How environmental treaties contribute to global health governance.

BACKGROUND: Recent work in international relations theory argues that international regimes do not develop in isolation, as previously assumed, but evolve as open systems that interact with other regimes. The implications of this insight's for sustainable development remains underexplored. Even thought environmental protection and health promotion are clearly interconnected at the impact level, it remains unclear how global environmental governance interacts with global health governance at the institutional level. In order to fill this gap, this article aims to assess how environmental treaties contribute to global health governance. METHODS AND RESULTS: To assess how environmental treaties contribute to global health governance, we conducted a content analysis of 2280 international environmental treaties. For each of these treaties, we measure the type and number of health-related provisions in these treaties. The result is the Health and Environment Interplay Database (HEIDI), which we make public with the publication of this article. This new database reveals that more than 300 environmental treaties have health-related provisions. CONCLUSIONS: We conclude that the global environmental regime contributes significantly to the institutionalization of the global health regime, considering that the health regime includes itself very few treaties focusing primarily on health. When reflecting on how global governance can improve population health, decision makers should not only consider the instruments available to them within the realm of global health institutions. They should broaden their perspectives to integrate the contribution of other global regimes, such as the global environmental regime.

Projection scenarios of body mass index (2013-2030) for Public Health Planning in Quebec.

BACKGROUND: Projection analyses can provide estimates of the future health burden of increasing BMI and represent a relevant and useful tool for public health planning. Our study presents long-term (2013-2030) projections of the prevalence and numbers of individuals by BMI category for adult men and women in Quebec. Three applications of projections to estimate outcomes more directly pertinent to public health planning, as well as an in-depth discussion of limits, are provided with the aim of encouraging greater use of projection analyses by public health officers. METHODS: The weighted compositional regression method is applied to prevalence time series derived from sixteen cross-sectional survey cycles, for scenarios of linear change and deceleration. Estimation of the component of projected change potentially amenable to intervention, future health targets and the projected impact on type 2 diabetes, were done. RESULTS: Obesity prevalence in Quebec is projected to rise steadily from 2013 to 2030 in both men (from 18.0-19.4% to 22.2-30.4%) and women (from 15.5-16.3% to 18.2-22.4%). Corresponding projected numbers of obese individuals are (579,000-625,000 to 790,000-1,084,000) in men and (514,000-543,000 to 661,000-816,000) in women. These projected increases are found to be primarily an 'epidemiologic' rather than 'demographic' phenomenon and thus potentially amenable to public health intervention. Assessment of obesity targets for 2020 illustrates the necessity of using projected rather than current prevalence; for example a targeted 2% drop in obesity prevalence relative to 2013 translates into a 3.6-5.4% drop relative to 2020 projected levels. Type 2 diabetes is projected to increase from 6.9% to 9.2-10.1% in men and from 5.7% to 7.1-7.5% in women, from 2011-2012 to 2030. A substantial proportion of this change (25-44% for men, and 27-43% for women) is attributable to the changing BMI distribution. CONCLUSIONS: Obesity in Quebec is projected to increase and should therefore continue to be a public health priority. Application of projections to estimate the proportion of change potentially amenable to intervention, feasible health targets, and future chronic disease prevalence are demonstrated. Projection analyses have limitations, but represent a pertinent tool for public health planning.

Trade and social determinants of health.

The effects of trade and trade liberalisation on the social determinants of health are not well known. Here, we outline a conceptual framework of links between trade liberalisation and health outcomes, and review existing evidence for these by focusing on four key factors: income, inequality, economic insecurity, and unhealthy diets. Even though trade liberalisation seems to have positive effects on economic growth, it is not sufficient to boost growth. In several countries, trade reforms have not translated into enhanced economic expansion because complementary policies are needed. Trade liberalisation and openness are associated with greater wage inequality and raised economic insecurity. Trade liberalisation has facilitated availability of highly processed, calorie-rich, nutrient-poor food in developing countries, but further research is needed to better understand the effects of trade on unhealthy diets. Policymakers and health professionals need to be aware that the global economy affects the health of populations and understand how risks associated with trade liberalisation can be mitigated.

Fostering the Catalyst Role of Government in Advancing Healthy Food Environments.

Effective approaches to non-communicable disease (NCD) prevention require intersectoral action targeting health and engaging government, industry, and society. There is an ongoing vigorous exploration of the most effective and appropriate role of government in intersectoral partnerships. This debate is particularly pronounced with regards to the role of government in controlling unhealthy foods and promoting healthy food environments. Given that food environments are a key determinant of health, and the commercial sector is a key player in shaping such environments (eg, restaurants, grocery stores), the relationship between government and the commercial sector is of primary relevance. The principal controversy at the heart of this relationship pertains to the potential influence of commercial enterprises on public institutions. We propose that a clear distinction between the regulatory and catalyst roles of government is necessary when considering the nature of the relationship between government and the commercial food sector. We introduce a typology of three catalyst roles for government to foster healthy food environments with the commercial sector and suggest that a richer understanding of the contrasting roles of government is needed when considering approaches NCD prevention via healthy food environments.

Trade Policy and Health: Adding Retrospective Studies to the Research Agenda Comment on "The Trans-Pacific Partnership: Is It Everything We Feared for Health?"

Prospective studies of the potential health consequences of trade and investment treaties, such as the Trans-Pacific Partnership, are critical. These studies can make visible to trade policy-makers the potential negative impacts associated to such treaties and can influence the outcomes of such negotiations. However, few researchers have examined retrospectively the consequences of trade agreements. With more than 400 trade agreements and more than 2000 investment treaties currently in force, researchers have a large corpus of agreements to analyse in order to assess not only their potential impacts on health system and population health, but also their actual impacts. This comment suggests some research questions that would benefit from retrospective inquiry.

Why and How Political Science Can Contribute to Public Health? Proposals for Collaborative Research Avenues.

Written by a group of political science researchers, this commentary focuses on the contributions of political science to public health and proposes research avenues to increase those contributions. Despite progress, the links between researchers from these two fields develop only slowly. Divergences between the approach of political science to public policy and the expectations that public health can have about the role of political science, are often seen as an obstacle to collaboration between experts in these two areas. Thus, promising and practical research avenues are proposed along with strategies to strengthen and develop them. Considering the interdisciplinary and intersectoral nature of population health, it is important to create a critical mass of researchers interested in the health of populations and in healthy public policy that can thrive working at the junction of political science and public health.

The economic consequences of obesity and overweight among adults in Quebec.

OBJECTIVES: This article presents the first study of the economic consequences of obesity and overweight in the Canadian province of Quebec. The article examines three types of direct costs: hospitalizations, medical visits and drug consumption; and one type of indirect cost: productivity loss due to disability. METHODS: The National Population Health Survey, conducted in all Canadian provinces by Statistics Canada between 1994 and 2011, provides self-reported longitudinal data for body mass index and the frequency of health care utilization and disability. RESULTS: When we compared obese adults in Quebec to those with a normal weight at the beginning of the follow-up period, we observed that the former had significantly more frequent visits to the physician, more frequent hospital stays and higher consumption of drugs between 1994 and 2011. We estimated the annual cost of the excess health care utilization and excess disability at more than CAD $2.9 billion in 2011. CONCLUSION: The results confirm that, similar to what had been found elsewhere in Canada and abroad, there are important economic consequences associated with overweight and obesity in Quebec.

Whole-of-society approach for public health policymaking: a case study of polycentric governance from Quebec, Canada.

In adopting a whole-of-society (WoS) approach that engages multiple stakeholders in public health policies across contexts, the authors propose that effective governance presents a challenge. The purpose of this paper is to highlight a case for how polycentric governance underlying the WoS approach is already functioning, while outlining an agenda to enable adaptive learning for improving such governance processes. Drawing upon a case study from Quebec, Canada, we employ empirically developed concepts from extensive, decades-long work of the 2009 Nobel laureate Elinor Ostrom in the governance of policy in nonhealth domains to analyze early efforts at polycentric governance in policies around overnutrition, highlighting interactions between international, domestic, state and nonstate actors and processes. Using information from primary and secondary sources, we analyze the emergence of the broader policy context of Quebec's public health system in the 20th century. We present a microsituational analysis of the WoS approach for Quebec's 21st century policies on healthy lifestyles, emphasizing the role of governance at the community level. We argue for rethinking prescriptive policy analysis of the 20th century, proposing an agenda for diagnostic policy analysis, which explicates the multiple sets of actors and interacting variables shaping polycentric governance for operationalizing the WoS approach to policymaking in specific contexts.

From policy coherence to 21st century convergence: a whole-of-society paradigm of human and economic development.

The 20th century saw accelerated human and economic development, with increased convergence in income, wealth, and living standards around the world. For a large part, owing to the well-entrenched Western-centric linear and siloed industrialization pattern, this positive transformation has also been associated with complex societal challenges at the nexus of agricultural, industrial, and health sectors. Efforts at cross-sectoral policy coherence have been deployed with limited success. To go beyond what has been possible thus far, the whole-of-society (WoS) paradigm for human and economic development proposes a 21st century convergence where, instead of the rest (of the world) converging with the West, sectoral and cross-sectoral efforts converge in their single and collective policy and action on a common target of human and economic development. In this paper, we first review and discuss contributions and limitations of policy coherence approaches. We then elaborate the institutional foundation of the WoS paradigm, taking as an anchor the well-established model of polycentric governance that views individuals, and state, market, and community, forming society as part of the same complex adaptive system. Actors within such systems self-organize into nested hierarchies that operate at multiple scales and move toward 21st century convergence of human and economic development.

Global health diplomacy for obesity prevention: lessons from tobacco control.

To date the global health diplomacy agenda has focused primarily on infectious diseases. Policymakers have not dedicated the same level of attention to chronic diseases, despite their rising contribution to the global burden of disease. Negotiation of the Framework convention on tobacco control provides an apt example from global health diplomacy to tackle diet-related chronic diseases. What lessons can be learned from this experience for preventing obesity? This article looks at why a global policy response is necessary, at the actors and interests involved in the negotiations, and at the forum for diplomacy.

Trade policy and health: from conflicting interests to policy coherence.

Policy incoherence at the interface between trade policy and health can take many forms, such as international trade commitments that strengthen protection of pharmaceutical patents, or promotion of health tourism that exacerbates the shortage of physicians in rural areas. Focusing on the national policy-making process, we make recommendations regarding five conditions that are necessary, but not sufficient, to ensure that international trade policies are coherent with national health objectives. These conditions are: space for dialogue and joint fact-finding; leadership by ministries of health; institutional mechanisms for coordination; meaningful engagement with stakeholders; and a strong evidence base.

Trade policy and health: from conflicting interests to policy coherence / Politique commerciale et santé: passer des conflits d'intérêts à une action cohérente / Políticas comerciales y salud: de los intereses enfrentados a la coherencia normativa

Policy incoherence at the interface between trade policy and health can take many forms, such as international trade commitments that strengthen protection of pharmaceutical patents, or promotion of health tourism that exacerbates the shortage of physicians in rural areas. Focusing on the national policy-making process, we make recommendations regarding five conditions that are necessary, but not sufficient, to ensure that international trade policies are coherent with national health objectives. These conditions are: space for dialogue and joint fact-finding; leadership by ministries of health; institutional mechanisms for coordination; meaningful engagement with stakeholders; and a strong evidence base.

L'incohérence des politiques à l'interface entre la politique commerciale et la santé peut prendre de nombreuses formes, par exemple les engagements commerciaux internationaux qui renforcent la protection des brevets pharmaceutiques ou la promotion du tourisme de santé qui agrave la pénurie de médecins en milieu rural. En mettant l'accent sur l'élaboration des politiques au niveau national, l'article formule des recommandations concernant cinq conditions nécessaires, mais non suffisantes, pour que les politiques commerciales internationales soient compatibles avec les objectifs sanitaires nationaux, à savoir : ménager une place au dialogue et à une action commune d'établissement des faits ; conférer un rôle de premier plan aux ministères de la santé ; prévoir des dispositifs institutionnels de coordination ; solliciter à bon escient l'implications des parties prenantes ; et disposer de bases factuelles solides.

La incoherencia normativa en el terreno de interacción de las políticas comerciales y la salud puede reflejarse en muchos aspectos, como los compromisos comerciales internacionales que refuerzan la protección de las patentes farmacéuticas, o el fomento de un turismo sanitario que agrava la escasez de médicos en las zonas rurales. Centrándonos en el proceso de formulación de políticas nacionales, hacemos algunas recomendaciones respecto a cinco condiciones que son necesarias, pero no suficientes, para asegurar que las políticas comerciales internacionales sean coherentes con los objetivos de salud nacionales. Esas condiciones son un espacio para el diálogo y la investigación conjunta, el liderazgo de los ministerios de salud, los mecanismos institucionales de coordinación, una participación significativa con los interesados directos y una base evidencial sólida.