Analysis of public records of lobbying practices of the ultra-processed sugary food and drink industries in Chile: a qualitative study.

Background: Given the role of commercial determinants on sugar consumption and health, this study aimed to describe lobbying practices of the ultra-processed sugary food and drinks industries in Chile between 2014 and 2022. Methods: Official meetings between ultra-processed sugary food and drinks industries and related commercial actors and Chilean government officials were obtained from the Chilean Lobby Registry. Relevant commercial names were initially identified based on their market share and expanded iteratively based on information from relevant meetings. Qualitative analysis followed a deductive-inductive approach using the Corporate Political Activity Model to identify and classify objectives, framing and action strategies. Findings: From 237 records identified, the Ministries of Health, Social Development, and Economy were the most frequently lobbied. Industry representatives sought to achieve their short- and long-term objectives by targeting a diverse range of authorities, including Ministers and Under-secretaries, using different strategies. Framing strategies focused on presenting sugary food and drinks industries as socially responsible and legitimate policy actors and criticised public health initiatives as 'bad solutions'. Action strategies aimed to influence policymaking and nurture corporate reputations. Interpretation: Extensive lobbying took place by the sugary food and drinks industries between 2014 and 2022, a period when major public health policies were being discussed in Chile. Lobbying strategies varied to meet industry objectives and targeted a diverse range of government institutions including high-ranking officials. Tighter regulations to stop inappropriate industry influence in public health policymaking are urgently required. Funding: Agencia Nacional de Investigación y Desarrollo (Chile)-PhD Scholarship. University College London-Open Access fees.

Industries, citizens, and non-governmental organizations' positioning and arguments used in European Union initiatives for alcohol taxation and cross-border regulation.

BACKGROUND: The European region has the highest daily alcohol consumption per capita and a high alcohol-related burden of disease. Policymaking at the European Union level is open to participation by interest groups, from public health organizations to alcohol industry representatives. This study aimed to map the interest groups present in the alcohol taxation and cross-border regulation initiatives and identify which arguments were used to support positions in favor or against them. METHODS: We used qualitative content analysis on the comments submitted on the official European Commission website during the 2017, 2018, 2020, and 2022 participation periods. Interest groups were characterized considering their positioning, and arguments were identified and compared by position and type of initiative. RESULTS: Opponents of changes to the structures of alcohol excise duties and cross-border regulations were mostly representatives of the alcohol and agricultural industries, and the proponents were mostly health-related nongovernmental organizations. Opponents of these initiatives used a wide variety of arguments, from economic and trade to health arguments, while proponents focused mainly on health arguments, such as the effectiveness of alcohol taxation in preventing alcohol-related morbidity and mortality. CONCLUSION: This study highlights the wide range of arguments used by opponents around alcohol control policies, contrasting with the health-centered arguments of proponents. It further shows that there is a lobbying network at the European Union level, combining national and international representatives of industry and non-governmental organizations. These findings provide an opportunity for better preparation for upcoming discussions on alcohol control at national and regional levels.

American Shoulder and Elbow Surgeons perspectives on political advocacy.

BACKGROUND: Physician involvement in political advocacy has become increasingly important in recent years. This study aims to explore the types of involvement and barriers to involvement in political advocacy among American Shoulder and Elbow Surgeons (ASES) members, identify issues considered most important by ASES members, and assess demographic factors that might correlate with involvement in political advocacy efforts among ASES members. METHODS: This survey was conducted by the ASES Political Advocacy Committee over a 2-week period in June 2021. The survey collected demographic information including sex, ethnicity, years in practice, practice type, political affiliation, and level of current involvement in political advocacy. Additional questions consisted of thoughts regarding current health care policy issues and the role of the American Academy of Orthopaedic Surgeons/ASES regarding such policy issues. RESULTS: We received 297 responses for a total response rate of 27%. Of those who responded, 24.6% identified as Democrat, 33% identified as Republican, and 42.4% identified as Independent. There was no difference in political affiliation between membership groups. Physician Reimbursement (82%), Medical Liability Reform (50%), and Physician Ownership (50%) were the most important issues identified among respondents. Physician Ownership, Physician Reimbursement and Graduate Medical Education and Student Loan Reform were most important to those in early practice, while Quality and Research was most important to those with greater than 25 years of practice experience. CONCLUSION: There is strong agreement among surgeons regarding the most important political advocacy issues. The efforts of the American Academy of Orthopaedic Surgeons and ASES should focus on these areas. Additionally, the vast majority of respondents felt that advocacy efforts had a positive impact on patients and surgeons.

The process of developing and implementing health and nursing policy: Implications of research and opportunities to influence.

AIM: To provide insight into the process of developing health and nursing policy and how that process can be influenced by both researchers and nursing leaders. BACKGROUND: Nurses care for people across the life course from birth to death, in our communities, hospitals, care homes and schools. They have unique insight into how people live their lives and how this affects their health. Despite being well placed to influence health policy, nurses often fail to capitalise on this. At the same time, academics often struggle to identify the policy implications of their research resulting in further missed opportunities to use policy influence. SOURCES OF EVIDENCE: Classical policy theory, which is predominantly drawn from economics and public administration together with a range of contemporary nursing and health policy studies, is used in this paper to discuss the policy process and opportunities to influence. DISCUSSION: Researchers need to focus on realistic policy suggestions that aim to raise awareness, highlight policy problems or set the agenda. In turn, nursing leaders, from National Nursing Associations, need to harness evidence to support their efforts to influence policy. In terms of influence, a range of approaches exist, and each lends itself to different parts of the policy cycle. CONCLUSION: The role nurses can play in health policy is not well developed in many countries. Nursing researchers and leaders are well placed to influence policy but must do so in a clear and pragmatic way recognising that policymakers make decisions despite being faced with conflicting evidence, competing demands and economic imperatives. IMPLICATIONS FOR NURSING PRACTICE: Recognising that nurses can offer much in terms of policy development, the paper argues that a pragmatic approach based on different forms of influence at different stages is likely to be most successful. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The evidence reviewed in this paper suggests that nursing academics and leaders need to identify realistic policy interventions when examining their own empirical work or identifying ways to individually or collectively influence policymakers.

Politics and health care spending in the United States: A case study from the passage of the 2003 Medicare Modernization Act.

This paper analyzes the interplay between congressional politics, the actions of the executive branch, and hospitals' regulated Medicare payments. We focus on the 2003 Medicare Modernization Act (MMA) and analyze a provision in the law - Section 508 - that raised certain hospitals' regulated payments. We show, via our analysis of the Section 508 program, that Medicare payments are malleable and can be influenced by political dynamics. In the cross-section, hospitals represented by members of Congress who voted "yea" on the MMA were more likely to receive Section 508 payment increases. We interviewed the Secretary of Health and Human Services who oversaw the MMA, and he described how these payment increases were designed to win support for the law. The Section 508 payment increases raised hospitals' activity and spending. Members of Congress representing recipient hospitals received increased campaign contributions after the Section 508 payment increases were extended. Ultimately, our analysis highlights how Medicare payment increases can serve as an appealing tool for legislative leaders working to win votes for wider pieces of legislation.

Uncovering lobbying strategies in sustainable finance disclosure regulations using machine learning.

PURPOSE: We analyse lobbying behaviour by using Machine Learning approaches. In the context of Sustainable Finance Disclosure Regulation (SFDR), we gain detailed insights, assign these to existing strategies, and measure how strongly which participant influences the regulation. STUDY DESIGN/METHODOLOGY/APPROACH: We use tri-gram analysis, sentiment analysis, and similarity analysis as methods to obtain insights into the political commentary process of European Supervisory Authorities (ESAs) drafts dealing with SFDR. FINDINGS: Our metadata helps to identify stakeholders and lobbying strategies. We found that the most negative comments came from the regulated, who argued strongly subjectively in a very objective environment of ESG disclosure. We also identified typical lobbying strategies based on arguments, persuasion, and classic cost-benefit considerations. ORIGINALITY/VALUE: We generate emotion values and synthesise detailed argument differences and show that modern algorithms can contribute to the identification of interest groups and lobbying strategies. Furthermore, we generate similarity values of arguments that can be taken into account in the analysis of the success of a lobbying strategy.

Corporate interest groups and their implications for global food governance: mapping and analysing the global corporate influence network of the transnational ultra-processed food industry.

BACKGROUND: A major challenge to transforming food systems to promote human health and sustainable development is the global rise in the manufacture and consumption of ultra-processed foods (UPFs). A key driver of this dietary transition is the globalization of UPF corporations, and their organized corporate political activity (CPA) intended to counter opposition and block government regulation. UPF industry CPA and the corporate interest groups who lobby on their behalf have been well described at the national level, however, at the global level, this network has not been systematically characterized. This study aims to map, analyse, and describe this network, and discuss the implications for global food policy action on UPFs, global food governance (GFG), and food systems transformation. METHODS: We conducted a network analysis of the declared interest group memberships of the world's leading UPF corporations, extracted from web sources, company reports, and relevant academic and grey literature. Data on the characteristics of these interest groups were further extracted for analysis, including year founded, level, type, and headquarter location. RESULTS: We identified 268 interest groups affiliated with the UPF industry. The UPF manufacturers Nestlé (n = 171), The Coca-Cola Company (n = 147), Unilever (n = 142), PepsiCo (n = 138), and Danone (n = 113) had the greatest number of memberships, indicating strong centrality in coordinating the network. We found that this network operates at all levels, yet key actors now predominantly coordinate globally through multistakeholder channels in GFG. The most common interest group types were sustainability/corporate social responsibility/multistakeholder initiatives, followed by branding and advertising, and food manufacturing and retail. Most corporate interest groups are headquartered where they can access powerful government and GFG decision-makers, nearly one-third in Washington DC and Brussels, and the rest in capital cities of major national markets for UPFs. CONCLUSIONS: The UPF industry, and especially its leading corporations, coordinate a global network of interest groups spanning multiple levels, jurisdictions, and governance spaces. This represents a major structural feature of global food and health governance systems, which arguably poses major challenges for actions to attenuate the harms of UPFs, and to realising of healthy and sustainable food systems.

Mapping the Lobbying Footprint of Harmful Industries: 23 Years of Data From OpenSecrets.

Policy Points Our research reveals the similarities and differences among the lobbying activities of tobacco, alcohol, gambling, and ultraprocessed food industries, which are often a barrier to the implementation of public health policies. Over 23 years, we found that just six organizations dominated lobbying expenses in the tobacco and alcohol sectors, whereas the gambling sector outsourced most of their lobbying to professional firms. Databases like OpenSecrets are a useful resource to monitor the commercial determinants of health. CONTEXT: Commercial lobbying is often a barrier to the development and implementation of public health policies. Yet, little is known about the similarities and differences in the lobbying practices of different industry sectors or types of commercial actors. This study compares the lobbying practices of four industry sectors that have been the focus of much public health research and advocacy: tobacco, alcohol, gambling, and ultraprocessed foods. METHODS: Data on lobbying expenditures and lobbyist backgrounds were sourced from the OpenSecrets database, which monitors lobbying in the United States. Lobbying expenditure data were analyzed for the 1998-2020 period. We classified commercial actors as companies or trade associations. We used Power BI software to link, analyze, and visualize data sets. FINDINGS: We found that the ultraprocessed food industry spent the most on lobbying ($1.15 billion), followed by gambling ($817 million), tobacco ($755 million), and alcohol ($541 million). Overall, companies were more active than trade associations, with associations being least active in the tobacco industry. Spending was often highly concentrated, with two organizations accounting for almost 60% of tobacco spending and four organizations accounting for more than half of alcohol spending. Lobbyists that had formerly worked in government were mainly employed by third-party lobby firms. CONCLUSIONS: Our study shows how comparing the lobbying practices of different industry sectors offers a deeper appreciation of the diversity and similarities of commercial actors. Understanding these patterns can help public health actors to develop effective counterstrategies.

Analyzing arguments on tobacco tax increases. Focus on French parliamentary questions and responses, 2000-2020.

INTRODUCTION: Tax increases are the most effective but still the least-used tobacco control measure. The tobacco industry (TI) employs lobbying strategies to oppose the implementation of tax policies on its products. Over the past two decades, French tobacco tax policies have been characterized by a relative inconsistency. This research aims to understand why, by analyzing the arguments of French policymakers (MPs and government) between 2000 and 2020 in favor or against tax increases. METHODS: To capture parliamentary debates, we performed an advanced term search on the French National Assembly website, using the keyword 'tobacco'. The search returned 5126 available documents out of which 1106 (12.6%, 645 questions, 461 responses) covered price and taxation and were included. They were analyzed using descriptive statistics and thematic content analysis (NVivo) and were compared, when relevant, to arguments raised in the international literature on TI lobbying against taxation increases. RESULTS: We found 3176 arguments on tobacco taxation: 77.2% were against tobacco tax increases and 22.7% were in favor of tax policies. Arguments varied depending on the source: 92.4% of MPs' arguments were against tax increases, while 52.1% of arguments from government responses were in favor. The anti-tax arguments were similar to those identified in the international literature that singled out negative economic and social consequences (illicit trade, penalizing tobacconists). Other arguments that were more specific to the French context, highlighted the key economic and social role played by tobacconists in France. Pro-tax arguments highlighted the health, economic and social benefits of tax policies. CONCLUSIONS: This is the first French tobacco research on parliamentary documents, although Parliament is a place of direct TI lobbying. It will enable public health actors to better understand the arguments used by the TI in order to counter them in front of MPs, and to better monitor debates in Parliament.

Lobbying in the face of politicisation: interest group strategies in trade policy.

How does the politicisation of trade policy affect the lobbying strategies chosen by interest groups? Several studies have shown that business associations tend to focus more on inside lobbying and citizen groups more on outside lobbying. We argue that politicisation makes this difference in lobbying strategy even more pronounced. Facing an issue that is contested and publicly salient, we should see business actors move even more toward inside lobbying and citizen groups move even more toward outside lobbying. We test this argument using a unique combination of evidence from a survey with 691 interest groups and an analysis of Twitter usage with respect to the Transatlantic Trade and Investment Partnership (TTIP) by 993 interest groups. The empirical evidence largely supports our argument. By making and testing this argument, we contribute to the literatures on the politicisation of trade policy and interest group strategies.

Healthcare lobbying and campaign finance activities of vision-related professional societies, 2015 to 2022.

Purpose: To compare the lobbying expenditures and political action committee (PAC) campaign finance activities of the American Academy of Ophthalmology (AAO), American Society of Cataract and Refractive Surgery (ASCRS), and American Optometric Association (AOA) from 2015 to 2022. Methods: Financial data were collected from the Federal Election Commission and OpenSecrets database. Analysis was performed to characterize and compare financial activity among the organizations. P < 0.05 was considered significant and all analyses were two-sided. Results: From 2015 to 2022, the AAO, ASCRS, and AOA spent $6,745,000, $5,354,406, and $13,335,000 on lobbying, respectively. The AOA's annual lobbying expenditure (median, $1,725,000) was significantly greater than AAO's ($842,500, P = 0.03) and ASCRS's ($694,289, P < 0.001). In PAC donations, OPHTHPAC, affiliated with AAO, received $3,221,737 from 2079 donors (median, $900); eyePAC, affiliated with ASCRS, received $506,255 from 349 donors ($500); and AOA-PAC received $6,642,588 from 3641 donors ($825). Compared to eyePAC, median donations to OPHTHPAC (P = 0.01) and AOA-PAC (P = 0.04) were significantly higher. In campaign spending, OPHTHPAC contributed $2,728,500 to 326 campaigns (median, $5000), eyePAC contributed $293,500 to 58 campaigns ($3000), and AOA-PAC contributed $5,128,673 to 617 campaigns ($5500). eyePAC's median campaign contribution was significantly lower than the AOA's (P < 0.001) and AAO's (P = 0.007). Every PAC directed most of its contributions toward Republican campaigns; eyePAC donated the highest proportion (64.9%). Conclusions: AOA was more assertive in shaping policy by increasing lobbying expenditures, fundraising, and donating to a greater number of election campaigns.

No Representation Without Compensation: The Effect of Interest Groups on Legislators' Policy Area Focus.

Interest groups seek to influence parliamentarians' actions by establishing exchange relationships. We scrutinize the role of exchange by investigating how interest groups impact parliamentarians' use of individual parliamentary instruments such as questions, motions, and bills. We utilize a new longitudinal dataset (2000-2015) with 524 Swiss parliamentarians, their 6342 formal ties to interest groups (i.e., board seats), and a variety of 23,750 parliamentary instruments across 15 policy areas. This enables us to show that interest groups systematically relate to parliamentarians' use of parliamentary instruments in the respective policy areas in which they operate-even when parliamentarians' time-invariant (fixed effects) and time-variant personal affinities (occupation, committee membership) to the policy area are accounted for. Personal affinities heavily moderate interest groups' impact on their board members' parliamentary activities. Moreover, once formal ties end, the impact of interest groups also wanes. These findings have implications for our understanding of how interest groups foster representation in legislatures.

Framing Marketing Responses to National Regulation: The Four Ps in Transnational Corporate Political Discourse Comment on "Understanding Marketing Responses to a Tax on Sugary Drinks: A Qualitative Interview Study in the United Kingdom, 2019".

A growing evidence base indicates that sugar-sweetened beverage (SSB) taxes are an effective tool to help reduce excess sugar intake. The effects of SSB taxes and the mechanisms which underlie them, however, are dependent on a number of interrelated factors such as policy design and responses of industry and consumers. Forde and colleagues contribute to unpacking these mechanisms by exploring the way in which the UK's Soft Drinks Industry Levy (SDIL) shaped the four Ps of soft drinks marketing: product, price, placement, and promotion. This commentary builds on the authors' insights by connecting them to existing knowledge on corporate political activity and the commercial determinants of health (CDOH) more broadly. Specifically, I discuss the risk that an industry framing of regulation-induced marketing changes as a voluntary step towards corporate responsibility undermines the need for government intervention to address obesity in other contexts and countries. I conclude by arguing that the public health community would benefit from considering marketing responses to regulation alongside industry narratives about these changes.

Commercial lobbying and political contributions: an Australian scoping review.

OBJECTIVE: Many of the most effective and equitable policies to reduce the burden of non-communicable diseases threaten the interests of powerful corporations. A first step for public health advocates seeking to challenge powerful corporate interests is to understand the nature and extent of corporate political practices. This scoping review explored public health research on two political practices in Australia: lobbying and political donations. METHODS: We searched six databases, two Google Advanced searches and 11 Australian public health websites. We screened 2866 documents in total, and extracted information about political practices, industry actors and datasets. RESULTS: 62 studies published between 1980 and 2021 were identified, analysing public health advocacy, policy submissions, direct engagement with government representatives and political donations. We extracted data from 14 studies that focused on direct engagement and/or political donations. Most focused on 'unhealthy commodity industries.' CONCLUSIONS: Analysis of lobbying and political contributions in Australia is a nascent but expanding area of public health research. We discuss opportunities for future research to strengthen the evidence base and support public health advocacy to counter harmful corporate practices and promote and protect population health. IMPLICATIONS FOR PUBLIC HEALTH: Countering powerful commercial interests requires greater investment in understanding corporate political activities.

An Analysis of Political Contributions by Urologists in the United States: 2003-2022.

INTRODUCTION: We sought to better understand the amounts and distribution of political contributions made by urologists in the United States. METHODS: The Federal Election Commission was analyzed for political contributions from 2003 to 2022 using the search terms "urology," "urologist," or "urologic surgeon." Contributions were classified by political party (Democratic, Republican, or Independent) and were analyzed for temporal, geographic, and demographic trends. RESULTS: There were a total of 26,441 unique contributions that resulted in $9,943,205 after adjusting for inflation. The total amount of political contributions increased significantly over time, with higher numbers during presidential election years. The Republican party received the highest proportion of donations (69.1%). Importantly, women urologists and urologists working in academic centers were significantly more likely to contribute to Democratic committees (P < .001 for both). Texas had the highest total amount of contributions ($395,152). Overall contributions to urology political action committees have steadily decreased since 2011, while contributions to individual campaigns and nonurology political action committees have increased. CONCLUSIONS: Urologists have been increasingly contributing to political campaigns over the past 19 years, with most of their individual and political action committee contributions going to Republican committees and candidates. Future research evaluating how growing political engagement by urologists affects the development of new health care policy will be important as a new generation of urologists begins to enter practice.

Aiding empirical research on the commercial determinants of health: a scoping review of datasets and methods about lobbying.

BACKGROUND: To support public health researchers and advocates seeking to challenge the influence of powerful commercial actors on health, it is necessary to develop a deeper understanding of corporate political activities. This project explores political science scholarship analysing lobbying to identify new datasets and research methods that can be applied to public health and stimulate further research and advocacy. METHODS: We undertook a systematic scoping review of peer-reviewed and grey literature reports analysing the practice of lobbying. Titles and abstracts of 4533 peer-reviewed and 285 grey literature reports were screened, with 233 peer-reviewed and 280 grey literature reports assessed for eligibility. We used a two-stage process for data extraction. In stage 1, we collected two pieces of information from all included studies: data sources and indicators used to measure lobbying. For the second stage, data extraction was limited to 15 studies that focused on meetings. RESULTS: The most common indicators used to measure lobbying activity were: registrations of active lobbyists; expenditure on lobbying; meetings; written comments and submissions made to government consultations; bills; and committee participation. A range of different data sources were used to analyse lobbying, including from governments, not-for-profits and commercial sources. All 15 studies analysing lobbyist meetings were from high-income contexts. The studies analysed three key variables: the types of government actors targeted by lobbying; the policies of interest; and the lobbyists and/or their clients. The studies used a range of taxonomies to classify policy issues and the types of actors engaged in lobbying. All studies discussed challenges with accessing and analysing lobbying data. CONCLUSIONS: There is enormous potential for public health research and advocacy concerned with commercial lobbying to learn from political science scholarship. This includes both conceptual frameworks and sources of empirical data. Moreover, the absence of good quality transparency internationally emphasises the importance of advocacy to support policy change to improve the quality of political transparency to make it easier to monitor commercial lobbying.

The effects of lobbying on the FDA's recall classification.

BACKGROUND: The US Food and Drug Administration (FDA) regulates goods accounting for 20% of US consumers' total expenditure. The agency's potential susceptibility to corporate lobbying and political influence may adversely affect the its abilities to fulfill its duties as a vital federal agency. This study assesses whether the FDA's product recall classifications in recall scenarios are influenced by firms' lobbying activities. METHODS: The universe of all FDA recalls between 2012 and 2019 is obtained from the FDA's website. Firm names are matched to federal-level lobbying data obtained from the Center for Responsive Politics - a non-profit and nonpartisan organization that tracks lobbying expenditures and campaign contributions. Analyses are conducted using ordinary-least-squares regressions, in which the dependent variable is recall classification and independent variables are three different measures of firms' lobbying activities in the one year prior to the recall. RESULTS: Firms that engage in lobbying appear more likely to receive favourable classifications from the FDA. When examining the above results by product type, we find that classification of food recalls seems to be subject to lobbying influence, but the same does not appear to be true for drug and device recalls. Evidence is consistent with the conjecture that the distinction between medical and food firms may be a result of medical firms targeting lobbying efforts at FDA approvals, rather than recalls. CONCLUSIONS: Between 2012 and 2019, the FDA's product recall classifications seem to be significantly influenced by firms' lobbying activities. Lobbying firms appear to have received more favorable (i.e., less severe) recall classifications compared to non-lobbying firms.

Qualitative analysis of front-of package labeling policy interactions between stakeholders and Health Canada.

Background: Front-of-package labelling regulations proposed by Health Canada in their Healthy Eating Strategy (2016) were finally passed in 2022, but remain unimplemented. This study analyzed interactions that occurred between stakeholders and government related to this policy proposal to identify key themes and policy implications. Methods: A qualitative framework analysis was conducted on publicly available documents for stakeholder correspondences related to front-of-package that occurred between 2016 and 2019 in Health Canada's Meetings and Correspondence on Healthy Eating database. Five sequential steps were applied: familiarization, identifying a thematic framework, indexing, charting, and mapping and interpretation. A complex systems (i.e., a dynamic system with multiple interconnecting components) lens was incorporated in the final step to deepen the analysis. Results: Hundred and seventy-three documents were included, the majority from industry stakeholders (n = 108, 62.4%). Three overarching themes were identified: industry trying to control the agenda and resist regulation; questioning the evidence supporting the policy and its impact on the agri-food industry; and dismissing the need and effectiveness of the policy. Incorporating a complex system lens found industry and non-industry stakeholders held markedly different perspectives on how cohesive the system defined by the front-of-package labelling policy was, and the policy impact on its stability. Economic and opportunity costs were the main trade-offs, and symbol misinterpretation considered an unintended consequence by industry. Finally, some stakeholders argued for wider policy scope incorporating more products, while others requested a narrower approach through exemptions. Conclusion: Interactions with industry stakeholders on health food policy proposals require careful consideration, given it may suit their interests to generate delays and policy discordance. Explicitly setting out the principles of engagement and actively encouraging non-industry stakeholder representation provides a more balanced approach to policy consultation and development.

A "willingness to be orchestrated": Why are UK diplomats working with tobacco companies?

Background: The tobacco epidemic is global and addressing it requires global collaboration. International and national policies have been adopted to promote collaboration for tobacco control, including an obligation on diplomatic missions to protect public health from the vested interests of the tobacco industry. However, incidents of diplomats engaging with the tobacco industry are still occurring despite these regulations. This paper presents a case study of a British ambassador actions, and it points to some of the challenges researchers face in monitoring such incidents. Methods: The incident studied in this paper was first identified through regular media monitoring conducted by the Tobacco Control Research Group at the University of Bath. The incident was further investigated by using the tools made available by the United Kingdom (UK) Freedom of Information Act, including submitting a request, asking for internal review, and submitting a complaint to the Information Commissioner's Office. Results: We identified clear evidence of the UK ambassador to Yemen opening a cigarette factory, part owned by British American Tobacco (BAT), in Jordan. Our investigation revealed a lack of documentation of this and similar incidents of interaction between diplomats and the tobacco industry. We raise concerns about the actions of diplomats which contravene both national and international policies. Discussion: Monitoring and reporting such activities produces several challenges. Diplomats' interactions with the tobacco industry represent a major concern for public health as such interactions seem to be systematically repeated. This paper calls for action to better implement national and international policies to protect the public health including in low- and middle-income countries (LMICs).