Can technology be good for health? Investigating health-promoting strategies in the private sector.

Introduction: This research investigates what might motivate tech companies and impact-driven investors to adopt a health-promoting strategy in their product development and capital allocation strategies. Methods: Participants were recruited for semi-structured interviews through purposive and snowball sampling. From 83 outreach attempts, thematic saturation required 19 completed interviews out of the 46 consumer technology executives and impact-focused investors who responded. Interviews were analyzed using grounded theory-based content analysis. Results: Seven coding categories resulted from inductive coding, with 83 sub-codes. The primary themes were: product-based health impact is magnified when matched to user demographics (making an equity mindset important); stakeholders are eager for reliable health metrics, especially those that hold across industry verticals; when capturing health impact, it is critical to include positive (i.e., economically beneficial) externalities. These results allowed for the creation of a logic model with a recommended theory of change for the private sector to develop health strategy. Discussion: Intentional integration of impact strategy with business priorities will allow teams to design products that promote health, driving buy-in and resource allocation while attracting investment and double returns. For policymakers, it is clear that tech policy and regulation for corporate reporting need to keep pace. These findings are limited by the purposive recruitment of participants, introducing potential bias and risk to generalizability.

The role of alcohol consumption in the lives of older Australian women: qualitative insights and an agenda for further research, policy and practice.

BACKGROUND: Alcohol consumption presents a threat to the health and wellbeing of women. The alcohol industry often pushes back at global efforts to prioritise the prevention of alcohol harms to women. Qualitative researchers have investigated how younger and midlife women conceptualise their alcohol consumption, but there is very limited research relating to older women (those 60 years and over). METHODS: Using data collected from an online qualitative survey, this paper explored the factors that influence how older Australian women drinkers (n = 144. 60-88 years) conceptualised the role of alcohol in their lives. The study used a 'Big Q' reflexive approach to thematic analysis, drawing upon sociological theories of risk and symbolic interactionism to construct four themes from the data. RESULTS: First, alcohol consumption was viewed by participants as an accepted and normalised social activity, that was part of Australian culture. Second, alcohol played a role for some participants as a way to cope with life changes (such as retirement), as well as managing stressful or challenging life circumstances (such as loneliness). Third, alcohol was part of the routines and rituals of everyday life for some women. For example, women discussed the consumption of wine with their evening meal as an important part of the structure of their day. Fourth, participants had clear personal expectancies about what it meant to be a 'responsible drinker'. They had clear narratives about personal control and moral obligation, which in some cases created a reduced perception of their own risk of alcohol-caused harm. CONCLUSIONS: This research provides a starting point for future public health research examining the factors that may shape older women's alcohol consumption beliefs and practices. Public health activities should consider the unique needs and potential vulnerabilities of older women drinkers, and how these may be potentially exploited by the alcohol industry.

Protecting whose welfare? A document analysis of competition regulatory decisions in four jurisdictions across three harmful consumer product industries.

BACKGROUND AND METHODS: Competition regulation has a strong influence on the relative market power of firms. As such, competition regulation can complement industry-specific measures designed to address harms associated with excessive market power in harmful consumer product industries. This study aimed to examine, through a public health lens, assessments and decisions made by competition authorities in four jurisdictions (Australia, South Africa, the United States (US), and the European Union (EU)) involving three harmful consumer product industries (alcoholic beverages, soft drinks, tobacco). We analysed legal case documents, sourced from online public registers and dating back as far as the online records extended, using a narrative approach. Regulatory decisions and harms described by the authorities were inductively coded, focusing on the affected group(s) (e.g., consumers) and the nature of the harms (e.g., price increases) identified. RESULTS: We identified 359 cases published by competition authorities in Australia (n = 202), South Africa (n = 44), the US (n = 27), and the EU (n = 86). Most cases (n = 239) related to mergers and acquisitions (M&As). Competition authorities in Australia, the US, and the EU were found to make many decisions oriented towards increasing the affordability and accessibility of alcohol beverages, soft drinks, and tobacco products. Such decisions were very often made despite the presence of consumption-reduction public health policies. In comparison, South Africa's competition authorities routinely considered broader issues, including 'Black Economic Empowerment' and potential harms to workers. CONCLUSION: Many of the competition regulatory decisions assessed likely facilitated the concentration of market power in the industries we explored. Nevertheless, there appears to be potential for competition regulatory frameworks to play a more prominent role in promoting and protecting the public's health through tighter regulation of excessive market power in harmful consumer product industries.

Gender-responsive health promotion for women: regulating the sociopolitical landscape of alcohol product marketing.

This perspective piece calls for health promotion action to regulate alcohol product marketing targeting women and create environments where it is possible to mitigate the harms of alcohol and protect women's health. Drawing on the Global Alcohol Action Plan in the context of the Australian National Women's Health Strategy 2020-30, we consider critical actions for gender-responsive health promotion to protect women from the ways alcohol companies market their products utilizing women's gendered social roles and entrenched stereotypes. We show how these subtle yet powerful gendered approaches to alcohol marketing have the potential for harm yet are not covered by the current mechanisms of the self-regulated Alcohol Beverages Advertising Code. We draw on the World Health Organization's 2024 Framework on Gender-Responsive Approaches to the Acceptability Availability and Affordability of Alcohol and make a call to regulate alcohol marketing targeting women.

Commercial milk formula marketing entry points: setting the course of infant and young child feeding trajectories.

BACKGROUND: There is a limited understanding of the dynamic influences that shape infant and young child feeding (IYCF) decisions over time. We conducted an innovative qualitative study to reconstruct IYCF trajectories across early life course phases, in the context of the socioecological model (SEM) and the commercial determinants of IYCF. METHODS: Women of different socioeconomic status were interviewed in two large metropolitan areas in Mexico. Our specific goal was to allow us to better understand if and how the commercial milk formula (CMF) marketing influenced breastfeeding decisions in a complex dynamic way involving the individual, relational, community and societal levels. RESULTS: Hospitals, health professionals, and interactions with social media were key category entry points throughout the prenatal, perinatal, early infancy period and beyond. The CMF industry interfered by engaging a wide array of actors across the different layers of the SEM, most prominently the health care system and the workplace. Through its marketing strategies the CMF operates subconsciously and its messages are most effective when health institutions, health care providers, workplace spaces and social norms are weak in their support for breastfeeding. CONCLUSIONS: The cases in our study highlight how, together with a weak breastfeeding counseling system, and health professionals who lack training in breastfeeding and normal infant behavior, lead to the opportunity for CMF marketing to shape infant feeding, and ultimately to the decision to feed formulas that some mothers were not planning to use and cannot afford.

The Commercial Determinants of Men's Health Promotion: A Case Study of Gambling, Nonnies, and Athleisurewear.

Although the social determinants of health have guided equity work with the tailoring of men's health promotion programs, the role of, and potential for, the commercial determinants of health in those interventions is rarely addressed and poorly understood. While four commercial products, tobacco, alcohol, ultra-processed food, and fossil fuels, account for more than a third of global deaths, there is a need to recognize that consumer goods industries can make both positive and negative contributions to health. This article begins much-needed discussions about what we might learn from, and strategically tap in the commercial sector to seed, scale, and sustain men's health promotion programs. Three case studies, online sports betting, beer and the rise of the nonny, and athleisurewear, are discussed. Connections between online sports betting and masculinities explain young men's disproportionate involvement and gambling addictions with recommendations to legislate an end to gambling advertisements and de-incentivize industry profiteering through penalties and higher taxes. Regarding beer and the rise of the nonny, brewers have innovated with non-alcoholic beer based on shifting consumption patterns and masculinities in their core market-men. The nonny reminds health promoters to know their end-user's values and behaviors to bolster program acceptability. Detailing Under Armour and Lululemon, two highly gendered but diversifying athleisurewear brands, the complexities of, and potential for, leveraging public health and industry collaborations are underscored. Taken together, the article findings suggest men's health promoters should rigorously explore tapping key commercial entities and tax revenues to advance the health of men and their communities.

Analysis of public records of lobbying practices of the ultra-processed sugary food and drink industries in Chile: a qualitative study.

Background: Given the role of commercial determinants on sugar consumption and health, this study aimed to describe lobbying practices of the ultra-processed sugary food and drinks industries in Chile between 2014 and 2022. Methods: Official meetings between ultra-processed sugary food and drinks industries and related commercial actors and Chilean government officials were obtained from the Chilean Lobby Registry. Relevant commercial names were initially identified based on their market share and expanded iteratively based on information from relevant meetings. Qualitative analysis followed a deductive-inductive approach using the Corporate Political Activity Model to identify and classify objectives, framing and action strategies. Findings: From 237 records identified, the Ministries of Health, Social Development, and Economy were the most frequently lobbied. Industry representatives sought to achieve their short- and long-term objectives by targeting a diverse range of authorities, including Ministers and Under-secretaries, using different strategies. Framing strategies focused on presenting sugary food and drinks industries as socially responsible and legitimate policy actors and criticised public health initiatives as 'bad solutions'. Action strategies aimed to influence policymaking and nurture corporate reputations. Interpretation: Extensive lobbying took place by the sugary food and drinks industries between 2014 and 2022, a period when major public health policies were being discussed in Chile. Lobbying strategies varied to meet industry objectives and targeted a diverse range of government institutions including high-ranking officials. Tighter regulations to stop inappropriate industry influence in public health policymaking are urgently required. Funding: Agencia Nacional de Investigación y Desarrollo (Chile)-PhD Scholarship. University College London-Open Access fees.

Building a Systems Map: Applying Systems Thinking to Unhealthy Commodity Industry Influence on Public Health Policy.

BACKGROUND: Unhealthy commodity industries (UCIs) engage in political practices to influence public health policy, which poses barriers to protecting and promoting public health. Such influence exhibits characteristics of a complex system. Systems thinking would therefore appear to be a useful lens through which to study this phenomenon, potentially deepening our understanding of how UCI influence are interconnected with one another through their underlying political, economic and social structures. As such this study developed a qualitative systems map to depict the complex pathways through which UCIs influence public health policy and how they are interconnected with underlying structures. METHODS: Online participatory systems mapping workshops were conducted between November 2021 and February 2022. As a starting point for the workshops, a preliminary systems map was developed based on recent research. Twenty-three online workshops were conducted with 52 geographically diverse stakeholders representing academia, civil society (CS), public office, and global governance organisations (CGO). Analysis of workshop data in NVivo and feedback from participants resulted in a final systems map. RESULTS: The preliminary systems map consisted of 40 elements across six interdependent themes. The final systems map consisted of 64 elements across five interdependent themes, representing key pathways through which UCIs impact health policy-making: (1) direct access to public sector decision-makers; (2) creation of confusion and doubt about policy decisions; (3) corporate prioritisation of commercial profits and growth; (4) industry leveraging the legal and dispute settlement processes; and (5) industry leveraging policy-making, norms, rules, and processes. CONCLUSION: UCI influence on public health policy is highly complex, involves interlinked practices, and is not reducible to a single point within the system. Instead, pathways to UCI influence emerge from the complex interactions between disparate national and global political, economic and social structures. These pathways provide numerous avenues for UCIs to influence public health policy, which poses challenges to formulating a singular intervention or limited set of interventions capable of effectively countering such influence. Using participatory methods, we made transparent the interconnections that could help identify interventions in future work.

Complex Interventions for a Complex System? Using Systems Thinking to Explore Ways to Address Unhealthy Commodity Industry Influence on Public Health Policy.

BACKGROUND: Interventions are needed to prevent and mitigate unhealthy commodity industry (UCI) influence on public health policy. Whilst literature on interventions is emerging, current conceptualisations remain incomplete as they lack considerations of the wider systemic complexities surrounding UCI influence, which may limit intervention effectiveness. This study applies systems thinking as a theoretical lens to help identify and explore how possible interventions relate to one another in the systems in which they are embedded. Related challenges to addressing UCI influence on policy, and actions to support interventions, were also explored. METHODS: Online participatory workshops were conducted with stakeholders with expertise in UCIs. A systems map, depicting five pathways to UCI influence, and the Action Scales Model were used to help participants identify interventions and guide discussions. Codebook thematic analysis was used to analyse the data. RESULTS: Fifty-two stakeholders participated in 23 workshops. Participants identified 27 diverse, interconnected and interdependent interventions corresponding to the systems map's pathways that reduce the ability of UCIs to influence policy. These include, for example, reform policy financing; regulate public-private partnerships (PPPs); reform science governance and funding; frame and reframe the narrative, challenge neoliberalism and gross domestic product (GDP) growth; leverage human rights; change practices on multistakeholder governance; and reform policy consultation and deliberation processes. Participants also identified four potential key challenges to interventions (ie, difficult to implement or achieve; partially formulated; exploited or misused; requires tailoring for context), and four key actions to help support intervention delivery (ie, coordinate and cooperate with stakeholders; invest in civil society; create a social movement; nurture leadership). CONCLUSION: A systems thinking lens revealed the theoretical interdependence between disparate and heterogenous interventions. This suggests that to be effective, interventions need to align, work collectively, and be applied synchronously to different parts of the system, including multiple levels of governance. Importantly, these interventions need to be supported by intermediary actions to be achieved. Urgent action is now required to strengthen healthy alliances and implement interventions.

Ghosts in the labour market: perceived health implications of informal labour in Australia.

Employment conditions are important social and commercial determinants of health. Informal employment-also known as 'cash-in-hand' and 'undeclared' work-is a discrete employment condition that has salience around the world. Fuelled by neoliberal ideology, informal employment has become increasingly common in high-income countries. Public health research concerning the health of informal workers comes largely from low- and middle-income countries, where the phenomenon is more visible. There has been little research on the health effects of informal employment in high-income countries including Australia. Twenty-nine workers aged 18 years and older, who were undertaking informal work activities, were recruited using social media and an online marketplace in Tarndanya (Adelaide-Kaurna Country), Australia. Qualitative narrative data, demographic profiles, and physical and mental health scores were collected. Most informal workers reported unfair and indecent employment conditions including job insecurity, low income, coercion, and lack of respect and dignity at work, and were often exposed to unsafe and unhealthy work environments. Workplace injuries and exposure to occupational hazards were common; and Physical and Mental Component Scores were poorer among informal workers when compared to the population of South Australia as a whole. With informal employment in Australia described as part of a 'significant, pervasive, damaging and growing' problem, there is a need for a health promotion lens over industrial relations policies in the interest of creating equitable access to fair and decent work.

The Perils of Partnership: Interactions Between Public Health England, Drinkaware, and the Portman Group Surrounding the Drink Free Days Campaign.

BACKGROUND: There is growing evidence that the alcohol industry seeks to obstruct public health policies that might affect future alcohol sales. In parallel, the alcohol industry funds organisations that engage in "responsible drinking" campaigns. Evidence is growing that the content and delivery of such campaigns serves industry, rather than public health interests, yet these organizations continue to be the subject of partnerships with government health departments. This study aimed to examine the nature and potential impacts of such partnerships by analysing the practices of the alcohol industry-funded charity Drinkaware during the establishment of the Drink Free Days campaign. METHODS: A case study based on an inductive analysis of documents revealed by freedom of information (FoI) request regarding communications between Drinkaware, Public Health England (PHE), and the Portman Group, in the years running up to, and during, the Drink Free Days campaign, a partnership between alcohol industry-funded charity Drinkware, and PHE. RESULTS: This study reveals a range of less visible, system-level effects of such partnerships for government departments and civil society. The tensions observed, as exhibited by discrepancies between internal and external communications, the emphasis on managing and mitigating the perception of negative consequences, and the links to wider alcohol industry initiatives and bodies, suggest the need for wider considerations of organizational conflicts of interest, and of possible indirect, harmful consequences to policy-making. These include the marginalization of other civil society voices, the displacing of more effective policy options, and strategic alignment with other industry lobbying activities. CONCLUSION: The findings have implications for how public health practitioners and health organisations might better weigh the potential trade-offs of partnership in the context of health promotion campaigns.

The role of metaphor in the corporate political strategies of health harming industries: Comparing the concept of balance in the gambling and opioid industry discourses.

Scholars have identified notable similarities between the political strategies employed by health-harming industries. This includes similarities in the narratives employed by industry actors seeking to oppose public health regulations that threaten their commercial interests. This study seeks to examine the use of a specific concept - the balance metaphor - in the policy discourses of two health-harming industries. Namely, the pharmaceutical industry implicated in the prescription opioid crisis in the US, and the UK gambling industry, whose products and practices are associated with a serious, but largely neglected, series of harms. We first review research on metaphors, demonstrating how this provides additional theoretically-informed concepts with which to understand how industry discourse circumscribes the terrain of policy debates in ways amenable to commercial interests. Building from these insights, we conducted a rhetorical analysis, examining how the concept of balance is employed by different actors in distinct contexts to shape understandings of the social and policy problems associated with gambling and opioid products and to promote industry-favourable regulatory responses to these. This brings a micro-level of analysis to supplement previous meso- and macro-level scholarship in this space. We use our findings to argue that the depoliticization of the policy process and objectivization of the policy space - in ways that obscure its contingent and political nature - through discourses of balance is itself an arch political act. Examining the metaphors used in policy debates and their functions provides important insights that can be used to inform the construction of counter-narratives to industry-favourable discourses, including the creative use of novel metaphors in the service of public health goals.

Urban health advantage and penalty in aging populations: a comparative study across major megacities in China.

Background: Urban living is linked to better health outcomes due to a combination of enhanced access to healthcare, transportation, and human development opportunities. However, spatial inequalities lead to disparities, resulting in urban health advantages and penalties. Understanding the relationship between health and urban development is needed to generate empirical evidence in promoting healthy aging populations. This study provides a comparative analysis using epidemiological evidence across diverse major Chinese cities, examining how their unique urban development trajectories over time have impacted the health of their aging residents. Methods: We tracked changes in air pollution (NO2, PM2.5, O3), green space (measured by NDVI), road infrastructure (ring road areas), and nighttime lighting over 20 years in six major cities in China. We followed a longitudinal cohort of 4992 elderly participants (average age 87.8 years) over 16,824 person-years. We employed Cox proportional hazard regression to assess longevity, assessing 14 variables, including age, sex, ethnicity, marital status, residence, household income, occupation, education, smoking, alcohol consumption, exercise, and points of interest (POI) count of medicine-related facilities, sports, and leisure service-related places, and scenic spots within a 5 km-radius buffer. Findings: Geographic proximity to points of interest significantly improves survival. Elderly living in proximity of the POI-rich areas had a 34.6%-35.6% lower mortality risk compared to those in POI-poor areas, for the highest compared to the lowest quartile. However, POI-rich areas had higher air pollution levels, including PM2.5 and NO2, which was associated with a 21% and 10% increase in mortality risk for increase of 10 µg/m3, respectively. The benefits of urban living had higher effect estimates in monocentric cities, with clearly defined central areas, compared to polycentric layouts, with multiple satellite city centers. Interpretation: Spatial inequalities create urban health advantages for some and penalties for others. Proximity to public facilities and economic activities is associated with health benefits, and may counterbalance the negative health impacts of lower green space and higher air pollution. Our empirical evidence show optimal health gains for age-friendly urban environments come from a balance of infrastructure, points of interest, green spaces, and low air pollution. Funding: Natural Science Foundation of Beijing (IS23105), National Natural Science Foundation of China (82250610230, 72061137004), World Health Organization (2024/1463606-0), Research Fund Vanke School of Public Health Tsinghua University (2024JC002), Beijing TaiKang YiCai Public Welfare Foundation, National Key R&D Program of China (2018YFC2000400).

Industries, citizens, and non-governmental organizations' positioning and arguments used in European Union initiatives for alcohol taxation and cross-border regulation.

BACKGROUND: The European region has the highest daily alcohol consumption per capita and a high alcohol-related burden of disease. Policymaking at the European Union level is open to participation by interest groups, from public health organizations to alcohol industry representatives. This study aimed to map the interest groups present in the alcohol taxation and cross-border regulation initiatives and identify which arguments were used to support positions in favor or against them. METHODS: We used qualitative content analysis on the comments submitted on the official European Commission website during the 2017, 2018, 2020, and 2022 participation periods. Interest groups were characterized considering their positioning, and arguments were identified and compared by position and type of initiative. RESULTS: Opponents of changes to the structures of alcohol excise duties and cross-border regulations were mostly representatives of the alcohol and agricultural industries, and the proponents were mostly health-related nongovernmental organizations. Opponents of these initiatives used a wide variety of arguments, from economic and trade to health arguments, while proponents focused mainly on health arguments, such as the effectiveness of alcohol taxation in preventing alcohol-related morbidity and mortality. CONCLUSION: This study highlights the wide range of arguments used by opponents around alcohol control policies, contrasting with the health-centered arguments of proponents. It further shows that there is a lobbying network at the European Union level, combining national and international representatives of industry and non-governmental organizations. These findings provide an opportunity for better preparation for upcoming discussions on alcohol control at national and regional levels.

"Older people will die of old age. I'll die of climate change": engaging children and young people in climate decision making for public health.

BACKGROUND: The climate crisis is a significant risk to the health and wellbeing of children, young people, and future generations. While there are calls for children and young people's engagement in climate decision making, current power structures limit their participation. This paper aimed to understand children's perspectives about the impact of the climate crisis on their futures, their ability to influence climate decisions, and strategies and mechanisms to facilitate their greater engagement in decisions made about the climate crisis. METHODS: Online in-depth interviews were conducted with n = 28 children (aged 12-16 years) across Australia. Photo elicitation techniques were used to prompt discussion about how the climate crisis impacted their futures, their ability to influence climate decisions, and strategies and mechanisms to engage them in climate decision making. A reflexive approach to thematic analysis was used to construct three themes from data. Images were analysed for ascribed meanings. RESULTS: First, participants stated that they and future generations will inherit the climate crisis from older generations, specifically decision makers. Second, they described a need to address a range of age-related barriers that limit children and young people's engagement in climate decision making, including perceptions about their capabilities. Finally, they discussed strategies and mechanisms to embed children and young people's perspectives within climate decision making, including at civic and political levels. CONCLUSIONS: Children and young people have the right to be involved in decisions made about the climate crisis which significantly impact their futures, including their health and wellbeing. They argue for structural changes to embed their views in climate decision making, and describe a range of engagement strategies and mechanisms to structure their perspectives and knowledge with decision making processes. Furthermore, genuine involvement of children and young people in climate discussions must avoid youthwashing and tokenistic participation. The public health community can help address barriers to youth participation in climate action and should actively engage and collaborate with children and young people to facilitate their political and democratic influence over the climate crisis. This involves making room and creating an accessible seat at the decision making table to ensure their perspectives are embedded in climate decisions.

"It's changing our lives, not for the better. It's important that we have a say". The role of young people in informing public health and policy decisions about gambling marketing.

BACKGROUND: Marketing has a significant impact on the normalisation of gambling for youth across the globe. This has included shaping positive attitudes towards gambling, as well as increasing the social and cultural acceptance of gambling - particularly aligned with valued activities such as sport. Because of this, public health experts argue that gambling marketing poses a significant risk to the health and wellbeing of youth. While young people are increasingly exposed to, and impacted by marketing for gambling products, they are rarely consulted about policy issues and options. This study aimed to explore young Australians' perceptions of current policy responses to gambling advertising, whether they thought young people should be involved in discussions and decisions about gambling marketing regulations, and their perceptions of the duty of governments to protect young people from gambling industry marketing strategies. METHODS: Qualitative focus groups (n = 22) were held with n = 64, 12-17 year olds in the Australian states of Victoria and New South Wales. Participants were asked to reflect on current gambling policies, particularly relating to marketing, what they thought should be done about gambling marketing, and if and how young people should be included in public health responses to gambling. An interpretivist 'Big Q' approach to reflexive thematic analysis was used. RESULTS: Young people highlighted the need for more effective regulations around the content and frequency of gambling marketing. They also wanted to see more realistic representations of the negative impacts of gambling to counter persistent positive commercial marketing messages. Most thought that young people should be given an opportunity to have a say about responses to gambling due to their unique experiences. Participants identified mechanisms to increase young people's engagement in decision making, such as direct lines of communication to different levels of government, involvement in research, and diversifying ways of engagement. Specific recommendations included more regulatory action such as bans on gambling advertising. CONCLUSIONS: Creating formal structures that facilitate the inclusion of young people's perspectives in decisions made about gambling can result in more innovative and effective strategies to prevent the harms from gambling industry products, promotions, and practices.

The rise and fall of the Queensland Government policy to restrict unhealthy food and alcohol advertising on publicly owned assets.

OBJECTIVE: To examine the strategies employed by opponents of the Queensland Government's policy to restrict unhealthy food and alcohol advertising on publicly owned assets and identify which of the opposing arguments appeared to influence the policy outcomes. METHODS: Retrospective qualitative policy analysis case study informed by the Policy Dystopia Model of corporate political activity. We used qualitative content analysis to examine data from stakeholder submissions to the 'Advertising content on Queensland Government advertising spaces' policies (v1 and 2), and Minister for Health's diaries. RESULTS: Stakeholders from the food, beverage, alcohol and advertising industries and several not-for-profit health organisations opposed the policy. Industry actors used discursive strategies, coalition management (including co-option of not-for-profit health organisations), information management and direct involvement with policy makers to communicate their arguments against the policy. The second version of the policy was weaker regarding scope and key policy provisions, reflecting the arguments of industry actors. CONCLUSIONS: Influence from industries with a clear conflict of interest should be minimised throughout policy development to ensure public health is prioritised over corporate gain. IMPLICATIONS FOR PUBLIC HEALTH: Our findings can support other jurisdictions to prepare for industry opposition when designing policies to restrict unhealthy food and alcohol marketing.

Continuities and change in alcohol policy at the global level: a documentary analysis of the 2010 Global Strategy for Reducing the Harmful Use of Alcohol and the Global Alcohol Action Plan 2022-2030.

BACKGROUND: There are only two major statements which define alcohol policy development at the global level. There has not been any comparative analysis of the details of these key texts, published in 2010 and 2022 respectively, including how far they constitute similar or evolving approaches to alcohol harm. METHODS: Preparatory data collection involved examination of documents associated with the final policy statements. A thematic analysis across the two policy documents was performed to generate understanding of continuity and change based on comparative study. Study findings are interpreted in the contexts of the evolving conceptual and empirical literatures. RESULTS: Both documents exhibit shared guiding principles and identify similar governance challenges, albeit with varying priority levels. There is more emphasis on the high-impact interventions on price, availability and marketing in 2022, and more stringent targets have been set for 2030 in declaring alcohol as a public health priority therein, reflecting the action-oriented nature of the Plan. The identified roles of policy actors have largely remained unchanged, albeit with greater specificity in the more recent statement, appropriately so because it is concerned with implementation. The major exception, and the key difference in the documents, regards the alcohol industry, which is perceived primarily as a threat to public health in 2022 due to commercial activities harmful to health and because policy interference has slowed progress. CONCLUSIONS: The adoption of the Global Alcohol Action Plan 2022-30 potentially marks a pivotal moment in global alcohol policy development, though it is unclear how fully it may be implemented. Perhaps, the key advances lie in advancing the ambitions of alcohol policy and clearly identifying that the alcohol industry should not be seen as any kind of partner in public health policymaking, which will permit progress to the extent that this influences what actually happens in alcohol policy at the national level.

Making Big Business Everybody's Business: Aboriginal leaders' perspectives on commercial activities influencing aboriginal health in Victoria, Australia.

BACKGROUND: The commercial determinants of health is a rapidly expanding field of research; however Indigenous perspectives remain notably underrepresented. For Indigenous peoples the intersection of globalisation, colonialism and capitalism may amplify commercially-driven health inequities. This study aimed to explore the perspectives of Aboriginal leaders regarding the influence of commercial activities on Aboriginal health and wellbeing in Victoria, Australia. METHODS: Semi-structured interviews with 23 Aboriginal leaders from across five sectors (n = 15 urban, n = 8 rural/regional) were analysed through reflexive thematic analysis. RESULTS: Three overarching themes were identified encompassing (i) harmful commercial practices and processes, (ii) improving corporate engagement and (iii) opportunities for self-determination through business. Participants expressed concern over aggressive marketing by the gambling industry, commercial exploitation of Aboriginal culture, the privatisation of public services, and lack of oversignt of corporate social responsibility strategies. Simultaneously, Aboriginal-led businesses were viewed as opportunities for cultural connection, and financial empowerment and self-determination. CONCLUSION: Numerous commercial entities and activities are perceived to influence Aboriginal health and wellbeing. This study highlights the need for stronger policy and regulation to mitigate harmful industry practices while incentivising the potential positive impacts of the commercial activities on Aboriginal health and wellbeing.