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Maani N, van Schalkwyk MC, Wiseman A, Petticrew M. Commercially driven efforts to frame alcohol harms have no place in UK health policy development. BMJ 2024; 385:q800. [PMID: 38575194 DOI: 10.1136/bmj.q800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
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Ralston R, Wagner-Rizvi T, van Schalkwyk MC, Maani N, Collin J. The WHO Foundation in global health governance: Depoliticizing corporate philanthropy. Soc Sci Med 2024; 344:116515. [PMID: 38412806 DOI: 10.1016/j.socscimed.2023.116515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 02/29/2024]
Abstract
The creation of the WHO Foundation during the COVID-19 pandemic represents a significant institutional development in the politics of financing the World Health Organization (WHO). In the context of longstanding acute financial pressures, the objective of the WHO Foundation is to widen WHO's resource base by attracting philanthropic donations from the commercial sector. In placing funding decisions 'at one remove' from WHO, the stated expectation is that the WHO Foundation will act as an intermediary, insulating the WHO from potential conflicts of interest and reputational risk through a combination of strategic distance from WHO and proximity with its norms and rules of engagement with non-state actors. Yet, whether this model has translated into practice remains understudied. In this article, we focus on emerging institutional practices within the WHO Foundation, highlighting a drift from its stated governance model. Based on analysis of WHO Foundation documents, we demonstrate how due diligence and transparency practices within the Foundation have been redesigned in ways that contradict or subvert its claims to applying alignment with WHO's governance norms, notably relating to its engagement with health harming industries such as alcohol and petrochemical companies. While this situation may seem paradoxical, we argue that, in placing funding decisions 'at one remove' from the formal institutions and structures of WHO, the creation of the Foundation has served to displace this issue to a more secluded arena where drifts in practice are less exposed to political oversight and scrutiny. Focusing on the discursive aspects of this process of depoliticisation, we contend that the Foundation has strategically managed 'fictional expectations' of accountable and transparent governance in order to mitigate concerns about its mandate and functions. This assessment provides new and important insights into the depoliticizing functions of the WHO Foundation and the significant implications this may have for global health governance.
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Affiliation(s)
- Rob Ralston
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, UK; SPECTRUM Consortium, UK.
| | - Tracey Wagner-Rizvi
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, UK; SPECTRUM Consortium, UK
| | - May Ci van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK
| | - Nason Maani
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, UK
| | - Jeff Collin
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, UK; SPECTRUM Consortium, UK
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Fitzgerald N, Mohan A, Purves R, O'Donnell R, Egan M, Nicholls J, Maani N, Smolar M, Fraser A, Briton T, Mahon L. Factors influencing public health engagement in alcohol licensing in England and Scotland including legal and structural differences: comparative interview analysis. Public Health Res (Southampt) 2024:1-36. [PMID: 38344914 DOI: 10.3310/bgtr4277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Background Greater availability of alcohol is associated with higher consumption and harms. The legal systems, by which premises are licensed to sell alcohol in England and Scotland, differ in several ways. The 'Exploring the impact of alcohol licensing in England and Scotland' study measured public health team activity regarding alcohol licensing from 2012 to 2019 and identified seven differences between England and Scotland in the timing and type of activities undertaken. Objectives To qualitatively describe the seven previously identified differences between Scotland and England in public health approaches to alcohol licensing, and to examine, from the perspective of public health professionals, what factors may explain these differences. Methods Ninety-four interviews were conducted with 52 professionals from 14 English and 6 Scottish public health teams selected for diversity who had been actively engaging with alcohol licensing. Interviews focused primarily on the nature of their engagement (n = 66) and their rationale for the approaches taken (n = 28). Interview data were analysed thematically using NVivo. Findings were constructed by discussion across the research team, to describe and explain the differences in practice found. Findings Diverse legal, practical and other factors appeared to explain the seven differences. (1) Earlier engagement in licensing by Scottish public health teams in 2012-3 may have arisen from differences in the timing of legislative changes giving public health a statutory role and support from Alcohol Focus Scotland. (2) Public Health England provided significant support from 2014 in England, contributing to an increase in activity from that point. (3) Renewals of statements of licensing policy were required more frequently in Scotland and at the same time for all Licensing Boards, probably explaining greater focus on policy in Scotland. (4) Organisational structures in Scotland, with public health stakeholders spread across several organisations, likely explained greater involvement of senior leaders there. (5) Without a public health objective for licensing, English public health teams felt less confident about making objections to licence applications without other stakeholders such as the police, and instead commonly negotiated conditions on licences with applicants. In contrast, Scottish public health teams felt any direct contact with applicants was inappropriate due to conflicts of interest. (6) With the public health objective in Scotland, public health teams there were more active in making independent objections to licence applications. Further in Scotland, licensing committee meetings are held to consider all new applications regardless of whether objections have been submitted; unlike in England where there was a greater incentive to resolve objections, because then a meeting was not required. (7) Finally, Scottish public health teams involved the public more in licensing process, partly because of statutory licensing forums there. Conclusions The alcohol premises licensing systems in England and Scotland differ in important ways including and beyond the lack of a public health objective for licensing in England. These and other differences, including support of national and local bodies, have shaped opportunities for, and the nature of, public health engagement. Further research could examine the relative success of the approaches taken by public health teams and how temporary increases in availability are handled in the two licensing systems. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Reseacrh programme as award number 15/129/11.
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Affiliation(s)
- Niamh Fitzgerald
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
- SPECTRUM Consortium, Edinburgh, UK
| | - Andrea Mohan
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Richard Purves
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Rachel O'Donnell
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - James Nicholls
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Nason Maani
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Laura Mahon
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
- SPECTRUM Consortium, Edinburgh, UK
- Alcohol Focus Scotland, Glasgow, UK
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Fitzgerald N, Egan M, O'Donnell R, Nicholls J, Mahon L, de Vocht F, McQuire C, Angus C, Purves R, Henney M, Mohan A, Maani N, Shortt N, Bauld L. Public health engagement in alcohol licensing in England and Scotland: the ExILEnS mixed-method, natural experiment evaluation. Public Health Res (Southampt) 2024:1-76. [PMID: 38345369 DOI: 10.3310/fsrt4135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Background International systematic reviews suggest an association between alcohol availability and increased alcohol-related harms. Alcohol availability is regulated through separate locally administered licensing systems in England and Scotland, in which local public health teams have a statutory role. The system in Scotland includes a public health objective for licensing. Public health teams engage to varying degrees in licensing matters but no previous study has sought to objectively characterise and measure their activity, examine their effectiveness, or compare practices between Scotland and England. Aim To critically assess the impact and mechanisms of impact of public health team engagement in alcohol premises licensing on alcohol-related harms in England and Scotland. Methods We recruited 39 diverse public health teams in England (n = 27) and Scotland (n = 12). Public health teams more active in licensing were recruited first and then matched to lower-activity public health teams. Using structured interviews (n = 66), documentation analysis, and expert consultation, we developed and applied the Public Health Engagement In Alcohol Licensing (PHIAL) measure to quantify six-monthly activity levels from 2012 to 2019. Time series of PHIAL scores, and health and crime outcomes for each area, were analysed using multivariable negative binomial mixed-effects models to assess correlations between outcome and exposure, with 18-month average PHIAL score as the primary exposure metric. In-depth interviews (n = 53) and a workshop (n = 10) explored public health team approaches and potential mechanisms of impact of alcohol availability interventions with public health team members and licensing stakeholders (local authority licensing officers, managers and lawyers/clerks, police staff with a licensing remit, local elected representatives). Findings Nineteen public health team activity types were assessed in six categories: (1) staffing; (2) reviewing and (3) responding to licence applications; (4) data usage; (5) influencing licensing stakeholders/policy; and (6) public involvement. Usage and intensity of activities and overall approaches varied within and between areas over time, including between Scotland and England. The latter variation could be explained by legal, structural and philosophical differences, including Scotland's public health objective. This objective was felt to legitimise public health considerations and the use of public health data within licensing. Quantitative analysis showed no clear evidence of association between level of public health team activity and the health or crime outcomes examined, using the primary exposure or other metrics (neither change in, nor cumulative, PHIAL scores). Qualitative data suggested that public health team input was valued by many licensing stakeholders, and that alcohol availability may lead to harms by affecting the accessibility, visibility and norms of alcohol consumption, but that the licensing systems have limited power to act in the interests of public health. Conclusions This study provides no evidence that public health team engagement in local licensing matters was associated with measurable downstream reductions in crime or health harms, in the short term, or over a 7-year follow-up period. The extensive qualitative data suggest that public health team engagement is valued and appears to be slowly reorienting the licensing system to better address health (and other) harms, especially in Scotland, but this will take time. A rise in home drinking, alcohol deliveries, and the inherent inability of the licensing system to reduce - or in the case of online sales, to contain - availability, may explain the null findings and will continue to limit the potential of these licensing systems to address alcohol-related harms. Future work Further analysis could consider the relative success of different public health team approaches in terms of changing alcohol availability and retailing. A key gap relates to the nature and impact of online availability on alcohol consumption, harms and inequalities, alongside development and study of relevant policy options. A national approach to licensing data and oversight would greatly facilitate future studies and public health input to licensing. Limitations Our interview data and therefore PHIAL scores may be limited by recall bias where documentary evidence of public health activity was not available, and by possible variability in grading of such activity, though steps were taken to minimise both. The analyses would have benefited from additional data on licensing policies and environmental changes that might have affected availability or harms in the study areas. Study registration The study was registered with the Research Registry (researchregistry6162) on 26 October 2020. The study protocol was published in BMC Medical Research Methodology on 6 November 2018. Funding This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 15/129/11.
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Affiliation(s)
- Niamh Fitzgerald
- Institute for Social Marketing and Health, University of Stirling, Scotland, UK
- SPECTRUM Consortium, UK
| | - Matt Egan
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- NIHR School for Public Health Research, Tyne and Wear, UK
| | - Rachel O'Donnell
- Institute for Social Marketing and Health, University of Stirling, Scotland, UK
| | - James Nicholls
- Faculty of Health Sciences and Sport, University of Stirling, Scotland, UK
| | - Laura Mahon
- Alcohol Focus Scotland, Glasgow, Scotland, UK
| | - Frank de Vocht
- NIHR School for Public Health Research, Tyne and Wear, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West, Bristol, UK
| | - Cheryl McQuire
- NIHR School for Public Health Research, Tyne and Wear, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Colin Angus
- SPECTRUM Consortium, UK
- School of Health and Related Research, University of Sheffield, UK
| | - Richard Purves
- Institute for Social Marketing and Health, University of Stirling, Scotland, UK
| | - Madeleine Henney
- School of Health and Related Research, University of Sheffield, UK
| | - Andrea Mohan
- School of Health Sciences, University of Dundee, Scotland, UK
| | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Niamh Shortt
- SPECTRUM Consortium, UK
- School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Linda Bauld
- SPECTRUM Consortium, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
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van Schalkwyk MCI, Hawkins B, Petticrew M, Maani N, Garde A, Reeves A, McKee M. Agnogenic practices and corporate political strategy: the legitimation of UK gambling industry-funded youth education programmes. Health Promot Int 2024; 39:daad196. [PMID: 38234277 PMCID: PMC10794875 DOI: 10.1093/heapro/daad196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Agnogenic practices-designed to create ignorance or doubt-are well-established strategies employed by health-harming industries (HHI). However, little is known about their use by industry-funded organizations delivering youth education programmes. We applied a previously published framework of corporate agnogenic practices to analyse how these organizations used them in three UK gambling industry-funded youth education programmes. Evidential strategies adopted previously by other HHI are prominent in the programmes' practitioner-facing materials, evaluation design and reporting and in public statements about the programmes. We show how agnogenic practices are employed to portray these youth education programmes as 'evidence-based' and 'evaluation-led'. These practices distort the already limited evidence on these educational initiatives while legitimizing industry-favourable policies, which prioritize commercial interests over public health. Given the similarities in political strategies adopted by different industries, these findings are relevant to research and policy on other HHI.
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Affiliation(s)
- May C I van Schalkwyk
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London WC1H 9SH, UK
| | - Benjamin Hawkins
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, University of Cambridge, Cambrdige CB2 0SL, UK
| | - Mark Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London WC1H 9SH, UK
| | - Nason Maani
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh Chrystal Macmillan Building 15a George Square, Edinburgh EH8 9LD, UK
| | - Amandine Garde
- Law & NCD Unit, School of Law and Social Justice, University of Liverpool, Liverpool L69 7ZR, UK
| | - Aaron Reeves
- Department of Social Policy and Intervention, Barnett House, 32 -37 Wellington Square, University of Oxford, Oxford OX1 2ER, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London WC1H 9SH, UK
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Hagenaars LL, Maani N, Schmidt LA. Is the commercial determinants conversation confined to the health sciences? Potentially, and that's a problem. Global Health 2024; 20:3. [PMID: 38167207 PMCID: PMC10759639 DOI: 10.1186/s12992-023-00989-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/06/2023] [Indexed: 01/05/2024] Open
Abstract
The commercial determinants of health (CDoH) are attracting increased interest and are of great importance when discussing how trade affects health. Through a citation analysis of recent foundational CDoH documents (a Lancet paper series and an Oxford University textbook), we find that fully 71% of all citations reference the health sciences. The health sciences may be well suited to documenting the specific pathways of how commercial (by)products and practices harm human health. However, to operationalize upstream solutions for mitigating these harms, our citation analysis suggests that the field can engage political scientists, economists, sociologists, the trade law and business, as well as advocates in civil society and journalism, more so than it currently does. With CDoH explicitly referring to the interaction between commerce and health, CDoH researchers might be uniquely positioned to get health on the agenda of others, which requires that CDoH methods, datasets, evidence reviews, and proposed interventions are drawn from the widest possible range of sources.
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Affiliation(s)
- Luc Louis Hagenaars
- University of California San Francisco School of Medicine, Philip R. Lee Institute for Health Policy Studies, Campus Box 0936, 490 Illinois Street, Floor 7, San Francisco, CA, 94158, USA.
- Department of Public Health, Amsterdam UMC Location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands.
| | - Nason Maani
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, 15a George Square, Edinburgh, UK
| | - Laura Anne Schmidt
- University of California San Francisco School of Medicine, Philip R. Lee Institute for Health Policy Studies, Campus Box 0936, 490 Illinois Street, Floor 7, San Francisco, CA, 94158, USA
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Stevenson LA, Maani N, Olsen JR. Introducing Critical Accounting for Governance as a Tool in Exploring the Commercial Determinants of Health. Int J Health Policy Manag 2023; 12:8128. [PMID: 38618769 PMCID: PMC10843405 DOI: 10.34172/ijhpm.2023.8128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/20/2023] [Indexed: 04/16/2024] Open
Affiliation(s)
| | - Nason Maani
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Jonathan R. Olsen
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Maani N, CI van Schalkwyk M, Petticrew M. Under the influence: system-level effects of alcohol industry-funded health information organizations. Health Promot Int 2023; 38:daad167. [PMID: 38097395 PMCID: PMC10721437 DOI: 10.1093/heapro/daad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
There is now an established body of evidence that the alcohol industry seeks to obstruct public health policies that could affect the availability, affordability or marketing of alcohol. In parallel, the alcohol industry is active in funding corporate social responsibility initiatives, with a particular focus on 'responsible drinking' campaigns, often facilitated by national-level charities established and/or funded by the alcohol industry and associated organizations. While evidence continues to grow regarding biases in the content produced by such health information organizations, they remain active in partnerships with government health departments on national health promotion campaigns and provide a range of health-related information to the public, community organizations and schools. To understand the implications of such access for policymakers, researchers and the public, there is a need to consider the wider, system-level influences of such organizations and their place in wider alcohol industry strategies. In this article, we describe evolving evidence of the direct and indirect strategic effects of such organizations and demonstrate how they serve key roles in the alcohol industry through their existence, content, partnerships and public profiles. We end by considering the implications for how we conceptualize charities established or funded (entirely or partly) by harmful commodity industries, and to what extent current conflicts of interest guidelines are sufficiently effective.
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Affiliation(s)
- Nason Maani
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, 15a George Square, Edinburgh, EH8 9LD, UK
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - May CI van Schalkwyk
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Mark Petticrew
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
- UK PRP SPECTRUM Consortium, Usher Institute, Old Medical School, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
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Affiliation(s)
- Nason Maani
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, 15a George Square, Edinburgh EH8 9LD, UK
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Petticrew M, Glover RE, Volmink J, Blanchard L, Cott É, Knai C, Maani N, Thomas J, Tompson A, van Schalkwyk MCI, Welch V. The Commercial Determinants of Health and Evidence Synthesis (CODES): methodological guidance for systematic reviews and other evidence syntheses. Syst Rev 2023; 12:165. [PMID: 37710334 PMCID: PMC10503085 DOI: 10.1186/s13643-023-02323-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/15/2023] [Indexed: 09/16/2023] Open
Abstract
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.
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Affiliation(s)
- Mark Petticrew
- Faculty of Public Health and Policy, LSHTM, London, WC1H 9SH, UK.
| | - Rebecca E Glover
- Faculty of Public Health and Policy, LSHTM, London, WC1H 9SH, UK
| | - Jimmy Volmink
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | | | - Cécile Knai
- Faculty of Public Health and Policy, LSHTM, London, WC1H 9SH, UK
| | - Nason Maani
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, EH8 9LD, UK
| | - James Thomas
- UCL Institute of Education, University College London, 20 Bedford Way, London, WC1H 0AL, UK
| | - Alice Tompson
- Faculty of Public Health and Policy, LSHTM, London, WC1H 9SH, UK
| | | | - Vivian Welch
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
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Zenone M, Snyder J, Bélisle-Pipon JC, Caulfield T, van Schalkwyk M, Maani N. Advertising Alternative Cancer Treatments and Approaches on Meta Social Media Platforms: Content Analysis. JMIR Infodemiology 2023; 3:e43548. [PMID: 37256649 DOI: 10.2196/43548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/13/2023] [Accepted: 03/27/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Alternative cancer treatment is associated with a greater risk of death than cancer patients undergoing conventional treatments. Anecdotal evidence suggests cancer patients view paid advertisements promoting alternative cancer treatment on social media, but the extent and nature of this advertising remain unknown. This context suggests an urgent need to investigate alternative cancer treatment advertising on social media. OBJECTIVE This study aimed to systematically analyze the advertising activities of prominent alternative cancer treatment practitioners on Meta platforms, including Facebook, Instagram, Messenger, and Audience Network. We specifically sought to determine (1) whether paid advertising for alternative cancer treatment occurs on Meta social media platforms, (2) the strategies and messages of alternative cancer providers to reach and appeal to prospective patients, and (3) how the efficacy of alternative treatments is portrayed. METHODS Between December 6, 2021, and December 12, 2021, we collected active advertisements from alternative cancer clinics using the Meta Ad Library. The information collected included identification number, URL, active/inactive status, dates launched/ran, advertiser page name, and a screenshot (image) or recording (video) of the advertisement. We then conducted a content analysis to determine how alternative cancer providers communicate the claimed benefits of their services and evaluated how they portrayed alternative cancer treatment efficacy. RESULTS We identified 310 paid advertisements from 11 alternative cancer clinics on Meta (Facebook, Instagram, or Messenger) marketing alternative treatment approaches, care, and interventions. Alternative cancer providers appealed to prospective patients through eight strategies: (1) advertiser representation as a legitimate medical provider (n=289, 93.2%); (2) appealing to persons with limited treatments options (n=203, 65.5%); (3) client testimonials (n=168, 54.2%); (4) promoting holistic approaches (n=121, 39%); (5) promoting messages of care (n=81, 26.1%); (6) rhetoric related to science and research (n=72, 23.2%); (7) rhetoric pertaining to the latest technology (n=63, 20.3%); and (8) focusing treatment on cancer origins and cause (n=43, 13.9%). Overall, 25.8% (n=80) of advertisements included a direct statement claiming provider treatment can cure cancer or prolong life. CONCLUSIONS Our results provide evidence alternative cancer providers are using Meta advertising products to market scientifically unsupported cancer treatments. Advertisements regularly referenced "alternative" and "natural" treatment approaches to cancer. Imagery and text content that emulated evidence-based medical providers created the impression that the offered treatments were effective medical options for cancer. Advertisements exploited the hope of patients with terminal and poor prognoses by sharing testimonials of past patients who allegedly were cured or had their lives prolonged. We recommend that Meta introduce a mandatory, human-led authorization process that is not reliant upon artificial intelligence for medical-related advertisers before giving advertising permissions. Further research should focus on the conflict of interest between social media platforms advertising products and public health.
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Affiliation(s)
- Marco Zenone
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jeremy Snyder
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | | | - May van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nason Maani
- Global Health Policy Unit, University of Edinburgh, Edinburgh, United Kingdom
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van Schalkwyk MCI, Collin J, Eddleston M, Petticrew M, Pearson M, Schölin L, Maani N, Konradsen F, Gunnell D, Knipe D. Conceptualising the commercial determinants of suicide: broadening the lens on suicide and self-harm prevention. Lancet Psychiatry 2023; 10:363-370. [PMID: 37019125 DOI: 10.1016/s2215-0366(23)00043-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/18/2023] [Accepted: 02/03/2023] [Indexed: 04/07/2023]
Abstract
Suicide is preventable, yet, in many settings, robust suicide prevention strategies have not been implemented. Although a commercial determinants of health lens is increasingly being applied to industries important to the field of suicide prevention, the interplay between the vested interests of commercial actors and suicide has received little attention. There is a need to shift attention to the causes of the causes, directing more focus to the ways that commercial determinants influence suicide and shape suicide prevention strategies. Such a shift in perspective, with an evidence base and precedents to draw upon, has transformative potential for research and policy agendas dedicated to understanding and addressing upstream modifiable determinants of suicide and self-harm. We propose a framework intended to help guide efforts to conceptualise, research, and address the commercial determinants of suicide and their inequitable distribution. We hope these ideas and lines of inquiry help to catalyse connections between disciplines and open further debate and discussion as to how to take such an agenda forward.
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Affiliation(s)
- May C I van Schalkwyk
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - Jeff Collin
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK; Prevention Research Partnership SPECTRUM Consortium, UK
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention and Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Mark Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK; Prevention Research Partnership SPECTRUM Consortium, UK
| | - Melissa Pearson
- Centre for Pesticide Suicide Prevention and Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Lisa Schölin
- Centre for Pesticide Suicide Prevention and Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Nason Maani
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK; Prevention Research Partnership SPECTRUM Consortium, UK
| | - Flemming Konradsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - David Gunnell
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Duleeka Knipe
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK; South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Maani N, van Schalkwyk MC, Petticrew M. Trends in alcohol-specific deaths in the UK and industry responses. Lancet Gastroenterol Hepatol 2023; 8:398-400. [PMID: 37030298 DOI: 10.1016/s2468-1253(23)00002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 04/08/2023]
Affiliation(s)
- Nason Maani
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh EH8 9LD, UK; Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK; Boston University School of Public Health, Boston, MA, USA.
| | - May Ci van Schalkwyk
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark Petticrew
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK; UK PRP SPECTRUM Consortium, London School of Hygiene and Tropical Medicine, London, UK
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14
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Maani N. A regulatory cliff edge: the potential health effects of the EU retained law bill. BMJ 2023; 381:798. [PMID: 37024139 DOI: 10.1136/bmj.p798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Nason Maani
- Global Health Policy Unit, University of Edinburgh
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15
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Maani N, Abdalla SM, Ettman CK, Parsey L, Rhule E, Allotey P, Galea S. Global Health Equity Requires Global Equity. Health Equity 2023; 7:192-196. [PMID: 36960163 PMCID: PMC10029999 DOI: 10.1089/heq.2022.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 03/24/2023] Open
Abstract
Many global health challenges are characterized by the inequitable patterning of their health and economic consequences, which are etched along the lines of pre-existing inequalities in resources, power, and opportunity. These links require us to reconsider how we define global health equity, and what we consider as most consequential in its pursuit. In this article, we discuss the extent to which improving underlying global equity is an essential prerequisite to global health equity. We conclude that if we are to improve global health equity, there is a need to focus more on foundational—rather than proximal—causes of ill health and propose ways in which this can be achieved.
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Affiliation(s)
- Nason Maani
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
- Rockefeller Foundation/Boston University Commission on Data, Determinants and Decision-making, Boston, Massachusetts, USA
| | - Salma M. Abdalla
- Rockefeller Foundation/Boston University Commission on Data, Determinants and Decision-making, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, USA
| | - Catherine K. Ettman
- Rockefeller Foundation/Boston University Commission on Data, Determinants and Decision-making, Boston, Massachusetts, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lily Parsey
- International Longevity Centre UK (ILC), London, United Kingdom
| | - Emma Rhule
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Pascale Allotey
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Sandro Galea
- Rockefeller Foundation/Boston University Commission on Data, Determinants and Decision-making, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, USA
- Address correspondence to: Sandro Galea, MD, MPH, DrPH, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA.
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16
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Dun-Campbell K, van Schalkwyk MCI, Petticrew M, Maani N, McGill E. How Do Industry-Funded Alcohol and Gambling Conferences Frame the Issues? An Analysis of Conference Agendas. J Stud Alcohol Drugs 2023; 84:309-317. [PMID: 36972028 DOI: 10.15288/jsad.22-00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE There is a growing evidence base that unhealthy commodity industries (including alcohol and gambling) promote industry-favorable framings of product harms and solutions. These framings adopt a focus on the individual while overlooking broader influences and solutions. One potential method to influence the framing of harms and solutions is funding and organizing conferences. This study aims to examine how industry-funded alcohol and gambling conferences present themselves and frame product harms and solutions. METHOD We conducted a descriptive examination and framing analysis of industry-funded alcohol and gambling conference descriptions and agendas or programs to examine how conferences were presented. We also examined how the included topics framed the issues of product harm and solutions. A hybrid approach (using both deductive and inductive coding) was used for framing analysis, informed by previous research. RESULTS All the included conferences were targeted at professionals outside of the respective industry, many specifically mentioning researchers or policy makers. Several of the conferences offered professional credits for attendance. We identified four key frames that are consistent with the existing evidence base: a complex link between product consumption and harm, focus on the individual, deflection from population-level approaches, and medicalization/specialization of solutions. CONCLUSIONS We found industry-favorable framings of harms and solutions within the alcohol and gambling conferences included in our sample. These conferences are aimed at professionals outside of the industry, including researchers and policy makers, with several offering professional credits for attendance. Greater awareness of the potential for industry-favorable framings at conference settings is required.
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Affiliation(s)
- Kate Dun-Campbell
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - May C I van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
| | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
| | - Elizabeth McGill
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Maani N, Lauber K. Tall Tales and Hidden Shallows: The Single-Minded Influence of the Alcohol Industry Over Public Discourse, Science, and Government Bodies--A Comment on Mitchell and McCambridge (2023). J Stud Alcohol Drugs 2023; 84:335-336. [PMID: 37132572 DOI: 10.15288/jsad.23-00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Affiliation(s)
- Nason Maani
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Kathrin Lauber
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
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18
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van Schalkwyk MC, Petticrew M, Maani N, Hawkins B. Denormalising alcohol industry activities in schools. Lancet Public Health 2023; 8:e90-e91. [PMID: 36709057 DOI: 10.1016/s2468-2667(22)00341-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/14/2022] [Indexed: 01/27/2023]
Affiliation(s)
- May Ci van Schalkwyk
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Mark Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Nason Maani
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
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Bagenal J, Zenone M, Maani N, Barbic S. Embracing the non-traditional: alcohol advertising on TikTok. BMJ Glob Health 2023; 8:bmjgh-2022-009954. [PMID: 36717153 PMCID: PMC9887687 DOI: 10.1136/bmjgh-2022-009954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 01/13/2023] [Indexed: 01/31/2023] Open
Affiliation(s)
- Jessamy Bagenal
- Masters in Public Health Programme, London School of Hygiene and Tropical Medicine, London, UK .,Editorial department, The Lancet, London, UK
| | - Marco Zenone
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK, UK
| | - Nason Maani
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Skye Barbic
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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20
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Maani N, McKee M. The England football team is better managed than the country's health policy. BMJ 2022; 379:o2953. [PMID: 36740884 DOI: 10.1136/bmj.o2953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Nason Maani
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine
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21
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van Schalkwyk MCI, Zenone M, Maani N, Petticrew M, McKee M. Back to our roots or sowing new seeds: thinking anew on the paradigms of health, harm and disease. J Public Health (Oxf) 2022; 44:i28-i33. [PMID: 36465052 PMCID: PMC9720360 DOI: 10.1093/pubmed/fdac093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/05/2022] [Indexed: 12/12/2022] Open
Abstract
Health, harms and disease are intimately linked, and their promotion and distribution are determined by the social, political and physical worlds in which people live. Yet, the popular narrative on health is still dominated by a biological model that focuses on a disease-causing 'pathogen' or 'agent' that leads to pathology which is diagnosable and amenable to intervention at the individual level via measures delivered through the health care and public health systems. This model generally rests on understanding populations as a collection of individuals, with the pattern of disease seen as the sum of a series of risk factors acting on each of them. Too little attention is paid to the ways in which health, harm, disease, causation and risk are conceptualized and used as guiding concepts in research, policy debates and other fora. We often overlook the distribution of health and the regulatory regimes, norms, values and rights that promote or undermine health. By challenging our ways of thinking about health, harms and disease, we can start to appreciate with greater depth the ways in which health can be threatened and what should be seen as harmful, and conversely, opportunities for moving our systems towards promoting and protecting health.
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Affiliation(s)
- May C I van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Marco Zenone
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
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22
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Fitzgerald N, Mohan A, Maani N, Purves R, de Vocht F, Angus C, Henney M, Nicholls J, Nichols T, Crompton G, Mahon L, McQuire C, Shortt N, Bauld L, Egan M. Measuring how PH stakeholders seek to influence alcohol premises licensing in England and Scotland: the Public Health engagement In Alcohol Licensing (PHIAL) measure. J Stud Alcohol Drugs 2022; 84:318-329. [PMID: 36971718 DOI: 10.15288/jsad.22-00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE In the United Kingdom, some public health teams (PHTs) routinely engage with local alcohol premises licensing systems, through which licenses to sell alcohol are granted. We aimed to categorize PHT efforts and to develop and apply a measure of their efforts over time. METHOD Preliminary categories of PHT activity were developed based on prior literature and were used to guide data collection with PHTs in 39 local government areas (27 in England; 12 in Scotland), sampled purposively. Relevant activity from April 2012 to March 2019 was identified through structured interviews (N = 62), documentation analysis, and follow-up checks, and a grading system was developed. The measure was refined based on expert consultation and used to grade relevant PHT activity for the 39 areas in 6-month periods. RESULTS The Public Health engagement In Alcohol Licensing (PHIAL) Measure includes 19 activities in six categories: (a) staffing; (b) reviewing license applications; (c) responding to license applications; (d) data usage; (e) influencing licensing stakeholders or policy; and (f) public involvement. PHIAL scores for each area demonstrate fluctuation in type and level of activity between and within areas over time. Participating PHTs in Scotland were more active on average, particularly on senior leadership, policy development, and working with the public. In England, activity to influence license applications before decision was more common, and a clear increase in activity is apparent from 2014 onward. CONCLUSIONS The novel PHIAL Measure successfully assessed diverse and fluctuating PHT engagement in alcohol licensing systems over time and will have practice, policy, and research applications.
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Affiliation(s)
- Niamh Fitzgerald
- Institute of Social Marketing & Health, University of Stirling, Stirling, FK9 4LA., SPECTRUM Consortium, UK
| | - Andrea Mohan
- School of Health Sciences, 11 Airlie Place, University of Dundee, Dundee, DD1 4HJ
| | - Nason Maani
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, SPECTRUM Consortium, UK, Boston University School of Public Health, Boston, USA
| | - Richard Purves
- Institute of Social Marketing & Health, University of Stirling, Stirling, FK9 4LA
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. BS8 2PS, NIHR School for Public Health Research, UK, NIHR Applied Research Collaboration West (ARC West)
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Regent Street, Sheffield, S1 4DA; SPECTRUM Consortium, UK
| | - Madeleine Henney
- School of Health and Related Research, University of Sheffield, Regent Street, Sheffield, S1 4DA
| | - James Nicholls
- Faculty of Health Sciences & Sport, University of Stirling
| | | | - Gemma Crompton
- Alcohol Focus Scotland 2nd Floor, 166 Buchanan Street, Glasgow G1 2LW
| | - Laura Mahon
- Alcohol Focus Scotland 2nd Floor, 166 Buchanan Street, Glasgow G1 2LW and SPECTRUM Consortium, UK
| | - Cheryl McQuire
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. BS8 2PS, NIHR School for Public Health Research, UK
| | - Niamh Shortt
- School of Geosciences, University of Edinburgh, Drummond St, Edinburgh, EH8 9XP, SPECTRUM Consortium, UK
| | - Linda Bauld
- Usher Institute, University of Edinburgh; SPECTRUM Consortium, UK
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, NIHR School for Public Health Research, UK
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23
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Maani N, McKee M. The commercial determinants of health: The mini-budget is a consequence of foundational forces medicine must bear witness to. BMJ 2022; 378:o2327. [PMID: 36167354 DOI: 10.1136/bmj.o2327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Nason Maani
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine
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24
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de Vocht F, McQuire C, Ferraro C, Williams P, Henney M, Angus C, Egan M, Mohan A, Purves R, Maani N, Shortt N, Mahon L, Crompton G, O'Donnell R, Nicholls J, Bauld L, Fitzgerald N. Impact of public health team engagement in alcohol licensing on health and crime outcomes in England and Scotland: A comparative timeseries study between 2012 and 2019. Lancet Reg Health Eur 2022; 20:100450. [PMID: 35799613 PMCID: PMC9253894 DOI: 10.1016/j.lanepe.2022.100450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Public health teams (PHTs) in England and Scotland engage to varying degrees in local alcohol licensing systems to try to reduce alcohol-related harms. No previous quantitative evidence is available on the effectiveness of this engagement. We aimed to quantify the effects of PHT engagement in alcohol licensing on selected health and crime outcomes. METHODS 39 PHTs in England (n = 27) and Scotland (n = 12) were recruited (of 40 contacted) for diversity in licensing engagement level and region, with higher activity areas matched to lower activity areas. Each PHT's engagement in licensing for each 6 month period from April 2012 to March 2019 was quantified using a new measure (PHIAL) developed using structured interviews, documentary analyses, and expert consultation. Outcomes examined were ambulance callouts, alcohol-related hospital admissions, alcohol-related and alcohol-specific mortality and violent, sexual and public order offences. Timeseries were analysed using multivariable negative binomial mixed-effects models. Correlations were assessed between each outcome and 18-month average PHIAL score (primary metric), cumulative PHIAL scores and change in PHIAL scores. Additionally, 6-month lagged correlations were also assessed. FINDINGS There was no clear evidence of any associations between the primary exposure metric and the public health or crime outcomes examined, nor between cumulative PHIAL scores or change in PHIAL score and any outcomes. There were no significant associations in England or Scotland when analysed separately or between outcomes and lagged exposure metrics. INTERPRETATION There is no clear evidence that allocating PHT resources to engaging in alcohol licensing is associated with downstream reductions in alcohol-related health harms or crimes, in the short term or over a seven year follow-up period. Such engagement likely has benefits in shaping the licensing system to take account of health issues longer term, but as current systems cannot reduce alcohol availability or contain online sales, their potential benefits are somewhat constrained. FUNDING The ExILEnS project is funded by the NIHR Public Health Research Programme (project number 15/129/11). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
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Affiliation(s)
- Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
- NIHR School for Public Health Research, UK
- NIHR Applied Research Collaboration West, UK
| | - Cheryl McQuire
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
- NIHR School for Public Health Research, UK
| | - Claire Ferraro
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Philippa Williams
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Madeleine Henney
- School of Health and Related Research, University of Sheffield, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, UK
- SPECTRUM Consortium, UK
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, UK
| | - Andrea Mohan
- School of Health Sciences, University of Dundee, UK
| | - Richard Purves
- Institute for Social Marketing & Health, University of Stirling, UK
| | - Nason Maani
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, UK
- Boston University School of Public Health, USA
| | - Niamh Shortt
- SPECTRUM Consortium, UK
- School of GeoSciences, University of Edinburgh, UK
| | - Laura Mahon
- SPECTRUM Consortium, UK
- Institute for Social Marketing & Health, University of Stirling, UK
- Alcohol Focus Scotland, UK
| | | | - Rachel O'Donnell
- Institute for Social Marketing & Health, University of Stirling, UK
| | - James Nicholls
- Institute for Social Marketing & Health, University of Stirling, UK
| | - Linda Bauld
- SPECTRUM Consortium, UK
- Usher Institute, University of Edinburgh, UK
| | - Niamh Fitzgerald
- SPECTRUM Consortium, UK
- Institute for Social Marketing & Health, University of Stirling, UK
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Tompson AC, Mulrenan C, Hartwell G, Petticrew M, van Schalkwyk MCI, Maani N. Commercial determinants of mental health. BMJ 2022; 378:o2034. [PMID: 35995433 DOI: 10.1136/bmj.o2034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Alice C Tompson
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Claire Mulrenan
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Greg Hartwell
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Mark Petticrew
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | | | - Nason Maani
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
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26
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O’Donnell R, Mohan A, Purves R, Maani N, Egan M, Fitzgerald N. How public health teams navigate their different roles in alcohol premises licensing: ExILEnS multistakeholder interview findings. Public Health Res 2022. [DOI: 10.3310/xcuw1239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
In England and Scotland, local governments regulate the sale of alcohol by awarding licences to premises to permit the sale of alcohol for consumption on or off the premises, under certain conditions; without such a licence, alcohol cannot be legally sold. In recent years, many local public health teams have become proactive in engaging with alcohol licensing, encouraging licensing authorities to act in ways intended to improve population health.
Objective
This research aimed to explore and understand the approaches and activities of public health stakeholders (i.e. NHS staff and other public health professionals) in seeking to influence local alcohol licensing policy and decisions, and the views of licensing stakeholders (i.e. licensing officers/managers, police staff with a licensing remit, elected members and licensing lawyers/clerks) on the acceptability and effectiveness of these approaches.
Participants
Local public health teams in England and Scotland were directly informed about this multisite study. Scoping calls were conducted with interested teams to explore their level of activity in alcohol licensing from 2012 across several categories. Twenty local authority areas with public health teams active in licensing matters were recruited purposively in England (n = 14) and Scotland (n = 6) to vary by region and rurality. Fifty-three in-depth telephone interviews (28 with public health stakeholders and 25 with licensing stakeholders outside health, such as local authority licensing teams/lawyers or police) were conducted. Interview transcripts were analysed thematically in NVivo 12 (QSR International, Warrington, UK) using inductive and deductive approaches.
Results
Public health stakeholders’ approaches to engagement varied, falling into three main (and sometimes overlapping) types. (1) Many public health stakeholders in England and all public health stakeholders in Scotland took a ‘challenging’ approach to influencing licensing decisions and policies. Reducing health harms was felt to necessitate a focus on reducing availability and generating longer-term culture change, citing international evidence on the links between availability and alcohol-related harms. Some of these stakeholders viewed this as being a narrow, ‘nanny state’ approach, whereas others welcomed public health expertise and its evidence-based approach and input. (2) Some public health stakeholders favoured a more passive, ‘supportive’ approach, with some reporting that reducing availability was unachievable. They reported that, within the constraints of current licensing systems, alcohol availability may be contained (at least in theory) but cannot be reduced, because existing businesses cannot be closed on availability grounds. In this ‘supportive’ approach, public health stakeholders supplied licensing teams with data on request or waited for guidance from licensing teams on when and how to get involved. Therefore, public health action supported the licensing team in their aim of promoting ‘safe’ and ‘responsible’ retailing of alcohol and/or focused on short-term outcomes other than health, such as crime. (3) Some public health stakeholders favoured a ‘collaborative’ approach in which they worked in close partnership with licensing teams; this could include a focus on containing availability or responsible retail of alcohol, or both.
Conclusions
In engaging with alcohol licensing, public health stakeholders adapted their approaches, sometimes resulting in a diminished focus on public health goals. Sampling did not include lower-activity areas, in which experiences might differ. The extent to which current licensing systems enable achievement of public health goals is questionable and the effectiveness of public health efforts merits quantitative evaluation.
Study registration
The study is registered with the Research Registry as researchregistry6162.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in Public Health Research. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rachel O’Donnell
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Andrea Mohan
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Richard Purves
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Nason Maani
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- SPECTRUM Consortium, Edinburgh, UK
| | - Matt Egan
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Niamh Fitzgerald
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
- SPECTRUM Consortium, Edinburgh, UK
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Affiliation(s)
- Nason Maani
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine and UK Prevention Research Partnership SPECTRUM Consortium, London, UK
| | - May Ci van Schalkwyk
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine
| | - Mark Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine and UK Prevention Research Partnership SPECTRUM Consortium, London, UK
| | - Kent Buse
- Healthier Societies Program, The George Institute for Global Health, Imperial College London
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Zenone M, Kenworthy N, Maani N. The Social Media Industry as a Commercial Determinant of Health. Int J Health Policy Manag 2022; 12:6840. [PMID: 35490262 PMCID: PMC10125226 DOI: 10.34172/ijhpm.2022.6840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/06/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Marco Zenone
- Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Nora Kenworthy
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, USA
| | - Nason Maani
- Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
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Maani N, van Schalkwyk M, Filippidis F, Knai C, Petticrew M. Manufacturing doubt: Assessing the effects of independent vs industry-sponsored messaging about the harms of fossil fuels, smoking, alcohol, and sugar sweetened beverages. SSM Popul Health 2022; 17:101009. [PMID: 35036514 PMCID: PMC8749266 DOI: 10.1016/j.ssmph.2021.101009] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/06/2021] [Accepted: 12/15/2021] [Indexed: 01/16/2023] Open
Abstract
Background Manufacturers of harmful products engage in misinformation tactics long employed by the tobacco industry to emphasize uncertainty about scientific evidence and deflect negative attention from their products. This study assessed the effects of one type of tactic, the use of "alternative causation" arguments, on public understanding. Methods In five trials (one for each industry) anonymized Qualtrics panel respondents were randomized to receive a message on the risk in question from one of four industry sponsored organizations (exposure), or from one of four independent organizations (control), on risks related to alcohol, tobacco, fossil fuel and sugar sweetened beverages. Logistic regression models were used to evaluate the effect of industry arguments about uncertainty on the primary outcome of public certainty about product risk, adjusting for age, gender and education. The results from all five trials were pooled in a random-effects meta-analysis. Findings In total, n=3284 respondents were exposed to industry-sponsored messaging about product-related risks, compared to n=3297 exposed to non-industry messages. Across all industries, exposure to industry-sponsored messages led to greater reported uncertainty or false certainty about risk, compared to non-industry messages [Summary odds ratio (OR) 1·60, confidence interval (CI) 1·28-1·99]. The effect was greater among those who self-rated as not/slightly knowledgeable (OR 2·24, CI 1·61-3·12), or moderately knowledgeable (OR 1·85, CI 1·38-2·48) compared to those very/extremely knowledgeable (OR 1·28, CI 1·03-1·60). Conclusions This study demonstrates that exposure to industry sponsored messages which appear intended to downplay risk significantly increases uncertainty or false certainty, with the effect being greater in less knowledgeable participants.
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Affiliation(s)
- N. Maani
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, UK
- Rockefeller Foundation, Boston University Commission on Data, Determinants and Decision-making, Boston University School of Public Health, Boston, USA
- SPECTRUM Research Consortium, London School of Hygiene and Tropical Medicine, London, UK
| | - M.C.I. van Schalkwyk
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - F.T. Filippidis
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - C. Knai
- SPECTRUM Research Consortium, London School of Hygiene and Tropical Medicine, London, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - M. Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, UK
- SPECTRUM Research Consortium, London School of Hygiene and Tropical Medicine, London, UK
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van Schalkwyk MCI, Petticrew M, Maani N, Hawkins B, Bonell C, Katikireddi SV, Knai C. Distilling the curriculum: An analysis of alcohol industry-funded school-based youth education programmes. PLoS One 2022; 17:e0259560. [PMID: 35020741 PMCID: PMC8754310 DOI: 10.1371/journal.pone.0259560] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/22/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND AIM For decades, corporations such as the tobacco and fossil fuel industries have used youth education programmes and schools to disseminate discourses, ideas and values favourable to their positions, and to pre-empt regulation that threatens profits. However, there is no systematic research into alcohol industry-funded youth education programmes. This article serves to address this important gap in the literature. METHODS Using a discourse theoretical approach informed by poststructural discourse theory and critical discourse analysis, we analysed teaching materials from three school-based youth education initiatives which focus on alcohol consumption and health harms: Drinkaware for Education, The Smashed Project (funded by Diageo), and Talk About Alcohol (Alcohol Education Trust). These materials, some of which are disseminated internationally, are provided to schools through intermediary bodies in receipt of alcohol industry funding. FINDINGS The analysis found that these materials drew from and presented discourses of personal responsibility, moderate alcohol consumption, and involved a narrowing of the problem definition and causes. The locus of the problem is located by the discourses within individuals including youth, with causes of youth alcohol consumption repeatedly presented as peer pressure and 'poor choices', with little or no mention of alcohol industry marketing or other practices. All programmes promoted familiarisation and normalisation of alcohol as a 'normal' adult consumer product which children must learn about and master how to use responsibly when older. The discourses constructed in these materials closely align with those of other alcohol industry corporate social responsibility discourses which employ selective presentation of harms, including misinformation about cancer, and ambiguous terms such as "responsible drinking". Furthermore, the role of alcohol price, availability and access, and the impacts of alcohol and the industry on inequities were not articulated within the discourses. The research was limited to an analysis of teaching materials and further research is needed to explore their impact on youth, teachers and wider discourses and social norms. CONCLUSION Alcohol industry-sponsored youth education programmes serve industry interests and promote moderate consumption while purportedly educating children about harms and influences of alcohol use. There are considerable conflicts of interest in the delivery of alcohol education programmes funded by the alcohol industry and intermediary bodies in receipt of such funding. Alcohol education materials should be developed independent from industry, including funding, and should empower children and young people to understand and think critically about alcohol, including harms and drivers of consumption, and effective interventions needed to protect them and others from alcohol-related harms. Independent organisations can use this analysis to critique their materials to strengthen alignment with meeting student and public health interests. The ongoing exposure of children and young people to such conflicted and misleading materials needs urgent attention from policymakers, practitioners, teachers and parents, and resources dependent on industry support should cease being used in schools.
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Affiliation(s)
- May C. I. van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), London, United Kingdom
| | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), London, United Kingdom
| | - Ben Hawkins
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Chris Bonell
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Cécile Knai
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), London, United Kingdom
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Millot A, Maani N, Knai C, Petticrew M, Guillou-Landréat M, Gallopel-Morvan K. Analysis of How Lobbying by the Alcohol Industry Has Eroded the French Évin Law Since 1991. J Stud Alcohol Drugs 2022; 83:37-44. [PMID: 35040758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVE The French Évin Law was passed in 1991 to prohibit alcohol advertising in media from targeting young people and to regulate content in authorized media. This research analyzes how lobbying by the alcohol industry has undermined this law over the last 30 years. METHOD A narrative approach, consisting of the collection and analysis of semistructured interviews with persons who recount their experience and offer interpretation, was used to analyze lobbying by the alcohol industry against the Évin Law from 1991 to 2020. We conducted 18 interviews with key French informants involved in implementing and/ or changing the Évin Law (including founders of the law) to identify strategies and arguments used by the alcohol industry. An established framework of corporate political activity specific to the alcohol industry was used to classify the findings. RESULTS The industry tactics and arguments were found to be similar to those in other countries; however, some were specific to France, such as highlighting winegrowing as central to French culture and integrating the wine industry into decision-making bodies, alliances with parliamentarians, and circumventions of the law. These specific features may be explained by the age of the Évin Law (30 years) and the economic weight of alcohol and wine at the heart of French culture. CONCLUSIONS The Évin Law has been continuously weakened since its initial implementation. This research analyzes the long-term lobbying strategies and arguments that have been used to erode it. The results are useful for other countries that have implemented alcohol marketing regulations to help anticipate tactics and arguments deployed by the alcohol industry to weaken marketing regulations.
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Affiliation(s)
- Ana Millot
- EHESP School of Public Health, Arènes UMR CNRS 6051, Rennes, France
| | - Nason Maani
- Boston University School of Public Health, Boston, Massachusetts, United States
- London School of Hygiene and Tropical Medicine, London, England
| | - Cécile Knai
- London School of Hygiene and Tropical Medicine, London, England
| | - Mark Petticrew
- London School of Hygiene and Tropical Medicine, London, England
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32
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Millot A, Maani N, Knai C, Petticrew M, Guillou-Landréat M, Gallopel-Morvan K. An Analysis of How Lobbying by the Alcohol Industry Has Eroded the French Évin Law Since 1991. J Stud Alcohol Drugs 2022. [DOI: 10.15288/jsad.2022.83.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ana Millot
- EHESP School of Public Health, Arènes UMR CNRS 6051, Rennes, France
| | - Nason Maani
- Boston University School of Public Health, Boston, Massachusetts, United States
- London School of Hygiene and Tropical Medicine, London, England
| | - Cécile Knai
- London School of Hygiene and Tropical Medicine, London, England
| | - Mark Petticrew
- London School of Hygiene and Tropical Medicine, London, England
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Millot A, Gallopel-Morvan K, Maani N, Knai C, Petticrew M, Guillou-Landréat M. An analysis of how lobbying by the alcohol industry has eroded the French marketing regulation law. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In response to the positive association between alcohol marketing and young people's alcohol consumption, several countries have adopted marketing regulation laws. This is the case in France with the 1991 Evin Law, which prohibits advertising in media targeting young people and regulates content in authorized media. However, this law has faced intense opposition from its inception. The aim of this research is to identify the arguments and lobbying strategies deployed by the alcohol industry to undermine it.
Methods
We conducted semi-structured interviews with 18 French key informants involved in implementing and/or updating the Evin Law, including initiators of the law, former ministers, non-governmental organizations, national public health institutes and academic associations and institutions. A thematic analysis was conducted to highlight strategies and arguments employed by the alcohol industry to undermine the Evin Law using Savell et al. framework (2016).
Results
Several of the identified strategies and arguments to combat marketing regulations were similar to those identified in other countries, while some strategies and arguments were specific to the French context. These include highlighting winegrowing and its integration into decision-making bodies, and forming alliances with parliamentarians. These specific features may in part be explained by the economic significance of alcohol and wine at the heart of French culture.
Conclusions
For the first time, the long-term lobbying strategies and arguments used by the alcohol industry to weaken the Evin Law are analyzed from the perspectives of those closely involved in its implementation. This study may be useful for other countries that have - or are in the process of - implementing alcohol marketing regulation laws.
Key messages
The pioneering French alcohol marketing regulation law has faced intense opposition from the alcohol industry, in particular viticulture. Analyzing the strategies and arguments used by the alcohol industry to erode this pioneering law is important to better counter them.
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Affiliation(s)
- A Millot
- Arènes UMR CNRS 6051, Ecole des Hautes Etudes en Santé Publique, Rennes, France
| | - K Gallopel-Morvan
- Arènes UMR CNRS 6051, Ecole des Hautes Etudes en Santé Publique, Rennes, France
| | - N Maani
- School of Public Health, Boston University, Boston, USA
- Faculty of Public Health and Policy, LSHTM, London, UK
| | - C Knai
- Faculty of Public Health and Policy, LSHTM, London, UK
| | - M Petticrew
- Faculty of Public Health and Policy, LSHTM, London, UK
| | - M Guillou-Landréat
- EA SPURBO, Addictive Disorders Department, Université de Bretagne Occidentale, Brest, France
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Maani N, Collin J, Friel S, Gilmore AB, McCambridge J, Robertson L, Petticrew M. The need for a conceptual understanding of the macro and meso commercial determinants of health inequalities. Eur J Public Health 2021; 31:674-675. [PMID: 34137840 PMCID: PMC8505001 DOI: 10.1093/eurpub/ckab048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, UK
| | - Jeff Collin
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, UK
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Sharon Friel
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, UK
- School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, The Australian National University, Canberra, Australia
| | - Anna B Gilmore
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, UK
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Jim McCambridge
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Lindsay Robertson
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, UK
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, UK
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Peake L, van Schalkwyk MCI, Maani N, Petticrew M. Analysis of the accuracy and completeness of cardiovascular health information on alcohol industry-funded websites. Eur J Public Health 2021; 31:1197-1204. [PMID: 34480167 DOI: 10.1093/eurpub/ckab135] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Alcohol Industry (AI), and the Social Aspects/Public Relations Organisations (SAPRO) it funds, has been shown to mis-represent the risk of alcohol with respect to cancer and pregnancy. It is theorized that the AI would position alcohol as 'heart healthy' to further undermine public perceptions of risks from drinking. METHODS A comparative analysis (including content, thematic and context analyses) of cardiovascular health information published on the websites of AI-funded (n = 18, such as 'Drinkaware' and the 'Distilled Spirits Council of the US') and non-AI-funded (n = 18, such as 'NHS.uk') organizations based in multiple high-income jurisdictions. RESULTS Websites of non-industry-funded health organizations were more likely than AI/SAPRO websites to label alcohol as a risk factor for a range of important cardiovascular diseases (such as myocardial infarction, congestive cardiac failure, hypertension and stroke). Conversely, AI/SAPRO websites were more likely to suggest alcohol was protective in the development of some heart conditions. AI/SAPRO websites frequently referenced the J-shaped curve as proof of benefit from moderate alcohol consumption; suggested a balance between the benefits and harms from drinking; positioned alcohol as consistent with a 'healthy lifestyle'; and framed drinking as a social norm. CONCLUSIONS AI-funded health organizations mis-represent the evidence on cardiovascular effects of moderate alcohol consumption. Healthcare professionals should appreciate the role of funding source in biasing content, and exercise caution when directing patients to content funded by the AI. Tighter regulation of messaging that AI/SAPRO's provide to the public is required, to avoid the dissemination of harmful misinformation.
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Affiliation(s)
- Lewis Peake
- South West Public Health Training Programme, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - May C I van Schalkwyk
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, LSHTM, London, UK
| | - Nason Maani
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, LSHTM, London, UK.,Department of Public Health Environments and Society, School of Public Health, Boston University, Boston, MA, USA
| | - Mark Petticrew
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, LSHTM, London, UK.,Department of Public Health Environments and Society, School of Public Health, Boston University, Boston, MA, USA
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van Schalkwyk MCI, Maani N, McKee M, Thomas S, Knai C, Petticrew M. "When the Fun Stops, Stop": An analysis of the provenance, framing and evidence of a 'responsible gambling' campaign. PLoS One 2021; 16:e0255145. [PMID: 34437561 PMCID: PMC8389453 DOI: 10.1371/journal.pone.0255145] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/17/2021] [Indexed: 11/25/2022] Open
Abstract
When the Fun Stops, Stop, is a prominent 'responsible gambling' campaign in the UK, originally funded and delivered by the industry-initiated and funded Senet Group. Since the Senet Group's dissolution in 2020, the campaign has been overseen by the Betting and Gambling Council (BGC), the main gambling industry trade body. There has been no prior analysis of the activities, ideas and framing adopted by the Senet Group, who claimed to be acting as an industry 'watchdog' and oversaw what they characterised as a major public education campaign. We collated written and image-based material related to the Senet Group and its When the Fun Stops, Stop campaign from multiple sources. Guided by Entman's four functions of framing, we analysed the Senet Group's framing of the issues it sought to address, particularly harmful gambling, as well as its causes, and the solutions, focusing on the group's main activity: the delivery of the When the Fun Stops, Stop campaign. We also critically appraised an evaluation of the campaign funded by the Senet Group, using the findings to interrogate the stated claims about the campaign's effectiveness. The analysis showed that the Senet Group's framing of the problem, its causes, and proposed responses resemble those adopted by other industries and industry-funded groups. This involves portraying any harms caused by their products as limited to an atypical minority, rejecting upstream determinants of harm, and promoting individually-targeted voluntary measures, all contrary to the evidence of what works in health promotion, and what would characterise a public health approach. Neither the existing evidence base nor the evidence presented by the Senet Group support their claims about the campaign's effectiveness. These findings add to concerns about industry-funded campaigns in other areas. To minimise conflicts of interest, interventions intended to address gambling-related harms, such as public education campaigns, should be evidence-based and developed, implemented and evaluated completely independent of the industry and industry-funded organisations.
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Affiliation(s)
- May CI van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
- School of Public Health, Boston University, Boston, MA, United States of America
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Samantha Thomas
- Faculty of Health, Institute for Health Transformation, School of Health and Soc. Dev., Deakin University, Geelong, Australia
| | - Cécile Knai
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
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van Schalkwyk MCI, Maani N, Pettigrew S, Petticrew M. Corporate ventriloquism undermines action on alcohol harms. BMJ 2021; 374:n1879. [PMID: 34344716 DOI: 10.1136/bmj.n1879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- May C I van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- SPECTRUM Consortium, UK
| | - Simone Pettigrew
- George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- SPECTRUM Consortium, UK
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Martins DC, Babajide O, Maani N, Abdalla SM, Gómez EJ, Pongsiri MJ, Tlou S, Leung GM, Benjamin GC, Goosby E, Dain K, Vega J, Zeinali Z, Stoeva P, Galea S, Sturchio J, Twum-Danso NAY. Integrating Social Determinants in Decision-Making Processes for Health: Insights from Conceptual Frameworks-the 3-D Commission. J Urban Health 2021; 98:51-59. [PMID: 34480328 PMCID: PMC8415431 DOI: 10.1007/s11524-021-00560-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 11/04/2022]
Abstract
The inclusion of social determinants of health offers a more comprehensive lens to fully appreciate and effectively address health. However, decision-makers across sectors still struggle to appropriately recognise and act upon these determinants, as illustrated by the ongoing COVID-19 pandemic. Consequently, improving the health of populations remains challenging. This paper seeks to draw insights from the literature to better understand decision-making processes affecting health and the potential to integrate data on social determinants. We summarised commonly cited conceptual approaches across all stages of the policy process, from agenda-setting to evaluation. Nine conceptual approaches were identified, including two frameworks, two models and five theories. From across the selected literature, it became clear that the context, the actors and the type of the health issue are critical variables in decision-making for health, a process that by nature is a dynamic and adaptable one. The majority of these conceptual approaches implicitly suggest a possible role for data on social determinants of health in decision-making. We suggest two main avenues to make the link more explicit: the use of data in giving health problems the appropriate visibility and credibility they require and the use of social determinants of health as a broader framing to more effectively attract the attention of a diverse group of decision-makers with the power to allocate resources. Social determinants of health present opportunities for decision-making, which can target modifiable factors influencing health-i.e. interventions to improve or reduce risks to population health. Future work is needed to build on this review and propose an improved, people-centred and evidence-informed decision-making tool that strongly and explicitly integrates data on social determinants of health.
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Affiliation(s)
- Diogo Correia Martins
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
| | - Opeyemi Babajide
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
| | - Nason Maani
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Salma M Abdalla
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Eduardo J. Gómez
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- Lehigh University, Bethlehem, USA
| | - Montira J. Pongsiri
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- Stockholm Environment Institute - Asia Centre, Bangkok, Thailand
| | - Sheila Tlou
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- Nursing Now, Tuggerah, Australia
| | - Gabriel Matthew Leung
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Georges C. Benjamin
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- American Public Health Association, Washington DC, USA
| | - Eric Goosby
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, USA
| | - Katie Dain
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- NCD Alliance, Geneva, Switzerland
| | - Jeanette Vega
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- National Research and Development Agency (ANID Chile), Santiago, Chile
| | - Zahra Zeinali
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
| | - Preslava Stoeva
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Sandro Galea
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Jeffrey Sturchio
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- Rabin Martin, New York, USA
| | - Nana A. Y. Twum-Danso
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- The Rockefeller Foundation, New York, USA
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Galea S, Ettman CK, Maani N, Abdalla SM. Taking the Long View: COVID-19 Priorities for the Biden Administration. J Health Polit Policy Law 2021; 46:577-584. [PMID: 33493275 DOI: 10.1215/03616878-8970781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic transformed the American political landscape, influencing the course of the 2020 election and creating an urgent policy priority for the new administration. The Biden-Harris plan for beating COVID-19 represents a practicable, technically competent plan to contain the pandemic, one that will serve the country well in the months ahead. The authors suggest that the United States would also benefit from an even bolder set of aspirations-reframing the national conversation on COVID-19, embedding equity in all health decision making, strengthening the social safety net, and changing how we talk about health-as part of the national response to COVID-19. This would represent a genuine step forward in the US approach to health, informed by the systemic flaws COVID-19 exposed, and would realize benefits from the pandemic moment that in turn would propel national health forward for the rest of the century.
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Maani N, Van Schalkwyk MC, Petticrew M, Ralston R, Collin J. The new WHO Foundation - global health deserves better. BMJ Glob Health 2021; 6:bmjgh-2021-004950. [PMID: 33547178 PMCID: PMC7871260 DOI: 10.1136/bmjgh-2021-004950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/09/2021] [Accepted: 01/14/2021] [Indexed: 12/19/2022] Open
Affiliation(s)
- Nason Maani
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, Greater London, UK .,SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, UK
| | - May Ci Van Schalkwyk
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, Greater London, UK.,SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, UK
| | - Rob Ralston
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, UK.,Global Health Policy Unit, School of Social and Political Science, The University of Edinburgh, Edinburgh, UK
| | - Jeff Collin
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University, Edinburgh, UK.,Global Health Policy Unit, School of Social and Political Science, The University of Edinburgh, Edinburgh, UK
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41
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van Schalkwyk MCI, Knai C, Jackson N, Maani N, Petticrew M. Schools for healthy lives, not for corporate interests. Lancet Child Adolesc Health 2021; 5:e14. [PMID: 33864742 DOI: 10.1016/s2352-4642(21)00097-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Affiliation(s)
- May C I van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK.
| | - Cécile Knai
- SPECTRUM Consortium, UK; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Nicki Jackson
- SPECTRUM Consortium, UK; School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Alcohol Healthwatch, Auckland, New Zealand
| | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; SPECTRUM Consortium, UK
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Abstract
Policy Points Despite the pandemic's ongoing devastating impacts, it also offers the opportunity and lessons for building a better, fairer, and sustainable world. Transformational change will require new ways of working, challenging powerful individuals and industries who worsened the crisis, will act to exploit it for personal gain, and will work to ensure that the future aligns with their interests. A flourishing world needs strong and equitable structures and systems, including strengthened democratic, research, and educational institutions, supported by ideas and discourses that are free of opaque and conflicted influence and that challenge the status quo and inequitable distribution of power.
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Affiliation(s)
- May Ci VAN Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine
| | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine.,School of Public Health, Boston University
| | | | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine
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Maani N, VAN Schalkwyk MC, Petticrew M, Galea S. The Commercial Determinants of Three Contemporary National Crises: How Corporate Practices Intersect With the COVID-19 Pandemic, Economic Downturn, and Racial Inequity. Milbank Q 2021; 99:503-518. [PMID: 33783862 PMCID: PMC8241267 DOI: 10.1111/1468-0009.12510] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Policy Points The United States finds itself in the middle of an unprecedented combination of crises: a global pandemic, economic crisis, and unprecedented civic responses to structural racism. While public sector responses to these crises have faced much justified criticism, the commercial determinants of these crises have not been sufficiently examined. In this commentary we examine the nature of the contributions of such actors to the conditions that underpin these crises in the United States through their market and nonmarket activities. On the basis of this analysis, we make recommendations on the role of governance and civil society in relation to such commercial actors in a post-COVID-19 world.
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Affiliation(s)
- Nason Maani
- Boston University School of Public Health.,London School of Hygiene and Tropical Medicine.,SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University
| | | | - Mark Petticrew
- London School of Hygiene and Tropical Medicine.,SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh University
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Maani N, Abdalla SM, Galea S. Avoiding a legacy of unequal non-communicable disease burden after the COVID-19 pandemic. Lancet Diabetes Endocrinol 2021; 9:133-135. [PMID: 33549161 PMCID: PMC9764233 DOI: 10.1016/s2213-8587(21)00026-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Nason Maani
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK.
| | | | - Sandro Galea
- Boston University School of Public Health, Boston, MA, USA
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45
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Knai C, Petticrew M, Capewell S, Cassidy R, Collin J, Cummins S, Eastmure E, Fafard P, Fitzgerald N, Gilmore AB, Hawkins B, Jensen JD, Katikireddi SV, Maani N, Mays N, Mwatsama M, Nakkash R, Orford JF, Rutter H, Savona N, van Schalkwyk MCI, Weishaar H. The case for developing a cohesive systems approach to research across unhealthy commodity industries. BMJ Glob Health 2021; 6:e003543. [PMID: 33593757 PMCID: PMC7888371 DOI: 10.1136/bmjgh-2020-003543] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/22/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Most non-communicable diseases are preventable and largely driven by the consumption of harmful products, such as tobacco, alcohol, gambling and ultra-processed food and drink products, collectively termed unhealthy commodities. This paper explores the links between unhealthy commodity industries (UCIs), analyses the extent of alignment across their corporate political strategies, and proposes a cohesive systems approach to research across UCIs. METHODS We held an expert consultation on analysing the involvement of UCIs in public health policy, conducted an analysis of business links across UCIs, and employed taxonomies of corporate political activity to collate, compare and illustrate strategies employed by the alcohol, ultra-processed food and drink products, tobacco and gambling industries. RESULTS There are clear commonalities across UCIs' strategies in shaping evidence, employing narratives and framing techniques, constituency building and policy substitution. There is also consistent evidence of business links between UCIs, as well as complex relationships with government agencies, often allowing UCIs to engage in policy-making forums. This knowledge indicates that the role of all UCIs in public health policy would benefit from a common approach to analysis. This enables the development of a theoretical framework for understanding how UCIs influence the policy process. It highlights the need for a deeper and broader understanding of conflicts of interests and how to avoid them; and a broader conception of what constitutes strong evidence generated by a wider range of research types. CONCLUSION UCIs employ shared strategies to shape public health policy, protecting business interests, and thereby contributing to the perpetuation of non-communicable diseases. A cohesive systems approach to research across UCIs is required to deepen shared understanding of this complex and interconnected area and also to inform a more effective and coherent response.
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Affiliation(s)
- Cécile Knai
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- SPECTRUM Consortium, UK
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- SPECTRUM Consortium, UK
| | - Simon Capewell
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
| | - Rebecca Cassidy
- Department of Anthropology, Goldsmiths University of London, London, UK
| | - Jeff Collin
- SPECTRUM Consortium, UK
- Global Public Health Unit, University of Edinburgh, Edinburgh, UK
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth Eastmure
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Patrick Fafard
- Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Niamh Fitzgerald
- SPECTRUM Consortium, UK
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Anna B Gilmore
- SPECTRUM Consortium, UK
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Ben Hawkins
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jørgen Dejgård Jensen
- Institute of Food and Resource Economics, University of Copenhagen, Frederiksberg, Denmark
| | | | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- SPECTRUM Consortium, UK
- School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Nicholas Mays
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Rima Nakkash
- Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
| | - Jim F Orford
- School of Psychology, University of Birmingham, Birmingham, UK
- King's College London, London, UK
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, Bath and North East Somer, UK
| | - Natalie Savona
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - May C I van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Heide Weishaar
- Center for International Health Protection, Robert Koch Institute, Berlin, Germany
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van Schalkwyk MC, Maani N, McKee M. Public health emergency or opportunity to profit? The two faces of the COVID-19 pandemic. Lancet Diabetes Endocrinol 2021; 9:61-63. [PMID: 33417836 PMCID: PMC9765138 DOI: 10.1016/s2213-8587(21)00001-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 11/20/2022]
Affiliation(s)
- May Ci van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK; School of Public Health, Boston University, Boston, MA, USA
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
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Petticrew M, Fitzgerald N, Maani N, McCambridge J, Pettigrew S, van Schalkwyk M. Responsible Drinking, Conflicts of Interest, and the Elephant in the Room: A Commentary on A Scoping Review of "Responsible Drinking" Interventions by Gray, Williams & Shaffer (2020). Health Commun 2021; 36:257-259. [PMID: 32981342 DOI: 10.1080/10410236.2020.1827541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine
| | | | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine
- School of Public Health, Boston University
| | | | | | - May van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine
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Affiliation(s)
- Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - May C I van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health, Boston University, Boston, MA, USA
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
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Maani N, Sabha N, Gustafson D, Ramani A, Fish J, Alexander M, Dowling J. CONGENITAL MYOPATHIES 2. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Affiliation(s)
- Sandro Galea
- Dean's Office, Boston University School of Public Health, Boston, MA 02119, USA.
| | - Nason Maani
- Dean's Office, Boston University School of Public Health, Boston, MA 02119, USA; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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