Background:
In Victoria, alcohol marketing is permitted in some forms on public transport. This marketing is overseen by a confusing combination of contracts, government policy and industry self-regulation enforced by governments and service providers. Governments and service providers may ensure individual contracts or services are compliant with relevant policies. However, a public health approach is needed to ensure these rules effectively protect children who use public transport from this harmful marketing. Here, we present an example of public health participation in the review of contracts and engagement with decision makers to protect children’s health and wellbeing.

Method: We reviewed and summarised current rules, policies, and regulations that oversee alcohol advertising on public transport in Victoria. We also tested how processes were followed by complaining about breaches. Inconsistencies, gaps and non-compliance with the rules were documented. We used this evidence to engage with public health partners and decision makers and urge for action to address the loopholes, non-compliance, and inconsistencies.

Results: We found that alcohol advertising rules varied by transport mode, region, and even local government area. There were discrepancies within industry self-regulation (such as Yarra Trams guidelines prohibiting alcohol advertising while the Outdoor Media Association policy does not). Some alcohol advertising rules varied by service contract timeframes, with newer contracts more likely to prohibit alcohol advertising. We also observed that complaints to government departments were not always assessed against the most appropriate rule. We subsequently approached partners and decision-makers by letter, face-to-face forums and meetings and observed interest in the issues and finding solutions to better protect children.

In conclusion, the case study highlights the importance of public health organisations engaging in contract and policy review processes to improve public health outcomes for children.

International trade and investment treaties affect domestic public health and the environment, yet these effects have historically been considered peripheral to economic objectives. The Sustainable Food System (SFS) Chapters in the European Union’s (EU) recent free trade agreements (FTAs) with Chile and New Zealand (NZ) codify, for the first time, the importance of healthy and sustainable diets as a common goal, and one that can be supported by FTAs. This study aimed to identify the origins, rationale, and conditions enabling the adoption of SFS Chapters in the EU-NZ and EU-Chile FTAs, to distil lessons that can support engagement between policy sectors and further innovation to generate healthier trade and investment policy. Empirical case study research methodology was applied with qualitative policy and governance analysis. We collected publicly accessible documentary data and interviews with 26 participants from government agencies, civil society, and private sector in the EU, NZ, and Chile. Data was analysed deductively based on a theory-informed analytical framework, followed by inductive analysis. The SFS Chapter was proposed by the EU as an expansion of its stringent domestic sustainability policies, in response to growing pressure from a) domestic agricultural producers to force the sustainability requirements on imported products, and b) left-wing and green political parties and environmental and health activists. The non-binding nature of the SFS chapter and previous discussions on relevant provisions within Sustainable Development and Trade Chapter enabled its smooth acceptance by NZ and Chile. This was further supported in NZ by common ideological grounds on SFS, with an agri-food industry already invested in research and technology in sustainable agriculture. The convergence of political and economic interests with health and sustainability imperatives, supported by strong domestic and global policies, can enable the adoption of clauses in FTAs that promote health and environmental agendas, such as SFS transformation.

Ultra-processed foods (UPFs) harm human health and the environment, and displace nutritious and traditional whole foods in dietary patterns. Experts now recognise the need for systems approaches to inform policy and regulatory responses to complex food system issues, such as the UPF challenge. Yet no prior studies have systematically reviewed the current state of recommended and implemented regulatory measures to tackle UPFs, to formulate a systems-based framework of regulatory interventions to control and reduce UPF consumption. This study aims to develop an ecological regulatory framework for the control and reduction of UPFs that displays and connects recommended and implemented measures across multiple food systems dimensions.
We adopted a theoretically grounded framework synthesis method. We formulated an initial conceptual framework from relevant theory, and then populated it with data from scholarly literature, reports and policy materials. To identify recommended UPF regulatory measures, we conducted a systematic search of relevant literature. The first phase of searches identified 1538 scholarly articles, of which 281 have proceeded to full text review. Preliminary results indicate that key categories of recommended UPF regulatory measures include specific laws and regulatory interventions (for example, taxes on UPF products, food labelling standards, or proposed reforms to consumer law, competition law, or corporations law) in addition to broader recommendations for policy actions to transform the systems structure, goals and paradigms.
This presentation will present key learnings and outcomes in association with the conference theme around the global, regional, and local governance for health. Importantly, our findings highlight the potential for an ecological approach to regulation to contribute to a ‘regulatory ecosystem’ of measures designed to respond to the UPF challenge and support healthier and more sustainable food systems. The proposed conceptual framework has considerable potential importance for guiding both international policy and national policy responses on UPFs.

Thailand has been at the forefront as one of the top medical destinations in Asia. The medical hub policy has been a priority agenda for every government for more than 20 years. The current National Strategy for Thailand's Development as an International Health Center (2017-2026) prioritises four hubs namely, Medical Service Hub, Wellness Hub, Product Hub, and Academic Hub. In addition, the current National Economic and Social Development Plan prioritises the wellness and medical tourism. However, with the changes in public health needs and the impacts from COVID-19, the strategy towards medical hub policy in Thailand need to be changed in order to address the needs within the country as well as those of medical tourists and foreign patients. The project aimed to understand the current and future policy direction, the changing role of the medical tourism providers and to develop a set of recommendations for medical hub policy in Thailand that supports health and economic sustainability, taking into account the country’s readiness, capacity and health security. The study was conducted by literature review and interviews with key informants from the policy, entrepreneurial, and academic sectors.
Medical hub activities have expanded beyond the private health sector to include collaboration of academic institutes to develop comprehensive medical centres accessible by both local and international patients. The country has shifted the focus to the wellness industry with green medicine and becoming a hub for medical education. Relevant government sector also developed strategy to ensure the risk-free tourism through the Amazing Thailand Safety and Health Administration (SHA). However, there are limitations resulting from COVID-19 that need to be addressed.
The study recommends mapping key players and actors in the medical hub policy ecosystem to identify their linkage and gaps of demand and supplies, reviewing and analysing existing challenges such as legal challenges, development of infrastructure and health personnel in response to the health need of the elderly both Thai nationals and foreigners, and promoting products that can be linked to the wellness hub such as herbal products.

The governance related to trade and health faces unprecedented challenges in today's global landscape. The concern on climate change and health is in high attention during the past decade. In term of international trade, many countries have developed measures to ensure that the production does not pose environmental impacts. This study analysed the case of the implementation of the Carbon Border Adjustment Mechanism (CBAM) under the “Fit for 55” policy by the European Union (EU) that are applied to six industrial products to be exported to the EU.

Meanwhile, the CBAM represents a significant policy measure to combat climate change by incentivizing emission reductions in international trade. This framework obliges importers to report carbon emissions embedded in imported goods and aims to gradually transition towards carbon emission-based tariffs. The CBAM's implementation poses challenges for global trade, particularly for exporters in developing countries, and highlights the need for inclusive and equitable trade governance frameworks.

Using a good governance framework, this study evaluates the current governance structures in the country in response to these challenges. While participation in decision-making processes shows some inclusivity, there remain gaps in stakeholder representation from outside government agencies. Transparency and responsiveness are identified as areas needing improvement, with recommendations to increase public access to meeting outcomes and foster greater flexibility in meeting formats. Moreover, ensuring accountability and efficiency in resource utilization calls for enhanced mechanisms to assess the impacts of policy decisions beyond treaty preparation. Overall, this study underscores the importance of adapting trade governance structures to address contemporary global challenges effectively.

Planetary health equity – the equitable enjoyment of good health and wellbeing in a sustainable ecosystem – is under threat from anthropogenic climate change and economic and social inequities. Driving these major challenges is the global consumptogenic system that encourages excessive production and consumption goods and services that are harming human and planetary health. Growth models lie at the core of the consumptogenic system. This paper examines the sources of economic growth in Australia, the coalitions that sustain this approach politically, and the implications of these dynamics for planetary health equity. Australia’s consumption-led growth model is underpinned by a combination of rising house prices and a permissive credit regime. This growth model is supported by a dominant growth coalition of producer interests, elements of organised labour, and property owners. The growth coalition has been able to successfully generate growth model policy convergence between the mainstream political parties. In turn this growth model, and associated growth coalition, has undermined the pursuit of planetary health equity in Australia by incentivising and driving excessive consumption, greenhouse gas emissions, and economic inequality.

Background: Integrated care is a mechanism to reduce system fragmentation and address the burdens faced by health systems, while aiming to achieve the Quintuple Aim. These initiatives see success from the clinical and patient experience perspectives yet are not commonly sustained. The literature emphasises the need for strong governance with a clear understanding of the context in which integrated care governance functions yet there is not sufficient translation of this into practice. A component of governance needing further research is the interplay between the public and fiercely private actors involved and the ongoing influence of these partnerships. Care Partnership Diabetes (CP-D) is a partnership, under NSW Health’s Collaborative Commissioning, governed by federal, state, and local actors.

Methods: Semi-structured interviews were conducted with staff across the CP-D partners. Transcripts were thematically analysed to gain insights into the functioning and strength of ties within the partnership.

Findings:Preliminary findings show a strong governance structure was developed but the program of work that was intended as the output of the partnership faced repeated contextual challenges. We categorised the challenges and facilitators to successful partnerships according to communication between partners, ongoing impacts from COVID-19, roles and strengths of partners, trust, and understanding project goals.

Key Message: Partnerships are inevitable within a health system where responsibilities are shared across federal, state, and local levels. Researching the influence of governance in integrated care will allow for insights into the how and why a partnership functions. Consideration for what tools are available to govern the dynamic of public actors managing initiatives that influence how private actors provide care is essential to facilitate a robust understanding of the influential factors associated with governance. Without this, partnerships may continue to be ineffectual leading to a waste of public resources, reduced accountability and transparency, and repetition of past mistakes.

Background: The recent collapse of the Sri Lankan economy has had a devastating impact on food security and nutrition, with food prices rising 94% and 32% of Sri Lankan households food insecure. In response, political priority for food production, promoting nutrition, fostering sustainability, and facilitating economic progress has increased. Against this crisis background, a circular economy approach presents a sustainable solution to address multiple food policy challenges.
Methods: We analysed policies related to food supply and nutrition using a matrix, to identify sustainable strategies for moving towards a circular economy model that seeks to eliminate waste and promote the sustainable utilisation of resources.
Findings: Existing agriculture and health policies prioritised food and nutrition security, including through multisectoral nutrition engagement and food standards. Within agriculture policies, there was also a focus on improving the income, employment prospects, and standard of living of agricultural workers. However, food loss and waste received minimal attention, as did the sustainable use of resources. The analysis identified several opportunities to strengthen policy attention to food loss and resource use across the food system, including agriculture, health, and industry policies, drawing on a circular economy lens.
Conclusion: The analysis indicated that integrating a circular economic approach into agriculture and nutrition policies could support Sri Lanka’s priority for the United Nations Sustainable Development Goals for 2030.

Recognising the importance of protecting breastfeeding, the World Health Organization (WHO) and UNICEF held a Congress on the WHO International Code of Marketing of Breastmilk Substitutes (The Code) in Geneva in June 2023. The event brought together over a hundred countries to advance understanding of The Code and share implementation strategies and build coalitions to thwart commercial influence on women’s decisions about infant and young child (IYC) feeding.

The Congress was timely as the Australian Government is reviewing its policy on the Infant Nutrition Council’s (INC) Marketing Agreement on Infant Formula (MAIF) this year. In 2024, the Australian Competition and Consumer Commission (ACCC) will make a determination on whether to reauthorise the Agreement. The MAIF is a voluntary industry agreement which purports to implement The Code in Australia. ACCC has previously been critical of current policy gaps.

Over many years, Australia has scored poorly on international benchmarks for The Code implementation. In the recent global Status of The Code Report, launched by WHO, UNICEF and IBFAN in May, Australia scored poorly. The WBTi AUS 2023 report reinforced Australia’s poor performance in the protection and support of breastfeeding, scoring 33/100 placing it 3rd from the bottom among 100 countries.

WHO/UNICEF research has exposed the shocking global extent of exploitative marketing strategies by the commercial formula milk (CMF) industry to influence women’s infant feeding decisions. In Australia too, the CMF industry uses marketing tactics from the tobacco and gambling playbook, including distortion of science, capture of health-care providers and parents, altering public opinion, and influencing policy makers. This systematically undermines breastfeeding in Australia.

2024 is a critical time for public health action on breastfeeding in Australia. New policy approaches are crucial to recognise international human rights obligations, eliminate inappropriate marketing practices through recommended regulatory action, and utilise existing and novel legal channels to stop new digital promotional techniques.

What will the Australian government decide?

The limits of the Gross Domestic Product (GDP) as an indicator of social and ecological well-being are well established. GDP is a prominent indicator because it conforms with an underlying paradigm of economic growth. Pursuing unlimited growth is causing several interlinked social and ecological crises. Systematic solutions for navigating just sustainability transitions are needed urgently.
Attempts to introduce beyond-GDP systems exist worldwide and in Australia. These systems could help catalyse transitions towards post-growth societies, in which social and ecological well-being is prioritised over growth-driven economic goals. Post-growth societies would have significantly different social, political and commercial determinants of health. In our study, we explored from a cross-scale perspective the role of food actors in post-growth transitions. We will begin the session by providing an overview of three Australian post-growth food enterprises operating at various stages of the food supply chain. The case studies analysed foster social and technological innovation. These enterprises prioritise social justice and ecological sustainability over financial extractivism. Systemic barriers and catalysers to achieving human and environmental health will be discussed. Secondly, our findings will illustrate the potential for food actors to inform beyond-GDP frameworks at a national level, in particular in relationship to the ‘Measuring what matters’ consultation process led by the Treasury (Australian Government) in 2022 – 2023.
This session will point out some practical steps that could help catalysing sustainability transitions. For example, more attention could be paid to exnovation in food systems transitions. Exnovation is the deliberate, planned organizational process of phasing out or stopping existing practices. Exnovation initiatives in food systems could be directed at unsustainable and unhealthy (food systems) practices, such as products, business models or entire paradigms. Additionally, an increased engagement of food actors in beyond-GDP explorations in Australia might be required to help shape well-being frameworks.

Food systems urgently need to be reoriented to deliver better social, environmental, and economic outcomes. Governance is key to achieving this; however, food system governance is fraught with competing interests, policy incoherence, and power asymmetries. In this presentation, we propose an approach to conceptualise and operationalise whole-of-food system governance that adopts paradigmatic considerations about the role of various state and non-state actors. The proposed approach brings all necessary actors and sectors together and is carefully designed to level out power asymmetries and to systematically consolidate interests and ideas. Informed by systems thinking, this whole-of-food system approach may enable a transformative change in the food system governance: it facilitates the shift in system paradigms, power and control structures, and system goals. This, in turn, will change the incentives at work throughout the food system, leading to better food system outcomes across environment, social, health, economic and other dimensions.