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.

Big Tobacco, Alcohol, and Food and NCDs in LMICs: An Inconvenient Truth and Call to Action Comment on "Addressing NCDs: Challenges From Industry Market Promotion and Interferences".

In their editorial, Tangcharoensathien et al1 describe the challenges of industry market promotion and policy interference from Big Tobacco, Alcohol, and Food in addressing non-communicable diseases (NCDs). They provide an overview of the increasing influence of corporate interest in emerging economies and government attempts to implement the World Health Organization (WHO) 'best buy' interventions. The authors largely draw on examples from Asia and a few selected countries, but provide little detail as to how aggressive marketing and policy interference plays out in a context of poor legislation and regulation in many low- and middleincome countries (LMICs), where the burden of NCDs is increasing at an alarming rate and governments face a high burden of disease with a limited budget for countering industry interference. This commentary provides some poignant examples of the influence of Big Tobacco, Alcohol, and Food on market regulation and policy interference in LMICs and argues for more policy coherence and accountability in terms of multisectoral action and civil society activism. Securing funds for health promotion and establishing health promotion foundations could help achieve that goal.

Influencing resilience: the role of policy entrepreneurs in mainstreaming climate adaptation.

One way to make development pathways more resilient in the face of a changing climate has been through mainstreaming adaptation into government policies, planning and sectoral decision-making. To date, many of the transferable lessons have taken the form of technical approaches such as risk assessments and toolkits. This article instead draws on evidence from South Asia to emphasise some of the more tacit and informal approaches used to influence adaptation policy. Despite their apparent significance in policy processes, such tactics are often neither planned for nor well reported in resilience-building projects and programme documents. Using evidence to populate a typology of influencing strategies, this article looks particularly at the role of policy entrepreneurs who navigate the political complexity of both formal and informal governance systems to promote successful adaptation mainstreaming. It concludes with recommendations for adaptation and resilience programming that can more effectively harness the breadth of influencing strategies.

Alcohol industry strategies to influence the reform of the Finnish Alcohol Law.

AIM: The aim of this study was to investigate the strategies used by the alcohol industry to influence the reform of the Alcohol Act in Finland during the preparation phase between 2016 and 2017. The study answers the following research question: what strategies were used by the alcohol industry to change the original purpose of the reform on alcohol in Finland? METHOD: Primary data were collected through 16 expert interviews with experts who had participated in the preparation of the alcohol reform in Finland, while secondary data were collected from prior literature, journal articles and Google databases. RESULTS: The results identified three main political strategies used by the alcohol industry to influence the reform of the law on alcohol in Finland during the preparation phase between 2016 and 2017: "information", under which the alcohol industry lobbied politicians in Parliament through Members of Parliament of the National Coalition Party due to the close ties between the two; "constituency building", under which the alcohol industry formed alliances with interest groups in the grocery-retail business in Finland, to advocate for liberalisation of the law, as well as the use of social media - specifically Twitter - to lobby the public; and lastly, "policy substitution" to promote self-regulation. CONCLUSIONS: The results suggest that the involvement of the alcohol industry in political decision-making following Finland's EU membership has given the industry legitimacy and new opportunities to influence alcohol policy, while limiting policies to protect the public from alcohol-related harms. The results may be useful to alcohol policy-makers.

Reassessing policy paradigms: A comparison of the global tobacco and alcohol industries.

Tobacco is widely considered to be a uniquely harmful product for human health. Since the mid-1990s, the strategies of transnational tobacco corporations to undermine effective tobacco control policy has been extensively documented through internal industry documents. Consequently, the sale, use and marketing of tobacco products are subject to extensive regulation and formal measures to exclude the industry from policy-making have been adopted in the Framework Convention on Tobacco Control. In contrast to tobacco, alcohol is subject to less stringent forms of regulation, and the alcohol industry continues to play a central role in policy-making in many countries and at the global level. This article examines whether there is a sufficient rationale for such different regulatory approaches, through a comparative analysis of the political economy of the tobacco and alcohol industries including the structure of the industries, and the market and political strategies they pursue. Despite some important differences, the extensive similarities which exist between the tobacco and alcohol industries in terms of market structure and strategy, and political strategy, call into question the rationale for both the relatively weak regulatory approach taken towards alcohol, and the continued participation of alcohol corporations in policy-making processes.

'Manage and mitigate punitive regulatory measures, enhance the corporate image, influence public policy': industry efforts to shape understanding of tobacco-attributable deforestation.

BACKGROUND: Deforestation due to tobacco farming began to raise concerns in the mid 1970s. Over the next 40 years, tobacco growing increased significantly and shifted markedly to low- and middle-income countries. The percentage of deforestation caused by tobacco farming reached 4 % globally by the early 2000s, although substantially higher in countries such as China (18 %), Zimbabwe (20 %), Malawi (26 %) and Bangladesh (>30 %). Transnational tobacco companies (TTCs) have argued that tobacco-attributable deforestation is not a serious problem, and that the industry has addressed the issue through corporate social responsibility (CSR) initiatives. METHODS: After reviewing the existing scholarly literature on tobacco and deforestation, we analysed industry sources of public information to understand how the industry framed deforestation, its key causes, and policy responses. To analyse industry strategies between the 1970s and early 2000s to shape understanding of deforestation caused by tobacco farming and curing, the Truth Tobacco Documents Library was systematically searched. The above sources were compiled and triangulated, thematically and chronologically, to derive a narrative of how the industry has framed the problem of, and solutions to, tobacco-attributable deforestation. RESULTS: The industry sought to undermine responses to tobacco-attributable deforestation by emphasising the economic benefits of production in LMICs, blaming alternative causes, and claiming successful forestation efforts. To support these tactics, the industry lobbied at the national and international levels, commissioned research, and colluded through front groups. There was a lack of effective action to address tobacco-attributable deforestation, and indeed an escalation of the problem, during this period. CONCLUSIONS: The findings suggest the need for independent data on the varied environmental impacts of the tobacco industry, awareness of how the industry seeks to work with environmental researchers and groups to further its interests, and increased scrutiny of tobacco industry efforts to influence environmental policy.

Methods for Influencing Social Policy: The Role of Social Experiments.

Research methods in community psychology have grown more diverse since the Swampscott conference, but rigorous social experiments maintain a place among the multiplicity of methods that can promote community psychology values. They are particularly influential in policy circles. Two examples of social experiments to end homelessness for different populations illustrate their role. Both studies show that offering extremely poor and disenfranchised people autonomy and the resources they seek works better than "helping" them to overcome deficits in ways designed by well-meaning service providers. Experiments are neither the first nor the last method community psychologists should employ, but are a critical part of the field's armamentarium for systems change.

How does the alcohol industry attempt to influence marketing regulations? A systematic review.

AIM: To systematically review, using a qualitative, narrative synthesis approach, papers examining alcohol industry efforts to influence alcohol marketing policy, and compare with those used by the tobacco industry. METHODS: Literature searches were conducted between April and July 2011, and updated in March 2013. Papers were included if they: made reference to alcohol industry efforts to influence (a) policy debates concerning marketing regulations, (b) new specific marketing policies or (c) broad alcohol policy which included marketing regulations; were written in English; and concerned the period 1990-2013. Alcohol industry political activity was categorized into strategies/tactics and frames/arguments. Data extraction was undertaken by the lead author and 100% of the papers were fully second-reviewed. Seventeen papers met the review criteria. RESULTS: Five main political strategies and five main frames were identified. The alcohol industry argues against marketing regulation by emphasizing industry responsibility and the effectiveness of self-regulation, questioning the effectiveness of statutory regulation and by focusing on individual responsibility. Arguments relating to industry responsibility are often reinforced through corporate social responsibility activities. The industry primarily conveys its arguments through manipulating the evidence base and by promoting ineffective voluntary codes and non-regulatory initiatives. CONCLUSIONS: The alcohol industry's political activity is more varied than existing models of corporate political activity suggest. The industry's opposition to marketing regulation centres on claims that the industry is responsible and that self regulation is effective. There are considerable commonalities between tobacco and alcohol industry political activity, with differences due potentially to differences in policy contexts and perceived industry legitimacy.