One of the most pressing issue in contemporary public health is how the commercial determinants of health can be governed. Evidence has accumulated that CDoH affect health through commercially produced, marketed and advertised products and through a range of behaviours of commercial actors, especially transnational corporations, that advance their profits often at the expense of public health considerations.
This poster will report on the application of systems thinking to develop a map of the ways in which the options for global and national governance are variously constrained and enabled through a variety of mechanisms and actors.
The diagram was developed as part of research to contribute to the WHO World Report on Commercial Determinants of Health. It identifies the key groups of players involved in the governance of commercial actors and their health impact (governments, international agencies, civil society, academics and investigative journalists). It maps the factors that either enable actions in support of health and those that constraint it and shows the relative power of the actors involved and the mechanisms they use. These mechanisms vary in their effectiveness from binding international agreements and enforceable taxation regimes and legislation to prohibit unsafe products to those that are largely ineffective including self-regulation and codes of conduct regarding conflicts of interest.
This systems mapping facilitates an overview of the global governance options and demonstrates the ways in which the different power available to different actors affects the effectiveness of governance.

Background:
South Africa’s healthcare system following colonialism and apartheid remains highly limited. Public health policy, programs, professional education and practice need to understand the reverberating and multi-generational impacts of colonialism on the marginalized yet resilient indigenous African healthcare system, its practitioners and the shared patients. The non-integration of African traditional medicine (ATM) into the prevailing healthcare system is evident in the lack of education on ATM in colleges and universities. To address this gap, a training programme for traditional health practitioners (THPs) and public sector healthcare workers (HCWs) was developed.

Intervention description:
A collaboration between the University of KwaZulu-Natal, the KwaZulu-Natal THP Forum and the KwaZulu-Natal Department of Health was enabled by the THPs Act 22 of 2007.
Training for THPs focused on laws that impact their profession, categories and practices. For HCWs, the World Health Organization African Region Module on “Traditional Medicine for Training of Health Science Students and Conventional Health Practitioners” was utilized. Furthermore, the inexplicit role of colonialism and economic divide experienced in these healthcare systems was uncovered. A monitoring and evaluation tool was developed for current priority indicators.

Results:
The HCW policy and practices focus on clinical skills. However, sporadic individual cultural competencies to patients and THPs in comprehensive primary healthcare (PHC) was observed. A strengths-based approach to professional collaboration is feasible and required for all HCWs.
The initial results of post-intervention data involved 583 THPs and 285 HCWs in 11 districts showing enhanced facility and THP collaborations through improved communication, patient referrals, programmes reporting and PHC governance platforms.

Lessons learnt:
Collaboration between HCWs and THPs at the PHC level is improved by training HCWs on aspects of ATM. HCWs require critical analysis skills regarding the role of colonization and the impact it has on THPs and patients’ health beliefs, practices and clinical outcomes. Supportive policies and implementation strategies require designated resources.

Background:
As a member of the World Health Organization (WHO), South Africa implements the primary healthcare and universal health coverage public health strategies. Multi-month dispensing of medicines for chronic health conditions, through the Central Chronic Medicines Dispensing and Distribution (CCMDD) adherence programme, began in 2015/2016 employing public-private partnerships.
Private sector service providers are medicine dispensers, distributers and pick-up points for public sector patients. Although post-colonial South Africa inherited and upholds biomedical health laws and practices, patients are exposed to and may use the indigenous African healthcare system (IAHS). With the existential resilience shown by the IAHS, much can be learnt about the social and communal perspectives for health and wellness by the patient-centred biomedical health system for health education, planning, financing and resources allocation.

Method:
This mixed methods study will conduct a cost effectiveness analysis (CEA) of the CCMDD programme and interviews to better understand the interactions of the allopathic and IAHS in South Africa.
The quantitative method will be a CEA of the CCMDD programme in 8 peri-urban and rural public healthcare facilities, targeting the resource rich human immuno-deficiency virus (HIV) programme, and clinician interviews.
The qualitative snowball method will interview African traditional health practitioner (THPs) around the facilities who are freely consulted by patients. The THPs’ interactions concerning patient adherence behaviours and the allopathic health system will focus on patients living with HIV.

Discussion:
The WHO acknowledges the need to decolonize global health because power imbalances dictate how ideas and values for health drive policy, practice and resource allocation.
This study will contribute to the improved understanding and implementation of universal health coverage in resource limited intra-provincial geographies; re-evaluation of the challenges and benefits of public-private partnerships and; improved understanding, support and enhancement of the integration of the medico-lab and African indigenous healthcare systems for sustainable patient health outcomes.


Ethics: University of KwaZulu Natal Biomedical Research Ethics Committee - BREC/00005792/2023. Approved 26 April 2024

Background: Resource extraction continues to be a key aspect of Australia’s economic profile, generating significant export earnings and thousands of jobs annually. Support for the resource extraction sector remains a key Australian policy objective. Continued and increased resource extraction activity will intensify social deprivation and health inequities experienced by resource dependent communities. This project aims to examine the impact of language on the framing of resource extraction in policy discourse from two successive Australian governments, and the consequences for health outcomes and health equity.
Methods: Using Bacchi’s What’s the Presented to Be approach, a qualitative discourse and policy analysis of three key Australian resource extraction policy documents was undertaken to examine how resource extraction is represented and the implications for resource-dependent communities.
Results: Findings indicate an enduring representation of resource extraction as overwhelmingly beneficial to Australian communities and to Australian statehood. All policy documents make contestable assumptions about a perpetual, abundant supply of natural resources, the sustainability of global demand and the ability of all Australians to benefit equally from resource extraction. While some references to supporting resource dependent communities were noted, the need for greater community support for resource extraction was proposed as a key problem to be addressed with a notable silence on potential negative social and health outcomes for those same communities.
Conclusion: Resource extraction policy discourse in Australia continues to overstate its benefits for host communities, obscuring the potential for negative health outcomes and perpetuates power structures that underpin health inequalities for resource dependent communities. Countering this enduring dominant discourse is important for improving health equity.

In a world of multi-interlinked crises, from climate change to rising social inequities, Planetary Health Equity (PHE), defined as ‘the equitable enjoyment of good health in a stable Earth system’, provides the shared goal among all actors, from public to private, to guide actions to address those interconnected crises, together and at the system level. Generating evidence that support the achievement of PHE is therefore pivotal, especially considering the role evidence have in informing policymaking. Therefore, which research is prioritized, particularly in health, have consequences for public and private policies, hence all of us. A particularly influential and powerful actor, who has become more prominent in health research in the last thirty years, is philanthropy. Indeed, philanthropic organizations have been found to be particular influential in setting global health priorities, often guided by the neoliberal economic ideology that prioritize technological and market-driven solutions over systemic changes addressing the social and commercial determinants of health. However, there is no comprehensive and recent empirical investigations on the current health philanthropy ecosystem. Using the data collected from publicly available databases and philanthropic organizations’ websites, this research, part of a broader PhD project, will map philanthropic organizations funding health research, detailing the amount of fundings and what type of research they prioritize. The databases and document analyses conducted will also provide an overview on the alignment of the current philanthropy’s health research priorities with the PHE goal. Indeed, mapping the current health philanthropy ecosystem is a first necessary step to inform further investigations that aim to provide insights into what type of values and interests guide those philanthropic organizations’ operation and what conditions may favor the elevation of PHE through philanthropy’s research priorities.

*The abstract presents the first part of the PhD candidate’s research project which will be conducted in the next few months*

Scholars and activists interested in commercial determinants and corporate power often observe that many of the world’s largest economies are companies, not governments. This anecdote is often deployed for its shock value, yet it offers a useful entry point into the empirical measurement of corporate power and associated political determinants of health. Our study developed a reproducible method to measure and rank the world’s largest economies and how they have changed over time.

Using data from the United Nations University World Institute for Development Economics Research’s (UNU-WIDER's) Government Revenue Dataset (GRD), the Organisation for Economic Cooperation and Development (OECD), the International Monetary Fund (IMF) and Fortune’s Global 500, we compared and ranked the revenues of companies and governments from 1994 through 2021. For each year we developed rankings of the top 100, 200, and 400 ‘global economies’. We used Orbis to classify the industry sectors of companies making the top 200 ranking each year.

In our updated ranking for 2021, Walmart was (again) the highest ranked company. We found that the proportion of companies and governments in the top 100 and 400 remained relatively stable over the study period. During this time, the revenue gap between the highest and lowest earning companies and governments in the top 100 increased 206 percent. Only 9% of companies making the top 200 produced traditionally harmful products (tobacco, alcohol, ultra-processed foods and fossil fuels).

Our project develops a new approach for public health surveillance of a crucial commercial determinant of health: the gap between company and government resources. While revenue is an imperfect proxy for power, our study lays the foundation for future research to empirically measure the interface between commercial and political determinants of health.

Background
Community awareness of the link between alcohol consumption and long-term health risks is low. Ready to Drink alcohol products (RTD) are the fastest growing alcohol product category and are popular with young adults who may not realise the long-term risks. Alcohol content labelling and pregnancy warning labels are mandated in Australia and some nutrition information and health claims are permitted but not mandated. Understanding current labelling practises and claims made on RTDs compared to regulatory requirements can enable advocacy for effective health policies that reduce alcohol harm.
Aim
The study aims to document claims, warning labels, nutrition and alcohol content and other labelling features such as product names and descriptions on RTDs sold in Australia and map them to current alcohol policies.
Methods
We surveyed RTD labels in major liquor retailers in Melbourne and online liquor stores. Product names, alcohol content, product volume, and (when present) nutrition information, claims and warnings were documented. Each of these labelling aspects was mapped against relevant labelling regulation, industry self-regulated policy and policy gaps.
Results
275 RTDs were observed. Of these, 148 products carried at least some nutrition information. Products contained 0.7-2.8 standard drinks per serve. The most common nutrition information labelled was energy-content (kJ/Cal) (n=148, 53.8%). The most common claims were energy-content (n=85, 30.9%), sugar-content (n=77, 28.0%) and natural flavours (n=68, 24.7%). 142 RTDs (51.6%) carried a Nutrition Information Panel. Regarding mandated labelling requirements, 275 (100%) RTDs had alcohol content labelled and 252 (91.6%) RTDs carried the pregnancy warning label.
Conclusions
RTDs carry variable but often little information to assist consumers to understand the health impact. Exceptions to this were alcohol content and pregnancy warning labels which are mandated. Many RTDs carry claims about nutrition or other content which may create a health halo. Future policy development should focus on these gaps.

Background: Political power is one of many ways in which commercial actors in Australia may shape public policy to their own benefit, sometimes to the detriment of public health. The commercial determinants of health (CDoH) is a field of public health practice concerned with the myriad ways in which large corporate actors and commercial entities may negatively impact public health in favour of raising profits and pleasing shareholders. To date, little CDoH research in Australia has analysed the pharmaceutical industry’s political power despite the industry being worth $11.1 billion in 2023.
Methods: Political contributions data was collected from the Australian Electoral Commission’s (AEC) Transparency Register. Pharmaceutical industry actors of interest were Medicines Australia and Medicines Australia’s Class 1 members as of 2024. 27 actors were included in total. The AEC requires data be recorded by both donors and recipients. Data for the Liberal Party of Australia, the Australian Labor Party, and relevant pharmaceutical industry actors was analysed to provide descriptive statistics.
Results: Many pharmaceutical industry actors, including Medicines Australia, regularly financially contribute to both major federal political parties in Australia. Over seven million Australian dollars (adjusted for inflation) in pharmaceutical industry contributions were reported over the 10-year period. Overall contributions increased 152% since 2013, with Medicines Australia being the highest contributor of the 27 included. No contributions of interest were categorised as ‘donations’, most were listed as ‘other’ with some listed as ‘subscriptions’.
Conclusions: Scrutiny of political practices, including political contributions can illustrate how political power is used by large commercial entities. The outcomes of using this power will not always be in the public interest. Understanding the political power available to the pharmaceutical industry in Australia is integral to knowing how this power is used. More transparency in Australia around political contributions would contribute to better democratic processes.

Background: Public health services including hospital management and clinical research have been intricately at the mercy of commerce, economy, and trade. Perhaps, what may be in the subconscious is how the financial valuations in terms of costing factors underpin unconscious bias during individual management’s decision making.
Objective: This presentation illustrates finance of clinical pathology-based public health research with a view to contribute to the discourse on strategy for improving cardiovascular research.
Method: A quotation for pathology tests was requested from a private pathology. Based on the quotation, the cost of running a pathology evidence-base cardiovascular medicine project including one higher degree research (HDR) student as personnel was determined. The determination is then related to the common emphasis and preference of research grant in academia.
Results: Medicare full-paying pathology costs indicated AU$16.95 for full blood count, AU$17.70 for liver function test, AU$11.65 for lipid profile, 56.55 for platelet function and AU$35.50 for coagulation screening; giving a total of AU$138.35. Quotation from private pathology for the same tests totalled AU$256.75, which is the actual cost for the pathology tests in a cardiovascular medicine research data collection. In consideration of one personnel for the project, five options include a clinical research assistant AU$75,000.00, research officer AU$92,500.00, postdoc fellow AU$108,677.00, PhD student stipend AU$41,000.00, or online HDR student without stipend AU$0.00. These data and personnel costs illustrate financial burden that could be cut-off by research-in-kind support plus online HDR candidate.
Conclusion: This report highlights opportunity for research of public health interest in the academic arena. Three of the ongoing strategies being suggested for sustainability of cardiovascular health research is diversification of funding sources, change from competitive to collaborative culture, and reduced dependence on government funding. This is because one of the threats to cardiovascular research is decline in fiscal funding. The report explicates why academic researcher with research-in-kind support plus online HDR candidate should be encouraged. Appropriate valuation of research-in-kind support relative to fiscal cash grant needs a new lens, especially in academia where regulations and reviewers may, albeit with unconscious bias, dismiss strategic opportunities.

Over the centuries, the structure of international trade governance has evolved significantly, reflecting changes in global dynamics, economic priorities, and emerging challenges. This study underscores the importance of examining the evolution of international trade structures at the global level and within Thailand. Initially, the transition towards multilateral organizations like the establishment of the GATT/WTO signified a shift towards more regulated trade governance. From the 1950s to the early 21st century, there was a proliferation of multilateral agreements and regional trade agreements covering an expanding range of countries and issues beyond WTO rules.
In Thailand, trade governance evolved from colonial-era agreements aimed at preserving sovereignty to post-World War II initiatives focused on economic development through market liberalization and investment protection. Looking ahead, international trade governance is expected to prioritize topical issues such as digital trade and climate change. Multilateral agreements will increase focus on cooperation among countries with common interests. The role of technology in facilitating trade and decentralizing trade relations is also anticipated to grow, reflecting a shift from extreme globalization to poly-globalization.
The results suggest that in order to adjust to new world orders, health sector actors as part of international trade governance should monitor changes related to trade regulations or negotiations to gain a clear understanding of the connection between trade and health. Collaboration across sectors, evidence-based decision-making in international negotiations, and addressing the impact of globalization, deglobalization, digitalization, and entrepreneurship in the short and long term are essential.