The Science for Profit Model-How and why corporations influence science and the use of science in policy and practice

Indigenous sovereignty in research and epistemic justice: Truth telling through research

Indigenous ways of knowing, being and doing are based on embodied sovereignty, relationality and countless generations of knowledge sharing. We call for epistemic justice in which Indigenous knowledge systems are recognised and valued in research-related contexts. We draw attention to how colonial knowledge systems silence, delegitimise and devalue specific knowers and ways of knowing, being and doing - through truth telling. This includes (1) the extent to which educational systems, research, practices, decisions, and reported outcomes are whitewashed - a process of structural and systemic discrimination, racism, and exclusion that actively alters or omits Indigenous and non-Euro-Western contributions and perspectives to fit Euro-Western norms and (2) whitewashed and racialised logic in scientific research that claims to be open, collaborative and transparent. Whitewashing not only obscures the history and contributions of Indigenous peoples and communities but also actively reinforces systemic biases and inequities. We assert the need for epistemic justice in public health research. Epistemic justice calls for Indigenous sovereignty and self-determination to be made visible. It may involve on how colonial policies, protocols, and regulations are connected to everyday lived inequities of Indigenous communities, families and individuals. Ultimately, epistemic justice is inherent to Indigenous peoples' health and wellness, self-determination and sovereignty.

Mapping corporate sponsorship of alcohol and gambling associations: An Australian pilot study

BACKGROUND AND AIMS

Alcohol and gambling industries use a range of strategies to oppose and undermine public health policies targeting their industries. Industry associations often play a visible role in advancing alcohol and gambling industry interests, yet there are few studies analysing who their members or partners are and the relationships between them. Our study developed an approach to map the landscape of Australian alcohol and gambling associations, their members and partners and the connections between commercial actors.

METHODS

We conducted our study in four phases: first, we systematically searched for alcohol and gambling industry associations; second, we identified and classified association members and/or partners; third, we mapped three types of relationships between associations and members/partners (umbrella associations, co-location and joint membership/partnerships); lastly, we analysed the disclosures of the members and partners of the Australian Hotels Associations and Clubs Associations.

RESULTS

We identified 126 industry associations and 1486 unique companies/organisations from multiple industry sectors that were members/partners. Only 75 (59.5%) associations provided a list of members/partners. Most companies/organisations were partners of only one association (n = 1218), while five companies were partners of more than 20 associations. Concerning relationships, we identified five national clusters, 27 instances of co-location and an extensive network linking associations through shared partnerships. Finally, we assessed 658 relationships between Hotels and Clubs Associations and their partners, of which only 91 (13.8%) were transparently disclosed.

CONCLUSIONS

In Australia, many alcohol and gambling industry associations do not disclose their members or corporate partners and provide limited funding information. Members and corporate partners of Australian alcohol and gambling industry associations rarely disclose their support and are diverse in focus, size, members, partners, purpose and activities.

Labelling the debate: a thematic analysis of alcohol industry submissions to the EU consultation on alcohol health warnings in Ireland

BACKGROUND

Building on the success of tobacco health warning labels, EU Member States and institutions are increasingly considering similar requirements for alcohol products. While industry responses to pricing and availability policies have been widely studied, their framing of Alcohol Health Warning Labels (AHWLs) as a policy solution remains comparatively underexplored. This paper examines how alcohol industry stakeholders responded to the EU notification process for Ireland's proposed alcohol labelling regulations, introduced under Ireland's Public Health (Alcohol) Act 2018.

METHODS

This paper analyses 16 submissions from alcohol industry actors to the European Commission regarding Ireland's proposed alcohol warning label regulations. Qualitative methods, specifically thematic analysis, were used to examine industry arguments. The research team first reviewed five submissions to inductively develop a codebook, which was then applied to the remaining submissions, with new codes added as necessary. Two team members independently coded each submission, and thematic content was refined through team discussion.

RESULTS

Alcohol industry arguments against AHWLs fall into four main themes: lack of evidence supporting the content of health warning labels and their broader use, negative trade and economic impacts of AHWLs, potential risks to EU governance posed by Ireland's labels, and the industry's self-positioning as responsible actors committed to public health. In addition, we identify novel industry strategies related to the intricacies of AHWLs, including a heightened focus on wording and language, coordination of activities across multiple governance levels, and tailored framing to suit the institutional context.

CONCLUSIONS

Alcohol industry actors employ arguments similar to those seen in other policy debates, which continue to pose a significant barrier to evidence-based alcohol policymaking. The analysis suggests that industry actors can strategically adapt their arguments to varying institutional settings and policy instruments, demonstrating their political dexterity and reinforcing the barriers to policy progress. These findings highlight the need for further research into the alcohol industry's influence and provide insights for jurisdictions considering labelling legislation.

Developing and evaluating an educational intervention on conflicts of interest and corporate influence on science

Financial conflicts of interest resulting from corporate funding of research can bias the evidence base. We designed an educational intervention that sought to enable participants to make informed decisions and mitigate risk when considering corporate funding for research. We used pre/post-test surveys, which comprised a mix of closed and open-ended questions, to evaluate the training and its impact on knowledge (Wilcoxon signed-rank test), attitudes and perceptions (Friedman's test with planned post hoc tests). Open-ended questions were coded and key themes identified. Twenty participants from the University of Bath (15 PhD students and 5 research staff) completed the pre-test survey and attended the training, 17 filled in the post-test survey, and 17 filled in the 3-month follow-up survey. All participants agreed or strongly agreed that the issues relating to conflict of interest presented in the training increased their interest in the topic. Participants' knowledge significantly increased between the pre and post-measures. Awareness of institutional conflict of interest policies and participants' confidence in mitigating the risks of corporate funding also significantly improved. For the other measures of impact, either there was not a statistically significant difference between the pre, post, and follow-up measures or there was, but post hoc tests were not significant after a Bonferroni correction. Our findings indicate that even a short educational intervention could increase researchers' confidence in and ability to make informed decisions about whether to accept corporate funding and under what conditions.

Impact of heated tobacco products on biomarkers of potential harm and adverse events: a systematic review and meta-analysis

OBJECTIVE

To systematically review available data on the effects of heated tobacco products (HTPs) on biomarkers of potential harm (BoPH) and adverse events, including comparison to cigarettes, e-cigarettes and smoking abstinence.

DATA SOURCES

Web of Science, Scopus, MedRxiv, ClinicalTrials.gov, ICTRP database and HTP manufacturer libraries were searched from January 2010 to December 2024.

STUDY SELECTION

Included studies were interventional clinical trials of any design that measured BoPH or adverse events in adults assigned a marketed HTP and another assigned either cigarettes, e-cigarettes or smoking abstinence.

DATA EXTRACTION

Two reviewers independently extracted data into a predesigned form and assessed risk of bias using Cochrane's Risk of Bias tool version 1.

DATA SYNTHESIS

BoPH data were synthesised using effect direction plots. A random-effects model was used to calculate pooled risk ratios for adverse event data. 40 studies (10 independent, 29 industry-affiliated and 1 of unclear affiliation) were included. Only nine studies lasted longer than 5 days. 19 involved using the intervention just once. Risk of bias was high for 32 studies and unclear for 8. Data on 143 BoPH indicated short-term HTP use had mixed effects compared with cigarettes, e-cigarettes and smoking abstinence. The rate of adverse event reporting was not significantly different between HTP and any comparator group.

CONCLUSIONS

Despite a growing evidence base, significant limitations hinder interpretation of the data, which do not yet provide clear indication of harm or benefit, even compared with cigarettes. Longer, better quality studies independent of tobacco industry funding are needed to determine the health impacts of HTPs.

Tobacco industry influence on breast cancer research, policy and public opinion: scoping the Truth Tobacco Industry Documents

OBJECTIVE

Over the last 35 years, there has been growing evidence suggesting a relationship between tobacco use and breast cancer. The tobacco industry's role in shaping research, policy and public opinion about the relationship is unknown. This study's objective is to determine if the tobacco industry-funded Council for Tobacco Research (CTR) Records and the Tobacco Institute (TI) Records, housed in the Truth Tobacco Industry Document Archive, contain documents related to internal research about breast cancer and strategies to influence the science and public opinion about breast cancer causes.

METHODS

We applied the situational scoping method, in which community advocates and university researchers collaborate, to (1) identify external events considered by CTR or TI as a threat or opportunity to business interests; (2) select events for further analysis and (3) conduct social worlds/arenas mapping of industry responses to selected events.

RESULTS

The CTR and TI Records contained 19 719 documents with the search term 'breast cancer' ranging from the 1950s to 1998. We analysed nine events relevant to the aim of this research. CTR and TI responded to external threats, pointing out methodological problems in studies they perceived as threatening, or characterising lung cancer as misdiagnosed or metastasised breast cancer. They responded to external opportunities with promoting and funding research focusing on smoking's 'protective effects' over breast cancer, and breast cancer's genetic, hormonal and dietary causes.

CONCLUSION

The CTR and TI Records are a rich source of documents related to tobacco industry efforts to influence breast cancer research, policy and public opinion away from any aetiologic relationship between tobacco use and breast cancer.

"Keep it a secret": Leaked Documents Suggest Philip Morris International, and Its Japanese Affiliate, Continue to Exploit Science for Profit

INTRODUCTION

The tobacco industry has a long history of manipulating science to conceal the harms of its products. As part of its proclaimed transformation, the world's largest tobacco company, Philip Morris International (PMI), states it conducts "transparent science." This paper uses recently leaked documents from PMI and its Japanese affiliate, Philip Morris Japan (PMJ), to examine its contemporary scientific practices.

AIMS AND METHODS

Twenty-four documents dating 2012 through 2020 available from the Truth Tobacco Industry Documents Library were examined using Forster's hermeneutic approach to analyzing corporate documentation. Thematic analysis using the Science for Profit Model was conducted to assess whether PMI and PMJ employed known corporate strategies to influence science in their interests.

RESULTS

PMJ contracted third-party external research organization, CMIC, to covertly fund a study on smoking cessation conducted by Kyoto University academics. No public record of PMJ's funding or involvement in this study was found. PMJ paid life sciences consultancy, FTI-Innovations, ¥3 000 000 (approx. £20 000) a month between 2014 and 2019 to undertake extensive science-adjacent work, including building relationships with key scientific opinion leaders and using academic events to promote PMI's science, products and messaging. FTI-Innovation's work was hidden internally and externally. These activities resemble known strategies to influence the conduct, publication and reach of science, and conceal scientific activities.

CONCLUSIONS

The documents reveal PMI and PMJ's recent activities mirror past practices to manipulate science, undermining PMI's proclaimed transformation. Tobacco industry scientific practices remain a threat to public health, highlighting the urgent need for reform to protect science from the tobacco industry's vested interests.

IMPLICATIONS

Japan is a key market for PMI, being a launch market for IQOS and having the highest heated tobacco product use globally. Our findings, in conjunction with other recent evidence, challenge PMI's assertion that it is a source of credible science and cast doubt on the quality and ethical defensibility of its research, especially its studies conducted in Japan. This, in turn, brings into question the true public health impacts of its products. There is an urgent need to reform the way tobacco-related science is funded and conducted. Implementation of models through which research can be funded using the industry's profits while minimizing its influence should be explored.

Integrative Field-Based Health and Performance Research: A Narrative Review on Experimental Methods and Logistics to Conduct Competition and Training Camp Studies in Athletes

Field-based sport research involves studies that collect data from athletes and/or teams during competition and/or their daily training environments. Over the last decade, sport-specific field-based research projects have significantly increased in number and complexity, partially owing to the further development of more portable measurement equipment (e.g., indirect calorimetry, desktop blood/gas analyzers, portable laboratories, etc.) and/or wearable or consumable technologies (e.g., smart watches, sensors, core temp pills, etc.). However, given these rapid advances and novelty, challenges remain in the validity and applicability of these devices. Unfortunately, there are no global ethical or best-practice standards for the use of portable devices and/or wearables in sport; however, this review will outline various opportunities and challenges. Many decision trade-offs are required when designing field-based research studies to balance gold-standard scientific rigor and strict research control with highly applied, but less-controlled, "real-world" conditions. To our knowledge, there are no narrative reviews that take a wholistic view of the logistical and methodological considerations of field-based research in athletes. Accordingly, this review takes a multi-disciplinary methodological approach (physiological, nutritional/energetic, biomechanical, musculoskeletal, cognitive, and psychosocial factors), along with the logistical considerations involved in project planning, research design, and ethics of field-based research with elite athletes and/or teams. We also provide practical guidance for characterizing the extreme demands of elite training and competition to support research that ultimately catalyzes improved understanding of the limits of human capacity. We hope this review can serve as a practical guide for researchers undertaking elite athlete field-based research.

Alcohol industry involvement in the delayed South Africa Draft Liquor Amendment Bill 2016: a case study based on freedom of information requests

BACKGROUND

South Africa is reported to have one of the highest per capita rates of alcohol consumption among drinkers globally, with alcohol harms exacerbating socio-economic inequalities in the country. The Draft Liquor Amendment Bill 2016 proposed new restrictions on alcohol advertising, availability, and liability of retailers and manufacturers for harm related to any contravention of the regulations. To date, the Bill has not progressed through the legislative process. The alcohol industry is known to use a diverse set of strategies to delay evidence-based policies globally.

METHODS

We aimed to explore Bill-related activity by industry within the National Economic and Development Labour Council, a multi-stakeholder forum that assesses socio-economic policies before they reach parliament. On 06 July 2023 we made a Request for Access to Record, using form two of the Promotion of Access to Information Act (PAIA), no. 2 of 2000 to the National Economic and Development Labour Council for access to minutes of all meetings, reports, and any other publications related to the Bill between January 2016 and December 2022. Informed by Ulucanlar et al's (2023) model and taxonomies of corporate political activity, we extracted data on industry Bill-related activity and thematically analysed key events, presented here as a narrative synthesis.

RESULTS

We identified activity by 14 alcohol industry organisations related to the Bill between 2016 and 2022. Industry representation on five National Economic and Development Labour Council-related committees identified between 2017 and 2021 facilitated their involvement in Bill-related discussions and supported access to other government departments. Community representation was low in all committees compared to industry, labour, and government. Industry funded two socio-economic assessments of the Bill in 2017 and 2022, despite an independent socio-economic impact assessment having already been completed. The 2017 report delayed progress of the Bill, and the 2022 're-evaluation' was more critical of the proposed measures, with the differing conclusions attributed to different methodologies. During the covid-19 pandemic, industry used a 'carrot and stick' approach of legal threats and donations to attempt to move towards self-regulation via a social compact. The National Economic and Development Labour Council confirmed in 2023 that the social compact was unsuccessful.

CONCLUSIONS

Early 'regulatory capture' gave the alcohol industry the opportunity to shape assessment of the Bill within the National Economic and Development Labour Council. Our findings are in line with previous studies on corporate influence on policy globally, and support calls for a reassessment of the role and proportion of industry representation within the National Economic and Development Labour Council locally.

Advice to early career nutritionists on working in and with the food industry

Early career researchers (ECRs) in nutrition and related fields often wish to approach commercial organisations for possible funding or collaboration in scientific projects and other activities. However, ECRs may experience challenges from their limited experience, lack of understanding of the food industry and concerns about working practices and research integrity. This commentary is oriented toward providing some basic, practical guidance for nutritionist scientists, to help in developing credible, principled and effective working relationships with the food industry. Based on the author's experience as an academic and industry researcher, and an advisor to academic-industry collaborative projects, the text addresses a range of related aspects including: understanding and approaching the food industry; the industry environment and drivers; contracts, confidentiality and communication; potential challenges; and ensuring scientific integrity.

Mapping commercial practices of the pesticide industry to shape science and policymaking: a scoping review

There is a growing body of evidence for how health harming industries (HHIs) engage in similar practices to influence science and policymaking. However, limited attention has been paid to the pesticide industry within the commercial determinants of health (CDOH) field. We conducted a scoping review to map practices adopted by the pesticide industry to influence science and policymaking and to assess the breadth and focus of the associated literature. We included 31 documents and categorized the extracted data using a typology of commercial practices. The documents described how major pesticide companies, and their trade bodies, have acted to influence science and maintain favourable regulatory environments while undermining the credibility of researchers and agencies that publish findings threatening to their commercial interests. A large proportion of the literature consists of historical analyses, narrative reviews, commentaries/perspective pieces, and investigative reports published in the grey literature, predominantly informed by analysis of internal industry documents and freedom of information requests. Most studies focus on high-income settings. There were a limited number of primary peer-reviewed empirical studies that explicitly aimed to study the practices of the pesticide industry from a CDOH perspective. However, our findings show that major pesticide companies adopt political and scientific practices highly similar to other HHIs. The review shows a critical need for research on the pesticide industry's current practices in low- and middle-income countries where the negative impacts of its activities on health and the environment are likely to be more marked.

Independent companies in the tobacco supply chain: transparency and environmental social governance

OBJECTIVE

Previous research has identified that transnational tobacco companies lack transparency and that they hide their harms to health and nature behind environmental, social and governance (ESG) reporting. Our objective was to find whether independent tobacco supply chain companies similarly lack transparency on tobacco-related activities while prominently displaying ESG.

METHODS

In this cross-sectional study, mentions of tobacco supply chain activities and ESG company official documentation and websites were explored for independent tobacco supply chain companies (n=80) with identified annual reports included in the Tobacco Supply Chain Database. Bivariable statistical analysis tested for differences in the visibility of tobacco supply chain contribution and ESG within official documents and websites. In depth exploration was undertaken for seven case study companies.

RESULTS

Independent tobacco supply chain companies were significantly less likely to mention their tobacco supply chain contribution than ESG (31% and 80%, respectively p<0.001) in annual reporting. Tobacco supply chain contribution was also less prominent than ESG on websites (29% and 79%, respectively, mentioned on the home page or a home page menu p<0.001). The companies were making median annual profits of over US$2 million (n=76), with a large variation of revenue from tobacco activity (5-100%) where it was reported (n=9).

CONCLUSIONS

Independent tobacco supply chain companies undertake ESG activities that they prominently display in official reporting and on websites while often being less transparent about their tobacco supply chain contribution. Potential investors and customers may thus be misled about the companies' true nature. More rigorous reporting requirements are needed.

Developing structures to support researchers studying health-harming industries

It is well-documented that health-harming industries and the groups they fund use a range of tactics that seek to interfere with academic research. With the development of scholarship relating to the Commercial Determinants of Health (CDoH), an increasing number of public health researchers are working to examine the activities of health-harming industries and the impacts they have on health and equity. However, there has been limited research investigating the experiences of these researchers and the range of strategies that could be used to support them. This qualitative interpretivist study involved 10 online focus groups with 28 public health researchers (ranging from PhD students to emeritus professors) in Australia and the UK. The researchers worked on issues related to the alcohol, gambling, tobacco or ultra-processed food industries. Participants outlined a range of personal and professional risks relating to their research, including social media attacks, complaints to university personnel and funders, attempts to discredit their research, legal threats and freedom of information requests. Some described the impacts this had on their overall well-being, and even on their family life. They commented that current university systems and structures to support them were variable and could differ between individuals within institutions. This often left researchers feeling isolated and unsupported. Universities should recognize the risks to researchers working on issues relating to health-harming industries. They should proactively develop strategies and resources to inform and support researchers to conduct research that is important for public health and equity.

Industry influence on public health policy formulation in the UK: a complex systems approach

Unhealthy commodity industries (UCIs) such as tobacco, alcohol, gambling, ultra-processed food and beverage producers are known to influence policy-making to advance their interests, often to the detriment of public health goals. This study mapped the complex system underpinning UCI's influence on public health policy formulation in the UK and identified potential interventions to shift the system towards being able to better attain public health goals. We conducted a participatory systems mapping workshop with ten experts to build a causal loop diagram (CLD) and identify potential interventions to address UCI's influence on public health policy development. The resulting CLD depicts a highly interconnected and reinforcing system driving UCI's involvement in public health policy formulation across five thematic areas. Among the most connected elements were the 'dominance of market mechanisms', 'perception of partnership as good governance principle', 'industry involvement lending perceived legitimacy to the policy formulation process', 'industry is seen as part of the solution' and 'industry ties to policy-makers'. Participants identified a total of 22 interventions within this system. Analysis of the CLD and interventions identified the potential for two key paradigmatic changes in this complex system: de-normalizing the perception of unhealthy commodity industry actors as legitimate stakeholders in policy formulation; and prioritizing public health and wellbeing objectives over profit and economic gain. In order to shift the system towards better attaining public health goals, interventions should reinforce each other and be supportive of these two key paradigmatic shifts.

Corporate activities that influence population health: a scoping review and qualitative synthesis to develop the HEALTH-CORP typology

INTRODUCTION

The concept of the commercial determinants of health (CDH) is used to study the actions of commercial entities and the political and economic systems, structures, and norms that enable these actions and ultimately influence population health and health inequity. The aim of this study was to develop a typology that describes the diverse set of activities through which commercial entities influence population health and health equity across industries.

METHODS

We conducted a scoping review to identify articles using CDH terms (n = 116) published prior to September 13, 2022 that discuss corporate activities that can influence population health and health equity across 16 industries. We used the qualitative constant comparative method to inductively code descriptions and examples of corporate activities within these articles, arrange the activities into descriptive domains, and generate an overarching typology.

RESULTS

The resulting Corporate Influences on Population Health (HEALTH-CORP) typology identifies 70 corporate activities that can influence health across industries, which are categorized into seven domains of corporate influence (i.e., political practices, preference and perception shaping practices, corporate social responsibility practices, economic practices, products & services, employment practices, and environmental practices). We present a model that situates these domains based on their proximity to health outcomes and identify five population groups (i.e., consumers, workers, disadvantaged groups, vulnerable groups, and local communities) to consider when evaluating corporate health impacts.

DISCUSSION

The HEALTH-CORP typology facilitates an understanding of the diverse set of corporate activities that can influence population health and the population groups affected by these activities. We discuss how the HEALTH-CORP model and typology could be used to support the work of policy makers and civil society actors, as well as provide the conceptual infrastructure for future surveillance efforts to monitor corporate practices that affect health across industries. Finally, we discuss two gaps in the CDH literature that we identified based on our findings: the lack of research on environmental and employment practices and a dearth of scholarship dedicated to investigating corporate practices in low- and middle-income countries. We propose potential avenues to address these gaps (e.g., aligning CDH monitoring with other occupational health monitoring initiatives).

How Could We Establish Monitoring and Surveillance of Health-Harming Corporations and Can Governments Be Trusted to Do It? Comment on "National Public Health Surveillance of Corporations in Key Unhealthy Commodity Industries - A Scoping Review and Framework Synthesis"

In the context of growing interest in the commercial determinants of health (CDOH) which has been defined as "the systems, practices, and pathways through which commercial actors drive health and equity," Bennett et al propose that governments implement monitoring of unhealthy commodity industries (UCIs) (including tobacco, alcohol, and ultra-processed foods) as part of their routine public health surveillance. We explore the evidence underpinning that suggestion and provide details on how corporate monitoring might be practically implemented drawing on lessons from tobacco industry monitoring which has been an established part of tobacco control. While governments should actively support such an approach as part of efforts to address commercially driven health harms, we urge caution in governments undertaking monitoring and identify significant barriers to implementation, while also suggesting ways in which those barriers might be overcome.

The opioid industry's use of scientific evidence to advance claims about prescription opioid safety and effectiveness

It is widely recognized that pharmaceutical marketing contributed to the ongoing US opioid epidemic, but less is understood about how the opioid industry used scientific evidence to generate product demand, shape opioid regulation, and change clinician behavior. In this qualitative study, we characterize select scientific articles used by industry to support safety and effectiveness claims and use a novel database, the Opioid Industry Documents Archive, to determine notable elements of industry and non-industry documents citing the scientific articles to advance each claim. We found that 15 scientific articles were collectively mentioned in 3666 documents supporting 5 common, inaccurate claims: opioids are effective for treatment of chronic, non-cancer pain; opioids are "rarely" addictive; "pseudo-addiction" is due to inadequate pain management; no opioid dose is too high; and screening tools can identify those at risk of developing addiction. The articles contributed to the eventual normalization of these claims by symbolically associating the claims with scientific evidence, building credibility, expanding and diversifying audiences and the parties asserting the claims, and obfuscating conflicts of interest. These findings have implications for regulators of industry products and corporate activity and can inform efforts to prevent similar public health crises.

Commercial determinants of mental ill health: An umbrella review

Mental ill health has complex and interrelated underlying causes, with wider determinants of health often overlooked as risk factors. The 'commercial determinants of health' are gradually receiving more attention and recognition but there is a relative lack of awareness of the commercial determinants of mental health. This aim of this umbrella review was to synthesise systematic review level evidence for the association between commercial determinants and mental health outcomes. This umbrella review included evidence from high, middle, and low-income countries. We included terms related to broader commercial activities and terms focused on six key unhealthy commodities (tobacco, alcohol, ultra-processed foods, gambling, social media, fossil fuels) and the impacts of fossil fuel consumption (climate change, air pollution, wider pollution). We included 65 reviews and found evidence from high quality reviews for associations between alcohol, tobacco, gambling, social media, ultra-processed foods and air pollution and depression; alcohol, tobacco, gambling, social media, climate change and air pollution with suicide; climate change and air pollution with anxiety; and social media with self-harm. There was a lack of evidence examining wider practices of commercial industries. Our umbrella review demonstrates that by broadening the focus on commercial determinants, the influence of commercial products and activities on mental ill health can be better understood. The lack of research examining broader commercial practices on mental ill health is an area that should be addressed. Our review highlights the existing base of high-quality evidence for many of these unhealthy commodities' impacts on mental ill health and indicates that commercial determinants is a valuable framework for understanding the drivers of mental ill health.

Conflicts of Interest in Nutrition: Categorical Thinking and the Stigma of Commercial Collaboration

There is a high level of concern about the possible influence of commercial organizations on food-related research and professional bodies, including regulatory and advisory panels. This has contributed to an increased emphasis on the declaration and management of conflicts of interest (CoI) in the reporting, evaluation, and application of research in nutrition science. However, common perceptions of CoI in nutrition, and procedures for declaring and managing these, often lack intellectual rigor and consistency. This commentary highlights 3 main issues related to CoI in nutrition, particularly the emphasis on industry-related CoI relative to other sources of conflict and bias. 1) Considerations of CoI in nutrition are largely limited to financial or collaborative links to the food industry, disregarding other important sources of influence such as intellectual allegiances or nonindustry financial and professional incentives. 2) Associations with industry incur ad hominem, often punitive stigmatization of individuals and their research, and inappropriate downgrading or exclusion of evidence. This disproportionately affects expertise in the food and agricultural sciences, in which commercial collaborations are widely encouraged. 3) These practices and related approaches to managing CoI are applied without due consideration of the nature of the conflicts and activities involved, the qualifications of individuals, or the availability of other, objective methods and guidance for assessing research quality and risks of bias. Overall, recognition of the nature and range of CoI in nutrition and approaches to their identification and management lack consistency and balance. A singular and strict focus specifically on industry-related CoI may paradoxically exacerbate rather than mitigate imbalance and bias in the field. This commentary outlines the underlying issues and the need for more comprehensive and nuanced approaches to the assessment, reporting, and management of CoI in nutrition.

Dynamics of combatting market-driven epidemics: Insights from U.S. reduction of cigarette, sugar, and prescription opioid consumption

Misuse and overconsumption of certain consumer products have become major global risk factors for premature deaths, with their total costs in trillions of dollars. Progress in reducing such deaths has been slow and difficult. To address this challenge, this review introduces the definition of market-driven epidemics (MDEs), which arise when companies aggressively market products with proven harms, deny these harms, and resist mitigation efforts. MDEs are a specific within the broader landscape of commercial determinants of health. We selected three illustrative MDE products reflecting different consumer experiences: cigarettes (nicotine delivery product), sugar (food product), and prescription opioids (medical product). Each met the MDE case definition with proven adverse health impacts, well-documented histories, longitudinal product consumption and health impact data, and sustained reduction in product consumption. Based on these epidemics, we describe five MDE phases: market expansion, evidence of harm, corporate resistance, mitigation, and market adaptation. From the peak of consumption to the most recent data, U.S. cigarette sales fell by 82%, sugar consumption by 15%, and prescription opioid prescriptions by 62%. For each, the consumption tipping point occurred when compelling evidence of harm, professional alarm, and an authoritative public health voice and/or public mobilization overcame corporate marketing and resistance efforts. The gap between suspicion of harm and the consumption tipping point ranged from one to five decades-much of which was attributable to the time required to generate sufficient evidence of harm. Market adaptation to the reduced consumption of target products had both negative and positive impacts. To our knowledge, this is the first comparative analysis of three successful efforts to change the product consumption patterns and the associated adverse health impacts of these products. The MDE epidemiological approach of shortening the latent time to effective mitigation provides a new method to reduce the impacts of harmful products.

WHO to build neglect of RF-EMF exposure hazards on flawed EHC reviews? Case study demonstrates how "no hazards" conclusion is drawn from data showing hazards

We examined one of the first published of the several systematic reviews being part of WHO's renewed initiative to assess the evidence of associations between man-made radiofrequency electromagnetic radiation (RF-EMF) and adverse health effects in humans. The examined review addresses experimental studies of pregnancy and birth outcomes in non-human mammals. The review claims that the analyzed data did not provide conclusions certain enough to inform decisions at a regulatory level. Our objective was to assess the quality of this systematic review and evaluate the relevance of its conclusions to pregnant women and their offspring. The quality and relevance were checked on the review's own premises: e.g., we did not question the selection of papers, nor the chosen statistical methods. While the WHO systematic review presents itself as thorough, scientific, and relevant to human health, we identified numerous issues rendering the WHO review irrelevant and severely flawed. All flaws found skew the results in support of the review's conclusion that there is no conclusive evidence for nonthermal effects. We show that the underlying data, when relevant studies are cited correctly, support the opposite conclusion: There are clear indications of detrimental nonthermal effects from RF-EMF exposure. The many identified flaws uncover a pattern of systematic skewedness aiming for uncertainty hidden behind complex scientific rigor. The skewed methodology and low quality of this review is highly concerning, as it threatens to undermine the trustworthiness and professionalism of the WHO in the area of human health hazards from man-made RF-EMF.

An expenditure analysis revealing how Philip Morris advertisements coincide with tobacco policymaking in Switzerland

INTRODUCTION

Prior research has linked media tobacco promotion to increased tobacco use and favorable perceptions of tobacco products. Switzerland's tobacco lobby employs advertisements to sway policy decisions in its favor, yet no recent research has assessed this in detail. Our study aims to provide detailed estimates of tobacco industry (TI) advertisement costs, focusing on Philip Morris International (PMI) in Switzerland, and examine potential chronological links between TI advertisement campaigns and parliamentary discussions on tobacco bills. By spreading knowledge on this issue, we aim to support the development of future tobacco advertisement regulations.

METHODS

We conducted an expenditure analysis of tobacco-related press advertisements in Swiss print media published between August 2020 and August 2021, accessed through the media intelligence firm Argus Data Insights. Advertisement costs were estimated using publicly available data. We plotted expenditure sums of PMI against key parliamentary session dates featuring discussions on proposed tobacco control measures, such as tighter restrictions on advertising.

RESULTS

Over 12 months, 501 advertisements with tobacco-specific headlines were published in Swiss press media. Of these, 437 advertisements (87.22%) were linked to PMI. PMI accounted for 88.21% (CHF 6486969) of total advertisement expenditure. Notably, PMI advertisements coincided with key political sessions discussing tobacco legislation in parliament, with a limited presence outside these periods.

CONCLUSIONS

PMI advertisements were published parallel to key moments of parliamentary discussions, suggesting an attempt by TI to potentially influence discussions. Applying such an advertisement monitoring methodology helps understand the contextual conditions of public health in Switzerland. By analyzing TI advertisements in print media, we sought to highlight regulatory gaps and support the creation of stricter advertising regulations. We recommend continuing such research to strengthen tobacco control policymaking. Key public health efforts should include raising awareness of TI tactics, implementing a comprehensive ban on tobacco advertising, and strategically engaging with the media in tobacco control campaigns.

Seeking to be seen as legitimate members of the scientific community? An analysis of British American Tobacco and Philip Morris International's involvement in scientific events

INTRODUCTION

For decades, tobacco companies manipulated and misused science. They funded and disseminated favourable research and suppressed research that showed the harms of their products, deliberately generating misinformation. While previous work has examined many of the practices involved, their engagement in scientific events has so far not been systematically studied. Here, we examine the involvement of British American Tobacco (BAT) and Philip Morris International (PMI) in scientific events, including conferences, symposia and workshops.

METHODS

Our analysis involved two steps. First, we collected all available data PMI and BAT provided on their websites to identify events. Second, we extracted information about the nature of tobacco industry involvement from event websites and materials.

RESULTS

We identified 213 scientific events that BAT and/or PMI representatives attended between April 2012 and September 2021. Most events took place in high-income countries in Europe and North America. They covered a diverse range of fields, including toxicology (n=60, 28.1%), medicine (n=25, 11.7%), biology (n=24, 11.3%), chemistry (n=23, 10.8%) and aerosol science (n=18, 8.5%), as well as dentistry (n=9, 4.2%), pharmaceutical science (n=8, 3.8%) and computing (n=8, 3.8%). We identified 356 posters provided by BAT and PMI that linked to 118 events (55.4%) as well as 77 presentations from 65 events (30.5%). Industry involvement through sponsorship (nine events), exhibition (three events) or organising committee (one event) was rare.

CONCLUSION

BAT and PMI representatives attended a large number and wide range of scientific events. Given that scientific events could be a crucial platform for building connections in the scientific sphere and disseminating industry's messages, this work highlights the importance of denormalising the tobacco industry's involvement in scientific events.

Document analysis of the Foundation for a Smoke-Free World's scientific outputs and activities: a case study in contemporary tobacco industry agnogenesis

BACKGROUND

Tobacco corporation Philip Morris International launched the Foundation for a Smoke-Free World (FSFW), a purportedly independent scientific organisation, in 2017. We aimed to systematically investigate FSFW's activities and outputs, comparing these with previous industry attempts to influence science, as identified in the recently developed typology of corporate influence on science, the Science for Profit Model (SPM).

DESIGN

We prospectively collected data on FSFW over a 4-year period, 2017-2021, and used document analysis to assess whether FSFW's activities mirror practices tobacco and other industries have historically used to shape science in their own interests. We used the SPM as an analytical framework, working deductively to search for use of the strategies it identifies, and inductively to search for any additional strategies.

RESULTS

Marked similarities between FSFW's practices and previous corporate attempts to influence science were observed, including: producing tobacco industry-friendly research and opinion; obscuring industry involvement in science; funding third parties which denigrate science and scientists that may threaten industry profitability; and promoting tobacco industry credibility.

CONCLUSIONS

Our paper identifies FSFW as a new vehicle for agnogenesis, indicating that, over 70 years since the tobacco industry began to manipulate science, efforts to protect science from its interference remain inadequate. This, combined with growing evidence that other industries are engaging in similar practices, illustrates the urgent need to develop more robust systems to protect scientific integrity.

The decision maker's lament: If I only had some science!

Environmental decision makers lament instances in which the lack of actionable science limits confident decision-making. Their reaction when the needed scientific information is of poor quality, uninformative, unintelligible, or altogether absent is often to criticize scientists, their work, or science in general. The considerations offered here encourage decision makers to explore alternative approaches to alleviate their disappointment. Ironically, many researchers lament the lack of support for the science they wish to deliver and accuse decision makers of failing to realize the value of the scientific studies they propose. Both communities would benefit by remembering that producing actionable science for a pending decision requires knowing the context for that decision beforehand. They may also look inward. Only then will they find answers to the question: What can I do within my own capacity to ensure that the necessary actionable science becomes available and facilitate its use to inform decisions?

Exploring Biosensors' Scientific Production and Research Patterns: A Bibliometric Analysis

More sustainable biosensor production is growing in importance, allowing for the development of technological solutions for several industries, such as those in the health, chemical, and food sectors. Tracking the latest advancements in biosensors' scientific production is fundamental to determining the opportunities for the future of the biosensing field. This article aims to map scientific production in the biosensors field by running a bibliometric analysis of journal articles registered in the Web of Science database under biosensor-related vital concepts. The key concepts were selected by researchers and biosensor technology developers working on the BioAssembler Horizon project. The findings lead to identifying the scientific and technological knowledge base on biosensing devices and tracking the main scientific organisations developing this technology throughout the COVID-19 period (2019-2023). The institutional origin of the publications characterised the global distribution of related knowledge competencies and research partnerships. These results are discussed, shedding light on the scientific, economic, political, and structural factors that contribute to the formation of a scientific knowledge-based focus on the performance and design of these sensors. Moreover, the lack of scientific ties between the three axes of organisations producing expertise in this area (China, USA, and Russia) points towards the need to find synergies through new mechanisms of co-authorship and collaboration.

Decolonising global health research: Shifting power for transformative change

Recent debates on decolonizing global health have spurred interest in addressing the power asymmetries and knowledge hierarchies that sustain colonial ideas and relationships in global health research. This paper applies three intersecting dimensions of colonialism (colonialism within global health; colonisation of global health; and colonialism through global health) to develop a broader and more structural understanding of the policies and actions needed to decolonise global health research. It argues that existing guidelines and checklists designed to make global health research more equitable do not adequately address the underlying power asymmetries and biases that prevail across the global health research ecosystem. Beyond encouraging fairer partnerships within individual research projects, this paper calls for more emphasis on shifting the balance of decision-making power, redistributing resources, and holding research funders and other power-holders accountable to the places and peoples involved in and impacted by global health research.

Building a Systems Map: Applying Systems Thinking to Unhealthy Commodity Industry Influence on Public Health Policy

BACKGROUND

Unhealthy commodity industries (UCIs) engage in political practices to influence public health policy, which poses barriers to protecting and promoting public health. Such influence exhibits characteristics of a complex system. Systems thinking would therefore appear to be a useful lens through which to study this phenomenon, potentially deepening our understanding of how UCI influence are interconnected with one another through their underlying political, economic and social structures. As such this study developed a qualitative systems map to depict the complex pathways through which UCIs influence public health policy and how they are interconnected with underlying structures.

METHODS

Online participatory systems mapping workshops were conducted between November 2021 and February 2022. As a starting point for the workshops, a preliminary systems map was developed based on recent research. Twenty-three online workshops were conducted with 52 geographically diverse stakeholders representing academia, civil society (CS), public office, and global governance organisations (CGO). Analysis of workshop data in NVivo and feedback from participants resulted in a final systems map.

RESULTS

The preliminary systems map consisted of 40 elements across six interdependent themes. The final systems map consisted of 64 elements across five interdependent themes, representing key pathways through which UCIs impact health policy-making: (1) direct access to public sector decision-makers; (2) creation of confusion and doubt about policy decisions; (3) corporate prioritisation of commercial profits and growth; (4) industry leveraging the legal and dispute settlement processes; and (5) industry leveraging policy-making, norms, rules, and processes.

CONCLUSION

UCI influence on public health policy is highly complex, involves interlinked practices, and is not reducible to a single point within the system. Instead, pathways to UCI influence emerge from the complex interactions between disparate national and global political, economic and social structures. These pathways provide numerous avenues for UCIs to influence public health policy, which poses challenges to formulating a singular intervention or limited set of interventions capable of effectively countering such influence. Using participatory methods, we made transparent the interconnections that could help identify interventions in future work.

Mapping the Lobbying Footprint of Harmful Industries: 23 Years of Data From OpenSecrets

Policy Points Our research reveals the similarities and differences among the lobbying activities of tobacco, alcohol, gambling, and ultraprocessed food industries, which are often a barrier to the implementation of public health policies. Over 23 years, we found that just six organizations dominated lobbying expenses in the tobacco and alcohol sectors, whereas the gambling sector outsourced most of their lobbying to professional firms. Databases like OpenSecrets are a useful resource to monitor the commercial determinants of health.

CONTEXT

Commercial lobbying is often a barrier to the development and implementation of public health policies. Yet, little is known about the similarities and differences in the lobbying practices of different industry sectors or types of commercial actors. This study compares the lobbying practices of four industry sectors that have been the focus of much public health research and advocacy: tobacco, alcohol, gambling, and ultraprocessed foods.

METHODS

Data on lobbying expenditures and lobbyist backgrounds were sourced from the OpenSecrets database, which monitors lobbying in the United States. Lobbying expenditure data were analyzed for the 1998-2020 period. We classified commercial actors as companies or trade associations. We used Power BI software to link, analyze, and visualize data sets.

FINDINGS

We found that the ultraprocessed food industry spent the most on lobbying ($1.15 billion), followed by gambling ($817 million), tobacco ($755 million), and alcohol ($541 million). Overall, companies were more active than trade associations, with associations being least active in the tobacco industry. Spending was often highly concentrated, with two organizations accounting for almost 60% of tobacco spending and four organizations accounting for more than half of alcohol spending. Lobbyists that had formerly worked in government were mainly employed by third-party lobby firms.

CONCLUSIONS

Our study shows how comparing the lobbying practices of different industry sectors offers a deeper appreciation of the diversity and similarities of commercial actors. Understanding these patterns can help public health actors to develop effective counterstrategies.

Vaping industry participation standards in health organizations: an exploratory policy content analysis

The vaping industry has been found to employ similar tactics to tobacco industry actors to seek credibility and distort the scientific evidence base around the health harms of nicotine vaping products. As vaping industry interests undermine vaping control efforts, safeguards are necessary to protect against this influence. We aimed to examine health organizations' policies on vaping industry participation in their activities in Australia. A descriptive approach integrating policy analysis and key informant surveys was used to obtain vaping industry participation information from health research stakeholders. Descriptive statistics on organization type, policy document type, policy document industry focus (tobacco or vaping) and respondent role and responsibility were collected. We used framework analysis to identify themes describing organizational allowances, constraints, and rationale for vaping industry research participation. Relevant health organizations were identified within Australia for policy searching (n = 156), which identified 47 unique policy documents. After contacting 267 key stakeholders from eligible organizations, 31 survey responses were analysed. Research organizations and universities were highly represented in both the policy and survey data. Most health research stakeholders recognized that vaping industry interests counteract public health priorities and opposed vaping industry participation. However, many organizations lacked clear, vaping industry-specific participation policies. To protect the integrity of the emerging evidence base around vaping harms which inform vaping policy, health organizations require strong, comprehensive policies to resist vaping industry participation in research.

"They try to suppress us, but we should be louder": a qualitative exploration of intimidation in tobacco control

BACKGROUND

Tobacco control advocates and researchers face powerful opponents who go to great lengths to protect their interests. While threats and attacks are documented in the grey literature, research into intimidation remains scarce. Building on previous exploratory research, this study seeks to offer in-depth insights into experiences of intimidation in the global tobacco control community.

METHODS

Using qualitative description, we conducted a focus group and semi-structured interviews with tobacco control advocates and researchers to explore their experiences, including forms of, and responses to, intimidation, and ways forward. Data were analysed using qualitative content analysis.

RESULTS

Twenty-nine individuals from across the globe participated in the study. They reported several forms of intimidation including attacks in the media; online harassment; legal threats; non-legal threats, including death threats; Freedom of Information requests; perceived or actual surveillance; as well as burglary and theft. Responses included non-action (i.e. ignoring attacks); withdrawal (i.e. abandoning a project, area or field); defensive adaptation, for example through self-censorship; and offensive measures, including exposing attacks or filing complaints. Responses were shaped by several factors, including type and level of support from within internal and external networks; as well as an individual's mindset, skills and experiences; and state-civil society relations. Participants suggested several measures that could help address intimidation: 1) report and monitor intimidation; 2) (better) prepare individuals through awareness raising and training (e.g. IT security, legal); 3) support those in need through legal advice, a peer-support network and involvement in response; and 4) look beyond tobacco control to learn and build connections.

CONCLUSION

Intimidation is a significant challenge to tobacco control that needs urgent attention. This study suggests measures to address intimidation that require commitment from, and collaboration amongst, multiple actors including governments, international organisations, funders, researchers and civil society. Moreover, collective action beyond tobacco control is needed to not only manage but move beyond intimidation.

Rebalancing commercial and public interests in prioritizing biomedical, social and environmental aspects of health through defining and managing conflicts of interest

Biomedical research is intended to benefit human beings and their health. Toward that end, scientific norms involve examining and criticizing the work of others and prioritizing questions that should be studied. Yet, in areas of health research where industry is active, it has often utilized well-honed strategies aimed at evading scientific standards and at dominating the research agenda, largely through its financial support and lack of transparency of its research practices. These tactics have now been documented to uniformly support industry products. Commercial entities are aided in this pursuit by public policy that has significantly embedded commercial interests and agendas into federal research funding and infrastructure. Therefore, to understand the resulting landscape and its effect on priority in health research agendas, traditional definitions of individual conflicts of interest (COI) and the less well developed institutional COI must be supplemented by a new construct of structural COI, largely operating as intellectual monopolies, in support of industry. These arrangements often result in financial and reputational resources that assure dominance of commercial priorities in research agendas, crowding out any other interests and ignoring justified returns to the public from investment of its tax dollars. There is no sustained attention to mechanisms by which public interests can be heard, normative issues raised, and then balanced with commercial interests which are transparently reported. Focus on research supporting approval of commercial products ignores social and environmental determinants of health. Commercial bias can invalidate regulatory research protections through obscuring valid risk-benefit ratios considered by IRBs.

The Commercial Determinants of Health and Evidence Synthesis (CODES): methodological guidance for systematic reviews and other evidence syntheses

BACKGROUND

The field of the commercial determinants of health (CDOH) refers to the commercial products, pathways and practices that may affect health. The field is growing rapidly, as evidenced by the WHO programme on the economic and commercial determinants of health and a rise in researcher and funder interest. Systematic reviews (SRs) and evidence synthesis more generally will be crucial tools in the evolution of CDOH as a field. Such reviews can draw on existing methodological guidance, though there are areas where existing methods are likely to differ, and there is no overarching guidance on the conduct of CDOH-focussed systematic reviews, or guidance on the specific methodological and conceptual challenges.

METHODS/RESULTS

CODES provides guidance on the conduct of systematic reviews focussed on CDOH, from shaping the review question with input from stakeholders, to disseminating the review. Existing guidance was used to identify key stages and to provide a structure for the guidance. The writing group included experience in systematic reviews and other forms of evidence synthesis, and in equity and CDOH research (both primary research and systematic reviews).

CONCLUSIONS

This guidance highlights the special methodological and other considerations for CDOH reviews, including equity considerations, and pointers to areas for future methodological and guideline development. It should contribute to the reliability and utility of CDOH reviews and help stimulate the production of reviews in this growing field.

Commercial lobbying and political contributions: an Australian scoping review

OBJECTIVE

Many of the most effective and equitable policies to reduce the burden of non-communicable diseases threaten the interests of powerful corporations. A first step for public health advocates seeking to challenge powerful corporate interests is to understand the nature and extent of corporate political practices. This scoping review explored public health research on two political practices in Australia: lobbying and political donations.

METHODS

We searched six databases, two Google Advanced searches and 11 Australian public health websites. We screened 2866 documents in total, and extracted information about political practices, industry actors and datasets.

RESULTS

62 studies published between 1980 and 2021 were identified, analysing public health advocacy, policy submissions, direct engagement with government representatives and political donations. We extracted data from 14 studies that focused on direct engagement and/or political donations. Most focused on 'unhealthy commodity industries.'

CONCLUSIONS

Analysis of lobbying and political contributions in Australia is a nascent but expanding area of public health research. We discuss opportunities for future research to strengthen the evidence base and support public health advocacy to counter harmful corporate practices and promote and protect population health.

IMPLICATIONS FOR PUBLIC HEALTH

Countering powerful commercial interests requires greater investment in understanding corporate political activities.

Aiding empirical research on the commercial determinants of health: a scoping review of datasets and methods about lobbying

BACKGROUND

To support public health researchers and advocates seeking to challenge the influence of powerful commercial actors on health, it is necessary to develop a deeper understanding of corporate political activities. This project explores political science scholarship analysing lobbying to identify new datasets and research methods that can be applied to public health and stimulate further research and advocacy.

METHODS

We undertook a systematic scoping review of peer-reviewed and grey literature reports analysing the practice of lobbying. Titles and abstracts of 4533 peer-reviewed and 285 grey literature reports were screened, with 233 peer-reviewed and 280 grey literature reports assessed for eligibility. We used a two-stage process for data extraction. In stage 1, we collected two pieces of information from all included studies: data sources and indicators used to measure lobbying. For the second stage, data extraction was limited to 15 studies that focused on meetings.

RESULTS

The most common indicators used to measure lobbying activity were: registrations of active lobbyists; expenditure on lobbying; meetings; written comments and submissions made to government consultations; bills; and committee participation. A range of different data sources were used to analyse lobbying, including from governments, not-for-profits and commercial sources. All 15 studies analysing lobbyist meetings were from high-income contexts. The studies analysed three key variables: the types of government actors targeted by lobbying; the policies of interest; and the lobbyists and/or their clients. The studies used a range of taxonomies to classify policy issues and the types of actors engaged in lobbying. All studies discussed challenges with accessing and analysing lobbying data.

CONCLUSIONS

There is enormous potential for public health research and advocacy concerned with commercial lobbying to learn from political science scholarship. This includes both conceptual frameworks and sources of empirical data. Moreover, the absence of good quality transparency internationally emphasises the importance of advocacy to support policy change to improve the quality of political transparency to make it easier to monitor commercial lobbying.

Corporate Political Activity: Taxonomies and Model of Corporate Influence on Public Policy

BACKGROUND

Non-communicable diseases (NCDs) kill 41 million people a year. The products and services of unhealthy commodity industries (UCIs) such as tobacco, alcohol, ultra-processed foods and beverages and gambling are responsible for much of this health burden. While effective public health policies are available to address this, UCIs have consistently sought to stop governments and global organisations adopting such policies through what is known as corporate political activity (CPA). We aimed to contribute to the study of CPA and development of effective counter-measures by formulating a model and evidence-informed taxonomies of UCI political activity.

METHODS

We used five complementary methods: critical interpretive synthesis of the conceptual CPA literature; brief interviews; expert co-author knowledge; stakeholder workshops; testing against the literature.

RESULTS

We found 11 original conceptualisations of CPA; four had been used by other researchers and reported in 24 additional review papers. Combining an interpretive synthesis of all these papers and feedback from users, we developed two taxonomies - one on framing strategies and one on action strategies. The former identified three frames (policy actors, problem, and solutions) and the latter six strategies (access and influence policy-making, use the law, manufacture support for industry, shape evidence to manufacture doubt, displace, and usurp public health, manage reputations to industry's advantage). We also offer an analysis of the strengths and weaknesses of UCI strategies and a model that situates industry CPA in the wider social, political, and economic context.

CONCLUSION

Our work confirms the similarity of CPA across UCIs and demonstrates its extensive and multi-faceted nature, the disproportionate power of corporations in policy spaces and the unacceptable conflicts of interest that characterise their engagement with policy-making. We suggest that industry CPA is recognised as a corruption of democracy, not an element of participatory democracy. Our taxonomies and model provide a starting point for developing effective solutions.

Defining and conceptualising the commercial determinants of health

Although commercial entities can contribute positively to health and society there is growing evidence that the products and practices of some commercial actors-notably the largest transnational corporations-are responsible for escalating rates of avoidable ill health, planetary damage, and social and health inequity; these problems are increasingly referred to as the commercial determinants of health. The climate emergency, the non-communicable disease epidemic, and that just four industry sectors (ie, tobacco, ultra-processed food, fossil fuel, and alcohol) already account for at least a third of global deaths illustrate the scale and huge economic cost of the problem. This paper, the first in a Series on the commercial determinants of health, explains how the shift towards market fundamentalism and increasingly powerful transnational corporations has created a pathological system in which commercial actors are increasingly enabled to cause harm and externalise the costs of doing so. Consequently, as harms to human and planetary health increase, commercial sector wealth and power increase, whereas the countervailing forces having to meet these costs (notably individuals, governments, and civil society organisations) become correspondingly impoverished and disempowered or captured by commercial interests. This power imbalance leads to policy inertia; although many policy solutions are available, they are not being implemented. Health harms are escalating, leaving health-care systems increasingly unable to cope. Governments can and must act to improve, rather than continue to threaten, the wellbeing of future generations, development, and economic growth.

Commercial determinants of health: future directions

This paper is about the future role of the commercial sector in global health and health equity. The discussion is not about the overthrow of capitalism nor a full-throated embrace of corporate partnerships. No single solution can eradicate the harms from the commercial determinants of health-the business models, practices, and products of market actors that damage health equity and human and planetary health and wellbeing. But evidence shows that progressive economic models, international frameworks, government regulation, compliance mechanisms for commercial entities, regenerative business types and models that incorporate health, social, and environmental goals, and strategic civil society mobilisation together offer possibilities of systemic, transformative change, reduce those harms arising from commercial forces, and foster human and planetary wellbeing. In our view, the most basic public health question is not whether the world has the resources or will to take such actions, but whether humanity can survive if society fails to make this effort.

National Public Health Surveillance of Corporations in Key Unhealthy Commodity Industries - A Scoping Review and Framework Synthesis

BACKGROUND

Corporations in unhealthy commodity industries (UCIs) have growing influence on the health of national populations through practices that lead to increased consumption of unhealthy products. The use of government-led public health surveillance is best practice to better understand any emerging public health threat. However, there is minimal systematic evidence, generated and monitored by national governments, regarding the scope of UCI corporate practices and their impacts. This study aims to synthesise current frameworks that exist to identify and monitor UCI influence on health to highlight the range of practices deployed by corporations and inform future surveillance efforts in key UCIs.

METHODS

Seven biomedical, business and scientific databases were searched to identify literature focused on corporate practices that impact human health and frameworks for monitoring or assessment of the way UCIs impact health. Content analysis occurred in three phases, involving (1) the identification of framework documents in the literature and extraction of all corporate practices from the frameworks; (2) initial inductive grouping and synthesis followed by deductive synthesis using Lima and Galea's 'vehicles of power' as a heuristic; and (3) scoping for potential indicators linked to each corporate practice and development of an integrated framework.

RESULTS

Fourteen frameworks were identified with 37 individual corporate practices which were coded into five different themes according the Lima and Galea 'Corporate Practices and Health' framework. We proposed a summary framework to inform the public health surveillance of UCIs which outlines key actors, corporate practices and outcomes that should be considered. The proposed framework draws from the health policy triangle framework and synthesises key features of existing frameworks.

CONCLUSION

Systematic monitoring of the practices of UCIs is likely to enable governments to mitigate the negative health impacts of corporate practices. The proposed synthesised framework highlights the range of practices deployed by corporations for public health surveillance at a national government level. We argue there is significant precedent and great need for monitoring of these practices and the operationalisation of a UCI monitoring system should be the object of future research.