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BACKGROUND: Different terms are described in the literature that refer to commercial determinants as drivers of ill-health. The aim of the present review was to provide an overview of the commercial determinants of health, through a review of the literature on this subject. The review was conducted in December 2019 and updated in February 2020. Searches were conducted from peer-reviewed scientific articles, commentaries, books, and books chapters, with no restriction in their publication dates and languages. MAIN BODY: The commercial determinants of health cover three areas. First, they relate to unhealthy commodities that are contributing to ill-health. Secondly, they include business, market and political practices that are harmful to health and used to sell these commodities and secure a favourable policy environment. Finally, they include the global drivers of ill-health, such as market-driven economies and globalisation, that have facilitated the use of such harmful practices. SHORT CONCLUSION: The discussion on the commercial determinants of health offers a unique opportunity to shift the dominant paradigm in public health, where individual behaviours are considered to be driven by inadequate environments. Ill-health, damages to the environment, and health and social inequalities, might be better understood through a commercial determinant lens.

In October 2017 in France, the government recognized the Nutri-Score front-of-pack labelling system as the only official system to be used on food products. As of July 2018, a total of 70 companies had implemented it voluntarily. There is ample evidence to support its use, and multiple expected benefits in terms of public health. We present here an essay discussing about the Nutri-Score saga. A policy dystopia model, from the literature on tobacco industry tactics, was adapted to classify the corporate political activity of the food industry during the development and implementation of the Nutri-Score. We conclude that, despite public commitments made by some industry actors to implement this system, the food industry is still strongly trying to influence policy and public opinion in the country. There are and will be many hurdles along the way, with food industry members trying to influence regulation at the European level, and building alliances with the media, among others, in France. Hopefully, public health objectives will prevail over commercial interests, in France and abroad.

BACKGROUND: The marketing practices of the breastmilk substitutes industry have been known for decades, but little is known about the influence of the baby food industry, more generally, on public health policy, research and practice, also known as 'corporate political activity' (CPA). In this study, the baby food industry refers to for-profit companies that manufacture, market or distribute breastmilk substitutes and food products for infants and young children under two years. In addition, trade associations, public relations firms, marketing agencies and individuals or groups affiliated with the baby food industry are also considered to be part of the baby food industry. The aim of the current study was to systematically identify and monitor the CPA of the baby food industry in the USA, shown by the activities of Nestlé, the largest industry actor in this sector in the country. METHODS: The case study consisted of an analysis of publicly available information for data published between January and November 2018. We included documents from the industry, the government and other sources, including professional organisations, charities and consumer associations. We analysed data using an existing framework to classify the CPA of the food industry. RESULTS: During the period of data collection, Nestlé employed a list of action-based 'instrumental strategies'. The most prominent strategy was 'information strategy', used to fund, produce and disseminate industry-preferred information. Nestlé was further found to 'establish relationships with key opinion leaders and health organisations, and the media', 'seek involvement in community' and directly influence policies and programs through indirect access and the placement of actors in government policy settings. The company also used argument-based 'discursive strategies' to frame the debate on diet- and public health-related issues. CONCLUSION: This study showed that Nestlé used various CPA strategies which may have influenced public health policy, research and ...

Abstract Background The political influence of the food industry, referred to as corporate political activity (CPA), represents a potential barrier to the development and implementation of effective public health policies for non-communicable diseases prevention. This paper reports on the feasibility and limitations of using publicly-available information to identify and monitor the CPA of the food industry in Australia. Methods A systematic search was conducted for information from food industry, government and other publicly-available data sources in Australia. Data was collected in relation to five key food industry actors: the Australian Food and Grocery Council; Coca Cola; McDonald's; Nestle; and Woolworths, for the period January 2012 to February 2015. Data analysis was guided by an existing framework for classifying CPA strategies of the food industry. Results The selected food industry actors used multiple CPA strategies, with 'information and messaging' and 'constituency building' strategies most prominent. Conclusions The systematic analysis of publicly-available information over a limited period was able to identify diverse and extensive CPA strategies of the food industry in Australia. This approach can contribute to accountability mechanisms for NCD prevention.

Objective: To gain deeper insight into the corporate political activity (CPA) of the Australian food industry from a public health perspective. Methods: Fifteen interviews with a purposive sample of current and former policy makers, public health advocates and academics who have closely interacted with food industry representatives or observed food industry behaviours. Results: All participants reported having directly experienced the CPA of the food industry during their careers, with the 'information and messaging' and 'constituency building' strategies most prominent. Participants expressed concern that food industry CPA strategies resulted in weakened policy responses to addressing diet-related disease. Conclusions: This study provides direct evidence of food industry practices that have the potential to shape public health-related policies and programs in Australia in ways that favour business interests at the expense of population health. Implications for public health: This evidence can inform policy makers and public health advocates and be used to adopt measures to ensure that public interests are put at the forefront as part of the policy development and implementation process.

Mexico is the largest soft drink market in the world, with high rates of obesity and type 2 diabetes. Due to strains on the nation's productivity and healthcare spending, Mexican lawmakers implemented one of the world's first public health taxes on sugar-sweetened beverages (SSBs) in 2014. Because Mexico's tax was designed to reduce SSB consumption, it faced strong opposition from transnational food and beverage corporations. We analysed previously secret internal industry documents from major corporations in the University of California San Francisco's Food Industry Documents Archive that shed light on the industry response to the Mexican soda tax. We also reviewed all available studies of the Mexican soda tax's effectiveness, contrasting the results of industry-funded and non-industry-funded studies. We found that food and beverage industry trade organisations and front groups paid scientists to produce research suggesting that the tax failed to achieve health benefits while harming the economy. These results were disseminated before non-industry-funded studies could be finalized in peer review. Mexico still provided a real-world context for the first independent peer-reviewed studies documenting the effectiveness of soda taxation—studies that were ultimately promoted by the global health community. We conclude that the case of the Mexican soda tax shows that industry resistance can persist well after new policies have become law as vested interests seek to roll back legislation, and to stall or prevent policy diffusion. It also underscores the decisive role that conflict-of-interest-free, peer-reviewed research can play in implementing health policy innovations.

Mexico is the largest soft drink market in the world, with high rates of obesity and type 2 diabetes. Due to strains on the nation's productivity and healthcare spending, Mexican lawmakers implemented one of the world's first public health taxes on sugar-sweetened beverages (SSBs) in 2014. Because Mexico's tax was designed to reduce SSB consumption, it faced strong opposition from transnational food and beverage corporations. We analysed previously secret internal industry documents from major corporations in the University of California San Francisco's Food Industry Documents Archive that shed light on the industry response to the Mexican soda tax. We also reviewed all available studies of the Mexican soda tax's effectiveness, contrasting the results of industry-funded and non-industry-funded studies. We found that food and beverage industry trade organisations and front groups paid scientists to produce research suggesting that the tax failed to achieve health benefits while harming the economy. These results were disseminated before non-industry-funded studies could be finalized in peer review. Mexico still provided a real-world context for the first independent peer-reviewed studies documenting the effectiveness of soda taxation-studies that were ultimately promoted by the global health community. We conclude that the case of the Mexican soda tax shows that industry resistance can persist well after new policies have become law as vested interests seek to roll back legislation, and to stall or prevent policy diffusion. It also underscores the decisive role that conflict-of-interest-free, peer-reviewed research can play in implementing health policy innovations.

Mexico is the largest soft drink market in the world, with high rates of obesity and type 2 diabetes. Due to strains on the nation's productivity and healthcare spending, Mexican lawmakers implemented one of the world's first public health taxes on sugar-sweetened beverages (SSBs) in 2014. Because Mexico's tax was designed to reduce SSB consumption, it faced strong opposition from transnational food and beverage corporations. We analysed previously secret internal industry documents from major corporations in the University of California San Francisco's Food Industry Documents Archive that shed light on the industry response to the Mexican soda tax. We also reviewed all available studies of the Mexican soda tax's effectiveness, contrasting the results of industry-funded and non-industry-funded studies. We found that food and beverage industry trade organisations and front groups paid scientists to produce research suggesting that the tax failed to achieve health benefits while harming the economy. These results were disseminated before non-industry-funded studies could be finalized in peer review. Mexico still provided a real-world context for the first independent peer-reviewed studies documenting the effectiveness of soda taxation-studies that were ultimately promoted by the global health community. We conclude that the case of the Mexican soda tax shows that industry resistance can persist well after new policies have become law as vested interests seek to roll back legislation, and to stall or prevent policy diffusion. It also underscores the decisive role that conflict-of-interest-free, peer-reviewed research can play in implementing health policy innovations.

BACKGROUND: Non-communicable diseases (NCDs) are the leading cause of mortality in Fiji, a middle-income country in the Pacific. Some food products processed sold and marketed by the food industry are major contributors to the NCD epidemic, and the food industry is widely identified as having strong economic and political power. However, little research has been undertaken on the attempts by the food industry to influence public health-related policies and programs in its favour. The "corporate political activity" (CPA) of the food industry includes six strategies (information and messaging; financial incentives; constituency building; legal strategies; policy substitution; opposition fragmentation and destabilisation). For this study, we aimed to gain a detailed understanding of the CPA strategies and practices of major food industry actors in Fiji, interpreted through a public health lens. METHODS AND RESULTS: We implemented a systematic approach to monitor the CPA of the food industry in Fiji for three months. It consisted of document analysis of relevant publicly available information. In parallel, we conducted semi-structured interviews with 10 stakeholders involved in diet- and/or public health-related issues in Fiji. Both components of the study were thematically analysed. We found evidence that the food industry adopted a diverse range of strategies in an attempt to influence public policy in Fiji, with all six CPA strategies identified. Participants identified that there is a substantial risk that the widespread CPA of the food industry could undermine efforts to address NCDs in Fiji. CONCLUSIONS: Despite limited public disclosure of information, such as data related to food industry donations to political parties and lobbying, we were able to identify many CPA practices used by the food industry in Fiji. Greater transparency from the food industry and the government would help strengthen efforts to increase their accountability and support NCD prevention. In other low- and middle-income countries, it is likely that a systematic document analysis approach would also need to be supplemented with key informant interviews to gain insight into this important influence on NCD prevention.

Background In the business literature, the term "corporate political activity" (CPA) refers to the political strategies undertaken by corporations to protect or expend their markets, by influencing, directly or indirectly, the policy process. There is evidence that food industry actors use such political practices, which poses a significant threat to public health. Our study objective was to identify the political practices of the food industry in Chile. Results In Chile, food industry actors supported community initiatives, particularly those targeted at children and those focused on environmental sustainability. Food industry actors also funded research through prizes, scholarships, and by supporting scientific events. Food industry actors lobbied against the development and implementation of a front-of-pack nutrition labelling policy, including with support from the Ministries of Economy, Agriculture and Foreign Affairs. Food industry actors, for example, claimed that there would be unintended negative consequences for society and the economy, and that the policy would breach trade agreements. The same arguments were used against a proposed tax increase on sugar-sweetened beverages. Food industry actors stressed their crucial role in the Chilean economy and claimed to be part of the solution in the prevention and control of obesity, with a particular focus on their efforts to reformulate food products, and their support of physical activity initiatives. Interviewees noted that the political influence of the food industry is often facilitated by the neo-liberal and market-driven economy of Chile. Nevertheless, this system was questioned through social protests that started in the country during data collection. Conclusions In Chile, food industry actors used numerous action- and argument-based CPA practices which may influence public health policy, research, and practice. Despite strong influence from the food industry, Chile adopted a front-of-pack nutrition labelling policy. While the country has some measures in place to manage the interactions between government officials or public health professionals, and the industry, there is still a need to develop robust mechanisms to address undue influence from corporations. ; Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) 2017/24744-0 Faculty of Health Sciences (FHS) at the American University of Beirut (AUB) - International Development Research Centre (IDRC) National Council for Scientific and Technological Development (CNPq) 309514/2018-5

Efforts to adopt public health policies that would limit the consumption of unhealthy commodities, such as tobacco, alcohol and ultra-processed food products, are often undermined by private sector actors whose profits depend on the sales of such products. There is ample evidence showing that these corporations not only try to influence public health policy; they also shape research, practice and public opinion. Globalization, trade and investment agreements, and privatization, amongst other factors, have facilitated the growing influence of private sector actors on public health at both national and global levels. Protecting and promoting public health from the undue influence of private sector actors is thus an urgent task. With this backdrop in mind, we launched the "Governance, Ethics, and Conflicts of Interest in Public Health" Network (GECI-PH Network) in 2018. Our network seeks to share, collate, promote and foster knowledge on governance, ethical, and conflicts of interest that arise in the interactions between private sectors actors and those in public health, and within multi-stakeholder mechanisms where dividing lines between different actors are often blurred. We call for strong guidance to address and manage the influence of private sector actors on public health policy, research and practice, and for dialogue on this important topic. Our network recently reached 119 members. Membership is diverse in composition and expertise, location, and institutions. We invite colleagues with a common interest to join our network.

BACKGROUND: In Colombia, public health policies to improve food environments, including front-of-pack nutrition labelling and marketing restrictions for unhealthy products, are currently under development. Opposition to these policies by the food industry is currently delaying and weakening these efforts. This opposition is commonly known as 'corporate political activity' (CPA) and includes instrumental (action-based) strategies and discursive (argument-based) strategies. Our aim was to identify the CPA of the food industry in Colombia. METHODS: We conducted a document analysis of information available in the public domain published between January–July 2019. We triangulated this data with interviews with 17 key informants. We used a deductive approach to data analysis, based on an existing framework for the CPA of the food industry. RESULTS: We identified 275 occurrences of CPA through our analysis of publicly available information. There were 197 examples of instrumental strategies and 138 examples of discursive strategies (these categories are not mutually exclusive, 60 examples belong to both categories). Interview participants also shared information about the CPA in the country. The industry used its discursive strategies to portray the industry in a 'better light', demonstrating its efforts in improving food environments and its role in the economic development of the country. The food industry was involved in several community programmes, including through public private initiatives. The industry also captured the media and tried to influence the science on nutrition and non-communicable diseases. Food industry actors were highly prominent in the policy sphere, through their lobbying, close relationships with high ranking officials and their support for self-regulation in the country. CONCLUSIONS: The proximity between the industry, government and the media is particularly evident and remains largely unquestioned in Colombia. The influence of vulnerable populations in communities and feeling of ...

OBJECTIVE: We identified mechanisms for addressing and/or managing the influence of corporations on public health policy, research and practice, as well as examples of where these mechanisms have been adopted from across the globe. DESIGN: We conducted a scoping review. We conducted searches in five databases on 4 June 2019. Twenty-eight relevant institutions and networks were contacted to identify additional mechanisms and examples. In addition, we identified mechanisms and examples from our collective experience working on the influence of corporations on public health policy, research and practice. SETTING: We identified mechanisms at the national, regional and global levels. RESULTS: Thirty-one documents were included in our review. Eight were peer-reviewed scientific articles. Nine discussed mechanisms to address and/or manage the influence of different types of industries; while other documents targeted specific industries. In total, we identified 49 mechanisms for addressing and/or managing the influence of corporations on public health policy, research and practice, and 43 of these were adopted at the national, regional or global level. We identified four main types of mechanisms: transparency; management of interactions with industry and of conflicts of interest; identification, monitoring and education about the practices of corporations and associated risks to public health; prohibition of interactions with industry. Mechanisms for governments (n=17) and academia (n=13) were most frequently identified, with fewer for the media and civil society. CONCLUSIONS: We identified several mechanisms that could help address and/or manage the negative influence of corporations on public health policy, research and practice. If adopted and evaluated more widely, many of the mechanisms described in this manuscript could contribute to efforts to prevent and control non-communicable diseases. TRIAL REGISTRATION DETAILS: The protocol was registered with the Open Science Framework on 27 May 2019 (https://osf.io/xc2vp).

OBJECTIVE: We identified mechanisms for addressing and/or managing the influence of corporations on public health policy, research and practice, as well as examples of where these mechanisms have been adopted from across the globe. DESIGN: We conducted a scoping review. We conducted searches in five databases on 4 June 2019. Twenty-eight relevant institutions and networks were contacted to identify additional mechanisms and examples. In addition, we identified mechanisms and examples from our collective experience working on the influence of corporations on public health policy, research and practice. SETTING: We identified mechanisms at the national, regional and global levels. RESULTS: Thirty-one documents were included in our review. Eight were peer-reviewed scientific articles. Nine discussed mechanisms to address and/or manage the influence of different types of industries; while other documents targeted specific industries. In total, we identified 49 mechanisms for addressing and/or managing the influence of corporations on public health policy, research and practice, and 43 of these were adopted at the national, regional or global level. We identified four main types of mechanisms: transparency; management of interactions with industry and of conflicts of interest; identification, monitoring and education about the practices of corporations and associated risks to public health; prohibition of interactions with industry. Mechanisms for governments (n=17) and academia (n=13) were most frequently identified, with fewer for the media and civil society. CONCLUSIONS: We identified several mechanisms that could help address and/or manage the negative influence of corporations on public health policy, research and practice. If adopted and evaluated more widely, many of the mechanisms described in this manuscript could contribute to efforts to prevent and control non-communicable diseases. TRIAL REGISTRATION DETAILS: The protocol was registered with the Open Science Framework on 27 May 2019 (https://osf.io/xc2vp).

BACKGROUND: The aggressive marketing of breastmilk substitutes (BMS) reduces breastfeeding, and harms child and maternal health globally. Yet forty years after the World Health Assembly adopted the International Code of Marketing of Breast-milk Substitutes (The Code), many countries are still to fully implement its provisions into national law. Furthermore, despite The Code, commercial milk formula (CMF) markets have markedly expanded. In this paper, we adopt the Philippines as a case study to understand the battle for national Code implementation. In particular, we investigate the market and political strategies used by the baby food industry to shape the country's 'first-food system', and in doing so, promote and sustain CMF consumption. We further investigate how breastfeeding coalitions and advocates have resisted these strategies, and generated political commitment for a world-leading breastfeeding policy framework and protection law (the 'Milk Code'). We used a case study design and process tracing method, drawing from documentary and interview data. RESULTS: The decline in breastfeeding in the Philippines in the mid-twentieth Century associated with intensive BMS marketing via health systems and consumer advertising. As regulations tightened, the industry more aggressively promoted CMFs for older infants and young children, thereby 'marketing around' the Milk Code. It established front groups to implement political strategies intended to weaken the country's breastfeeding policy framework while also fostering a favourable image. This included lobbying government officials and international organizations, emphasising its economic importance and threats to foreign investment and trade, direct litigation against the government, messaging that framed marketing in terms of women's choice and empowerment, and forging partnerships. A resurgence in breastfeeding from the mid-1980s onwards reflected strengthening political commitment for a national breastfeeding policy framework and Milk Code, resulting in-turn, ...