Suchergebnisse

Tobacco, alcohol and unhealthy foods are key contributors to non-communicable diseases globally. Public health advocates have been proactive in recent years, developing systems to monitor and mitigate both health harms and influence by these industries. However, establishing and implementating strong government regulation of these unhealthy product-producing industries remains challenging. The relevant regulatory instruments lie not only with ministries of health but with agriculture, finance, industry and trade, largely driven by economic concerns. These policy sectors are often unreceptive to public health imperatives for restrictions on industry, including policies regarding labelling, marketing and excise taxes. Heavily influenced by traditional economic paradigms, they have been more receptive to industry calls for (unfettered) market competition, the rights of consumers to choose and the need for government to allow industry free rein; at most to establish voluntary standards of consumer protection, and certainly not to directly regulate industry products and practices. In recent years, the status quo of a narrow economic rationality that places economic growth above health, environment or other social goals is being re-evaluated by some governments and key international economic agencies, leading to windows of opportunity with the potential to transform how governments approach food, tobacco and alcohol as major, industry-driven risk factors. To take advantage of this window of opportunity, the public health community must work with different sectors of government to(1) reimagine policy mandates, drawing on whole-of-government imperatives for sustainable development, and (2) closely examine the institutional structures and governance processes, in order to create points of leverage for economic policies that also support improved health outcomes.

AbstractMalnutrition remains a global challenge and is hampering the achievement of Sustainable Development Goals. At the United Nations, governments have committed to taking action on food systems and nutrition. Government intervention in this space will necessarily intersect trade and health policy. This Practitioner Commentary considers the implications for policymakers in the trade and health communities. We argue that there is an opportunity for 'soft guidance' to play an important role in helping governments navigate potential tensions between trade and nutrition policies.

AbstractThe interaction of international investment agreements and public health is marked by ambivalence. Investment treaties can help attract investment into the health sector but also enable international legal claims by foreign investors against public health measures. This paper seeks to better understand their relationship by systematically mapping the purpose of health inclusions in bilateral investment treaties (BITs) between 1959 and 2021. We find that health‐related clauses, present in 18% of all BITs, are used both as a shield and a sword. Most health mentions protect host countries from claims against public health measures, yet an increasing number of recent BITs, primarily from developing countries, also pursue an offensive public health agenda by advancing health safety at work and health‐related corporate social responsibility of investors.

Addressing the global challenge of malnutrition in all its forms will require policy measures to improve food environments, yet progress has been patchy and often slow, particularly for regulatory measures. International trade and investment agreements (TIAs) may limit governments' "policy space" for public health regulation. Constraints have been particularly apparent for public health measures targeting unhealthy commodities, including ultra-processed foods. Challenges and disputes regarding food environment regulation under TIAs (even if successfully defended) can entail significant drain of human and financial resources, and political capital. Lack of awareness or understanding of the implication of TIAs on policy space for regulation can contribute to regulatory chill and policy inertia. Governments lacking capacity to interpret their "legally available" policy space may want to err on the side of caution when there is perceived risk of a formal dispute—even if such threats are unfounded. This paper draws on analysis of literature, trade and investment dispute documentation, and data from inter-disciplinary expert interviews (n= 22) to present a new conceptual framework for the potential impacts of TIAs on policy space for regulating food environments. The analysis that underpins the framework focusses on the key policy domains of fiscal policies, front-of-pack nutrition labeling, restrictions on marketing to children, nutrient limits, and product bans. Analysis indicates that regulatory context and stakeholder influence, policy design, and mechanisms associated with TIA rules and provisions intersect in ways contributing to policy space outcomes. This new framework can provide a basis for rapidly assessing policy coherence between TIAs and food environment regulations in these domains. It can also be used to identify areas where further legal analysis would strengthen the development and defense of regulatory proposals. The framework may be applied to nutrition regulation more broadly, given the common themes that emerged across the different domains due to common interests of stakeholders, notably the food industry. It thus provides a basis for analyzing the political economy of regulation to address the commercial determinants of health in relation to unhealthy food and beverages.

Background
Pharmacists have important roles in consumers' access to medicines and healthcare. Pharmacy policy advocates have recognised that evidence is important but often insufficient for policy change to support expanded roles of pharmacists, but there has been minimal exploration of why this is the case.

Aims and objectives
To characterise, classify, and describe the types of knowledge that were considered and used in these two pharmacy policy issues in Australia: codeine up-scheduling and pharmacist-administered vaccinations.

Methods
Using documentary data and semi-structured interviews, we identified the research-based, practical, and political knowledge used in these policy processes, drawing on Head's 'three lenses of evidence-based policy'. We used a 'programmatic approach' to analyse how evidence is used in policymaking, where the use and framing of evidence is considered in light of policy actors' institutional roles and goals.

Findings
Practical knowledge demonstrating pharmacists' ability to conduct clinical activities and political knowledge of institutional processes and acceptability were used for both issues; however, research evidence was more identifiable in up-scheduling. Evidence was prioritised and used differently depending on stakeholders' goals.

Discussion and conclusions
Our analysis offers insights for the Australian pharmacy sector advocating for policies to benefit individual and public health. Although medicines regulation and pharmacy practice are phenomena that exist globally, institutional and policymaking contexts differ by country. The pharmacy sector needs to consider these contexts to effectively engage policymakers and optimise evidence use in developing and implementing desired policies.

BACKGROUND: Regulation of food environments is needed to address the global challenge of poor nutrition, yet policy inertia has been a problem. A common argument against regulation is potential conflict with binding commitments under international trade and investment agreements (TIAs). This study aimed to identify which actors and institutions, in different contexts, influence how TIAs are used to constrain policy space for improving food environments, and to describe their core beliefs, interests, resources and strategies, with the objective of informing strategic global action to preserve nutrition policy space. METHODS: We conducted a global stakeholder analysis applying the Advocacy Coalition Framework, based on existing academic literature and key informant interviews with international experts in trade and investment law and public health nutrition policy. RESULTS: We identified 12 types of actors who influence policy space in the food environment policy subsystem, relevant to TIAs. These actors hold various beliefs regarding the economic policy paradigm, the nature of obesity and dietary diseases as health problems, the role of government, and the role of industry in solving the health problem. We identified two primary competing coalitions: 1) a 'public health nutrition' coalition, which is overall supportive of and actively working to enact comprehensive food environment regulation; and 2) an 'industry and economic growth' focussed coalition, which places a higher priority on deregulation and is overall not supportive of comprehensive food environment regulation. The industry and economic growth coalition appears to be dominant, based on its relative power, resources and coordination. However, the public health nutrition coalition maintains influence through individual activism, collective lobbying and government pressure (e.g. by civil society), and expert knowledge generation. CONCLUSIONS: Our analysis suggests that industry and economic growth-focussed coalitions are highly capable of leveraging ...

AbstractThe 2011 high‐level meeting of the United Nations General Assembly on non‐communicable diseases (NCDs), and subsequent developments in global public policy on NCDs can be seen as a contemporary case study in global health governance. As the debate on what constitutes appropriate and desirable governance continues, highly contrasting models are being compared as starting points. We define these as the global health initiative model and the convention/strategy model. Each has a different strategy at its core and represents a different response to key normative challenges that are said to plague global health governance – participation, scope of action, balancing power, legitimacy and effectiveness. As the current structure of the Global Coordinating Mechanism for NCDs within the WHO emerges as a possible new model, we argue that these normative challenges need to be addressed to safeguard against potential policy ineffectiveness.