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Article ; Online: The utilisation of legal instruments by United Nations actors to restrict the exposure of children to unhealthy food and beverage marketing

Fiona Sing / Sally Mackay / Margherita Cinà / Boyd Swinburn

Globalization and Health, Vol 19, Iss 1, Pp 1-

a qualitative content analysis of UN instruments

2023 Volume 12

Abstract: Abstract Introduction United Nations (UN) agencies are influential global health actors that can introduce legal instruments to call on Member States to act on pressing issues. This paper examines the deployment and strength of global health law ... ...

Abstract	Abstract Introduction United Nations (UN) agencies are influential global health actors that can introduce legal instruments to call on Member States to act on pressing issues. This paper examines the deployment and strength of global health law instruments used by UN actors to call on Member States to restrict the exposure of children to unhealthy food and beverage marketing. Methods Global health law instruments were identified from a review of four UN agencies that have a mandate over children’s exposure to marketing of unhealthy food and beverage products namely: the World Health Organization (WHO); the Food and Agriculture Organization (FAO); the United Nations General Assembly (UNGA) and the UN Office of the High Commissioner for Human Rights (OHCHR). Data on marketing restrictions were extracted and coded and descriptive qualitative content analysis was used to assess the strength of the instruments. Results A wide range of instruments have been used by the four agencies: seven by the WHO; two by the FAO; three by the UNGA; and eight by the UN human rights infrastructure. The UN human rights instruments used strong, consistent language and called for government regulations to be enacted in a directive manner. In contrast, the language calling for action by the WHO, FAO and UNGA was weaker, inconsistent, did not get stronger over time and varied according to the type of instrument used. Conclusion This study suggests that a child rights-based approach to restricting unhealthy food and beverage marketing to children would be supported by strong human rights legal instruments and would allow for more directive recommendations to Member States than is currently provided by WHO, FAO and UNGA. Strengthening the directives in the instruments to clarify Member States’ obligations using both WHO and child rights mandates would increase the utility of global health law and UN actors’ influence.
Keywords	Global health law ; Marketing ; Child rights ; Global health governance ; Public aspects of medicine ; RA1-1270
Subject code	340
Language	English
Publishing date	2023-06-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Readiness for sugar sweetened beverage taxation in sub-Saharan Africa

Ntombizodwa Ndlovu / Boyd Swinburn

Global Health Action, Vol 14, Iss

2021 Volume 1

Keywords	Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Taylor & Francis Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Barriers and enablers in designing regulations to restrict the exposure of children to unhealthy food and beverage marketing

Fiona Sing / Angela Carriedo / Sally Mackay / Tim Tenbensel / Boyd Swinburn

Frontiers in Political Science, Vol

2023 Volume 5

Abstract: BackgroundThe insidious and pervasive nature of marketing of unhealthy food and beverages has been identified as one of several strategies the unhealthy food and beverage industry uses to exert their influence on population food choices and diet. ... ...

Abstract	BackgroundThe insidious and pervasive nature of marketing of unhealthy food and beverages has been identified as one of several strategies the unhealthy food and beverage industry uses to exert their influence on population food choices and diet. Regulating the food and beverage industry's marketing practices is one mechanism to mitigate this commercial determinant of health. This paper seeks to understand the main barriers and enablers that governments face when attempting to design an appropriate regulatory system.Methods14 semi-structured expert interviews were undertaken with participants across different jurisdictions (Ireland, United Kingdom, Chile, Canada, Norway, Portugal and Brazil) who were involved in introducing marketing restrictions; and a purposive documentary analysis was carried out. A thematic analysis of this data was conducted informed by the Health Policy Triangle.ResultsMultiple common technical and political issues were experienced by governments regarding the form and substance of the policy design regardless of the jurisdictional context. Such issues included: whether to introduce a mandatory approach; what age group to protect; what nutrient classification system to use; how to define “marketing to children”; and what mediums, settings and techniques to cover. The actors opposing regulation challenged the form and substance of each design element. However, having a strong political mandate to introduce regulation; multiple actors working together, including multiple government ministries, academics and civil society actors; and a strong evidence base supporting the policy design helped policymakers navigate the technical and political challenges faced when designing the regulatory approach.ConclusionDespite the different political contexts and actors involved in different jurisdictions internationally, there are many commonalities in the challenges and enabling factors faced by governments. Understanding the technical and political challenges experienced by governments and how these ...
Keywords	marketing and advertising ; child health ; food marketing ; non-communicable disease (NCD) ; regulation ; Political science ; J
Subject code	360 ; 320
Language	English
Publishing date	2023-02-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The healthiness of New Zealand school food environments

Erica D'Souza / Stefanie Vandevijvere / Boyd Swinburn

Australian and New Zealand Journal of Public Health, Vol 46, Iss 3, Pp 325-

a national survey

2022 Volume 331

Abstract: Abstract Objective: To evaluate the healthiness of New Zealand school food environments. Methods: In 2016, primary and secondary schools were invited to complete a cross‐sectional questionnaire. School nutrition policies were analysed using an adapted ... ...

Abstract	Abstract Objective: To evaluate the healthiness of New Zealand school food environments. Methods: In 2016, primary and secondary schools were invited to complete a cross‐sectional questionnaire. School nutrition policies were analysed using an adapted Wellness School Assessment Tool. Canteen menus were analysed using the National Food and Beverage Classification System, and a sample of menus (n=54) were validated using fieldworker observations. Results: In total, 819 schools (response rate 33%) participated. Forty per cent had a nutrition policy, and those analysed (n=145) lacked comprehensiveness and contained weak statements. Seventy‐one per cent sold food and beverages during the school day. The school food service offered mainly unhealthy items. Many schools (81%) used food and beverages for fundraising with 90% of them using ‘less healthy’ items. Most had vegetable gardens (80%), included nutrition education in the curriculum (90%), were not sponsored by food and beverage companies (94%) and did not have commercial advertising on school grounds (97%). Conclusion: New Zealand school nutrition policies are weak, and canteen and fundraising items are largely unhealthy, which undermine other positive efforts. Implications for public health: This study provides evidence of unhealthy school food environments and supports the need for stronger national‐level policy.
Keywords	School food ; food environment ; obesity prevention ; food policy ; Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2022-06-01T00:00:00Z
Publisher	Wiley
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The interface between international trade and investment agreements and food environment policymaking

Kelly Garton / Boyd Swinburn / Anne Marie Thow

Frontiers in Political Science, Vol

A conceptual framework

2022 Volume 4

Abstract: Addressing the global challenge of malnutrition in all its forms will require policy measures to improve food environments, yet progress has been patchy and often slow, particularly for regulatory measures. International trade and investment agreements ( ... ...

Abstract	Addressing the global challenge of malnutrition in all its forms will require policy measures to improve food environments, yet progress has been patchy and often slow, particularly for regulatory measures. International trade and investment agreements (TIAs) may limit governments' “policy space” for public health regulation. Constraints have been particularly apparent for public health measures targeting unhealthy commodities, including ultra-processed foods. Challenges and disputes regarding food environment regulation under TIAs (even if successfully defended) can entail significant drain of human and financial resources, and political capital. Lack of awareness or understanding of the implication of TIAs on policy space for regulation can contribute to regulatory chill and policy inertia. Governments lacking capacity to interpret their “legally available” policy space may want to err on the side of caution when there is perceived risk of a formal dispute—even if such threats are unfounded. This paper draws on analysis of literature, trade and investment dispute documentation, and data from inter-disciplinary expert interviews (n = 22) to present a new conceptual framework for the potential impacts of TIAs on policy space for regulating food environments. The analysis that underpins the framework focusses on the key policy domains of fiscal policies, front-of-pack nutrition labeling, restrictions on marketing to children, nutrient limits, and product bans. Analysis indicates that regulatory context and stakeholder influence, policy design, and mechanisms associated with TIA rules and provisions intersect in ways contributing to policy space outcomes. This new framework can provide a basis for rapidly assessing policy coherence between TIAs and food environment regulations in these domains. It can also be used to identify areas where further legal analysis would strengthen the development and defense of regulatory proposals. The framework may be applied to nutrition regulation more broadly, given the common ...
Keywords	policy space ; food environment interventions ; trade and investment agreements ; political economy ; public health ; Political science ; J
Subject code	360
Language	English
Publishing date	2022-12-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Implementing healthy food environment policies in New Zealand

Sally Mackay / Sarah Gerritsen / Fiona Sing / Stefanie Vandevijvere / Boyd Swinburn

Health Research Policy and Systems, Vol 20, Iss 1, Pp 1-

nine years of inaction

2022 Volume 13

Abstract: Abstract Background The INFORMAS [International Network for Food and Obesity/Non-communicable Diseases (NCDs) Research, Monitoring and Action Support] Healthy Food Environment Policy Index (Food-EPI) was developed to evaluate the degree of implementation ...

Abstract	Abstract Background The INFORMAS [International Network for Food and Obesity/Non-communicable Diseases (NCDs) Research, Monitoring and Action Support] Healthy Food Environment Policy Index (Food-EPI) was developed to evaluate the degree of implementation of widely recommended food environment policies by national governments against international best practice, and has been applied in New Zealand in 2014, 2017 and 2020. This paper outlines the 2020 Food-EPI process and compares policy implementation and recommendations with the 2014 and 2017 Food-EPI. Methods In March–April 2020, a national panel of over 50 public health experts participated in Food-EPI. Experts rated the extent of implementation of 47 “good practice” policy and infrastructure support indicators compared to international best practice, using an extensive evidence document verified by government officials. Experts then proposed and prioritized concrete actions needed to address the critical implementation gaps identified. Progress on policy implementation and recommendations made over the three Food-EPIs was compared. Results In 2020, 60% of the indicators were rated as having “low” or “very little, if any” implementation compared to international benchmarks: less progress than 2017 (47%) and similar to 2014 (61%). Of the nine priority actions proposed in 2014, there was only noticeable action on one (Health Star Ratings). The majority of actions were therefore proposed again in 2017 and 2020. In 2020 the proposed actions were broader, reflecting the need for multisectoral action to improve the food environment, and the need for a mandatory approach in all policy areas. Conclusions There has been little to no progress in the past three terms of government (9 years) on the implementation of policies and infrastructure support for healthy food environments, with implementation overall regressing between 2017 and 2020. The proposed actions in 2020 have reflected a growing movement to locate nutrition within the wider context of planetary health and with recognition of the social determinants of health and nutrition, resulting in recommendations that will require the involvement of many government entities to overcome the existing policy inertia. The increase in food insecurity due to COVID-19 lockdowns may provide the impetus to stimulate action on food polices.
Keywords	Food environments ; Government policy ; Nutrition ; Accountability ; INFORMAS ; Obesity prevention ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: International Trade and Investment Agreements as Barriers to Food Environment Regulation for Public Health Nutrition

Kelly Garton / Anne Marie Thow / Boyd Swinburn

International Journal of Health Policy and Management, Vol 10, Iss Special Issue on Political Economy of Food Systems, Pp 745-

A Realist Review

2021 Volume 765

Abstract: BackgroundAchieving healthy food systems will require regulation across the supply chain; however, binding international economic agreements may be constraining policy space for regulatory intervention in a way that limits uptake of ‘best-practice’ ... ...

Abstract	BackgroundAchieving healthy food systems will require regulation across the supply chain; however, binding international economic agreements may be constraining policy space for regulatory intervention in a way that limits uptake of ‘best-practice’ nutrition policy. A deeper understanding of the mechanisms through which this occurs, and under which conditions, can inform public health engagement with the economic policy sector. MethodsWe conducted a realist review of nutrition, policy and legal literature to identify mechanisms through which international trade and investment agreements (TIAs) constrain policy space for priority food environment regulations to prevent non-communicable diseases (NCDs). Recommended regulations explored include fiscal policies, product bans, nutrition labelling, advertising restrictions, nutrient composition regulations, and procurement policies. The process involved 5 steps: initial conceptual framework development; search for relevant empirical literature; study selection and appraisal; data extraction; analysis and synthesis, and framework revision. ResultsTwenty-six studies and 30 institutional records of formal trade/investment disputes or specific trade concerns (STCs) raised were included. We identified 13 cases in which TIA constraints on nutrition policy space could be observed. Significant constraints on nutrition policy space were documented with respect to fiscal policies, product bans, and labelling policies in 4 middle-income country jurisdictions, via 3 different TIAs. In 7 cases, trade-related concerns were raised but policies were ultimately preserved. Two of the included cases were ongoing at the time of analysis.TIAs constrained policy space through 1) TIA rules and principles (non- discrimination, necessity, international standards, transparency, intellectual property rights, expropriation, and fair and equitable treatment), and 2) interaction with policy design (objectives framed, products/services affected, nutrient thresholds chosen, formats, and time given ...
Keywords	non-communicable diseases (ncds) ; nutrition policy ; international trade ; investment agreements ; policy analysis ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2021-12-01T00:00:00Z
Publisher	Kerman University of Medical Sciences
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Commentary on South Africa’s syndemic of undernutrition, obesity, and climate change

Agnes Erzse / Adam Balusik / Petronell Kruger / Evelyn Thsehla / Boyd Swinburn / Karen Hofman

South African Journal of Science, Vol 119, Iss 3/

2023 Volume 4

Keywords	syndemic ; food environment ; climate change ; nutrition ; Science ; Q ; Science (General) ; Q1-390 ; Social Sciences ; H ; Social sciences (General) ; H1-99
Language	English
Publishing date	2023-03-01T00:00:00Z
Publisher	Academy of Science of South Africa
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Who influences nutrition policy space using international trade and investment agreements? A global stakeholder analysis

Kelly Garton / Boyd Swinburn / Anne Marie Thow

Globalization and Health, Vol 17, Iss 1, Pp 1-

2021 Volume 16

Abstract: Abstract Background Regulation of food environments is needed to address the global challenge of poor nutrition, yet policy inertia has been a problem. A common argument against regulation is potential conflict with binding commitments under ... ...

Abstract	Abstract Background Regulation of food environments is needed to address the global challenge of poor nutrition, yet policy inertia has been a problem. A common argument against regulation is potential conflict with binding commitments under international trade and investment agreements (TIAs). This study aimed to identify which actors and institutions, in different contexts, influence how TIAs are used to constrain policy space for improving food environments, and to describe their core beliefs, interests, resources and strategies, with the objective of informing strategic global action to preserve nutrition policy space. Methods We conducted a global stakeholder analysis applying the Advocacy Coalition Framework, based on existing academic literature and key informant interviews with international experts in trade and investment law and public health nutrition policy. Results We identified 12 types of actors who influence policy space in the food environment policy subsystem, relevant to TIAs. These actors hold various beliefs regarding the economic policy paradigm, the nature of obesity and dietary diseases as health problems, the role of government, and the role of industry in solving the health problem. We identified two primary competing coalitions: 1) a ‘public health nutrition’ coalition, which is overall supportive of and actively working to enact comprehensive food environment regulation; and 2) an ‘industry and economic growth’ focussed coalition, which places a higher priority on deregulation and is overall not supportive of comprehensive food environment regulation. The industry and economic growth coalition appears to be dominant, based on its relative power, resources and coordination. However, the public health nutrition coalition maintains influence through individual activism, collective lobbying and government pressure (e.g. by civil society), and expert knowledge generation. Conclusions Our analysis suggests that industry and economic growth-focussed coalitions are highly capable of ...
Keywords	International trade and investment ; Policy space ; Nutrition policy ; Food systems governance ; Stakeholder analysis ; Advocacy ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2021-10-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Understanding the dynamics of obesity prevention policy decision-making using a systems perspective

Brydie Clarke / Janelle Kwon / Boyd Swinburn / Gary Sacks

PLoS ONE, Vol 16, Iss 1, p e

A case study of Healthy Together Victoria.

2021 Volume 0245535

Abstract: Introduction Despite global recommendations for governments to implement a comprehensive suite of policies to address obesity, policy adoption has been deficient globally. This paper utilised political science theory and systems thinking methods to ... ...

Abstract	Introduction Despite global recommendations for governments to implement a comprehensive suite of policies to address obesity, policy adoption has been deficient globally. This paper utilised political science theory and systems thinking methods to examine the dynamics underlying decisions regarding obesity prevention policy adoption within the context of the Australian state government initiative, Healthy Together Victoria (HTV) (2011-2016). The aim was to understand key influences on policy processes, and to identify potential opportunities to increase the adoption of recommended policies. Methods Data describing government processes in relation to the adoption of six policy interventions considered as part of HTV were collected using interviews (n = 57), document analyses (n = 568) and field note observations. The data were analysed using multiple political science theories. A systematic method was then used to develop a Causal Loop Diagram (CLD) for each policy intervention. A simplified meta-CLD was generated from synthesis of common elements across each of the six policy interventions. Results The dynamics of policy change could be explained using a series of feedback loops. Five interconnected balancing loops served to reduce the propensity for policy change. These pertained to an organisational norm of risk aversion, and the complexity resulting from a whole-of-government policy approach and in-depth stakeholder consultation. However, seven virtuous reinforcing loops helped overcome policy resistance through policy actor capabilities that were improved over time as policy actors gained experience in advocating for change. Conclusion Policy processes for obesity prevention are complex and resistant to change. In order to increase adoption of recommended policies, several capabilities of policy actors, including policy skills, political astuteness, negotiation skills and consensus building, should be fostered and strengthened. Strategies to facilitate effective and broad-based consultation, both across and ...
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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