Corporate strategies such as lobbying, self-regulation, and public-private partnerships can lead to increased production and consumption of unhealthy foods and enable associated environmental degradation. These strategies are increasingly being scrutinised by public health researchers, but their integration into policy is unknown.
Our study is determining to extent to which Australian food-related policies address commercial determinants of health. We reviewed over 150 federal and state food-related policies in agriculture, environment, food processing, manufacturing and marketing sectors. Key themes were coded according to a pre-defined coding framework which identified instances where the government acknowledged the impacts of the social and commercial determinants of health and the environment, as well as examples of government policy appearing to endorse commercial strategies that may be adverse to health.
Our preliminary findings indicate that Australian food policies rarely consider the negative impacts of the commercial activities on health and the environment. Rather, Australian food-related policies may even act to enable and legitimise corporate strategies which are likely to impact both human health and environmental sustainability negatively. Examples include encouraging industry involvement in policy creation processes, endorsing self-regulation, creating and supporting public-private partnerships, enabling the corporate capture of science through co-financed research funding and promoting (and thus legitimising) corporate-social-responsibility activities. We have also identified policy silences where there is a lack of engagement with important issues, such as protecting human health and mitigating climate change. Furthermore, we find instances of the hollowing-out of the public sector, for example where regulatory enforcement is tendered out to non-government organisations.
Our research highlights the need for robust and independent food-related policies in Australia to mitigate the negative impacts of corporate influence on population health and environmental sustainability and contribute to challenging rather than encouraging what has come to be seen as the corporate playbook for protection of their interests.

Harmful commercial products are ubiquitous in the environments where young people live, work, play and study. This project explored the opportunity of enlisting young people as allies in responding to the influence of the commercial determinants of health. A codesign approach was adopted to develop social media content to be used as part of a health promotion campaign addressing e-cigarette use on an Australian university campus.

Survey data was collected from 237 students confirming strong anti-e-cigarette industry sentiment, concern about the environmental impact of e-cigarette disposal and the health impacts of e-cigarette use. Based on these three themes, social media messages were codesigned with a group of six students.

Nine draft social media advertisements were selected for testing (three from each theme). Seventeen students, not involved in the design process, attended individual qualitative interviews to review and comment on the draft advertisements. The purpose was to determine which content was most engaging and likely to change attitudes toward e-cigarette use. Messages which focused on concern about the impact of e-cigarette use on the environment and e-cigarette industry practices were found to be the most engaging. Students stated they were already aware of the health concerns of e-cigarette use so thought these messages were least engaging.

The evidence from this project indicates the concern that young people have for the influence of harmful products such as e-cigarettes on the environment and broader concerns about the practices of commercial actors. The project reveals the opportunities to move beyond traditional health impact messages when aiming to influence attitudes toward harmful commercial products. It also highlights the importance of including young people in the development of messaging for that target audience. This grassroots action allows young people to regain some control of the messaging around the products which determine their health.

Background
Today’s youth and future generations will inherit the increasingly harmful and complex health outcomes of the climate crisis, yet they have limited power to influence decisions made about key structural drivers.

Methods
In-depth interviews and photo elicitation techniques were used to explore how n=28 children in Australia (aged 12-16) view the impacts of the climate crisis on their futures, and strategies and mechanisms to engage them in decisions about the commercial and political determinants. A reflexive approach to thematic analysis was used to construct themes.

Results
Children described the injustice of not having contributed to the harmful practices and decisions which created the climate crisis yet being burdened with the outcomes, including to their health and wellbeing. They discussed how their age both presents a structural barrier to influencing climate decisions, and negatively influences public and government opinions about youth engagement capabilities. Finally, they explored strategies and mechanisms to engage them and embed their influence in climate decisions, including via traditional advocacy approaches and social media, partnering with climate and youth organisations, and youth representation in decision-making.

Conclusions
Failing to involve children (and the wider population of youth) in decisions about the key structural determinants of the climate crisis infringes on youth rights to participate in decisions that impact their futures. There is a need for stakeholders (including researchers, practitioners, educators, climate and youth organisations, governments and various other institutions) to actively outreach to and collaborate with youth to develop strategies and mechanisms to engage them and embed their influence in climate decisions about structural, on both local and global levels. Furthermore, the public health community must do better to actively include youth and platform them in public health discussions about the climate crisis.

Changes to food systems are necessary to address the global syndemic of obesity, undernutrition and climate change. Food procurement policies offer an opportunity to address issues at higher levels of the food system, targeting the supply chain and food environments collectively through government leadership. While governments have created sustainability guidelines and nutrition standards to support healthy food procurement, the mechanisms by which these policies are implemented in individual contracting decisions is not clear. This study seeks to understand the political economy of such contracting, the interests that stakeholders bring to their decision making and the power they yield in this process. A political economy analysis methodology is used to examine implementation barriers and enablers, focusing on structural and contextual factors, stakeholders, bargaining processes, incentives and ideas. Food procurement in government operated hospitals and schools within Queensland and South Australia are the focus of this research. Key informant interviews were conducted with a range of government stakeholders and contracted providers (n=22). Several political economy factors influence the strategic use of procurement contracts. These include competing priorities, partnerships and networks, decentralisation, resourcing, monitoring and accountability, authorising environment, negotiations, buying power, broader market drivers, corporate activity and staying ahead of competitors, commitment and reliability, and trade-offs. While not standardised in practice there was support for the use of contracts to support policy implementation. The approach was working well in some areas, largely hospitals, where it is bringing attention to the policy among sites and suppliers, providing accountability, placing responsibility on suppliers and improving the availability of healthy and sustainable products. There are increased opportunities for smaller, local suppliers to enter the market, facilitated by changes in procurement policy to support and prioritise local businesses. However, there are improvements to be made and benefits are yet to be realised across schools.

Asthma is one of the most prevalent chronic diseases in Australia, affecting quality of life, limiting productivity, and placing a significant burden on the healthcare system and taxpayer. The continuation of car-centric urban design along with divergent policy pathways related to fuel standards, vehicle regulations and freight transport play a significant role in asthma incidence and prevalence in Australia, particularly in children.
Using the empirical focus of reducing children’s exposure to traffic pollution, this research aims to explore the role played by health experts in addressing research-policy gaps for ‘wicked’ policy decisions where public health is weighed against competing political interests.
Quantitative methods are used to explore childhood asthma risks related to two policies decisions. 1) The state planning approval for a major Victorian road project and 2). the state and local government process for siting childcare centres and schools.
Qualitative methods of document analysis and semi-structured interviews are used to construct a case study that explores the interplay of public health evidence and expertise with politics, competing economic interests, and community activism in Melbourne’s inner west.
The case study provides one of the first pieces of empirical evidence related to the science-policy interface of a contested environmental health issue in Australia. The evidence produced provides valuable lessons for scientists and health experts seeking to influence policies for the betterment of public health and environment. It is hoped it will contribute towards practical guidelines that help balance advocacy, policy influence and evidence-based expertise.

The true extent of Australia’s illicit tobacco market is largely unknown, namely due to difficulties in estimating the size of illicit markets and monitoring products that are otherwise legally available (Puljević et al., 2024). These uncertainties undermine efforts to neutralise a widening tobacco tax gap (ATO, 2022), rising consumption of harmful, unregulated products (AIHW, 2024), and illicit-tobacco-related crimes. This paper seeks to theoretically bridge these gaps and offer a pragmatic policy framework that compromises between Australia's public health priorities and fiscal objectives.

The paper is comprised of three main sections. Firstly, we canvas the ‘moral economy’ of Australian illicit tobacco trade; an alternative economic system within which purchasing illicit tobacco is 'ecologically rational' due to suboptimal law enforcement and informal rules of exchange that predominate interactions across formal-informal tobacco marketplaces. Secondly, we develop a behavioural economic model of crime simulating these factors in order to evidence their effects on consumers' decision-making under uncertainty. Lastly, we extend these findings to public health governance, proposing a pragmatic approach to government spending on deterrence that balances public health priorities with economic considerations.

Australian Institute of Health & Welfare. (2024). National drug strategy household survey 2022-2023. https://www.aihw.gov.au/about-our-data/our-data-collections/national-drug-strategy-household-survey/2022-ndshs

Australian Taxation Office. (2022). Latest estimate and findings. https://www.ato.gov.au/about-ato/research-and-statistics/in-detail/tax-gap/tobacco-tax-gap/latest-estimates-and-findings

Puljević, C., King, M., Meciar, I., & Gartner, C. (2024). Smoking out Australia's growing illicit tobacco market: Current trends and future challenges. International Journal of Drug Policy, 127, 104424. https://doi.org/https://doi.org/10.1016/j.drugpo.2024.104424

Alcohol control is a commercial and political determinant of preconception health. Alcohol control is needed to prevent neurodevelopmental disabilities such as Fetal Alcohol Spectrum Disorder (FASD), which results from the consumption of alcohol during pregnancy. FASD has lifelong impacts, including cognitive and behavioural problems, mental health problems and substance misuse.

In Australia, it is likely that many young people who enter the justice system have undiagnosed FASD. Research at Western Australia's Banksia Hill youth detention centre found that of 99 young people aged 13 to 17 years, 36% had a diagnosis of FASD, and 89% had at least one domain of severe neurodevelopmental impairment.

Economic analyses confirm that FASD is expensive to society involving health, education, disability, and justice sectors. Of great concern is the over-representation of Indigenous young people involved with youth justice systems in Australia, including Indigenous young people with cognitive impairment.

Accountability and action are needed. The Australian FASD Indigenous Framework guides Indigenous and non-Indigenous peoples' journey together to heal the harms from colonisation, which has laid the foundations for FASD in Indigenous communities.

First, a proactive commitment is needed to the primary prevention of alcohol harm in pregnancy, including legislated restrictions on the advertising and promotion of alcohol, appropriate taxation and pricing, and limited access to alcohol through restricted liquor outlets and opening hours and community-initiated alcohol restrictions.

Second, early diagnosis of FASD and better support for children and young people with FASD and their families are needed.

Third, we must consider new ways to respond to youth crime, such as justice reinvestment models, which shift costs and services into the community. Rehabilitation and diversionary programs provide alternatives to incarceration, are evidence-based, have better outcomes, are far cheaper than prison, and are preferable for children, including children with disability.

Avoidable risk factors, such as unhealthy diets, cost Australians $24 billion/year in healthcare costs 1. More evidence demonstrating the health and economic cost benefits of early action on preventive risk factors is required to demonstrate the diseases averted, cost savings and value for public money. To highlight the impact for prevention, WPHU (Western Public Health Unit) applied the Deakin University ACE health economics modelling tool 2 to their local population to identify the cost savings associated with promoting optimal diet in early childhood (children aged to 2 years).

Modelling suggests that sustained dietary changes could result in significant health benefits and healthcare cost-savings from cases of chronic disease avoided. For instance, reducing the consumption of one serve of sweet biscuits/day could result in healthcare cost-savings of $419M, and 14,620 cases of diabetes averted over the lifetime. Increasing vegetable consumption by 1 serve/day could result in $182M in healthcare cost-savings if sustained over the lifetime, and 10,086 cases of ischaemic heart disease averted.

This data provided strong justification for the implementation of INFANT (INfant Feeding, Active play, and NutriTion), an evidence-based program for parents demonstrating significant long-term benefits in large-scale trials3.

WPHU is spotlighting the power of economic health modelling by delivering freely accessible webinars.

With healthcare costs expected to grow in the future, it is critical for public health to use the powerful tool of economic modelling to communicate the value of prevention work.

References

1. Australian Institute of Health and Welfare. (2022). Health system spending per case of disease and for certain risk factors. Retrieved from https://shorturl.at/bfRpC

2. Ananthapavan, J., et al. (2020). Priority-setting for obesity prevention—The Assessing Cost-Effectiveness of obesity prevention policies in Australia (ACE-Obesity Policy) study. PLoS One, 15(6).

3. Australian Institute of Family Studies. (2024). INFANT (INfant Feeding Active play and NuTrition). Retrieved from https://shorturl.at/c2NDO

Breastfeeding plays a crucial role in infant growth during the early stages of development. Data indicates that 47.5% of infants in Indonesia are not exclusively breastfed within the first six months. By the age of two months, one in four breastfed infants also receives breast milk substitutes, commonly commercial milk formula (CMF). This shift is primarily attributed to unethical marketing and advertising practices surrounding CMF. The marketing process involves health professional organizations and the Ministry of Health of the Republic of Indonesia through public-private partnerships. Additionally, corporate social responsibility serves as a direct cross-promotion avenue to the public. This issue is further complicated by the lack of strict regulation of CMF sales by the Indonesian government, despite acknowledging "The WHO Code" on breastmilk substitutes marketing. Exposure to CMF marketing influences societal norms regarding breastfeeding, undermines mothers' confidence and perceived ability to breastfeed, and shapes perceptions of the safety and benefits of breast milk substitutes. In 2023, CMF sales in Indonesia reached USD 2.308 billion, making it the largest industry of its kind in Southeast Asia. To address this issue, laws pertaining to CMF marketing and advertising must be rigorously enforced, particularly to prevent unethical collaborations between healthcare professionals and the CMF industry, other relevant governmental institutions such as community health centers, private health clinics, hospitals, and the Ministry of Health. Furthermore, the sales of formula milk should be restricted from retail markets to limit accessibility to the public.

Keywords: Breastfeeding; Breast Milk Substitutes; Marketing Practices; Regulation

Reference :
Euromonitor. (2023, September). Milk Formula in Indonesia. Passport Euromonitor.

Green, M., Pries, A. M., Hadihardjono, D. N., Izwardy, D., Zehner, E., & Moran, V. H. (2021, March 12). Breastfeeding and breastmilk substitute use and feeding motivations among mothers in Bandung City, Indonesia. Maternal & Child Nutrition, 17, 1-13.

WHO. (2023, August 1). Mothers need more support amid decline in Indonesia's breastfeeding rates. World Health Organization (WHO).

Wood, B., O’Sullivan, D., Baker, P., Ulep, V., & McCoy, D. (2022, October). Who benefits from undermining breastfeeding? Exploring the global commercial milk formula industry’s generation and distribution of wealth and income. UNU-IIGH Research Reports.

Recent research into the commercial determinants of health has focused on the diverse strategies unhealthy commodity industries (such as tobacco, alcohol and gambling) use in influencing policymakers, but the mechanism by which they achieve such influence is unclear. A common assumption is that industry actors invest in accessing political actors for the purpose of exposing them to their ideas and framings; let’s call this ‘framing exposure theory’. However, their time with politicians could be for other purposes. An alternative approach involves seeing the contact as primarily aimed at forming and consolidating comfortable, no-pressure and mutually valued relationships with political actors; let’s call this ‘collegial friendship theory’. This presentation will put forward the advantages of collegial friendship over framing exposure theory. It will back this up with extracts from interviews from three studies with current and former MPs in Aotearoa NZ. It will also explore its implications for public health advocacy.

The Control of Marketing Promotion of Infant and Young Child Food Act B.E. 2560 (the Act) has been implemented in Thailand since 2017. However, the Department of Health (DOH), the Ministry of Public Health advocated for three years, between 2014 and 2017.
During the policy formulation, particularly, in the legislative process, DOH faced corporate political activities (CPA) from baby food companies. We can categorize the CPA into two groups. First, 'information and messaging' such as the baby food companies met policymakers to give evidence or provide beneficial information to companies. Second, 'constituency building', for example, the baby food industry cultivated contacts with policymakers to gain access to working groups, technical groups, and advisory groups to consider and review drafts of the Act.
DOH coped with the CPA during legislation by gaining awareness among health professionals about CPA and providing accurate information about the Act to relevant organizations and policymakers to build an understanding of the Act, as the CPA caused relevant people to misunderstand and be concerned about the Act. Furthermore, DOH had a technical team to generate evidence and information documents, such as the purpose and advantages of the Act, and distributed them to the interested public and legislators. The team also prepared educational or technical materials to clarify controversial issues about the Act. Moreover, relevant officials refused the informal meeting with the baby food companies to avoid lobbying and conflicts of interest.
However, the CPA weakened some provisions of the original draft of the Act, which was developed based on the International Code of Marketing of Breastmilk Substitutes. For instance, the Act does not regulate growing-up milk (powdered milk for children aged one year onwards). Also, the companies are able to support health professional associations to conduct conferences and meetings.

This research explores the mediating role of international trade in the relationship between fiscal decentralization and environmental pollution. Initially, we establish hypotheses within a conceptual framework build upon a theoretical context. We then conduct empirical research using panel data covering 170 Chinese mainland cities from 2003 to 2021. We do so by applying the OLS estimation to perform our baseline model then we run the causal mediation analysis to estimate the direct and indirect effect of fiscal decentralization on environmental pollution across Chinese cities. The results demonstrate that fiscal decentralization increases environmental pollution across Chinese’s cities, and international trade has partially mediated between fiscal decentralization and environmental pollution. Our results suggest that policymakers should consider implementing measures to mitigate the negative environmental impacts of fiscal decentralization and international trade, including environmental regulations, promoting eco-friendly production practices, and encouraging sustainable trade practices. The robustness of the results is confirmed through the application of various methodologies. A further investigation of the heterogeneous effect of fiscal decentralization on environmental pollution has also been conducted.