Revisiting the Corporate and Commercial Determinants of Health

Continuities and change in alcohol policy at the global level: a documentary analysis of the 2010 Global Strategy for Reducing the Harmful Use of Alcohol and the Global Alcohol Action Plan 2022-2030

BACKGROUND

There are only two major statements which define alcohol policy development at the global level. There has not been any comparative analysis of the details of these key texts, published in 2010 and 2022 respectively, including how far they constitute similar or evolving approaches to alcohol harm.

METHODS

Preparatory data collection involved examination of documents associated with the final policy statements. A thematic analysis across the two policy documents was performed to generate understanding of continuity and change based on comparative study. Study findings are interpreted in the contexts of the evolving conceptual and empirical literatures.

RESULTS

Both documents exhibit shared guiding principles and identify similar governance challenges, albeit with varying priority levels. There is more emphasis on the high-impact interventions on price, availability and marketing in 2022, and more stringent targets have been set for 2030 in declaring alcohol as a public health priority therein, reflecting the action-oriented nature of the Plan. The identified roles of policy actors have largely remained unchanged, albeit with greater specificity in the more recent statement, appropriately so because it is concerned with implementation. The major exception, and the key difference in the documents, regards the alcohol industry, which is perceived primarily as a threat to public health in 2022 due to commercial activities harmful to health and because policy interference has slowed progress.

CONCLUSIONS

The adoption of the Global Alcohol Action Plan 2022-30 potentially marks a pivotal moment in global alcohol policy development, though it is unclear how fully it may be implemented. Perhaps, the key advances lie in advancing the ambitions of alcohol policy and clearly identifying that the alcohol industry should not be seen as any kind of partner in public health policymaking, which will permit progress to the extent that this influences what actually happens in alcohol policy at the national level.

Communication Policy to Reduce Health Disparities: A Cross-Language Content Analysis of YouTube Television Advertising

INTRODUCTION

This study aimed to identify disparate health-related marketing across English- and Spanish-language television networks in New York City, ultimately to inform policy that can counteract disproportionate health-related marketing that provides harmful content to and withholds beneficial information from Latinx populations.

METHODS

A 2-week composite sample of primetime English-language (National Broadcasting Company and Columbia Broadcasting System) and Spanish-language (Telemundo and Univision) television networks from YouTube television was randomly drawn from September 7, 2022 to September 27, 2022 in New York City. A total of 9,314 health-related television advertisements were identified for systematic media content analysis and coded into categories: alcohol, core or noncore foods/beverages, mental health/tobacco prevention, health insurance, medical centers, and pharmaceuticals. Analyses conducted in 2022-2024 included intercoder reliability and descriptive and rate difference estimates using total advertisement broadcasting time in the full sample and subsamples by language networks on YouTube television.

RESULTS

Spanish television networks broadcast greater health-adverse advertisements per hour for alcohol (rate difference=4.91; 95% CI=3.96, 5.85) and noncore foods/beverages (rate difference=13.43; 95% CI=11.52, 15.34) and fewer health-beneficial advertisements per hour for mental health/tobacco prevention (rate difference= -0.99; 95% CI= -1.45, -0.54), health insurance (rate difference= -1.00; 95% CI= -1.44, -0.57), medical centers (rate difference= -0.55; 95% CI= -1.23, 0.12), and pharmaceuticals (rate difference= -5.72; 95% CI= -7.32, -4.11) than New York City primetime English television networks.

CONCLUSIONS

Multilevel policy innovation and implementation are required to mitigate primetime television marketing strategies that contribute to health inequities.

Capitalism and the 'commercial determinants of health': A more-than-human micropolitics

This paper argues that studies of the 'commercial determinants of health' (CDoH) need to acknowledge fully the part the capitalist mode of commodity production and exchange plays in producing negative health outcomes. This proposition is supported by recourse to a recent development in political economy that has established a more-than-human, relational and monist (or 'flat') ontology of capitalism, in place of the more conventional neo-Marxist perspective. This ontology reveals a dynamic to capitalism that operates beyond human intentionality, driven by the supply of, and demand for the capacities of commodities. This dynamic determines the production and consumption of all commodities, some among which (such as tobacco, alcohol and processed foods) contribute to ill-health. A case study of food consumption reveals how these supply and demand affects drive 'unhealthy' food choices by consumers. Ways to undermine this more-than-human dynamic are offered as an innovative approach to addressing the effects of commerce and capitalism upon health.

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

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

The Political Economy of Digital Health Equity: Structural Analysis

Digital technologies have produced many innovations in care delivery and enabled continuity of care for many people when in-person care was impossible. However, a growing body of research suggests that digital health can also exacerbate health inequities for those excluded from its benefits for reasons of cost, digital literacy, and structural discrimination related to characteristics such as age, race, ethnicity, and socioeconomic status. In this paper, we draw on a political economy perspective to examine structural barriers to progress in advancing digital health equity at the policy level. Considering the incentive structures and investments of powerful actors in the field, we outline how characteristics of neoliberal capitalism in Western contexts produce and sustain digital health inequities by describing 6 structural challenges to the effort to promote health equity through digital health, as follows: (1) the revenue-first incentives of technology corporations, (2) the influence of venture capital, (3) inequitable access to the internet and digital devices, (4) underinvestment in digital health literacy, (5) uncertainty about future reimbursement of digital health, and (6) justified mistrust of digital health. Building on these important challenges, we propose future immediate and long-term directions for work to support meaningful change for digital health equity.

The Pitfalls of Ascribing Moral Agency to Corporations: Public Obligation and Political and Social Contexts in the Commercial Determinants of Health

Policy Points Government and civil society should be held more accountable for creating food and beverage regulatory policies rather than assigning moral agency to the food and beverage industry. Nutrition policymaking institutions should ensure civil society's ability to design regulatory policy. Government policymaking institutions should be isolated from industry interference.

Media coverage of commercial industry activities impacting Aboriginal and Torres Strait Islander health, 2018-2022

This study aimed to examine the extent and nature of Australian news media coverage of commercial industry activities that explicitly speak to Aboriginal and Torres Strait Islander contexts. We undertook content and framing analysis of Australian newspaper and online media articles published between January 2018 and March 2022 that included terms related to 'Indigenous', 'commercial' and 'health'. Analysis focused on the nature of coverage, framing of responsibility, patterns over time and stakeholder representation. Forty-six media articles were included in the analysis. Half of these articles related to the actions of three companies (Woolworths, WAM Clothing and Rio Tinto). Most articles described negative health and well-being impacts of commercial activity, while four described positive impacts. The most common voice represented in media articles was from industry (n = 25). Aboriginal or Torres Strait Islander voices were represented in 21 articles. This analysis highlights how commercial activities in Australia are reported to negatively influence Aboriginal and Torres Strait Islander health and well-being, and that industry voices are more commonly represented in the media related to these issues.

Characterizing restrictions on commercial advertising and sponsorship of harmful commodities in local government policies: a nationwide study in England

BACKGROUND

Commercial advertising and sponsorship drive the consumption of harmful commodities. Local authorities (LAs) have considerable powers to reduce such exposures. This study aimed to characterize local commercial policies across all English LAs.

METHODS

We conducted a census of all English LAs (n = 333) to identify local commercial policies concerning advertising and sponsorship of tobacco, alcohol, less healthy foods and gambling, through online searches and Freedom of Information requests. We explored policy presence, commodity frequency and type, and associations with LA characteristics (region, urban/rural and deprivation).

RESULTS

Only a third (106) of LAs in England had a relevant policy (32%). These included restrictions on tobacco (91%), gambling (79%), alcohol (74%) and/or less healthy foods (24%). Policy prevalence was lowest in the East of England (22%), North East (25%) and North West (27%), higher in urban areas (36%) than rural areas (28%) and lower in the least (27%) compared with the most (38%) deprived areas. Definitions in policies varied, particularly for alcohol and less healthy foods.

CONCLUSIONS

English LAs currently underutilize their levers to reduce the negative impacts of harmful commodity industry marketing, particularly concerning less healthy foods. Standardized guidance, including clarity on definitions and application, could inform local policy development.

Benefits and risks: Views of humanitarian organizations in Lebanon on corporate assistance

Compounding humanitarian and political crises within and across countries have been met with shrinking public resources for coordination, recovery, and mitigation. This resource constrained humanitarian environment presents opportunities for multinational corporations to supplement budgets and actively participate in new markets through connecting with humanitarian work. Given the well-established influence of corporations on public health, an assessment of industry funding to humanitarian assistance is necessary especially in the fragile context of Lebanon with a substantial refugee population and multiple compounding crises. This paper examines three aspects of corporate assistance in humanitarian crises in Lebanon. It investigates the modality of corporate assistance to humanitarian agencies, the extent to which humanitarian agency staff are aware of implications of this assistance along with any ethical considerations related to it, and both the risks and benefits for corporations and people. This study explores the views of 14 local and international humanitarian agencies in Lebanon) through in-depth interviews conducted between 2020 and 2022. Interviews were recorded, transcribed and subject to thematic analysis. All agencies participating in the study provided social and health assistance as well as education, vocational training, and other services to refugees or Lebanese. Findings indicate that the majority of them receive corporate funding in varying amounts and in-kind contributions to support various projects. Despite imposed conditions by the corporations, such as posting logos and stories, the agencies perceived the benefits of partnering, mentioning financial assistance in time of need, and flexible agendas that outweigh the risks of conflicts of interest of corporate branding on the populations they serve. Benefits to the corporations themselves relate to corporate social responsibility, increased market reach and visibility. Challenges in partnering with for-profits include ethical considerations and programmatic issues, however no guidelines were reported to exist to detect corporate conflicts of interest, instead most of the agencies rely on their value systems for screening.

Situating commercial determinants of health in their historical context: a qualitative study of sugar-sweetened beverages in Jamaica

BACKGROUND

Non-communicable diseases (NCDs) are the leading cause of mortality across the Caribbean and similar regions. Structural determinants include a marked increase in the dependency on food imports, and the proliferation of processed foods, including sugar-sweetened beverages (SSBs). We focused on Jamaica as a case study and the health challenge of SSBs, and situated contemporary actions, experiences and policies within their historical context to investigate underlying drivers of commercial determinants of health and attempts to counter them. We asked: how can a historical perspective of the drivers of high level SSB consumption in Jamaica contribute to an enhanced understanding of the context of public health policies aimed at reducing their intake?

METHODS

An ethnographic approach with remote data collection included online semi-structured interviews and workshops with 22 local experts and practitioners of health, agriculture and nutrition in Jamaica and attending relevant regional public webinars on SSBs and NCD action in the Caribbean. Our analysis was situated within a review of historical studies of Caribbean food economies with focus on the twentieth century. Jamaican and UK-based researchers collected and ethnographically analysed the data, and discussed findings with the wider transdisciplinary team.

RESULTS

We emphasise three key areas in which historical events have shaped contextual factors of SSB consumption. Trade privileged sugar as a cash crop over food production during Jamaica's long colonial history, and trade deregulation since the 1980s through structural adjustment opened markets to transnational companies. These changes increased Jamaican receptiveness to the mass advertisement and marketing of these companies, whilst long-standing power imbalances hampered taxation and regulation in contemporary public health actions. Civil society efforts were important for promoting structural changes to curb overconsumption of SSBs and decentring such entrenched power relations.

CONCLUSION

The contemporary challenge of SSBs in Jamaica is a poignant case study of commercial determinants of health and the important context of global market-driven economies and the involvement of private sector interests in public health policies and governance. Historically contextualising these determinants is paramount to making sense of the sugar ecology in Jamaica today and can help elucidate entrenched power dynamics and their key actors.

An umbrella review of the acceptability of fiscal and pricing policies to reduce diet-related noncommunicable disease

CONTEXT

Poor diet has been implicated in a range of noncommunicable diseases. Fiscal and pricing policies (FPs) may offer a means by which consumption of food and non-alcoholic beverages with links to such diseases can be influenced to improve public health.

OBJECTIVE

To examine the acceptability of FPs to reduce diet-related noncommunicable disease, based on systematic review evidence.

DATA SOURCES

MEDLINE, EMBASE, PsychInfo, SCI, SSCI, Web of Science, Scopus, EconLit, the Cochrane Library, Epistemonikos, and the Campbell Collaboration Library were searched for relevant studies published between January 1, 1990 and June 2021.

DATA EXTRACTION

The studies included systematic reviews of diet-related FPs and: used real-world evidence; examined real or perceived barriers/facilitators; targeted the price of food or non-alcoholic beverages; and applied to entire populations within a jurisdiction. A total of 9996 unique relevant records were identified, which were augmented by a search of bibliographies and recommendations from an external expert advisory panel. Following screening, 4 systematic reviews remained.

DATA ANALYSIS

Quality appraisal was conducted using the AMSTAR 2 tool. A narrative synthesis was undertaken, with outcomes grouped according to the WHO-INTEGRATE criteria. The findings indicated a paucity of high-quality systematic review evidence and limited public support for the use of FPs to change dietary habits. This lack of support was related to a number of factors that included: their perceived potential to be regressive; a lack of transparency, ie, there was mistrust around the use of revenues raised; a paucity of evidence around health benefits; the deliberate choice of rates that were lower than those considered necessary to affect diet; and concerns about the potential of such FPs to harm economic outcomes such as employment.

CONCLUSION

The findings underscore the need for high-quality systematic review evidence on this topic, and the importance of responding to public concerns and putting in place mechanisms to address these when implementing FPs. This study was funded by Safefood [02A-2020].

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42021274454.

Taking on the Corporate Determinants of Ill-health and Health Inequity: A Scoping Review of Actions to Address Excessive Corporate Power to Protect and Promote the Public's Health

BACKGROUND

In many sectors of the economy, for-profit business corporations hold excessive power relative to some governments and civil society. These power imbalances have been recognised as important contributors to many pressing and complex societal challenges, including unhealthy diets, climate change, and widening socio-economic inequalities, and thus pose a major barrier to efforts to improve public health and health equity. In this paper, we reviewed potential actions for addressing excessive corporate power.

METHODS

We conducted a scoping review of diverse literature (using Scopus, Web of Science, HeinOnline, and EBSCO databases), along with expanded searches, to identify state and collective actions with the potential to address excessive corporate power. Actions were thematically classified into overarching strategic objectives, guided by Meagher's '3Ds' heuristic, which classifies actions to curb corporate power into three groups: dispersion, democratisation, and dissolution. Based on the actions identified, we proposed two additional strategic objectives: reform and democratise the global governance of corporations, and strengthen countervailing power structures.

RESULTS

We identified 178 documents that collectively cover a broad range of actions to address excessive corporate power. In total, 18 interrelated strategies were identified, along with several examples in which aspects of these strategies have been implemented.

CONCLUSION

The proposed framework sheds light on how a diverse set of strategies and actions that seek to address excessive corporate power can work synergistically to change the regulatory context in which corporations operate, so that broader societal goals, including health and equity, are given much greater prominence and consideration vis-à-vis powerful corporate interests.

Illustrating the impact of commercial determinants of health on the global COVID-19 pandemic: Thematic analysis of 16 country case studies

Previous research on commercial determinants of health has primarily focused on their impact on non-communicable diseases. However, they also impact on infectious diseases and on the broader preconditions for health. We describe, through case studies in 16 countries, how commercial determinants of health were visible during the COVID-19 pandemic, and how they may have influenced national responses and health outcomes. We use a comparative qualitative case study design in selected low- middle- and high-income countries that performed differently in COVID-19 health outcomes, and for which we had country experts to lead local analysis. We created a data collection framework and developed detailed case studies, including extensive grey and peer-reviewed literature. Themes were identified and explored using iterative rapid literature reviews. We found evidence of the influence of commercial determinants of health in the spread of COVID-19. This occurred through working conditions that exacerbated spread, including precarious, low-paid employment, use of migrant workers, procurement practices that limited the availability of protective goods and services such as personal protective equipment, and commercial actors lobbying against public health measures. Commercial determinants also influenced health outcomes by influencing vaccine availability and the health system response to COVID-19. Our findings contribute to determining the appropriate role of governments in governing for health, wellbeing, and equity, and regulating and addressing negative commercial determinants of health.

Australian young people's perceptions of the commercial determinants of the climate crisis

There is increasing public health focus on how corporate practices impact population health and well-being. While the commercial determinants of the climate crisis pose serious threats to human and planetary health, governments largely seek to balance climate action with economic imperatives. Global stakeholders recognize that young people have important voices in influencing climate responses. However, few studies have investigated young people's perceptions of the commercial determinants of the climate crisis. A qualitatively led online survey of n = 500 young Australians (15-24 years) investigated their understanding of corporate responses to the climate crisis, factors that influenced these responses and strategies to respond. A reflexive approach to thematic analysis was used. Three themes were constructed from the data. First, young people perceived that corporate responses to the climate crisis focussed on soft options and lacked meaningful action. Second, they stated that these responses were largely influenced by economic imperatives rather than planetary health, with policy levers needed to implement environmentally responsible corporate practices. Third, young people perceived that systems needed change to create demand for a cleaner environment, leading to improved practices. Young people have a clear understanding of the commercial determinants of the climate crisis and associated threats to population health. They recognize that corporate practices (and consumer demand) will not change without significant policy and structural change. Public health and health promotion stakeholders should work alongside young people to influence decision-makers to address harmful corporate behaviours.

Power and Other Commercial Determinants of Health: An Empirical Study of the Australian Food, Alcohol, and Gambling Industries

BACKGROUND

Commercial determinants of health (CDoH) represent a critical frame for exploring undue corporate and commercial influence over health. Power lenses are integral to understanding CDoH. Impacts of food, alcohol, and gambling industries are observable CDoH outcomes. This study aims to inform understanding of the systems and institutions of commercial and/or corporate forces working within the Australian food, alcohol, and gambling industries that influence health and well-being, including broader discourses materialised via these systems and institutions.

METHODS

Twenty semi-structured interviews were conducted with key-informants on Australian public policy processes. Interviewees were current and former politicians, political staff members, regulators and other public servants, industry representatives, lobbyists, journalists, and researchers with expertise and experience of the Australian food, alcohol, and/ or gambling industries. Interviews sought participants' perceptions of Australian food, alcohol, and gambling industries' similarities and differences, power and influence, relationships, and intervention opportunities and needs.

RESULTS

Strategies and tactics used by Australian food, alcohol and gambling industries are similar, and similar to those of the tobacco industry. They wield considerable soft (eg, persuasive, preference-shaping) and hard (eg, coercive, political, and legal/economic) power. Perceptions of this power differed considerably according to participants' backgrounds. Participants framed their understanding of necessary interventions using orthodox neoliberal discourses, including limiting the role of government, emphasising education, consumer freedom, and personal choice.

CONCLUSION

Food, alcohol, and gambling industries exercise powerful influences in Australian public policy processes, affecting population health and well-being. Per Wood and colleagues' framework, these manifest corporate, social, and ecological outcomes, and represent considerable instrumental, structural, and discursive power. We identify power as arising from discourse and material resources alike, along with relationships and complex industry networks. Addressing power is essential for reducing CDoH harms. Disrupting orthodox discourses and ideologies underpinning this should be a core focus of public health (PH) advocates and researchers alike.

Alcohol and Public Health: Failure and Opportunity

Policy Points Public health science regarding alcohol consumption and problems, alcohol's role in equity and social justice, and identification of effective policy interventions has grown steadily stronger in the past 30 years. Progress on effective alcohol policies has stalled or gone backward in the United States and much of the world. Because alcohol influences at least 14 of the 17 sustainable development goals, as well as more than 200 disease and injury conditions, reducing alcohol problems should offer a platform for collaboration across public health silos but will require that public health itself respect and follow its own science.

The biomedical securitization of global health

BACKGROUND

The COVID-19 outbreak has shifted the course in the global health debate further towards health security and biomedical issues. Even though global health had already played a growing role in the international policy agenda, the pandemic strongly reinforced the interest of the media, the general public and the community in cross-border infectious diseases. This led to a strengthening of the already dominant biomedical understanding of global health and the securitization of health in foreign policy.

METHODS

This paper critically provides a narrative, iterative review of the health security literature available to date, with a special focus on the development of the currently prevailing concept of health security and the dual trend towards the securitization and biomedicalization of global health.

FINDINGS

In a world increasingly determined by power asymmetries, unequal distribution of opportunities and resources, and inadequate governance structures, securitizing health has become a key feature of global governance. Health security is predominantly based on a concept that neglects the global burden of disease determined by non-communicable conditions rather than by infectious diseases. Moreover, it exhibits a trend towards biomedical solutions and neglects root causes of global health crises.

CONCLUSIONS

As important as health security is, the underlying concept driven by biomedical and technocratic reductionism falls short. It widely neglects the social, economic, political, commercial and environmental determination of health. Beyond improved health care and prevention, health-in-all policies are ultimately required for ensuring health security and reducing one of its main challenges, health inequalities within and between countries. Global health security must first and foremost seek to guarantee the universal right to health and therefore emphasise the social, economic, commercial and political determination of health.

Marketing of commercial milk formula: a system to capture parents, communities, science, and policy

Despite proven benefits, less than half of infants and young children globally are breastfed in accordance with the recommendations of WHO. In comparison, commercial milk formula (CMF) sales have increased to about US$55 billion annually, with more infants and young children receiving formula products than ever. This Series paper describes the CMF marketing playbook and its influence on families, health professionals, science, and policy processes, drawing on national survey data, company reports, case studies, methodical scoping reviews, and two multicountry research studies. We report how CMF sales are driven by multifaceted, well resourced marketing strategies that portray CMF products, with little or no supporting evidence, as solutions to common infant health and developmental challenges in ways that systematically undermine breastfeeding. Digital platforms substantially extend the reach and influence of marketing while circumventing the International Code of Marketing of Breast-milk Substitutes. Creating an enabling policy environment for breastfeeding that is free from commercial influence requires greater political commitment, financial investment, CMF industry transparency, and sustained advocacy. A framework convention on the commercial marketing of food products for infants and children is needed to end CMF marketing.

The political economy of infant and young child feeding: confronting corporate power, overcoming structural barriers, and accelerating progress

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.

Typology of how 'harmful commodity industries' interact with local governments in England: a critical interpretive synthesis

INTRODUCTION

Industries that produce and market potentially harmful commodities or services (eg, tobacco, alcohol, gambling, less healthy foods and beverages) are a major influence on the drivers of behavioural risk factors for non-communicable diseases. The nature and impact of interactions between public bodies and 'harmful commodity industries' (HCIs) has been widely recognised and discussed at national and international levels, but to date little is known about such interactions at local or regional government levels. This study aimed to identify and characterise actual and potential interactions and proposes a typology of interactions between HCIs and English local authorities (LAs).

METHODS

Five electronic databases covering international literature (PubMed, EBSCO, OVID, Scopus and Web of Science) were searched up to June 2021. We also performed online searches for publicly available, web-based grey literature and documented examples of interactions in an English LA context. We conducted a critical interpretive synthesis of the published and grey literature to integrate and conceptualise the data in the context of English LAs.

RESULTS

We included 47 published papers to provide the frame for the typology, which was refined and contextualised for English LAs through the available grey literature. Three categories were developed, describing the medium through which interactions occur: (1) direct involvement with LAs, (2) involvement through intermediaries and (3) involvement through the local knowledge space. Within these, we grouped interactions into 10 themes defining their nature and identified illustrative examples.

CONCLUSION

Our typology identifies complex inter-relationships and characterises interactions between HCIs and LAs, with illustrative examples from English LAs. Drawn from well-established theories and frameworks in combination with contextual information on English LAs, this typology explores the LA perspective and could help local decision-makers to maximise population health while minimising negative impacts of HCIs.

PROSPERO REGISTRATION NUMBER

CRD42021257311.

US and EU Free Trade Agreements and implementation of policies to control tobacco, alcohol, and unhealthy food and drinks: A quasi-experimental analysis

BACKGROUND

Identifying and tackling the factors that undermine regulation of unhealthy commodities is an essential component of effective noncommunicable disease (NCD) prevention. Unhealthy commodity producers may use rules in US and EU Free Trade Agreements (FTAs) to challenge policies targeting their products. We aimed to test whether there was a statistical relationship between US and EU FTA participation and reduced implementation of WHO-recommended policies.

METHODS AND FINDINGS

We performed a statistical analysis assessing the probability of at least partially implementing 10 tobacco, alcohol, and unhealthy food and drink policies in 127 countries in 2014, 2016, and 2019. We assessed differences in implementation of these policies in countries with and without US/EU FTAs. We used matching to conduct 48 covariate-adjusted quasi-experimental comparisons across 27 matched US/EU FTA members (87 country-years) and performed additional analyses and robustness checks to assess alternative explanations for our results. Out of our 48 tests, 19% (9/48) identified a statistically significant decrease in the predicted probability of at least partially implementing the unhealthy commodity policy in question, while 2% (1/48) showed an increase. However, there was marked heterogeneity across policies. At the level of individual policies, US FTA participation was associated with a 37% reduction (95%CI: -0.51 to -0.22) in the probability of fully implementing graphic tobacco warning policies, and a 53% reduction (95%CI: -0.63 to -0.43) in the probability of at least partially implementing smoke-free place policies. EU FTA participation was associated with a 28% reduction (95%CI: -0.45 to -0.10) in the probability of fully implementing graphic tobacco warning policies, and a 25% reduction (95%CI: -0.47 to -0.03) in the probability of fully implementing restrictions on child marketing of unhealthy food and drinks. There was a positive association with implementing fat limits and bans, but this was not robust. Associations with other outcomes were not significant. The main limitations included residual confounding, limited ability to discern precise mechanisms of influence, and potentially limited generalisability to other FTAs.

CONCLUSIONS

US and EU FTA participation may reduce the probability of implementing WHO-recommended tobacco and child food marketing policies by between a quarter and a half-depending on the FTA and outcome in question. Governments negotiating or participating in US/EU FTAs may need to establish robust health protections and mitigation strategies to achieve their NCD mortality reduction targets.

Racism, xenophobia, discrimination, and the determination of health

This Series shows how racism, xenophobia, discrimination, and the structures that support them are detrimental to health. In this first Series paper, we describe the conceptual model used throughout the Series and the underlying principles and definitions. We explore concepts of epistemic injustice, biological experimentation, and misconceptions about race using a historical lens. We focus on the core structural factors of separation and hierarchical power that permeate society and result in the negative health consequences we see. We are at a crucial moment in history, as populist leaders pushing the politics of hate have become more powerful in several countries. These leaders exploit racism, xenophobia, and other forms of discrimination to divide and control populations, with immediate and long-term consequences for both individual and population health. The COVID-19 pandemic and transnational racial justice movements have brought renewed attention to persisting structural racial injustice.

Strategies used by the soft drink industry to grow and sustain sales: a case-study of The Coca-Cola Company in East Asia

BACKGROUND

The market and non-market activities of the food and beverage industry contribute to unhealthy and unsustainable dietary patterns, increasingly in low-income and middle-income countries (LMICs). We aimed to describe how The Coca-Cola Company (TCCC), as the world market leader in the sugar-sweetened beverage sector, operationalises their activities in LMICs in East Asia, among the world's most highly populated yet under-researched countries, to illustrate the ways in which these activities may negatively influence health outcomes.

METHODS

We adopted a theoretically-guided qualitative research design and documentary analysis method. Data sources included: industry documents and web pages, marketing case studies obtained from the World Advertising Research Centre, media reports, global trade summaries and websites of industry associations. To guide data analysis, we synthesised a conceptual framework from existing commercial determinants of health literature, to describe ways in which the market and non-market activities of TCCC influence health.

RESULTS

TCCC leverages subsidiary companies and investments in international networks to expand its supply chains. The company engages in frequent political activities to minimise the implementation of nutrition policies that may impact profits. The company markets products, particularly on digital and mobile devices, often targeting children, adolescents and mothers, and undertakes public relations activities related to human rights, environmental sustainability and community and economic supports, and these public relations activities are often integrated into marketing campaigns. The identified activities of TCCC are frequently in direct contrast to efforts to improve the healthfulness of population diets in East Asia LMICs.

CONCLUSIONS

A public health analysis of the market and non-market activities of corporations active in unhealthy commodity industries needs to be broad in scope to cover the diverse set of strategies used to increase their market power and influence. Governments should consider a suite of policy options to attenuate these commercial determinants of unhealthy diets.

Trust, but Verify Comment on "'Part of the Solution': Food Corporation Strategies for Regulatory Capture and Legitimacy"

According to Lacy-Nichols and Williams, the food industry is increasingly forestalling regulation with incremental concessions and co-option of policy-making discourses and processes; bolstering their legitimacy via partnerships with credible stakeholders; and disarming critics by amending their product portfolios whilst maintaining high sales volumes and profits. Their assessment raises a number of fundamental philosophical questions that we must address in order to form an appropriate public health response: is it appropriate to treat every act of corporate citizenship with cynicism? If voluntary action leads to better health outcomes, does it matter whether profits are preserved? How should we balance any short-term benefits from industry-led reforms against the longer-term risk stemming from corporate capture of policy-making networks? I argue for a nuanced approach, focused on carefully defined health outcomes; allowing corporations the benefit of the doubt, but implementing robust binding measures the moment voluntary actions fail to meet independently set objectives.

The commercial determinants of Indigenous health and well-being: a systematic scoping review

INTRODUCTION

Health inequity within Indigenous populations is widespread and underpinned by colonialism, dispossession and oppression. Social and cultural determinants of Indigenous health and well-being are well described. Despite emerging literature on the commercial determinants of health, the health and well-being impacts of commercial activities for Indigenous populations is not well understood. We aimed to identify, map and synthesise the available evidence on the commercial determinants of Indigenous health and well-being.

METHODS

Five academic databases (MEDLINE Complete, Global Health APAPsycInfo, Environment Complete and Business Source Complete) and grey literature (Australian Indigenous HealthInfoNet, Google Scholar, Google) were systematically searched for articles describing commercial industry activities that may influence health and well-being for Indigenous peoples in high-income countries. Data were extracted by Indigenous and non-Indigenous researchers and narratively synthesised.

RESULTS

56 articles from the USA, Canada, Australia, New Zealand, Norway and Sweden were included, 11 of which were editorials/commentaries. The activities of the extractive (mining), tobacco, food and beverage, pharmaceutical, alcohol and gambling industries were reported to impact Indigenous populations. Forty-six articles reported health-harming commercial practices, including exploitation of Indigenous land, marketing, lobbying and corporate social responsibility activities. Eight articles reported positive commercial industry activities that may reinforce cultural expression, cultural continuity and Indigenous self-determination. Few articles reported Indigenous involvement across the study design and implementation.

CONCLUSION

Commercial industry activities contribute to health and well-being outcomes of Indigenous populations. Actions to reduce the harmful impacts of commercial activities on Indigenous health and well-being and future empirical research on the commercial determinants of Indigenous health, should be Indigenous led or designed in collaboration with Indigenous peoples.

How independent is the international food information council from the food and beverage industry? A content analysis of internal industry documents

BACKGROUND

The International Food Information Council (IFIC) and its partner foundation (IFIC Foundation) widely disseminate nutrition information and participate in relevant policymaking processes. Prior research has established a connection between IFIC and large food and beverage companies, representing a potential conflict of interest. The authors reviewed public records documents to investigate the connection between IFIC and industry, and to describe how IFIC communicates policy-relevant information about nutrition science to the public.

METHODS

The research team collected communications between IFIC and members of the research and policymaking communities by using state and federal transparency laws. The team analyzed the content of these documents with a commercial determinants of health framework while allowing for new themes to emerge, guided by the broad analytic questions of how and why does IFIC communicate nutrition information to policymakers and the broader public?

RESULTS

IFIC employs self-designed research and media outreach to disseminate nutrition information. Communications from IFIC and its affiliates related to nutrition information fell within major themes of manufacturing doubt and preference shaping.

CONCLUSIONS

IFIC uses media outlets to preemptively counter information about the negative health impacts of added sugars and ultra-processed foods, and promotes a personal-responsibility narrative about dietary intake and health. IFIC and its affiliates disseminate a narrow subset of nutrition and health information consistent with corporate interests and in opposition to public health policies associated with improved population health.

Racial capitalism and the US formula shortage: A policy analysis of the formula industry as a neocolonial system

The U.S. is currently experiencing a formula shortage and an infant feeding crisis that began with a formula recall and the hospitalization of 4 infants, 2 of whom died. Since 1981, governments around the world have been calling for an end to blatant human rights violations made by the commercial milk formula (CMF) industry. These practices not only involve targeting nutritionally vulnerable populations of mothers and newborns to turn a profit, but also actively undermining the implementation of policies, legislation, and regulatory oversight that might compromise their accumulation of wealth. In this paper we analyze the 2022 formula-shortage-as-infant-feeding-crisis through the lens of the history of colonialism and critical theory in the anthropology of reproduction. First, we provide an overview of the colonial roots of the formula industry from a global perspective. We then focus on how the mechanisms of racial exploitation remain entrenched in the U.S. approach to infant feeding policies, regulation and investment, setting the stage for the current infant feeding crisis. Through our analysis of the 2022 infant feeding crisis we demonstrate how the multinational CMF industry perpetuates racial capitalism and racialized health inequities and disparities through its operations as a neocolonial enterprise. Finally, we offer policy interventions and potential solutions that are grounded in structural interventions for more equitable, anticolonial, antiracist infant feeding systems.

TV Advertising, Corporate Power, and Latino Health Disparities

INTRODUCTION

This study identifies mental health, tobacco prevention, alcohol/beer, food/beverage, pharmaceutical, and other health-related advertisements across Spanish- and English-language TV networks owned by the same parent media company in the U.S. as commercial determinants of health disparities for Latino populations and/or viewers of Spanish-language TV.

METHODS

A 3-week composite sample of Telemundo and National Broadcasting Company prime-time TV owned by the same parent media company was randomly drawn from March 31, 2021 to June 12, 2021 in Houston, Texas. A total of 1,593 health-related advertisements were yielded for systematic content analysis. Analyses included intercoder reliability, descriptive and bivariate analysis, and rate ratio and rate difference calculations.

RESULTS

Telemundo had significantly more health-adverse and fewer health-beneficial advertisements than National Broadcasting Company. Telemundo broadcasted about 11 more alcohol (95% CI=9.1, 12.5) and 5 more unhealthy/noncore food/beverages (95% CI=2.0, 7.2) advertisements per hour of TV advertisement programming than the National Broadcasting Company. Telemundo also broadcasted about 1 fewer mental health/tobacco prevention (95% CI= -0.9, -0.2), 3 fewer healthy/core food/beverages (95% CI= -1.5, -4.3), and 4 fewer pharmaceutical (95% CI= -2.4, -5.7) advertisements per hour of advertisement programming than the National Broadcasting Company.

CONCLUSIONS

Overall greater health-adverse and fewer health-beneficial advertisements are broadcasted on Spanish-language than on English-language TV. Unchecked corporate marketing strategies may serve as a commercial determinant of health disparities for Latino populations by Spanish-language TV.

Rainbows over the world's public health: determinants of health models in the past, present, and future

The need to visualise the complexity of the determinants of population health and their interactions inspired the development of the rainbow model. In this commentary we chronicle how variations of this model have emerged, including the initial models of Haglund and Svanström (1982), Dahlgren and Whitehead (1991), and the Östgöta model (2014), and we illustrate how these models have been influential in both public health and beyond. All these models have strong Nordic connections and are thus an important Nordic contribution to public health. Further, these models have underpinned and facilitated other examples of Nordic leadership in public health, including practical efforts to address health inequalities and design new health policy approaches.

Apart from documenting the emergence of rainbow models and their wide range of contemporary uses, we examine a range of criticisms levelled at these models – including limitations in methodological development and in scope. We propose the time is ripe for an updated generic determinants of health model, one that elucidates and preserves the core value in older models, while recognising the developments that have occurred over the past decades in our understanding of the determinants of health. We conclude with an example of a generic model that fulfills the general purposes of a determinants of health model while maintaining the necessary scope for further adjustments to be made in the future, as well as adjustments to location or context-specific purposes, in education, research, health promotion and beyond.

Using Regulatory Stances to See All the Commercial Determinants of Health

Policy Points The commercial determinants of health (CDoH) concept, which currently focuses on markets that harm health, should be expanded to refer to the interface between commerce and health, which can sometimes have positive public health consequences. The regulatory stances framework helps us classify public health preferences for regulating specific markets related to CDoH, based on the intended effects of regulations on market size. The regulatory stances a jurisdiction can adopt can be classified as ranging from prohibitionist through contractionist, permissive, and expansionist, to universalist. The regulatory stances framework increases the usefulness of the CDoH concept by expanding the conversation beyond negative determinants of health and providing a fuller view of the tools at the disposal of society to alter markets and improve health.

CONTEXT

The effects of commerce on the public health are omnipresent. The commercial determinants of health (CDoH) represent a burgeoning area of scholarly debate and activist policymaking to redress markets that adversely affect public health. The CDoH debate is a logical extension of the tobacco control movement, but, to its detriment, the CDoH conversation remains primarily focused policies and proposals that are analogous to historical tobacco control strategies.

METHODS

This paper argues that for the CDoH to develop further and broaden its appeal, it should expand to cover markets with conditional and positive impacts on health. To explain and order this conversation, a comparative framework for regulatory policy is introduced: the regulatory stances. The regulatory stances classify a regulatory policy based on the intended effect of policy on the size of a market in the future relative to the present.

FINDINGS

Some markets that interface between commerce and health do not inherently harm health. Regulatory policy toward these markets should be different in intent than regulatory policy for markets with negative health effects.

CONCLUSIONS

By using the regulatory stances framework to encompass markets that have positive or conditional effects on health as well as those that have adverse health effects, the CDoH conversation can shift away from the exclusive focus on strategies to shrink markets with adverse health impacts to consider a wider array of policy options.

Study protocol: assessing the association between corporate financial influence and implementation of policies to tackle commercial determinants of non-communicable diseases: a cross-sectional analysis of 172 countries

INTRODUCTION

There are many case studies of corporations that have worked to undermine health policy implementation. It is unclear whether countries that are more exposed to corporate financial influence are systematically less likely to implement robust health policies that target firms' financial interests. We aim to assess the association between corporate financial influence and implementation of WHO-recommended policies to constrain sales, marketing and consumption of tobacco, alcohol and unhealthy foods.

METHODS AND ANALYSIS

We will perform a cross-sectional analysis of 172 WHO Member States using national datasets from 2015, 2017 and 2020. We will use random effects generalised least squares regression to test the association between implementation status of 12 WHO-recommended tobacco, alcohol and diet policies, and corporate financial influence, a metric that combines disclosure of campaign donations, public campaign finance, corporate campaign donations, legislature corrupt activities, disclosure by politicians and executive oversight. We will control for GDP per capita, population aged >65 years (%), urbanisation (%), level of democracy, continent, ethno-linguistic fractionalisation, legal origin, UN-defined 'Small Island Developing States' and Muslim population (%) (to capture alcohol policy differences). We will include year dummies to address the possibility of a spurious relationship between the outcome variable and the independent variables of interests. For example, there may be an upward global trend in policy implementation that coincides with an upward global trend in the regulation of lobbying and campaign finance.

ETHICS AND DISSEMINATION

As this study uses publicly available data, ethics approval is not required. The authors have no conflicts of interest to declare. Findings will be submitted to a peer-reviewed journal for publication in the academic literature. All data, code and syntax will be made publicly available on GitHub.

Investigating Employment Quality for Population Health and Health Equity: A Perspective of Power

Employment quality (EQ) has gained increasing attention as a determinant of health, but the debate among occupational health researchers over the measurement of EQ poses a challenge to advancing the literature. This is especially problematic when the concept is used across social, cultural, and national borders, as EQ is shaped by power dynamics within sociopolitical and economic contexts that are specific to each society. Investigating EQ in context could help develop a clearer understanding as to why EQ is configured in certain ways, how best EQ could be measured, how EQ impacts health, and ultimately how EQ could be improved. In this paper, we propose that attention to social context-and in particular power-may help advance the research on EQ and health. We present an allegory, or a visual description, that articulates the power balance in the employer-worker relation as well as in the sociopolitical context in which the employer-worker relation takes place. We end by proposing specific approaches for occupational health researchers to incorporate a perspective of power in EQ research that may clarify the concept and measurement of EQ. A clearer recognition of EQ as a product of power in social context aligns with the research approach of addressing work as a social structural determinant of health.

A Framing Analysis of Consultation Submissions on the WHO Global Strategy to Reduce the Harmful Use of Alcohol: Values and Interests

BACKGROUND

In response to the magnitude of harms caused by alcohol, the World Health Organization (WHO) Global Strategy to Reduce the Harmful Use of Alcohol (GAS) was endorsed in 2010. We analysed submissions to the 2019 WHO consultation on the implementation of the GAS to identify how different stakeholders frame alcohol use and control; and to assess how stakeholders engage with the consultation process, with possibly harmful consequences for public health policy.

METHODS

All submissions from WHO Member States, international organisations, non-governmental organisations (NGOs), academic institutions and private sector entities were identified and used as data for an inductive framing analysis. This involved close reading and data familiarisation, thematic coding and identifying emergent framings. Through the analysis of texts, framing analysis can give insights into the values and interests of stakeholders. Because framing influences how issues are conceptualised and addressed, framing analysis is a useful tool to study policy-making processes.

RESULTS

We identified 161 unique submissions and seven attachments. Emerging frames were grouped according to their function: defining the problem, assigning causation, proposing solutions, or justifying and persuading. Submissions varied in terms of the framing they deployed and how this was presented, eg, how the problem was defined. Proposed policy solutions also varied. Targeted solutions emphasising individual responsibility tended to be supported by industry and some Member States. Calls for universal regulation and global mobilisation often came from NGOs and academia. Stakeholders drew on evidence and specific value systems to support the adoption of certain problem and solution ideas and to oppose competing framing.

CONCLUSION

Alcohol control is a contested policy field in which different stakeholders use framing to set the agenda and influence what policy solutions are considered legitimate. WHO should consider which interests are served by these different framings and how to weigh different stakeholders in the consultation process.

Conceptualising the Commercial Determinants of Health Using a Power Lens: A Review and Synthesis of Existing Frameworks

BACKGROUND

There is increasing recognition that power imbalances that favour corporations, especially those active in unhealthy commodity industries, over other actors are central to the ways in which corporations influence population health. However, existing frameworks for analysing corporate strategies and practices that impact on health do not incorporate concepts of power in consistent ways. This paper aimed to review the ways in which corporate power has been incorporated into such frameworks, and to propose a revised framing of the commercial determinants of health (CDoH) that makes concepts of power explicit.

METHODS

We conducted a narrative review of frameworks that identify corporate strategies and practices and explain how these influence population health. Content analysis was conducted to identify explicit references to different qualities of power - its origins, nature, and manifestations.

RESULTS

Twenty-two frameworks were identified, five of which used theories of power. A wide range of contexts that shape, and are shaped by corporate power were discussed, as were a diversity of corporate, social and ecological outcomes. A variety of material and ideational sources of power was also covered. We proposed an integrated 'Corporate Power and Health' framework to inform analysis of the CDoH, organised around key questions on power set out by Foucault. The proposed framework draws from a number of well-established corporate power theories and synthesises key features of existing CDoH frameworks.

CONCLUSION

Public health advocates, researchers and policy-makers would likely be better placed to understand and address the CDoH by engaging with theories of power to a greater extent, and by explicitly incorporating concepts of corporate power in analyses of how the deployment of corporate strategies and practices influence population health.

Powerful Allies and Weak Consensus: Towards a Deeper Understanding of how Health-Harming Industries Seek to Influence Global Health Governance Comment on "Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases"

Suzuki et al have identified commonalities in the policy positions adopted at a global forum by commercial sector actors and high-income countries (HICs), on the one hand, and non-governmental organizations (NGOs) and low- and middle-income countries (LMICs), on the other, in ways that may allow commercial sector actors to block or delay evidence-based policies through the creation of political controversy. The ability of industry actors to draw on the support of the most politically and economically powerful countries for their favoured policy agenda is an important contribution to understanding the dynamics of global health governance in the area of non-communicable diseases (NCDs) and beyond. Here we assess the relevance of this paper for the field of corporate actors' research and the potential avenues this opens up for further study. More specifically we emphasize the need for comparative, cross disciplinary research to examine the power of heath-harming industries and the relevance of these findings for decolonizing global health.

Children’s, parents’ and professional stakeholders’ views on power concerning the regulation of online advertising of unhealthy food to young people in the UK: A qualitative study

Examinations of corporate power have demonstrated the practices and activities Unhealthy Commodity Industries (UCIs) employ to exert their power and influence on the public and health policy. The High in Fat Sugar and Salt (HFSS) product industry have exploited the online environment to market their products to young people. Regulating UCIs’ marketing can limit the power of those industries and is argued to be one of the most appropriate policy responses to such marketing. However, there is minimal consideration of how stakeholders view regulation of online advertising of HFSS products to young people. This UK-focused study addressed this through a secondary analysis of focus groups with young people (n = 15), the primary analysis of focus groups with parents (n = 8), and interviews with professional stakeholders (n = 11). The findings indicated that participants’ views on the regulation of online advertising of HFSS products were informed by how professional stakeholders exerted instrumental, structural and discursive power. Participants cited regulation as a means to re-negotiate problematic power dynamics to increase young people’s and parents’ autonomy over young people’s diets, yet concern remained as to the impact regulation may have on individual autonomy. To garner increased public support for such regulatory policies, it may be beneficial for advocates to emphasise the empowering elements of those regulatory policies. Advocacy actors may wish to shift their framing of regulation from one that focuses on restricting industry practices, to one that centres on empowering individuals.

Governing ultra-processed food and alcohol industries: the presence and role of non-government organisations in Australia

OBJECTIVE

The roles of non-governmental organisations (NGOs) in regulating harmful commodity industries (HCIs) are understudied. The aim of this paper is to identify the NGOs and the roles that they play in the governance of the ultra-processed food and alcohol industries in Australia.

METHODS

We undertook an exploratory descriptive analysis of NGOs identified from an online search based on the typology we developed of type, issue area and governance function.

RESULTS

A total of 134 relevant Australian NGOs were identified: 38 work on food issues, 61 with alcohol issues and 35 are active in both. In the food domain, 90% of NGOs engage in agenda setting, 88% in capacity building, 15% in implementation and 12% in monitoring. In the alcohol domain, 92% of NGOs are active in agenda setting, 72% in capacity building, 35% in implementation and 8% in monitoring.

CONCLUSIONS

Australian NGOs are active actors in the food and alcohol governance system.

IMPLICATIONS FOR PUBLIC HEALTH

There are many opportunities for NGOs to regulate HCI practices, building on their relative strengths in agenda setting and capacity building, and expanding their activities in monitoring and implementation. A more detailed examination is needed of strategies that can be used by NGOs to be effective regulators in the governance system.

Exploring ways to respond to rising obesity and diabetes in the Caribbean using a system dynamics model

Diabetes and obesity present a high and increasing burden of disease in the Caribbean that have failed to respond to prevention policies and interventions. These conditions are the result of a complex system of drivers and determinants that can make it difficult to predict the impact of interventions. In partnership with stakeholders, we developed a system dynamics simulation model to map the system driving diabetes and obesity prevalence in the Caribbean using Jamaica as a test case. The study aims to use the model to assess the magnitude changes necessary in physical activity and dietary intake to achieve global targets set by the WHO Global Action plan and to test scenarios for interventions to reduce the burden of diabetes and obesity. Continuing current trends in diet, physical activity, and demographics, the model predicts diabetes in Jamaican adults (20+ years) to rise from 12% in 2018 to 15.4% in 2030 and 20.9% by 2050. For obesity, it predicts prevalence to rise from 28.6% in 2018 to 32.1% by 2030 and 39.2% by 2050. The magnitude change necessary to achieve the global targets set by the World Health Organization is so great as to be unachievable. However, a combination of measures both upstream (including reducing the consumption of sugar sweetened beverages and ultra processed foods, increasing fruit and vegetable intake, and increasing moderate-to-vigorous activity) at the population level, and downstream (targeting people at high risk and with diabetes) can significantly reduce the future burden of diabetes and obesity in the region. No single intervention reduces the prevalence of these conditions as much as a combination of interventions. Thus, the findings of this model strongly support adopting a sustained and coordinated approach across various sectors to synergistically maximise the benefits of interventions.

Divergent decennial trends in mental health according to age reveal poorer mental health for young people: repeated cross-sectional population-based surveys from the HUNT Study, Norway

OBJECTIVES

Public health trends are formed by political, economic, historical and cultural factors in society. The aim of this paper was to describe overall changes in mental health among adolescents and adults in a Norwegian population over the three last decades and discuss some potential explanations for these changes.

DESIGN

Repeated population-based health surveys to monitor decennial changes.

SETTING

Data from three cross-sectional surveys in 1995-1997, 2006-2008 and 2017-2019 in the population-based HUNT Study in Norway were used.

PARTICIPANTS

The general population in a Norwegian county covering participants aged 13-79 years, ranging from 48 000 to 62 000 000 in each survey.

MAIN OUTCOME MEASURES

Prevalence estimates of subjective anxiety and depression symptoms stratified by age and gender were assessed using the Hopkins Symptom Checklist-5 for adolescents and the Hospital Anxiety and Depression Scale for adults.

RESULTS

Adolescents' and young adults' mental distress increased sharply, especially between 2006-2008 and 2017-2019. However, depressive symptoms instead declined among adults aged 60 and over and anxiety symptoms remained largely unchanged in these groups.

CONCLUSIONS

Our trend data from the HUNT Study in Norway indicate poorer mental health among adolescents and young adults that we suggest are related to relevant changes in young people's living conditions and behaviour, including the increased influence of screen-based media.

The alcohol industry, the tobacco industry, and excise taxes in the US 1986-89: new insights from the tobacco documents

BACKGROUND

The UCSF Industry Documents Library has provided public health researchers with key insights into the organization of political activities in the tobacco industry. Much less is known about the alcohol industry. In the US, there is some existing evidence of cooperation between the two industries, particularly in areas where there are mutual interests and/or policy goals at stake. Efforts to raise excise taxes on tobacco and alcohol products are one such example.

METHODS

We systematically searched the UCSF Industry Documents Library for data on alcohol industry actors and their political activities. Using content generated by alcohol and tobacco actors, we sought to identify new evidence of collaborations to shape excise tax policy debates in the US in the 1980s and 1990s.

RESULTS

We uncover evidence of the alcohol industry's efforts to shape excise tax policy debates, both at the national and state level. Excise taxes were defined by both alcohol and tobacco companies and related organisations as a key threat to profits. We show how the alcohol industry confronted this challenge in the late 1980s in the US, uncovering the range of monitoring, coordinating, and public-facing activities used to defeat proposed tax increases at both state and federal levels. The former draws particular attention to Oregon, where alcohol industry actors were not simply operating at the behest of the tobacco industry, but actively led a campaign to advance both brewing and tobacco interests.

CONCLUSIONS

The tobacco documents offer a key resource for studying economic interests beyond that of the tobacco industry, operating in collaboration with tobacco companies. Here, brewers advanced shared interests with tobacco, and these findings have implications for advancing understanding of alcohol and tobacco industry political strategies. The findings also suggest that financial documents from other public repositories could be used to generate new inferences about corporate political activities.

Enhancing our understanding of the commercial determinants of health: Theories, methods, and insights from political science

Public health researchers concerned with the commercial industry's influence over health policy have contributed to the development of a new field of inquiry, Corporative Political Activity (CPA). While the CPA literature has improved our understanding of the tactics that industries use to influence health policy and outcomes, ironically, this literature appears to have fallen short of thoroughly engaging those social science disciplines focusing on the relationship between industry and government in the policymaking process, such as political science. The purpose of this article is to reveal how political science theory and method can generate new research questions for CPA scholars; propose alternative qualitative methodological approaches to causal inference, with a focus on historical and temporal analysis; and establish adequacy in causal mechanisms. The application of political science theories and methods may assist CPA researchers in their efforts to explain the durability and efficacy of CPA political tactics at the domestic government level, which of these tactics are more important, while providing greater depth into explaining how and why industries continue to obstruct policymaking. The author then propose an alternative political science analytical framework, Political Analysis of Corporate Political Activity (PACPA), that may provide a more thorough understanding of the politics of the commercial sector's policy influence. This framework integrates the political science literature highlighting the political and institutional contexts shaping interest group activities and policymaking influence along with the CPA literature discussing these issues, through a historically-based qualitative case study approach emphasizing the causal mechanisms behind industry's political activities. With respect to methodology, this article relied on an analysis of qualitative documents through a variety of on-line search engines and the author's extensive knowledge of the topic. Select case studies were used as illustrations supporting the author's claims. This research began in November 2020 and concluded in June 2021.

Corporate Social Responsibility Reporting for Stakeholders’ Health and Wellbeing in the Food and Beverage Industry: A Case Study of a Multinational Company

The concept of corporate social responsibility (CSR) used to be seen as a social obligation of businesses to make decisions and take responsible action in accordance with the goals and values of the society. The concept is today understood as the continuing commitment by businesses to behave ethically and contribute to economic development while improving the quality of life of the workforce and their families as well as the local community and society at large. This study aimed to apply Chowdhury and co-authors’ framework to the Unilever Global Reporting Initiative (GRI) Content Index 2020 to explore the feasibility of the framework as well as identify potential challenges related to its use in the field of public health. Findings show that the framework is suitable for analysing CSR reporting on activities aimed to promote internal and external stakeholders’ health and wellbeing from a public health perspective. A greater number of GRI disclosures reported by Unilever related to external stakeholders’ health and wellbeing than to activities impacting internal stakeholders. Further research should aim at testing the framework in other types of business organizations across other types of industries.

Social, political, commercial, and corporate determinants of rural health equity in Canada: an integrated framework

People in rural and remote areas often experience greater vulnerability and higher health-related risks as a result of complex issues that include limited access to affordable health services and programs. During disruptive events, rural populations face unique barriers and challenges due to their remoteness and limited access to resources, including digital technologies. While social determinants of health have been highlighted as a tool to understand how health is impacted by various social factors, it is crucial to create a holistic framework to fully understand rural health equity. In this commentary, we propose an integrated framework that connects the social determinants of health (SDOH), the political determinants of health (PDOH), the commercial determinants of health (ComDOH), and the corporate determinants of health (CorpDOH) to address health inequity in rural and remote communities in Canada. The goal of this commentary is to situate these four determinants of health as key to inform policy-makers and practitioners for future development of rural health equity policies and programs in Canada.

Protocol: Effectiveness of message content and format on individual and collective efficacy in reducing the intention to consume sugar-sweetened beverages

The strategic use of media is a common approach to promote health. A large body of evidence identifies specific features that increase message efficacy, including tailoring messages to the target audience and using a storytelling format. Yet most message testing research has focused on individual-level outcomes, ignoring the social and environmental determinants of health behaviors, which require collective action and political will to change. Grounded in an ecological approach to communication, we will carry out two double-blinded randomized experiments to test the relative effectiveness of message tailoring (culturally-tailored vs. standard) and format (narrative vs. didactic) to increase the intention to reduce individual sugar-sweetened beverage consumption, the understanding of social and commercial determinants of health, and the sense of empowerment among young adult Latinas. Based on power analyses (80% power at alpha = 0.05), we will randomize 438 participants to two groups (traditional standard infographic and culturally-tailored infographic) in the first study, and 662 participants to two groups (culturally-tailored infographic and culturally-tailored comic book) in the second study. All participants will be measured by a pre-treatment test and an immediate post-treatment test. We hypothesize that culturally-tailored comic book will be most effective, and traditional standard infographic will be least effective, on all levels of outcomes. This study will provide empirical evidence in communication strategies to help young Latinos or other racial/ethnic minority young people to pursue positive dietary behaviors that both benefit themselves and contribute to change of social norms.

What do we know about corporate social responsibility and stakeholders physical activity? A Public Health Perspective

In the past decade and in the context of sustainable development, business organizations have been expected to partner with governments and others to address societal problems, including those pertinent to population health. Accordingly, through their corporate social responsibility (CSR) strategies and policies, companies should collaborate in health promotion efforts to modify the effects of the health determinants (including those concerning behavior change) affecting internal and external stakeholders. Although CSR strategies and policies are linked to stakeholder health and wellbeing (e.g. employee satisfaction), little is known of how these strategies affect physical activity. Thus, this perspective paper aims to contribute to the discussion of the topic by investigating what scientific evidence exists regarding the relationship between CSR and physical activity. So far there are indications that some business are implementing CSR activities targeting internal (e.g. employees) and external (e.g. consumers) stakeholders, especially in developed countries. Furthermore, among external stakeholders, CSR activities with a physical activity component targeted children, youth, the disabled, the under-privileged, and the elderly. However, there is still very little empirical evidence available using appropriate quantitative and qualitative designs. Public health and health science researchers in general should strive to advance our understanding of how CSR affects population health behavior, paving the way to develop frameworks for resilient, ethical, and sustainable health promotion.

Tracing the connections between international business and communicable diseases

We posit that international business and the emergence and spread of communicable diseases are intrinsically connected. To support our arguments, we first start with a historical timeline that traces the connections between international business and communicable diseases back to the sixth century. Second, following the epidemiology of communicable diseases, we identify two crucial transitions related to international business: the emergence of epidemics within a host country and the shift from epidemics to global pandemics. Third, we highlight international business contextual factors (host country regulatory quality, urbanization, trade barriers, global migration) and multinationals' activities (foreign direct investment, corporate political activity, global supply chain management, international travel) that could accelerate each transition. Finally, building on public health insights, we suggest research implications for business scholars on how to integrate human health challenges into their studies and practical implications for global managers on how to help prevent the emergence and spread of communicable diseases.