Health is shaped by many sectors beyond the healthcare system, and through a complex web of policies and programs that are formulated, influenced, and implemented by the state, the private sector, and civil society. In the face of rising social and health inequities it is necessary to analyse and critique the ideas and power dynamics that exist within public policy, to offer alternatives that may be favourable for equity.

This research critiques Australia’s federal agricultural policy, Ag2030, through a novel conceptual framework that establishes connections between power, privilege, public policy, structural outcomes, and socioeconomic advantage. We applied a systems lens to policy analysis, questioning the ways in which ideas about identity, and resource value (e.g., human labour and knowledge, nature, infrastructure) and control are constructed in Ag2030. We also analysed the mechanisms – the rules for accumulation and distribution – within the policy that maintain and/or disrupt privilege.

Ag2030 establishes a narrative of the Federal Government being a crucial actor in enabling the agricultural ‘industry’ to achieve a “clear growth agenda” (target of $100 billion farmgate output by 2030). ‘Regional and rural communities’ are seen as beneficiaries by way of job creation, disaster relief, and increased access to workers. Overwhelming priority is placed on trade, exports, and establishing and consolidating international markets, with negligible mention of domestic food security. Technology and innovation are presented as vital to facilitating this market expansion, with less focus on mechanisms to enhance human capital. Environmental stewardship is commodified through nature markets that incentivise farmers to conduct land management practices in return for a new income stream alongside the production of food.

Through this analysis, we demonstrate that Australia’s agricultural policy carries a dominant economic growth framing, while neglecting alternative framings and issues such as human rights, food sovereignty, and social and health equity.

As the most pervasive and lethal epidemiological calamity since the 1918-19 Spanish Influenza outbreak, the COVID-19 pandemic represented a crisis in public health. It also exemplified a crisis of public health: exposing how pervasive neoliberal restructuring over previous decades increased the likelihood of illness and death and, ultimately, intensified the scope of the pandemic. Yet, notwithstanding early disquiet, such upheaval has not engendered widespread questioning of neoliberal ideology or its institutional codification. Rather, public health responses to this interregnum have largely adopted a post-political orientation. Marked by depoliticised, biomedical and/or lifestyles-based formulations of ‘health’ – evacuating from debate the structural antagonisms of capitalism that produce deleterious health outcomes – this inclination promotes techno-managerial solutions designed to better govern individuals within the political economic status quo. By naturalising the latter, it also forecloses its contestation and formulation of a broader, transformative public health politics.

This paper contends that, when analysing COVID-19 and discerning policy lessons for future outbreaks, proliferating public health interventions informed by behavioural economics (BE) have buttressed this post-political thrust. Specifically, the paper utilises conceptual insights from critical political economy to demonstrate how BE functions ideologically in this manner: disavowing how extant neoliberal policies and capitalist socio-ecological antagonisms contributed to globalising COVID-19, and further destabilised population health during its dissemination. Instead, unfavourable health outcomes are rendered as contingent phenomena arising from ‘irrational’ individual socio-economic behaviour, while their endemic structural determinants remain uncontested. Hence, rather than proffering radically different public health responses to tackle future outbreaks, poor health is rendered corrigible via technocratic policy ‘nudges’ incentivising ‘rational’ individual behaviour within the status quo. The paper concludes that the experience of COVID-19 exhibits the need for a more capacious public health politics: disputing the structural causes and symptoms pandemic events, and grounded in re-politicised conceptions of the political economy of health.

The purpose of this presentation is to review the political analysis and strategic orientation of the global People’s Health Movement (PHM) in relation to the impact on global health of the prevailing regime of global economic governance.
Many public health people in Australia are unfamiliar with the political analysis and strategic directions of PHM. As a consequence of this presentation, participants will have a broader library of resources to draw upon in making sense of the global health and considering how best to engage.
The global People’s Health Movement was founded at the first People’s Health Assembly in Bangladesh in December 2000, held as a deliberate response to the broken promise of ‘Health for All by the Year 2000’ (1977). The People’s Charter for Health, adopted at that Assembly, continues to provide inspiration and guidance for PHM.
PHM recognises critical links between the global health crisis and the workings of capitalism and imperialism. These links include deepening economic inequality, fiscal crisis, global gender disparities, extreme intellectual property rights, privatisation, ecological degradation, industrial food systems, and war and conflict.
These links are facets of an integrated global regime of economic governance. Capitalism, imperialism, patriarchy and coloniality are key theoretical frameworks for understanding how this regime reproduces global health inequalities (and drives ongoing ecological degradation).
Exploring possible scenarios of global change (from the dystopic ‘business as usual’ to more hopeful scenarios), can assist in moving from analysis to action as well as identifying the emergent dynamics which could determine the real-world outcomes.
This scenarios-of-change analysis points to forms of action – cultural, political, professional – which might provide leverage over our forthcoming history, and help shift our present trajectory towards a more equitable and convivial civilisation and a more harmonious relationship between humanity and Mother Earth.

Commercial determinants of health describe the ways in which the activities of commercial players impact on population health. This paper describes one of the pathways by which this happens by exploring the impact of alienation on people’s health, especially mental health. Alienation is part of Marx’s theory of class and was used to explain the ways in which the modes of production under capitalism impact health.
The paper will report on ongoing research on the applicability of the concept of alienation to twenty-first century Australia and its ability to explain the growing health inequities that have evolved in the last three decades (PHIDU, 2022). Our research has included a narrative literature review on the ways in which alienation impacts on health, data from a series of studies on employment and the ways in which it might generate alienation, and new research on the impact of patterns of contemporary consumption on alienation.
Our narrative literature review is highlighting the ways in which public health researchers have used the concept of alienation and indicated it has primarily been used in relation to processes of production. Our studies on aspects of employment: informal and gig work, suicide and employment, and university employment experiences indicate the pathways by which employment creates alienation. We will also report on our emerging insights on how excessive consumption fuels alienation and impacts mental health.
Our conclusions are that alienation is a vital concept in understanding the roots of rising rates of mental illness, ongoing high rates of suicide and the consequent rise in health inequities. Examining the pathways between commercial determinants, alienation and health provide indicators about the policy solutions required to reduce health inequities in Australia.

References
Public Health Information Development Unit. Social Health Atlas of Australia: Inequality Graphs: Time Series. 2022 Adelaide: Torrens University Australia; 2022

Competition regulation plays a key role in determining which firms can build market power, and what firms can do with such power. Accordingly, competition regulation has the potential to complement industry-specific measures designed to address the rising global burden of death and disease associated with harmful consumer product industries (i.e., ‘industrial epidemics’), at least to the extent these are driven and reinforced by excessive market power. Nevertheless, in this presentation, we contend that, in recent decades, competition regulation has likely facilitated the rise of ‘industrial epidemics’ insofar as it has mostly tolerated rising market power in such industries. To start with, we highlight how the goal of competition policy around the world has been increasingly shaped by a neoliberal discourse that has shifted the focus of competition regulation onto a narrow set of economic concerns (i.e., ‘consumer welfare’ in neoclassical terms), outlining how this shift has in some ways legitimised rising market power. Following this, we present findings of our own work involving the analysis of assessments and decisions made by a selection of competition authorities across three key harmful consumer product industries (tobacco, alcohol, and soft drinks). In general, the findings support the argument that competition regulation has indeed likely facilitated the rise of ‘industrial epidemics’ to some degree. Still, we shed light on important examples of historical and contemporary alternatives to the neoliberal form of competition regulation that could work more synergistically with public health policies targeting harmful consumer product industries. These include the reinvigoration of merger regulation, and the incorporation of sustainability and public interest objectives into competition regulatory frameworks more broadly. Given the influence of competition regulation on the public’s health, we argue that it is critical for public health researchers and advocates to actively engage in, and ideally seek to shape, such discussions and reforms.

A relatively small number of for-profit asset managers – financial intermediaries that invest capital on behalf of other investors – have emerged in recent decades to become some of the most influential commercial actors in the global political economy. Despite their important role in society, asset managers have received surprisingly little attention from a public health perspective. In this presentation, we present a novel conceptual framework of key pathways and mechanisms through which asset managers may influence health and equity. Regarding asset class-specific pathways, we outline how asset manager investments in publicly listed corporate equity and private equity can drive and reinforce ‘shareholder primacy’, often to the detriment of public health outcomes. In addition, we describe important ways by which asset manager investments in so-called ‘real assets’ (e.g., housing, hospitals, farmland) and essential commodities can drive ill-health and inequity. Regarding more generalised pathways, we examine ways in which the large and highly concentrated asset management sector can drive economic inequities, influence policy and political decision-making, and shape the global ‘development’ agenda, in turn raising crucial questions about power and accountability in the global political economy. We argue that measures that challenge so-called ‘asset manager capitalism’ constitute a core component of efforts seeking to address the commercial determinants of ill-health and inequity. Such measures include those that seek to increase and protect the public ownership of companies and assets in essential sectors; leverage the power of pension funds to challenge investor short-termism; regulate private investment funds in the public interest; challenge corporate governance oriented towards maximising short-term shareholder value; and, more broadly, strengthen efforts to challenge the various aspects of neoliberalism and neocolonialism.

Marketing has powerfully driven the displacement of breastfeeding at levels well beyond basic human need, with implications for the health of women as well as children. Baby food corporations significantly impact infant feeding practices, creating an environment favouring early weaning and sales of commercial milk formula (CMF). The 2023 Lancet Series on Breastfeeding highlights the dynamics. This presentation describes the political economy of infant and young child feeding, with a focus on how gendered power systems exploit policy gaps to shape women’s breastfeeding decisions.¹
The marketing strategies of CMF corporations exploit parental anxieties and pathologize normal infant behaviours to promote sales. Structural factors and policy gaps also play a role. Economic institutions and fiscal policies often favor the formula industry, and breastfeeding remains under-recognized in food policy discussions. Addressing gender biases in statistical systems could make the economic gains from breastfeeding more visible and prioritize its protection in trade decisions. The time-consuming nature of infant care, particularly exclusive breastfeeding for 6 months, is another factor. The International Labor Organization’s Maternity Protection Convention sets standards for paid leave and breastfeeding breaks, but over half a billion women lack such protections. Fiscal policies should prioritize income security, quality childcare, and women-centered maternity care free from commercial influence.
Currently, trade and commerce often trump women’s and children’s rights on infant and young child feeding.
This presentation calls for transformational change to these gendered power systems. Key recommendations from the 2023 Lancet Breastfeeding Series will be presented.

Baker P, Smith JP, Garde A, Grummer-Strawn LM, Wood B, Sen G, Hastings G, Perez-Escamilla R, Ling CY, Rollins N, McCoy D, Lancet Breastfeeding Series G. The political economy of infant and young child feeding: confronting corporate power, overcoming structural barriers, and accelerating progress. Lancet. 2023 Feb 11;401(10375):503-524.

Current socio-political and economic systems are driving intersecting crises due to climate change, social inequities, and health inequities. Existing economic and social inequities are compounded as climate change impacts are inequitably distributed between and within countries, undermining planetary health equity, defined as the equitable enjoyment of good health in a stable Earth system. This study examines the extent and nature of planetary health equity considerations within national governments’ Nationally Determined Contribution reports (NDCs) to the UNFCCC, key objects of governance and international cooperation for climate action.

Using quantitative content analysis and qualitative thematic analysis, we examine discussion within NDCs of social determinants of planetary health equity that mediate impacts of climatic changes and socio-economic inequalities on human health. Inferential analyses also provide insight into country variation by level of democracy and CO2 emissions, illuminating geopolitical tensions in countries’ responsibilities and commitments to mitigate climate change.

NDCs include relatively greater discussion of economic issues compared to health outcome and social determinants-related content. Among high-income countries, we found moderate positive associations between levels of CO2 emissions and more frequent use of economic terms, and a negative association of economic language with levels of democracy. Democracy was also positively associated with discussion of equity and justice norms, indicating potential for progressive climate action through democratic pressures.

The relative frequency of economic frames in NDCs suggests that there is a need to reorient policy attention toward the inequitable impacts of climate change for development and health, relative to the existing focus on short-term economic impacts. We identify enabling and constraining factors for progressive climate change policymaking, providing critical insights for inter-governmental cooperation, mobilisation of national political will for regulating climate-warming emissions as a public health intervention, and advocacy to support these processes.

This study examines the political economy surrounding access to COVID-19 vaccines across Southeast Asian countries, emphasising the institutional, ideational, and actor interests at play across trade and health sectors during the COVID-19 pandemic. Using a scoping review of existing literature, the study maps the levels of vaccine access in countries across the region at critical COVID-19 pandemic junctures and delves into the types of vaccines acquired by each nation within the Southeast Asia region, offering insights into the discrepancies in vaccine availability. This review will help delineate universal barriers to vaccine access shared among all Southeast Asian countries, as well as those specific to the region. Through interviews with key interviewees, including former and current policymakers, experts, diplomats, business actors, and civil society in Indonesia, Thailand, and Cambodia, the study aims to identify regional challenges and country-specific barriers to vaccine access in the context of international trade and health policy. By elucidating these complexities, the research aims to contribute to health equity in the global south, particularly Southeast Asia, and shed light on the dynamics of equitable vaccine access.

This research explores the relationship between financialisaton, finance systems, and public health outcomes in Australia by examining opportunities and threats. It explores how financial policies may influence health equity, and access to healthcare, with the aim to examine these dynamics in an attempt to strengthen policy coherence and promote equitable health outcomes within the socio-economic landscape, disruptive global economic trends and the rising cost of living. It also highlights these policies in shaping healthcare affordability, emphasising targeted interventions to improve health outcomes amidst economic challenges. Financialisaton which is the growing dominance of financial motives and financial institutions¹, presents profound implications for health outcomes. Australia is vested into global financial markets and experiences both opportunities and challenges from financialisaton. While financial innovations can propel economic growth and health sector investment, prioritising short-term financial gains may undercut long-term health goals, exacerbating inequities and weakening health system resilience². Research shows that health financial resources are proportional to health status³. Hence, efforts are needed to support vulnerable population groups with financial resources, favouring equity over efficiency. This can be most effective with grassroots approaches and interventions through data-driven policy and systems change as evidenced by global studies, particularly in minority and rural/ remote communities⁴. This presentation will examine how financialisaton can be leveraged to further improve equitable health outcomes by analysing evidence on the impact of financial policies on health financing, access to healthcare services, and health equity. Key areas are health financing, assessing how financialisaton affects funding for public health initiatives, examining the healthcare accessibility amidst financialisaton trends including in marginalised and CALD communities and addressing equity disparities in health outcomes resulting from financialisaton. This presentation seeks to inform policymakers and researchers on addressing current complexities of financial systems and high cost-of-living while safeguarding public health interests in Australia.
¹ (Cordilha, 2022)
² (Kruk et al., 2018)
³ (McMaughan et al., 2020)
⁴ (McMaughan et al., 2020)

The use of large global consultancy firms by businesses and governments is a worldwide phenomenon, and by 2023 it was estimated that the global consultancy market exceeds US $1trillion annually. There is a legitimate, albeit limited, role for engagement with governments. However, negative aspects of their operations include facilitating transnational corporations and other businesses as commercial determinants of health and equity. Global consultancy firms are not usually considered to be important commercial drivers of ill health. Nor are they often understood as powerful actors in their own right. However, things to be learned for the conference theme ‘Commercial and Political Determinants of Health’ will include evidence that they play a major role in promoting neoliberal public policies including privatisation and outsourcing of government services. They are active players in a complex economic-political web involving regulators, the private sector, and professional standards institutions.
Global consultancy firms also contribute to excessive profiteering and wealth extraction by private actors at the expense of the public interest and of public health, and a hollowing out of the capacity of the public sector by undertaking outsourced government roles. These firms are also the architects of tax avoidance schemes for transnational corporations and other clients, with wide-ranging conflicts between private and public interests, but limited accountability mechanisms. Evidence presented to two parliamentary inquiries in Australia will inform final reports which are due for release in mid-2024 and will help to better illuminate aspects of these firms’ operations and related recommendations to government. Outcomes for the conference theme Commercial and Political Determinants of Health include understanding the need for global accountancy firms to face more stringent regulation and to potentially be structurally separated in ways to curtail wide-ranging conflicts of interest and instead promote health and equity.

The rise of ultra-processed foods in human diets raises serious concern for public and planetary health. The problem arises not because of growing demand for such foods alone. It also reflects the globalization and rising power of UPF manufacturers and affiliated industries to shape food systems and dietary outcomes in their interests. This includes the industry’s underlying economic and financial incentive structures, its marketing activities, and its lobbying and other political practices to shape policy, regulation and norms. The problem is not just about ultra-processed foods or diets, but about ultra-processed food systems, and the commercial actors and drivers behind them. What does it mean to organize a global public health response to this challenge? What policy approach, and which political strategies, might the public health community consider to actively counter, and ultimately attenuate, the commercial determinants of ultra-processed diets? Reflecting on a five-year team-based programme of work on this topic, including multi-country workshops and interviews, this presentation outlines a set of ideas for countering the power of the UPF industry in food systems, mobilizing a global public health response, and ultimately – to promote healthy and sustainable food systems. Five main ideas are put forward, including: a) taking a whole of systems and commercial determinants approach to defining this challenge; b) disrupting the industry’s economic power and incentives structures, shifting towards other types of industries and food systems actors; c) safeguarding governance, policy and professional practice from undue influence; and d) mobilizing broad-based coalitions to actively engage political leaders, campaign for change, coupled with robust research and evaluation.