Mass media campaigns and the 'file drawer problem': A mixed methods study of how to avoid campaign failure.

Mass media campaigns are frequently used to address public health issues. Considering the considerable cost, there has been little analysis of why campaigns sometimes fail. This study used a sequential mixed methods approach to explore the mechanisms that can lead to failure and to identify what can be done to avoid or overcome common mistakes in campaign planning, implementation, and evaluation. We conducted interviews and a survey with 28 public health social marketing and mass media campaign experts over three rounds of research and analysed the data thematically, generating themes inductively. We identified four systemic factors that drive success: long-term strategic thinking and commitment, understanding the campaign context, doing and learning from evaluation, and fostering strong relationships. The factors did not operate in isolation, rather good (or poor) execution in one area was likely to influence performance in another. The experts also emphasised that a change of political context could drastically affect one or more of the identified factors. Our analysis showed that campaign failures are not simply individuals making mistakes. Systemic issues throughout the planning, execution, and evaluation phases need to be addressed if campaign outcomes are to improve.

Talking about a nanny nation: investigating the rhetoric framing public health debates in Australian news media.

Objectives and importance of study: News media portrayal of public health issues influences public opinion, policy action and decision making. This study aimed to analyse the use of 'nanny state' frames in Australian news media coverage; identify the stakeholders invoking this frame; determine which public health-related policies attract such framing; and investigate whether 'nanny state' framing is directly challenged in news coverage. STUDY TYPE: A qualitative framing analysis. METHODS: Articles featuring the term 'nanny state' that were published in Australian print newspapers during matched periods between March and September in 2017 and 2018 were sourced through Factiva, coded and analysed for content and 'nanny state' framing. Content analysis was used to identify any public health-related issues that the terminology nanny state was applied to, and who was portrayed as imposing the nanny state. Frame analysis was used to analyse what meanings are co-presented with the phrase nanny state. RESULTS: Out of 81 print newspaper articles that included the term 'nanny state', 19% linked the term to restricting personal choice or creating dissatisfaction with too many health-related rules and regulations broadly, across a range of issues, including: bike helmets, e-cigarettes, firearm restrictions, seatbelts, pool fences and smoking bans. The next most frequent links were to regulations on alcohol (17%), road safety (14%), obesity-related issues (7%) and tobacco control (6%). Of the 81 articles, 53% appeared in news publications owned by News Corporation Australia, 20% in Fairfax Media (Nine Entertainment) publications, 17% in Daily Mail and General Trust and 10% in publications owned by other organisations. Governments were the entity most frequently framed as imposing the nanny state. Most nanny state framings (73%) were negative towards public health controls and focused on policies and regulations. Nanny state was portrayed as an assault on freedom and choice (14%) and used to attack proponents of nanny state controls (11%), while few articles framed the nanny state (7%) in a favourable light. CONCLUSIONS: 'Nanny state' is a rhetorical device commonly used in Australian news media that may contribute to discrediting of the regulation of a range of health-related issues. News Corp publications are a major propagator of nanny state rhetoric in Australian newspaper media. Public health advocates are not commonly represented within nanny state debates within the news media.

Obesity prevention in children and young people: what policy actions are needed?

Overweight and obesity in childhood and adolescence are associated with adverse health consequences throughout the lifecourse. Rates of childhood overweight and obesity have reached alarming proportions in many countries and pose an urgent and serious challenge. Policy responses across the world have been piecemeal. Evidence based policy actions and interventions are available to build a comprehensive approach to overweight and obesity but, in most countries, a narrow selection of interventions are chosen, often implemented over short time periods and typically with small-scale investment. The most cost-effective policy actions are rarely selected, or only partially adopted. Genuinely comprehensive, long-term population-wide approaches are scant. Leading-edge fiscal and regulatory strategies face aggressive, often effective, opposition from lobby groups. We outline the policy actions, governance and accountability mechanisms needed to tackle this global epidemic.

Comprehensive sector-wide strategies to prevent and control obesity: what are the potential health and broader societal benefits? A case study from Australia.

AIM: Several countries have recently established multistakeholder strategies to prevent or control overweight and obesity; however, studies have not yet been done on their effectiveness and likely impact. This study's objectives were to (i) explore sector-wide benefits and impacts likely to accrue from implementing an obesity prevention strategy in the Australian state of New South Wales; (ii) discuss the wider implications of the findings for research and practice; and (iii) strengthen the case for sustained implementation of a comprehensive, intersectoral approach. METHOD: A case study approach, including evidence reviews and illustrative epidemiological models, was used to show potential benefits from meeting selected targets and objectives specified in the strategy. RESULTS: For adults, improved health outcomes potentially include reductions in all-cause mortality, cardiovascular disease, type 2 diabetes, various cancers, osteoarthritis, infant mortality and healthcare costs. Potential benefits beyond the health sector involve disability payments, absenteeism, worker productivity, workplace injuries and insurance claims. For children and adolescents, improved health outcomes potentially include metabolic risk factors, dental health, prehypertension/hypertension, cardiovascular disease risk factors, depression, rates of mortality in hospitalised children, bullying and otitis media. CONCLUSION: Sector-wide health, social and economic benefits from successful implementation of multisector obesity prevention strategies are likely to be substantial if specified targets are achieved. Epidemiological modelling described in this paper for selected examples provides illustrative rather than comprehensive evidence for potential benefits. Process evaluation of the extent of implementation of these multisectoral strategies, together with the accumulated data on intervention effectiveness, will determine their potential population health benefit. Quantifying the health and social benefits that are likely to accrue if comprehensive sector-wide obesity prevention and control strategies are established can strengthen advocacy for their sustained implementation.

Assessing the usefulness of systematic reviews for policymakers in public health: A case study of overweight and obesity prevention interventions.

OBJECTIVE: Systematic reviews (SRs) should include policy-relevant information in order to more readily inform policy and practice. We investigated whether SRs of overweight and obesity prevention interventions are framed in such a way that maximises their usefulness for policymakers. METHOD: We conducted a systematic review of SRs of overweight and obesity prevention interventions published in 4 databases any time up to December 2014. We analysed the SRs for their usefulness to policymakers, using a coding frame developed based on literature around what policymakers want and need from systematic reviews. Systematic reviews were assessed for a) policy links and framing; b) quality assessment and conflict of interest statements: and c) discussion of policy implications. RESULTS: Of the 153 SRs that met the inclusion criteria, very few (7%) had authors from policy-based organisations, 48% had funding from such organisations, and almost a third (31%) framed their introduction or aims around policy. Most (69%) discussed issues affecting generalisability of the SR findings but only a quarter (24%) discussed cost or cost-effectiveness of the intervention under investigation. Less than a third (29%) of SRs discussed the policy implications of their findings. SRs that were policy-framed were significantly more likely to discuss costs (PR=1.8, 95%CI 1.0-3.0) and policy implications (PR=2.5, 95%CI 1.5-4.0). CONCLUSION: SRs should discuss the policy and practice implications of their findings to maximise the influence of SRs on policy making. It is recommended that SR guidelines are updated to include generalisability and discussion of policy and practice implications as a requirement.