF was assessed against guidance on CPCF nutrient composition and labelling requirements provided by Codex Alimentarius and the World Health Organization (WHO). Each of the seven countries had at least two national binding legal measures related to the nutrient composition or labelling of CPCF; however, there was limited alignment with the guidance from Codex and WHO. No country was fully aligned with the three CPCF-specific Codex standards/guidelines and only one country was in full alignment with the recommendations related to the protection of breastfeeding from the 'WHO Guidance on ending the inappropriate promotion of foods for infants and young children'. The findings of the review indicate that the existing national binding legal measures are insufficient to ensure that the CPCF sold as suitable for older infants and young children are nutritionally adequate and labelled in a responsible manner that does not mislead caregivers. Improved and enforced national binding legal measures for CPCF, in alignment with global guidance, are required to ensure that countries protect, promote and support optimal nutrition for children 6-36 months of age.
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Affiliation(s)
| | - Tuan Nguyen
- Alive and Thrive East Asia Pacific, FHI 360/FHI SolutionsHanoiVietnam
| | | | | | - Paul Zambrano
- Alive and Thrive East Asia Pacific, FHI 360/FHI SolutionsHanoiVietnam
| | - Duong Vu
- Alive and Thrive East Asia Pacific, FHI 360/FHI SolutionsHanoiVietnam
| | | | - Jennifer Cashin
- Alive and Thrive East Asia Pacific, FHI 360/FHI SolutionsHanoiVietnam
| | - Roland Kupka
- UNICEF East Asia Pacific Regional OfficeBangkokThailand
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Norov B, Cristobal-Maramag C, Van Minh H, Long KQ, Huse O, Nkoroi A, Luvsanjamba M, Phuong DH, Kupka R, Lobstein T, Jewell J, Castro MC, Oliver N, Watson F. Prevention of childhood overweight and obesity in Mongolia, the Philippines and Vietnam: identifying priority actions. Health Promot Int 2023; 38:daad187. [PMID: 38156876 PMCID: PMC10756053 DOI: 10.1093/heapro/daad187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Low- and middle-income countries are increasingly faced with a triple burden of malnutrition: endemic underweight, micronutrient deficiencies and rising prevalence of overweight. This study aimed to address existing knowledge gaps and to identify priority policy options in Mongolia, the Philippines and Vietnam. A landscape analysis approach was adopted using methods set out in a UNICEF global toolkit. Quantitative and qualitative data were compiled from a range of global and national sources on childhood overweight and obesity, risk factors and policy responses. Key informant interviews and validation workshops were undertaken with key food and nutrition stakeholders from government and non-government organizations to identify priority policy options for the prevention of overweight and obesity among children. Overweight and obesity among children are increasing in all three countries. Associated risk factors are related to maternal nutrition, birthweight, breastfeeding, as well as diets and physical activity shaped by increasingly obesogenic environments. Key informants identified undefined policy approaches, poor community understanding and food and beverage industry influence as barriers to addressing overweight and obesity. Key policy priorities include restricting the marketing of unhealthy food and beverages, unhealthy food and beverage taxation, introduction of front-of-pack nutrition labels and improving school nutrition environments. Mongolia, the Philippines and Vietnam are all facing an increasing burden of childhood overweight and obesity. Despite differing national contexts, similar environmental factors are driving this rise. A suite of evidence-based policies can effectively be introduced to address obesogenic environments.
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Affiliation(s)
- Bolormaa Norov
- Nutrition Department, National Center for Public Health, Peace Ave 46, Ulaanbaatar 13381, Mongolia
| | - Cherry Cristobal-Maramag
- Health and Nutrition Unit, Nutrition Center of the Philippines, Launchpad Coworking 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, The Philippines
| | - Hoang Van Minh
- Hanoi University of Public Health, 1A Đ. Đức Thắng, Đông Ngạc, Bắc Từ Liêm, Hà Nội, Vietnam
| | - Khương Quỳnh Long
- Hanoi University of Public Health, 1A Đ. Đức Thắng, Đông Ngạc, Bắc Từ Liêm, Hà Nội, Vietnam
| | - Oliver Huse
- Deakin University, Geelong Australia, Global Obesity Centre for Preventive Health and Nutrition, Institute for Health Transformation, 1 Gheringhap St 3220
- East Asia and Pacific Regional Office, UNICEF, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand
| | - Alice Nkoroi
- Philippines Country Office, UNICEF, 14th Floor, North Tower, Rockwell Business Center Sheridan, Sheridan Street corner United Street, Highway Hills, Mandaluyong City 1550, Philippines
| | - Munkhjargal Luvsanjamba
- Mongolia Country Office, UNICEF, UN House, United Nations street-14, Ulaanbaatar 14201, Mongolia
| | - Do Hong Phuong
- Vietnam Country Office, UNICEF, The Green One UN House, 304 Kim Ma, Ba Dinh District, Hanoi, Vietnam
| | - Roland Kupka
- East Asia and Pacific Regional Office, UNICEF, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand
| | - Tim Lobstein
- Policy Section, World Obesity Federation, 5th Floor, 38 Chancery Lane, London, WC2A 1EN, UK
- The Boden Initiative, University of Sydney, John Hopkins Dr, Camperdown, Sydney, 2050, NSW, Australia
| | - Jo Jewell
- Nutrition Section, UNICEF, 3 United Nations Plaza, New York, NY 10017, USA
| | - Mary Christine Castro
- Health and Nutrition Unit, Nutrition Center of the Philippines, Launchpad Coworking 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, The Philippines
| | - Nikka Oliver
- Health and Nutrition Unit, Nutrition Center of the Philippines, Launchpad Coworking 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, The Philippines
| | - Fiona Watson
- East Asia and Pacific Regional Office, UNICEF, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand
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Huse O, Backholer K, Nguyen P, Calibo A, Guirindola M, Desnacido JP, Sacks G, Bell AC, Peeters A, Angeles-Agdeppa I, Ananthapavan J. A comparative analysis of the cost-utility of the Philippine tax on sweetened beverages as proposed and as implemented. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 41:100912. [PMID: 37780636 PMCID: PMC10534259 DOI: 10.1016/j.lanwpc.2023.100912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/01/2023] [Accepted: 09/10/2023] [Indexed: 10/03/2023]
Abstract
Background In response to increasing overweight and obesity, the Philippine government introduced a tax on sweetened beverages (SBs) in 2018. Evidence suggests that the beverage industry influenced the final tax design, making it more favourable for industry than the initially proposed bill. This study aimed to compare the relative health and economic benefits of the proposed SB tax with the implemented SB tax. Methods Philippine dietary consumption data were combined with price elasticity data from Mexico and data from Australia adapted to the Philippine context to estimate reductions in SB purchases and changes in body mass index (BMI) following the implementation of the tax. A multi-state, multiple-cohort Markov model was used to estimate the change in health-adjusted life years (HALYs) due to reduction in the epidemiology of obesity-related diseases, healthcare cost savings and government taxation revenue, resulting from both the proposed and implemented tax policies, over the lifetime of the 2018 Philippine population. Findings The proposed and implemented taxes were modelled to be dominant (cost-saving and improving health). Intervention costs were modelled to be PHP305.2 million (M) (approximately US$6M). Compared to the proposed tax, the implemented tax was modelled to result in a 43.0% smaller reduction in targeted beverage intake (51.1 ml/person/day vs. 89.7 ml/person/day), a 43.5% smaller reduction in BMI (0.35 kg/m2 vs. 0.62 kg/m2), 39.7% fewer HALYs gained (2,503,118 vs. 4,149,030), 39.9% fewer healthcare cost savings (PHP16.4 billion (B) vs. PHP27.3B), and 27.7% less government taxation revenue (PHP426.3B vs. PHP589.4B). Interpretation While the implemented tax in the Philippines will benefit population health, it is likely to yield less benefit than the proposed tax. The influence of the food and beverage industry on policy processes has the potential to lessen the benefits of population NCD prevention policies. Funding OH was supported to conduct this research by an Australian Government Research Training Program Stipend Scholarship. The funding body had no role in data collection and analysis, or manuscript preparation.
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Affiliation(s)
- Oliver Huse
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Kathryn Backholer
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Phuong Nguyen
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Anthony Calibo
- Child Health Division, Department of Health, Medical Specialist IV, Disease Prevention and Control Bureau, Manila (2011-2020), Philippines
- Institute of Pediatrics and Child Health, St. Luke's Medical Center, Quezon City, Philippines
| | - Mildred Guirindola
- Department of Science and Technology, Food and Nutrition Research Institute, Manila, Philippines
| | - Josie P. Desnacido
- Department of Science and Technology, Food and Nutrition Research Institute, Manila, Philippines
| | - Gary Sacks
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Andrew Colin Bell
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Anna Peeters
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Imelda Angeles-Agdeppa
- Department of Science and Technology, Food and Nutrition Research Institute, Manila, Philippines
| | - Jaithri Ananthapavan
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
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Ching C, Sethi V, Nguyen TT, Murira Z, Shats K, Rowel D, Ahmed K, Dorji K, Chakma I, Haag KC, Singh PP, Khatoon S, Bukhari UK, Aminee A, Ghosh S, Forissier T, Kappos K, Zambrano P, Khan GM. Law matters - assessment of country-level code implementation and sales of breastmilk substitutes in South Asia. Front Public Health 2023; 11:1176478. [PMID: 37937076 PMCID: PMC10626485 DOI: 10.3389/fpubh.2023.1176478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/28/2023] [Indexed: 11/09/2023] Open
Abstract
Objectives This study examines the status of implementation of the International Code of Marketing of Breast-milk Substitutes of eight countries in the South Asia region (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka), and describes the sales value and volume of commercial milk formula (CMF) marketed as breastmilk substitutes (BMS) and baby food in four countries (Bangladesh, India, Pakistan, and Sri Lanka). Design A mix of descriptive methods is used to assess national status of Code implementation, including a desk review of the 2022 WHO/UNICEF/IBFAN Code Status Report, systematic content analysis of national Code measures, and insights generated from the participation of key government and UNICEF/WHO actors in a regional workshop that aimed to identify each country's barriers, gaps, and the status of Code implementation. Data on the sales value and volume of CMF and baby food between 2007 to 2021 and with the prediction to 2026 in Bangladesh, India, Pakistan, and Sri Lanka were obtained from Global Data. Findings There are major gaps in Code implementation in countries even with legal measures considered substantially aligned with the Code, such as the inadequate age range of CMF covered in the scope, insufficient safeguards against conflicts of interest in the health system, lack of warning of risks of intrinsic contamination of powdered milk formula, and an absence of effective monitoring and enforcement mechanisms. Data on CMF sales shows health facilities and pharmacies sustain the highest sales. Lower sales volume of infant formula (including special formula), compared to other CMF such as follow-up formula and growing-up milk, has been observed in three of the four countries (Bangladesh, India, and Sri Lanka). Overall, GUM, followed by baby cereals, accounted for a large portion of CMF and baby foods sales in the same three countries. Recommended actions include (1) Closing the gaps between national measures and the Code, (2) Ensuring effective monitoring and enforcement mechanisms, (3) Strengthening conflicts of interest safeguards in the health system, (4) Tackling digital marketing, and (5) Galvanizing political support and support from in-country public health and women's rights jurist networks.
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Affiliation(s)
| | - Vani Sethi
- UNICEF Regional Office for South Asia, Kathmandu, Nepal
| | | | - Zivai Murira
- UNICEF Regional Office for South Asia, Kathmandu, Nepal
| | | | | | | | | | | | | | | | - Salma Khatoon
- UNICEF Field Office for Khyber-Pakhtunkhwa, Peshawar, Pakistan
| | | | | | - Sebanti Ghosh
- Alive & Thrive, Global Nutrition, FHI360, New Delhi, India
| | | | - Kristen Kappos
- Alive & Thrive, Global Nutrition, FHI 360, Washington, DC, United States
| | - Paul Zambrano
- Alive & Thrive, Global Nutrition, FHI 360, Manila, Philippines
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Huse O, Reeve E, Zambrano P, Bell C, Peeters A, Sacks G, Baker P, Backholer K. Understanding the corporate political activity of the ultra - processed food industry in East Asia: a Philippines case study. Global Health 2023; 19:16. [PMID: 36879312 PMCID: PMC9986662 DOI: 10.1186/s12992-023-00916-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Evidence is mounting that the ultra - processed food industry seeks to influence food and nutrition policies in ways that support market growth and protect against regulatory threats, often at the expense of public health. However, few studies have explored how this occurs in lower - middle income countries. We aimed to explore if and how the ultra - processed food industry seeks to influence food- and nutrition - related policy processes in the Philippines, a lower - middle income country in East Asia. METHODS Semi - structured key informant interviews were conducted with ten representatives from the Philippines government and non - government organisations closely involved with nutrition policy making in the Philippines. Interview schedules and data analysis were guided by the policy dystopia model, which we used to identify the instrumental and discursive strategies used by corporate actors to influence policy outcomes. RESULTS Informants were of the view that ultra - processed food companies in the Philippines sought to delay, prevent, water - down and circumvent implementation of globally recommended food and nutrition policies by engaging in a range of strategies. Discursive strategies included various tactics in which globally recommended policies were framed as being ineffective or highlighting potential unintended negative impacts. Instrumental strategies included: directly engaging with policymakers; promoting policies, such as industry - led codes and practices, as substitutes for mandatory regulations; presenting evidence and data that industry has generated themselves; and offering gifts and financial incentives to government individuals and agencies. CONCLUSIONS In the Philippines, the ultra - processed food industry engaged in overt activities designed to influence food and nutrition policy processes in their favour. A range of measures to minimise industry influence on policy processes should be introduced, to ensure that implemented food and nutrition policies align with best practice recommendations.
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Affiliation(s)
- Oliver Huse
- Global Centre for Preventative Health and Nutrition, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, Australia.
| | - Erica Reeve
- Global Centre for Preventative Health and Nutrition, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Paul Zambrano
- Alive & Thrive Southeast Asia, FHI 360, Manila, Philippines
| | - Colin Bell
- Global Centre for Preventative Health and Nutrition, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Anna Peeters
- Global Centre for Preventative Health and Nutrition, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Gary Sacks
- Global Centre for Preventative Health and Nutrition, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Phillip Baker
- Faculty of Health, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Kathryn Backholer
- Global Centre for Preventative Health and Nutrition, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, Australia
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Stierman EK, Maliqi B, Mary M, Dohlsten MA, Katwan E, Moran AC, Creanga AA. Changes in the health systems and policy environment for maternal and newborn health, 2008-2018: An analysis of data from 78 low-income and middle-income countries. Soc Sci Med 2023; 321:115765. [PMID: 36801755 PMCID: PMC10024243 DOI: 10.1016/j.socscimed.2023.115765] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/31/2022] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Political, social, economic, and health system determinants play an important role in creating an enabling environment for maternal and newborn health. This study assesses changes in health systems and policy indicators for maternal and newborn health across 78 low- and middle-income countries (LMICs) during 2008-2018, and examines contextual factors associated with policy adoption and systems changes. METHODS We compiled historical data from WHO, ILO, and UNICEF surveys and databases to track changes in ten maternal and newborn health systems and policy indicators prioritized for tracking by global partnerships. Logistic regression was used to examine the odds of systems and policy change based on indicators of economic growth, gender equality, and country governance with available data from 2008 to 2018. RESULTS From 2008 to 2018, many LMICs (44/76; 57·9%) substantially strengthened systems and policies for maternal and newborn health. The most frequently adopted policies were national guidelines for kangaroo mother care, national guidelines for use of antenatal corticosteroids, national policies for maternal death notification and review, and the introduction of priority medicines in Essential Medicines Lists. The odds of policy adoption and systems investments were significantly greater in countries that experienced economic growth, had strong female labor participation, and had strong country governance (all p < 0·05). CONCLUSIONS The widespread adoption of priority policies over the past decade is a notable step in creating an environment supportive for maternal and newborn health, but continued leadership and resources are needed to ensure robust implementation that translates into improved health outcomes.
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Affiliation(s)
- Elizabeth K Stierman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA.
| | - Blerta Maliqi
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Meighan Mary
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - Martin Aj Dohlsten
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Elizabeth Katwan
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Allisyn C Moran
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Andreea A Creanga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA; Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
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8
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Baker P, Smith JP, Garde A, Grummer-Strawn LM, Wood B, Sen G, Hastings G, Pérez-Escamilla R, Ling CY, Rollins N, McCoy D. The political economy of infant and young child feeding: confronting corporate power, overcoming structural barriers, and accelerating progress. Lancet 2023; 401:503-524. [PMID: 36764315 DOI: 10.1016/s0140-6736(22)01933-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/21/2022] [Accepted: 09/26/2022] [Indexed: 02/10/2023]
Abstract
Despite increasing evidence about the value and importance of breastfeeding, less than half of the world's infants and young children (aged 0-36 months) are breastfed as recommended. This Series paper examines the social, political, and economic reasons for this problem. First, this paper highlights the power of the commercial milk formula (CMF) industry to commodify the feeding of infants and young children; influence policy at both national and international levels in ways that grow and sustain CMF markets; and externalise the social, environmental, and economic costs of CMF. Second, this paper examines how breastfeeding is undermined by economic policies and systems that ignore the value of care work by women, including breastfeeding, and by the inadequacy of maternity rights protection across the world, especially for poorer women. Third, this paper presents three reasons why health systems often do not provide adequate breastfeeding protection, promotion, and support. These reasons are the gendered and biomedical power systems that deny women-centred and culturally appropriate care; the economic and ideological factors that accept, and even encourage, commercial influence and conflicts of interest; and the fiscal and economic policies that leave governments with insufficient funds to adequately protect, promote, and support breastfeeding. We outline six sets of wide-ranging social, political, and economic reforms required to overcome these deeply embedded commercial and structural barriers to breastfeeding.
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Affiliation(s)
- Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Julie P Smith
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Amandine Garde
- Law & Non-Communicable Diseases Unit, School of Law and Social Justice, University of Liverpool, Liverpool, UK
| | | | - Benjamin Wood
- Global Centre for Preventive Health and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Gita Sen
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | | | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | | | - Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - David McCoy
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia.
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Capili DIS, Datu-Sanguyo J, Mogol-Sales CS, Zambrano P, Nguyen TT, Cashin J, Mathisen R. Cross-sectional multimedia audit reveals a multinational commercial milk formula industry circumventing the Philippine Milk Code with misinformation, manipulation, and cross-promotion campaigns. Front Nutr 2023; 10:1081499. [PMID: 36819680 PMCID: PMC9932888 DOI: 10.3389/fnut.2023.1081499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/05/2023] [Indexed: 02/05/2023] Open
Abstract
The Philippine Milk Code was enacted in 1986 to protect breastfeeding and reduce inappropriate marketing of breastmilk substitutes (BMS). The Philippine Milk Code is categorized as "substantially aligned" with the International Code of Marketing of Breast-milk Substitutes ("the Code"), but its provisions are assessed as relatively weak in prohibiting promotion to the general public. The extent to which violations of the Philippine Milk Code persist in traditional media platforms and in the digital space has not been systematically explored. This study employed a cross-sectional multimedia audit to examine the marketing and promotion of products under the scope of the Code, as well as those regulated by the Philippine Milk Code. Through a media monitoring conducted from March to September 2018, a total of 430 unique television (n = 32), printed (n = 87) and online (n = 311) promotional materials were identified. A coding tool was used to analyze the content, including the marketing elements used in the materials. Our findings show that commercial milk formula (CMF) for children ≥36 months old was the most promoted type of product (n = 251); and staging of events (n = 211), provision of special discounts or financial inducements (n = 115) and the use of taglines (n = 112) were the most used marketing elements. Promotion of CMF for children <36 months old was uncommon, which supports the conclusion that there is broad compliance with the Philippine Milk Code in terms of the types of products promoted. However, analysis of marketing elements reveals that the CMF industry circumvents the Philippine Milk Code through the use of false and misleading health and nutrition claims, emotionally manipulative language in promotional materials, and cross-promotion. The findings indicate gaps in enforcement and regulatory measures that require urgent attention.
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Affiliation(s)
| | - Janice Datu-Sanguyo
- Alive & Thrive East Asia Pacific, FHI 360, Muntinlupa, Philippines,*Correspondence: Janice Datu-Sanguyo,
| | | | - Paul Zambrano
- Alive & Thrive East Asia Pacific, FHI 360, Manila, Philippines
| | - Tuan T. Nguyen
- Alive & Thrive East Asia Pacific, FHI 360, Hanoi, Vietnam
| | - Jennifer Cashin
- Alive & Thrive East Asia Pacific, FHI 360, Washington, DC, United States
| | - Roger Mathisen
- Alive & Thrive East Asia Pacific, FHI 360, Hanoi, Vietnam
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10
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Wiist WH. The Foundations of Corporate Strategies Comment on "'Part of the Solution': Food Corporation Strategies for Regulatory Capture and Legitimacy". Int J Health Policy Manag 2022; 11:2732-2735. [PMID: 35397485 PMCID: PMC9818111 DOI: 10.34172/ijhpm.2022.7174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/28/2022] [Indexed: 01/21/2023] Open
Abstract
The "Part of the Solution" article describes how the food industry has evolved its strategies to respond to critics and government regulation by co-option and appeasement to create a less hostile environment. Rather than focusing research on single industries it would be more efficient and productive to focus on corporate political activities (CPAs) that directly influence democratic institutions and processes having authority over laws, policy, rules and regulations that govern industry. The most influential and direct CPA are election campaign donations, lobbying, and the reverse revolving door (RRD). In the United States those CPA flow from rights of corporations that underlie all industry strategies. The US history of how corporations obtained their rights is described, and research about the affirmative effects of those three CPA is summarized. Health research is needed about those CPA and their effects on health law, policy and regulation in the United States and other nations.
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Affiliation(s)
- William H. Wiist
- Global Health Program, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
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11
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Samaniego JAR, Maramag CC, Castro MC, Zambrano P, Nguyen TT, Datu-Sanguyo J, Cashin J, Mathisen R, Weissman A. Implementation and Effectiveness of Policies Adopted to Enable Breastfeeding in the Philippines Are Limited by Structural and Individual Barriers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10938. [PMID: 36078649 PMCID: PMC9517919 DOI: 10.3390/ijerph191710938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
The Philippines has adopted policies to protect, promote, and support breastfeeding on par with global standards, yet the impact of these policies is not well understood. This study assesses the adequacy and potential impact of breastfeeding policies, as well as the perceptions of stakeholders of their effectiveness and how to address implementation barriers. This mixed methods study entailed a desk review of policies and documents and in-depth interviews with 100 caregivers, employees, employers, health workers, and policymakers in the Greater Manila Area. Although the Philippines has a comprehensive breastfeeding policy framework, its effectiveness was limited by structural and individual barriers. Structural barriers included inconsistent breastfeeding promotion, limited access of mothers to skilled counseling, limited workplace breastfeeding support, gaps in legal provisions, weak monitoring and enforcement of the Philippine Milk Code, and the short duration and limited coverage of maternity leave. Individual barriers included knowledge and skills gaps, misconceptions, and low self-confidence among mothers due to insufficient support to address breastfeeding problems, misconceptions in the community that undermine breastfeeding, limited knowledge and skills of health workers, and insufficient support extended to mothers by household members. Breastfeeding policies in the Philippines are consistent with global standards, but actions to address structural and individual barriers are needed to enhance their effectiveness for improving breastfeeding practices.
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Affiliation(s)
| | | | | | - Paul Zambrano
- Alive & Thrive Southeast Asia, FHI 360, Quezon City 1101, Philippines
| | - Tuan T. Nguyen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam
| | | | - Jennifer Cashin
- Alive & Thrive Southeast Asia, FHI 360, Washington, DC 20009, USA
| | - Roger Mathisen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam
| | - Amy Weissman
- Asia Pacific Regional Office, FHI 360, Bangkok 10330, Thailand
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12
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Pettigrew S, Coyle D, McKenzie B, Vu D, Lim SC, Berasi K, Poowanasatien A, Suya I, Kowal P. A review of front-of-pack nutrition labelling in Southeast Asia: Industry interference, lessons learned, and future directions. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 3:100017. [PMID: 37384259 PMCID: PMC10305914 DOI: 10.1016/j.lansea.2022.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Front-of-pack nutrition labelling is an evidence-based nutrition intervention that is recommended by the World Health Organization and other health agencies as an effective non-communicable disease prevention strategy. To date, the types of front-of-pack labels that have been identified as being most effective have yet to be implemented in Southeast Asia. This has been partly attributed to extensive industry interference in nutrition policy development and implementation. This paper outlines the current state of food labelling policy in the region, describes observed industry interference tactics, and provides recommendations for how governments in Southeast Asia can address this interference to deliver best-practice nutrition labelling to improve diets at the population level. The experiences of four focal countries - Malaysia, Thailand, the Philippines, and Viet Nam - are highlighted to provide insights into the range of industry tactics that are serving to prevent optimal food labelling policies from being developed and implemented. Funding This research was supported by the United Kingdom Global Better Health Programme, which is managed by the United Kingdom Foreign, Commonwealth and Development Office and supported by PricewaterhouseCoopers in Southeast Asia.
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Affiliation(s)
- Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, 1 King St Newtown NSW 2042, Sydney, Australia
| | - Daisy Coyle
- The George Institute for Global Health, University of New South Wales, 1 King St Newtown NSW 2042, Sydney, Australia
| | - Briar McKenzie
- The George Institute for Global Health, University of New South Wales, 1 King St Newtown NSW 2042, Sydney, Australia
| | - Duong Vu
- Alive & Thrive Southeast Asia, FHI 360, 7F, Opera Business Center, 60 Ly Thai To Street, Hanoi, Vietnam
| | - Shiang Cheng Lim
- RTI International Malaysia, Unit 5.2 & 5.3, Level 5, Nucleus Tower, Jalan PJU 7/6, Mutiara Damansara Petaling Jaya, Selangor, 47820, Malaysia
| | - Kyra Berasi
- Global Health Advocacy Incubator, 1400 I (Eye) Street NW, Suite 1200, Washington, DC 20005, USA
| | - Amphika Poowanasatien
- FHI360, Asia Pacific Regional Office, 19th Floor, Tower 3, Sindhorn Building, 130-132 Wireless Road, Kwaeng Lumpini, Khet Phatumwan, Bangkok 10330 Thailand
| | - Inthira Suya
- FHI360, Asia Pacific Regional Office, 19th Floor, Tower 3, Sindhorn Building, 130-132 Wireless Road, Kwaeng Lumpini, Khet Phatumwan, Bangkok 10330 Thailand
| | - Paul Kowal
- Better Health Programme Southeast Asia, 7 Straits View, Marina One, Singapore, 018936
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13
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Becker GE, Ching C, Nguyen TT, Cashin J, Zambrano P, Mathisen R. Babies before business: protecting the integrity of health professionals from institutional conflict of interest. BMJ Glob Health 2022; 7:bmjgh-2022-009640. [PMID: 35926917 PMCID: PMC9358938 DOI: 10.1136/bmjgh-2022-009640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Constance Ching
- Alive & Thrive Southeast Asia, FHI Solutions / FHI 360, Washington, District of Columbia, USA
| | - Tuan T Nguyen
- Alive & Thrive Southeast Asia, FHI Solutions / FHI 360, Hanoi, Viet Nam
| | - Jennifer Cashin
- Alive & Thrive Southeast Asia, FHI Solutions / FHI 360, Washington, District of Columbia, USA
| | - Paul Zambrano
- Alive & Thrive Southeast Asia, FHI Solutions / FHI 360, Manila, Philippines
| | - Roger Mathisen
- Alive & Thrive Southeast Asia, FHI Solutions / FHI 360, Hanoi, Viet Nam
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14
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Tomori C. Addressing the Global Influence of Unethical Formula Marketing. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-22-00120. [PMID: 35487548 PMCID: PMC9053143 DOI: 10.9745/ghsp-d-22-00120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/15/2022] [Indexed: 12/04/2022]
Abstract
Projects that seek to address Code implementation need to understand the current landscape of corporate marketing activities in the government and health care settings and mobilize stakeholders from the government to the community when implementing these projects.
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Affiliation(s)
- Cecília Tomori
- Johns Hopkins School of Nursing, Baltimore, MD, USA.
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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