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INTRODUCTION: There is an urgent need for effective action to address the over 10 million annual deaths attributable to unhealthy diets. Food industry interference with policies aimed at reducing non-communicable diseases (NCDs) is widely documented at the national level but remains under-researched at the global level. Thus, this study explores how ultra-processed food industry actors have attempted to influence NCD policy at WHO. METHODS: A combination of inductive and deductive thematic coding of internal industry documents, academic literature and interviews with key informants from international organisations and global civil society was used to identify action-based strategies ultra-processed food industry actors employ to influence global-level policy. RESULTS: Ultra-processed food industry actors have attempted to influence WHO and its policies through three main action-based strategies: coalition management, involvement in policy formulation, and information management. Coalition management includes the creation and use of overt alliances between corporations—business associations—and more covert science-focused and policy-focused intermediaries, the hiring of former WHO staff and attempted co-option of civil society organisations. Industry involvement in policy formulation is operationalised largely through the lobbying of Member States to support industry positions, and business associations gaining access to WHO through formal consultations and hearings. Information management involves funding and disseminating research favourable to commercial interests, and challenging unfavourable evidence. CONCLUSION: We provide novel insights into how ultra-processed food industry actors shape global-level NCD policy and identify a clear need to guard against commercial interference to advance NCD policy. In their approach, the political behaviour of multinational food corporations bears similarities to that of the tobacco industry. Increased awareness of, and safeguarding against, commercial interference at the ...

A key driver for promoting physical activity is reducing the global burden of noncommunicable diseases, particularly cardiovascular disease, cancer and diabetes. These diseases are responsible for more than 41 million deaths annually, of which a third occur before the age of 70 years.1 Physical activity has multiple positive impacts on noncommunicable diseases such as heart disease, stroke, diabetes, and breast and colon cancer,2 as well as numerous social and economic benefits including reduced use of fossil fuels, cleaner air and less congested, safer roads. All these effects are closely linked to several sustainable development goals.3 However, policy actions have been insufficient and uneven, and government strategies to increase physical activity have not consistently increased the proportion of the adult population meeting recommended levels of activity.4 Without significant scaling of efforts at local, regional, national and international levels, the global targets for physical activity are unlikely to be achieved.

Global initiatives have raised awareness of the need for cross-departmental and cross-sectoral activities to support urban health, sustainability, and equity, with respective indicators routinely used as a way to catalyze and monitor action toward pre-defined goals. Despite the existence of at least 145 urban health indicator (UHI) tools globally, there has been very little research on the use of indicators by policy- and decision-makers; more attention has been devoted to their development and validation. This paper describes the second part of a two-part systematic review of the characteristics (part A) and use (part B, this part) of UHI tools by municipal built environment policy- and decision-makers. Part B is a narrative synthesis of studies on the use of UHI tools. This PRISMA-P compliant review follows a mixed methods sequential explanatory design. The search was conducted using seven bibliographic databases, grey literature searches, and key journal hand searches. Ten studies describing the use of ten UHI tools in seven countries were included in the narrative synthesis, resulting in development of a theory of change (ToC). We found that both expert-led and participatory indicator projects can be underpinned by research evidence and residents' knowledge. Our findings contradict the dominant view of indicator use in policy-making as a linear process, highlighting a number of technical, organizational, political, knowledge, and contextual factors that affect their use. Participatory UHI tools with community involvement were generally more effective at supporting "health in all policies" and "whole-of-society" approaches to governing healthy cities than expert-led processes. UHI tool producers proposed a range of techniques to address urban health complexity characteristics. Finally, in combining data from both parts of the review, we found that potentially important UHI tool features, such as neighbourhood-scale data, were influential in the use of indicators by built environment policy- and decision-makers.

BACKGROUND: There is wide agreement that there is a lack of attention to health in municipal environmental policy-making, such as urban planning and regeneration. Explanations for this include differing professional norms between health and urban environment professionals, system complexity and limited evidence for causality between attributes of the built environment and health outcomes. Data from urban health indicator (UHI) tools are potentially a valuable form of evidence for local government policy and decision-makers. Although many UHI tools have been specifically developed to inform policy, there is poor understanding of how they are used. This study aims to identify the nature and characteristics of UHI tools and their use by municipal built environment policy and decision-makers. METHODS: Health and social sciences databases (ASSIA, Campbell Library, EMBASE, MEDLINE, Scopus, Social Policy and Practice and Web of Science Core Collection) will be searched for studies using UHI tools alongside hand-searching of key journals and citation searches of included studies. Advanced searches of practitioner websites and Google will also be used to find grey literature. Search results will be screened for UHI tools, and for studies which report on or evaluate the use of such tools. Data about UHI tools will be extracted to compile a census and taxonomy of existing tools based on their specific characteristics and purpose. In addition, qualitative and quantitative studies about the use of these tools will be appraised using quality appraisal tools produced by the UK National Institute for Health and Care Excellence (NICE) and synthesised in order to gain insight into the perceptions, value and use of UHI tools in the municipal built environment policy and decision-making process. This review is not registered with PROSPERO. DISCUSSION: This systematic review focuses specifically on UHI tools that assess the physical environment's impact on health (such as transport, housing, air quality and greenspace). This study will help indicator producers understand whether this form of evidence is of value to built environment policy and decision-makers and how such tools should be tailored for this audience. SYSTEMATIC REVIEW REGISTRATION: N/A.

On 16(th) March 2016, the government of the United Kingdom announced the Soft Drinks Industry Levy (SDIL), under which UK soft-drink manufacturers were to be taxed according to the volume of products with added sugar they produced or imported. We use 'event study' methodology to assess the likely financial effect of the SDIL on parts of the soft drinks industry, using stock returns of four UK-operating soft-drink firms listed on the London Stock Exchange. We found that three of the four firms experienced negative abnormal stock returns on the day of announcement. A cross-sectional analysis revealed that the cumulative abnormal returns of soft drink stocks were not significantly less than that of other food and drinks-related stocks beyond the day of the SDIL announcement. Our findings suggest that the SDIL announcement was initially perceived as detrimental news by the market but negative stock returns were short-lived, indicating a lack of major concerns for industry. There was limited evidence of a negative stock market reaction to the two subsequent announcements: release of draft legislation on 5(th) December 2016, and confirmation of the tax rates on 8(th) March 2017.

On 16th March 2016, the government of the United Kingdom announced the Soft Drinks Industry Levy (SDIL), under which UK soft-drink manufacturers were to be taxed according to the volume of products with added sugar they produced or imported. We use 'event study' methodology to assess the likely financial effect of the SDIL on parts of the soft drinks industry, using stock returns of four UK-operating soft-drink firms listed on the London Stock Exchange. We found that three of the four firms experienced negative abnormal stock returns on the day of announcement. A cross-sectional analysis revealed that the cumulative abnormal returns of soft drink stocks were not significantly less than that of other food and drinks-related stocks beyond the day of the SDIL announcement. Our findings suggest that the SDIL announcement was initially perceived as detrimental news by the market but negative stock returns were short-lived, indicating a lack of major concerns for industry. There was limited evidence of a negative stock market reaction to the two subsequent announcements: release of draft legislation on 5th December 2016, and confirmation of the tax rates on 8th March 2017.

In March 2016, the UK government announced the Soft Drinks Industry Levy (SDIL) which came into effect in April 2018. In common with the reaction to sugar-sweetened beverage (SSB) taxes in other countries, the SDIL announcement was met with strong industry opposition, with claims that it would harm their profits. The SDIL was designed to incentivise reformulation of SSBs by providing a 2-year delay between the announcement and the enforcement of the levy, and adopting a two-tiered rate based on the sugar content of the drinks. Using interrupted time series analysis, this paper examines how the domestic turnover of UK soft drinks manufacturers changed after the announcement and the implementation of the SDIL. Our results show some evidence of a short-term negative impact of the SDIL announcement on the domestic turnover of the UK soft drinks manufacturers. This effect, however, did not continue post-implementation. These findings suggest that manufacturers were, to a large extent, able to mitigate the effects of levy before it came into effect.

In March 2016, the UK government announced the Soft Drinks Industry Levy (SDIL) which came into effect in April 2018. In common with the reaction to sugar-sweetened beverage (SSB) taxes in other countries, the SDIL announcement was met with strong industry opposition, with claims that it would harm their profits. The SDIL was designed to incentivise reformulation of SSBs by providing a 2-year delay between the announcement and the enforcement of the levy, and adopting a two-tiered rate based on the sugar content of the drinks. Using interrupted time series analysis, this paper examines how the domestic turnover of UK soft drinks manufacturers changed after the announcement and the implementation of the SDIL. Our results show some evidence of a short-term negative impact of the SDIL announcement on the domestic turnover of the UK soft drinks manufacturers. This effect, however, did not continue post-implementation. These findings suggest that manufacturers were, to a large extent, able to mitigate the effects of levy before it came into effect.

On 16th March 2016, the government of the United Kingdom announced the Soft Drinks Industry Levy (SDIL), under which UK soft-drink manufacturers were to be taxed according to the volume of products with added sugar they produced or imported. We use 'event study' methodology to assess the likely financial effect of the SDIL on parts of the soft drinks industry, using stock returns of four UK-operating soft-drink firms listed on the London Stock Exchange. We found that three of the four firms experienced negative abnormal stock returns on the day of announcement. A cross-sectional analysis revealed that the cumulative abnormal returns of soft drink stocks were not significantly less than that of other food and drinks-related stocks beyond the day of the SDIL announcement. Our findings suggest that the SDIL announcement was initially perceived as detrimental news by the market but negative stock returns were short-lived, indicating a lack of major concerns for industry. There was limited evidence of a negative stock market reaction to the two subsequent announcements: release of draft legislation on 5th December 2016, and confirmation of the tax rates on 8th March 2017.

In March 2016, the UK government announced the Soft Drinks Industry Levy (SDIL) which came into effect in April 2018. In common with the reaction to sugar-sweetened beverage (SSB) taxes in other countries, the SDIL announcement was met with strong industry opposition, with claims that it would harm their profits. The SDIL was designed to incentivise reformulation of SSBs by providing a 2-year delay between the announcement and the enforcement of the levy, and adopting a two-tiered rate based on the sugar content of the drinks. Using interrupted time series analysis, this paper examines how the domestic turnover of UK soft drinks manufacturers changed after the announcement and the implementation of the SDIL. Our results show some evidence of a short-term negative impact of the SDIL announcement on the domestic turnover of the UK soft drinks manufacturers. This effect, however, did not continue post-implementation. These findings suggest that manufacturers were, to a large extent, able to mitigate the effects of levy before it came into effect.

On 16th March 2016, the government of the United Kingdom announced the Soft Drinks Industry Levy (SDIL), under which UK soft-drink manufacturers were to be taxed according to the volume of products with added sugar they produced or imported. We use 'event study' methodology to assess the likely financial effect of the SDIL on parts of the soft drinks industry, using stock returns of four UK-operating soft-drink firms listed on the London Stock Exchange. We found that three of the four firms experienced negative abnormal stock returns on the day of announcement. A cross-sectional analysis revealed that the cumulative abnormal returns of soft drink stocks were not significantly less than that of other food and drinks-related stocks beyond the day of the SDIL announcement. Our findings suggest that the SDIL announcement was initially perceived as detrimental news by the market but negative stock returns were short-lived, indicating a lack of major concerns for industry. There was limited evidence of a negative stock market reaction to the two subsequent announcements: release of draft legislation on 5th December 2016, and confirmation of the tax rates on 8th March 2017.

BACKGROUND: Research on the influence of the physical environment on physical activity is rapidly expanding and different measures of environmental perceptions have been developed, mostly in the US and Australia. The purpose of this paper is to (i) provide a literature review of measures of environmental perceptions recently used in European studies and (ii) develop a questionnaire for population monitoring purposes in the European countries. METHODS: This study was done within the framework of the EU-funded project 'Instruments for Assessing Levels of Physical Activity and Fitness (ALPHA)', which aims to propose standardised instruments for physical activity and fitness monitoring across Europe. Quantitative studies published from 1990 up to November 2007 were systematically searched in Pubmed, Web of Science, TRIS and Geobase. In addition a survey was conducted among members of the European network for the promotion of Health-Enhancing Physical Activity (HEPA Europe) and European members of the International Physical Activity and Environment Network (IPEN) to identify published or ongoing studies. Studies were included if they were conducted among European general adult population (18+y) and used a questionnaire to assess perceptions of the physical environment. A consensus meeting with an international expert group was organised to discuss the development of a European environmental questionnaire. RESULTS: The literature search resulted in 23 European studies, 15 published and 8 unpublished. In these studies, 13 different environmental questionnaires were used. Most of these studies used adapted versions of questionnaires that were developed outside Europe and that focused only on the walkability construct: The Neighborhood Environment Walkability Scale (NEWS), the abbreviated version of the NEWS (ANEWS) and the Neighborhood Quality of Life Study (NQLS) questionnaire have been most commonly used. Based on the results of the literature review and the output of the meeting with international experts, a European environmental questionnaire with 49 items was developed. CONCLUSION: There is need for a greater degree of standardization in instruments/methods used to assess environmental correlates of physical activity, taking into account the European-specific situation. A first step in this process is taken by the development of a European environmental questionnaire.

In 2018, the UK Government's Secretary of State for Health and Social Care articulated an ambition to increase healthy life expectancy by five years by 2035 for England, while also reducing the gap in this between the rich and the poor1. While we doubt that England – or indeed any high-income country – could achieve this ambition, we describe a set of policies with the potential to make a significant contribution.