Agnogenic practices and corporate political strategy: the legitimation of UK gambling industry-funded youth education programmes.

Agnogenic practices-designed to create ignorance or doubt-are well-established strategies employed by health-harming industries (HHI). However, little is known about their use by industry-funded organizations delivering youth education programmes. We applied a previously published framework of corporate agnogenic practices to analyse how these organizations used them in three UK gambling industry-funded youth education programmes. Evidential strategies adopted previously by other HHI are prominent in the programmes' practitioner-facing materials, evaluation design and reporting and in public statements about the programmes. We show how agnogenic practices are employed to portray these youth education programmes as 'evidence-based' and 'evaluation-led'. These practices distort the already limited evidence on these educational initiatives while legitimizing industry-favourable policies, which prioritize commercial interests over public health. Given the similarities in political strategies adopted by different industries, these findings are relevant to research and policy on other HHI.

The political economy of infant and young child feeding: confronting corporate power, overcoming structural barriers, and accelerating progress.

Despite increasing evidence about the value and importance of breastfeeding, less than half of the world's infants and young children (aged 0-36 months) are breastfed as recommended. This Series paper examines the social, political, and economic reasons for this problem. First, this paper highlights the power of the commercial milk formula (CMF) industry to commodify the feeding of infants and young children; influence policy at both national and international levels in ways that grow and sustain CMF markets; and externalise the social, environmental, and economic costs of CMF. Second, this paper examines how breastfeeding is undermined by economic policies and systems that ignore the value of care work by women, including breastfeeding, and by the inadequacy of maternity rights protection across the world, especially for poorer women. Third, this paper presents three reasons why health systems often do not provide adequate breastfeeding protection, promotion, and support. These reasons are the gendered and biomedical power systems that deny women-centred and culturally appropriate care; the economic and ideological factors that accept, and even encourage, commercial influence and conflicts of interest; and the fiscal and economic policies that leave governments with insufficient funds to adequately protect, promote, and support breastfeeding. We outline six sets of wide-ranging social, political, and economic reforms required to overcome these deeply embedded commercial and structural barriers to breastfeeding.

UK Nutrition Research Partnership 'Hot Topic' workshop report: A 'game changer' for dietary health - addressing the implications of sport sponsorship by food businesses through an innovative interdisciplinary collaboration.

Overweight and obesity is a global concern as a significant risk factor for non-communicable diseases. Increased energy intake due to greater consumption of energy-dense food or non-alcoholic beverages high in fat, saturated fat, sugar or salt ('HFSS food') is the main explanation for population weight gain. The principal drivers underlying this consumption are the commercial determinants of health in the food chain, particularly the marketing of HFSS food. In the UK, some rules do regulate certain forms of HFSS food marketing (such as television and online advertising to children) and the government is considering strengthening these. However, although sports sponsorship by 'HFSS food businesses' (defined as a business preparing, cooking, storing, handling, distributing, supplying or selling food and whose products are primarily HFSS) is increasingly recognised as linked to HFSS food consumption, it has received little attention. This is all the more concerning in light of the recent proliferation of 'HFSS food businesses' and HFSS products partnering with sports organisations. Against this background, we hosted a workshop to focus on the relationship between health, nutrition and the sponsorship of sport and related marketing by 'HFSS food businesses' and to consider the implications for obesity prevention strategies in the UK and beyond. This innovative workshop capitalised on, and contributed to, ongoing efforts to conceptually unite existing research by bringing together an interdisciplinary team of experts providing unique and complementary perspectives on how to address sports sponsorship as one of the channels through which 'HFSS food businesses' contribute to poor nutrition and diet-related diseases. This report summarises the structure, participants and discussions from the workshop; the existing evidence base; and the future research and policy opportunities we plan to pursue.

The Regulation of Alcohol Marketing in France: The Loi Evin at Thirty.

When adopted in 1991, the French Loi Evin was pioneering as one of the first in the world to regulate alcohol marketing as extensively. This short contribution assesses whether it remains fit for purpose over 30 years later. To this effect, it assesses its main provisions, considers the legislative amendments that have ensued as well as the extensive interpretation French courts have given of its scope, before concluding that the prospects for its revisions are limited in the near future.

Freedom of Commercial Expression and Public Health Protection at the European Court of Human Rights.

This contribution considers the case law of European Court of Human Rights (ECtHR) and focuses on the extent to which the Contracting Parties to the European Convention on Human Rights (ECHR) can regulate the tobacco, alcohol, and food industries in a manner compatible with their ECHR obligations. After briefly presenting the two key cases dealing specifically with tobacco advertising, this contribution considers the main factors that the ECtHR takes into account when balancing competing concerns, and in particular freedom of commercial expression and public health protection. It concludes that none of these factors is absolute, as the Court considers the strength of each one of them on the facts of each case. Nevertheless, it is clear from its case law that States have a wide margin of appreciation to regulate marketing practices that are inimical to public health and the prevention of non-communicable diseases more specifically, to the extent that even extensive advertising restrictions can be compatible with Article 10 of the ECHR.

INTRODUCTION Commercial Speech and the Commercial Determinants of Health.

This article introduces a symposium that aims to identify and critically assess the legal strategies of the tobacco, alcohol, and food and beverage industries which rest on freedom of expression arguments.

Reassessing the health impacts of trade and investment agreements: a systematic review of quantitative studies, 2016-20.

To ensure a high level of health protection, governments must ensure that health and trade policy objectives are aligned. We conducted a systematic review of the health impacts of trade policies, including trade and investment agreements (TIAs), to provide a timely overview of this field. We systematically reviewed studies evaluating the health impacts of trade policies published between Jan 19, 2016, and July 10, 2020. Included studies were quantitative studies evaluating the impact of TIAs and trade policies on health determinants or outcomes. We evaluated methodological quality and performed a narrative synthesis. 21 of 28 067 articles identified via searches met our criteria. Methodologically strong studies found reduced child mortality, deteriorating worker health, rising supplies of sugar, ultra-processed food, tobacco, and alcohol supplies, and increased drug overdoses following trade reforms, compared with the time periods before trade reform. However, associations varied substantially across contexts and socioeconomic characteristics. Our findings show that trade policies, including TIAs, have diverse effects on health and health determinants. These effects vary substantially across contexts and socioeconomic groups. Governments seeking to adopt healthy trade policies should consider these updated findings to ensure that opportunities for health improvement are leveraged and widely shared, while harms are avoided, especially among vulnerable groups.

Protecting noncommunicable disease prevention policy in trade and investment agreements.

Preventing noncommunicable diseases is a global priority, for which the World Health Organization has recommended policies to reduce the consumption of tobacco products, alcohol and unhealthy foods. However, regulation has been strongly opposed by affected industries, who have invoked the provisions of legally binding trade and investment agreements. The aim of this analysis of the legal, economic and public health literature was to present a short primer on the relationship between noncommunicable disease prevention policy and trade and investment agreements to help public health policy-makers safeguard public health policies. The analysis identified opportunities for protecting, and even promoting, public health in trade and investment agreements, including: (i) ensuring exceptions for public health measures are included in agreements; (ii) committing to good regulatory practice that balances transparency and cooperation with the need for governments to limit the influence of vested interests; (iii) ensuring trade and investment agreement preambles acknowledge the importance of public health; (iv) excluding investor-state dispute settlement mechanisms from agreements; and (v) limiting the scope and definition of key provisions on investor protection to reduce the risk of investment disputes. This synthesis of the multidisciplinary literature also provides support for greater strategic and informed engagement between the health and trade policy sectors. In addition, ensuring a high level of health protection in trade and investment agreements requires cooperation between disciplines, engagement with experts in law, economics and public health policy, and fully transparent policy processes and governance structures.

La prévention des maladies non transmissibles constitue une priorité mondiale. Dans ce contexte, l'Organisation mondiale de la Santé a recommandé des politiques visant à réduire la consommation de produits du tabac, d'alcool et d'aliments nocifs pour la santé. Néanmoins, cette régulation s'est heurtée à une forte opposition de la part des industries concernées, qui ont invoqué les dispositions prévues dans les accords juridiquement contraignants en matière de commerce et d'investissement. La présente analyse se penche sur la littérature juridique, économique et de santé publique. Son but: décrire brièvement la relation entre les mesures de prévention des maladies non transmissibles d'une part, et les accords en matière de commerce et d'investissement d'autre part, afin d'aider les législateurs compétents à défendre les politiques de santé publique. Cette analyse a identifié divers moyens de préserver, voire de promouvoir la santé publique dans les accords de commerce et d'investissement, notamment: (i) en veillant à inclure des exceptions pour les mesures de santé publique dans les accords; (ii) en s'engageant à respecter les bonnes pratiques réglementaires, qui concilient la transparence et la coopération avec la nécessité, pour les gouvernements, de limiter l'influence des intérêts en place; (iii) en s'assurant que les accords de commerce et d'investissement mentionnent dans leur préambule l'importance de la santé publique; (iv) en excluant de ces accords les mécanismes de règlement des différends entre États et investisseurs; et enfin, (v) en limitant la portée et la définition des dispositions fondamentales sur la protection des investisseurs afin de diminuer le risque de différend. Cette synthèse de littérature multidisciplinaire contribue également à plus d'engagement stratégique et éclairé entre les politiques sanitaires et commerciales. En outre, garantir un haut niveau de protection sanitaire dans les accords de commerce et d'investissement implique une collaboration entre plusieurs disciplines, la mobilisation d'experts en droit, en économie et en politiques de santé publique, ainsi que des structures de gouvernance et des processus d'élaboration des politiques entièrement transparents.

La prevención de las enfermedades no transmisibles es una prioridad mundial, por lo que la Organización Mundial de la Salud ha recomendado la adopción de políticas para reducir el consumo de productos de tabaco, alcohol y alimentos malsanos. Sin embargo, las industrias afectadas se han opuesto con firmeza a la regulación, invocando las disposiciones de los acuerdos comerciales y de inversión jurídicamente vinculantes. El objetivo de este análisis sobre la documentación jurídica, económica y de salud pública fue presentar una breve introducción sobre la relación entre la política de prevención de las enfermedades no transmisibles y los acuerdos comerciales y de inversión para ayudar a las autoridades responsables de formular las políticas de salud pública a protegerlas. El análisis identificó oportunidades para proteger, e incluso promover, la salud pública en los acuerdos comerciales y de inversión, que incluyen i) garantizar la inclusión de excepciones para las medidas de salud pública en los acuerdos; ii) comprometerse con las buenas prácticas regulatorias que equilibran la transparencia y la cooperación con la necesidad de los gobiernos de limitar la influencia de los intereses creados; iii) garantizar que los preámbulos de los acuerdos comerciales y de inversión reconocen la importancia de la salud pública; iv) excluir de los acuerdos los mecanismos de resolución de disputas entre inversores y Estados; y v) limitar el alcance y la definición de las disposiciones clave sobre la protección de los inversores para reducir el riesgo de disputas sobre las inversiones. Esta síntesis de la documentación multidisciplinar también respalda un mayor compromiso estratégico e informado entre los sectores de la salud y la política comercial. Además, se requiere la cooperación entre las disciplinas, la participación de especialistas en derecho, economía y política de salud pública, y procesos políticos y estructuras de gobernanza totalmente transparentes para garantizar un alto nivel de protección de la salud en los acuerdos comerciales y de inversión.