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AbstractThe confluence of social and health inequities and global environmental degradation shines a light on fundamental ruptures in society. A systems view of humanity reminds us that this status quo is not static, and that the shifting political and economic sands provide an important window of opportunity to collectively change the system towards the public good, such that communities are able to live with good health, dignity and in an environmentally sustainable way. To enable this, global policy, and in particular global health policy must break out of the policy silos and refocus in a systems way. If the system is to adapt, an ambitious vision for the system is needed that is different to the status quo. No one regulatory model that can improve complex societal problems, rather we must use a plurality of approaches. Reorienting the system to achieve positive outcomes depends on reimagining the purpose of structural regulatory powers, and the releasing the agency of networks of concerned actors. In a hyper‐connected world there are many partners to help create systems of hope.

There are many reasons for the health inequities that we see around the world today. Public policy and the way society organises its affairs affects the economic, social and physical factors that influence the conditions in which people are born, grow, live, work and age - the social determinants of health. Tackling health inequities is a political issue that requires leadership, political courage, progressive public policy, social struggle and action, and a sound evidence base.

Scholarship on the commercial determinants of health (CDoH) has sought to understand the multiple ways corporate policies, practices and products affect population health. At the same time, gender is recognised as a key determinant of health and an important axis of health inequalities. To date, there has been limited attention paid to the ways in which the CDoH engage with and impact on gender inequalities and health. This review seeks to address this gap by examining evidence on the practices and strategies of two industries-tobacco and alcohol-and their interaction with gender, with a particular focus on women. We first describe the practices by which these industries engage with women in their marketing and corporate social responsibility activities, reinforcing problematic gender norms and stereotypes that harm women and girls. We then examine how tobacco and alcohol companies contribute to gender inequalities through a range of strategies intended to protect their market freedoms and privileged position in society. By reinforcing gender inequalities at multiple levels, CDoH undermine the health of women and girls and exacerbate global health inequalities. ; While this research received no specific funding, both authors are members of the SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm) funded by the UK Prevention Research Partnership (MR/S037519/1).

This article argues that health outcomes, specifically nutrition related health outcomes, are socially determined, and can be linked to a wider political economy in which peoples' dietary consumption is structurally determined, evolving from political, economic and social forces. The article examines trade and investment agreements as regulatory vehicles that cultivate poor dietary consumption and inequalities in health outcomes between and within countries. How does this happen? The liberalization of trade and investment, and unfettered influence of powerful economic interests including transnational food and beverage companies has resulted in trade agreements that enable excess availability, affordability and acceptability of highly processed, nutrient poor foods worldwide, ultimately resulting in poor nutrition and consequently oral and other non-communicable diseases. These trade and nutrition policy tensions shine a spotlight on the challenges ahead for global health and development policies, including achievement of the Sustainable Development Goals.

Many of the societal level factors that affect health – the 'social determinants of health (SDH)' – exist outside the health sector, across diverse portfolios of government, and other major institutions including non-governmental organisations (NGOs) and the private sector. This has created growing interest in how to create and implement public policies which will drive better and fairer health outcomes. While designing policies that can improve the SDH is critical, so too is ensuring they are appropriately administered and implemented. In this paper, we draw attention to an important area for future public health consideration – how policies are managed and implemented through complex administrative layers of 'the state.' Implementation gaps have long been a concern of public administration scholarship. To precipitate further work in this area, in this paper, we provide an overview of the scholarly field of public administration and highlight its role in helping to understand better the challenges and opportunities for implementing policies and programs to improve health equity.

Abstract Human-induced climate change will affect the lives of most populations in the next decade and beyond. It will have greatest, and generally earliest, impact on the poorest and most disadvantaged populations on the planet. Changes in climatic conditions and increases in weather variability affect human wellbeing, safety, health and survival in many ways. Some impacts are direct-acting and immediate, such as impaired food yields and storm surges. Other health effects are less immediate and typically occur via more complex causal pathways that involve a range of underlying social conditions and sectors such as water and sanitation, agriculture and urban planning. Climate change adaptation is receiving much attention given the inevitability of climate change and its effects, particularly in developing contexts, where the effects of climate change will be experienced most strongly and the response mechanisms are weakest. Financial support towards adaptation activities from various actors including the World Bank, the European Union and the United Nations is increasing substantially. With this new global impetus and funding for adaptation action come challenges such as the importance of developing adaptation activities on a sound understanding of baseline community needs and vulnerabilities, and how these may alter with changes in climate. The global health community is paying heed to the strengthening focus on adaptation, albeit in a slow and unstructured manner. The aim of this paper is to provide an overview of adaptation and its relevance to global health, and highlight the opportunities to improve health and reduce health inequities via the new and additional funding that is available for climate change adaptation activities.

AbstractThe consumption of harmful commodities drives the noncommunicable disease (NCD) epidemic globally and in Pacific small island developing states. Multisectoral committees are commonly chosen avenues to facilitate policy coherence across government sectors in regulating the commercial determinants of health (CDoH), but these committees often fail to function as intended. This paper aims to explore the institutional conditions that enable or constrain multisectoral committees in facilitating policy coherence for tobacco control in Fiji and Vanuatu. An exploratory, qualitative research design was applied, incorporating a two‐case study design with within‐case analysis and cross‐case synthesis. Data collection consisted of 70 in‐depth interviews in 2018 and 2019. Data collection and analysis were informed by an analytical framework drawn from the institutional collective action framework. The results show that the current amount of authority behind the investigated multisectoral committees in Fiji and Vanuatu is inadequate to meaningfully bring stakeholders together for an issue with high complexity. Moreover, multisectoral discussions on tobacco control have a high risk to break down, as the collaboration may generate unwanted impacts to one or more actors and the net benefits are perceived to be low. The authority behind multisectoral committees might be strengthened by the chairmanship of a cross‐sectoral, high‐level government official and the allocation of more resources for managing intersectoral engagement. Divergent preferences might be brought closer together by showcasing the socioeconomic costs of NCDs and policies affecting the availability, affordability, accessibility, and desirability of tobacco and raising awareness about CDoH in nonhealth sectors.

AbstractMultisectoral governance has been recognized to be vital to regulate harmful commodity industries, yet countries struggle with reaching policy coherence due to government agencies' conflicting mandates and industry interference. Limited empirical evidence is available on how interests, ideas, and institutions intersect and influence multisectoral governance in low‐ and middle‐income countries, particularly in Pacific small island developing states (PSIDS), often exploited by vested industry interests and whose non‐communicable disease crisis commands urgent action to regulate harmful commodities. This study assessed the ways interests, ideas, and institutions intersect and shape multisectoral tobacco governance in PSIDS. Interviewee data collected in Fiji and Vanuatu show that the idea of individual responsibility, the limited recognition of commercial determinants of health, the centralization of authority, and the vulnerabilities of small island developing states, (including small population, land, economy, geographic isolation, and status as a developing economy), prevent these states from achieving policy coherence in multisectoral tobacco governance.

The emerging global trade and investment regime is a site of ongoing contestation between states, powerful industry actors and civil society organisations seeking to infuence the formation of legal rules, principles, practices and institutions. The inclusion of major transnational tobacco, alcohol and ultraprocessed food companies seeking to influence governments in these processes has resulted in the expanded distribution and consumption of unhealthy commodities across the globe, overshadowing many of the positive impacts for health hypothesised from liberalised trade. The growing number of pathways for market actors to exert undue influence over national and international regulatory environments provided by agreements, such as the Comprehensive and Progressive Agreement for Trans-Pacific Partnership, has given many cause to be concerned. In the context of continued commitment by states to international trade and investment negotiations, we present several avenues for public health scholars, advocates and practitioners to explore to rebalance public and private interests in these deals.

Critical social and economic resources, such as employment, education, and health services, increasingly require online access, highlighting the growing need to address equity of access to high-speed broadband telecommunications. Ensuring access to broadband requires the necessary infrastructure which, in Australia, is the National Broadband Network (NBN). In this paper, we use policy implementation theory to examine the translation of the government's NBN policy into service delivery, specifically in relation to the choice of policy instruments to install the broadband infrastructure, the associated barriers and enablers to their implementation, and the equity considerations that are emerging as the policy is implemented. We conducted a rapid review of NBN policy documents and academic and grey literature to map the NBN policy instruments and to examine how key contextual, political, and technical aspects of NBN policy implementation are likely to affect equity. Our findings indicate a range of equity concerns in the implementation of NBN policy. The instrument choice of a public–private 'hybrid' organisation to implement NBN policy has created a fertile ground for competing political, social, and commercial priorities, thereby affecting how the policy is implemented and thus increasing the risks to equity as it competes with other priorities. As these mixed public–private instruments become more prevalent as policy tools to deliver major infrastructure, determining the best means to safeguard equity is a vital consideration to ensure the benefits are distributed fairly.

AbstractIndigenous peoples in Australia and similar colonised countries are subject to racism and systemic socioeconomic disadvantages, resulting in worse health outcomes compared to non‐Indigenous counterparts. Such inequities persist despite governments' attempts to reduce them. Since 2008, Australian governments have committed to a national 'Closing the Gap' (CTG) to reduce inequities in health, education, and employment outcomes between Aboriginal and Torres Strait Islander peoples and other Australians, but with limited success. We applied policy theory and a cultural safety framework developed for the research to analyse stakeholder perceptions of CTG policy implementation between 2008 and 2019. We identified policy‐shaping ideas and policy incoherence in the environment surrounding CTG policy that obstructed culturally safe policy. Top‐down, prescriptive modes of implementation were also a barrier. However, Indigenous‐led policy partnerships and community‐controlled services in the health sector have met principles of cultural safety. Identifying these strengths and weaknesses points to ways in which implementation of CTG policies can be improved to achieve cultural safety and reduce Indigenous health inequities. These results may hold lessons for similar countries such as the United States, New Zealand, and Canada.