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Profits And Pandemics: Prevention Of Harmful Effects Of Tobacco, Alcohol, And Ultra-Processed Food And Drink Industries
Abstract
The 2011 UN high-level meeting on non-communicable diseases (NCDs) called for multisectoral action including with the private sector and industry. However, through the sale and promotion of tobacco, alcohol, and ultra-processed food and drink (unhealthy commodities), transnational corporations are major drivers of global epidemics of NCDs. What role then should these industries have in NCD prevention and control? We emphasise the rise in sales of these unhealthy commodities in low-income and middle-income countries, and consider the common strategies that the transnational corporations use to undermine NCD prevention and control. We assess the effectiveness of self-regulation, public-private partnerships, and public regulation models of interaction with these industries and conclude that unhealthy commodity industries should have no role in the formation of national or international NCD policy. Despite the common reliance on industry self-regulation and public-private partnerships, there is no evidence of their effectiveness or safety. Public regulation and market intervention are the only evidence-based mechanisms to prevent harm caused by the unhealthy commodity industries.
... Furthermore, products such as tobacco and highly palatable foods may be designed to maximize public consumption and industry profits, which may come at great expense to public health [3]. Federal regulation can serve as a powerful counterweight to protect population health. ...
... Products sold to US consumers, such as tobacco and hyper-palatable foods, may be designed to maximize public consumption at great risk to public health [3]. In this regard, commonalities between the practices of US tobacco and food companies have been highlighted for the past 20 years [3,38,39]. ...
... Products sold to US consumers, such as tobacco and hyper-palatable foods, may be designed to maximize public consumption at great risk to public health [3]. In this regard, commonalities between the practices of US tobacco and food companies have been highlighted for the past 20 years [3,38,39]. This paper underscores the fact that these commonalities are the direct result of shared ownership: US T A B L E 1 Food item hyper-palatability by year and tobacco company ownership. ...
Background and aims:
US tobacco companies owned leading US food companies from 1980 to 2001. We measured whether hyper-palatable foods (HPF) were disproportionately developed in tobacco-owned food companies, resulting in substantial tobacco-related influence on the US food system.
Design:
The study involved a review of primary industry documents to identify food brands that were tobacco company-owned. Data sets from the US Department of Agriculture were integrated to facilitate longitudinal analyses estimating the degree to which foods were formulated to be hyper-palatable, based on tobacco ownership.
Setting and cases:
United States Department of Agriculture data sets were used to identify HPF foods that were (n = 105) and were not (n = 587) owned by US tobacco companies from 1988 to 2001.
Measurements:
A standardized definition from Fazzino et al. (2019) was used to identify HPF. HPF items were identified overall and by HPF group: fat and sodium HPF, fat and sugar HPF and carbohydrates and sodium HPF.
Findings:
Tobacco-owned foods were 29% more likely to be classified as fat and sodium HPF and 80% more likely to be classified as carbohydrate and sodium HPF than foods that were not tobacco-owned between 1988 and 2001 (P-values = 0.005-0.009). The availability of fat and sodium HPF (> 57%) and carbohydrate and sodium HPF (> 17%) was high in 2018 regardless of prior tobacco-ownership status, suggesting widespread saturation into the food system.
Conclusions:
Tobacco companies appear to have selectively disseminated hyper-palatable foods into the US food system between 1988 and 2001.
... MDG 8 specifically called for a 'global partnership for development', incorporating the private sector, new technologies, and the pharmaceutical industry (1,25,26). Additionally, MDG 4 and 5 focused on women and children's health, and MDG 6 acknowledged diseases like malaria, tuberculosis, and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (27,28). A significant gap of the MDGs was the lack of goals or targets related to NCDs. ...
... From the analysis of the final 30 articles, a total of six themes were identified as key pillars that influence the role that the private sector has on NCD management and control. These included public-private partnerships (PPPs) (2,22,25,27,(43)(44)(45)(46)(47)(48)(49), knowledge mobilization (28,30,(49)(50)(51)(52)(53)(54)(55)(56), direct investment and finance (28,44,49,50,(55)(56)(57)(58)(59)(60)(61)(62), healthcare provision (28,46,53,57,59,60,63), innovation (1,30,45,48,58,59,63), and governance and policy (2,26,27,30,44,64). Each theme entails specific subthemes, which are all defined based on the final articles used for synthesis. ...
... From the analysis of the final 30 articles, a total of six themes were identified as key pillars that influence the role that the private sector has on NCD management and control. These included public-private partnerships (PPPs) (2,22,25,27,(43)(44)(45)(46)(47)(48)(49), knowledge mobilization (28,30,(49)(50)(51)(52)(53)(54)(55)(56), direct investment and finance (28,44,49,50,(55)(56)(57)(58)(59)(60)(61)(62), healthcare provision (28,46,53,57,59,60,63), innovation (1,30,45,48,58,59,63), and governance and policy (2,26,27,30,44,64). Each theme entails specific subthemes, which are all defined based on the final articles used for synthesis. ...
Background: Due to the high mortality rates globally, addressing non-communicable diseases (NCDs) is a priority included in the Sustainable Development Goals (SDGs). Because the private sector is growing as a provider of health-related goods and services in many places, especially where public sector programs are weak, it has been identified as a significant stakeholder in health systems' management of NCDs. Yet the contributions of the private health sector to addressing NCDs has not been systematically evaluated.
... En la actualidad, fumar (tabaco), beber alcohol y apostar se encuentran entre las actividades recreativas más populares para los europeos occidentales y los norteamericanos (Moodie et al., 2013). Aunque estas actividades recreativas son agradables en sí mismas, tienen un alto coste. ...
... Las opiniones negativas sobre las políticas de control también pueden dificultar su aplicación y cumplimiento (Moskalewicz et al., 2013). Además, para contrarrestar con éxito los esfuerzos de las industrias productoras, que no son necesariamente conscientes del peligro que supone su producción, los gobiernos necesitan un fuerte apoyo de la sociedad civil (Moodie et al., 2013). Por ello, se han realizado numerosos estudios empíricos sobre las actitudes de los ciudadanos hacia las políticas de control. ...
... These changes affect feeding rhythms with the disappearance of structured meals and moments of sharing meals. They also affect diets, consisting in an inflation of energy dense ultra-processed foods that contain little or no fibrous material, high in unhealthy types of dietary fat, free sugars, and sodium (16). People with low health literacy levels appear to be more affected by these changes, and obesity in adults is significantly correlated with functional health literacy in multivariate logistic regressions adjusted on other confounders (income, parent obesity, ethnicity, sex) (17, 18). ...
... The "Sanitation Pass" was created in France on June 1 st , 2021 (as in Germany, Italy and Latvia), and the European regulation "Vaccination Pass" on January 22, 2022, making de facto vaccination compulsory for many activities of daily life. [16] Vaccination uptake and specific hesitancy On July 28, 2022, 78.6% of the French population had a complete vaccination protocol (2 injections), and 62.2% had a first booster (76). Vaccine hesitancy has been very heterogenous in Europe ranging from 6.4% of adults in Spain to 61.8% in Bulgaria, based on different attitudes like trust in government or high conspiracy beliefs (77). ...
The general purpose of this thesis was the study of tools to enhance health behaviour with patients in primary care waiting rooms. The time patients spent in the waiting room was used as an opportunity for a moment of health education. A systematic review on educative efficiency of audio-visual aids in primary care waiting rooms learned that audio-visual aids broadcasting messages using screens (TVs, computers, tablets, smartphones with Bluetooth® pairing) probably enhance patients’ knowledge, but a change in health behaviour remains controversial. In a second phase the thesis focused on the annual advertisement campaign by posters and pamphlets in general practice (GP) waiting rooms to promote seasonal influenza vaccination as a paradigm to measure the efficacy of posters and pamphlets with a randomized controlled trial (RCT). It is notable that the validity of studies in the field of changes in health behaviour is often invalidated by experimental artefacts, in particular, the so-called Hawthorne effect (HE), related to behavioural changes in patients and in investigators caused by the experimental environment. The thesis sought to update and refine the definition of the HE in medical research and more specifically in primary care. Following our refined definition, the probability of a HE in the RCT was scarce, but no indisputable evidence was strengthening our conclusions. We redesigned our RCT bypassing the limitations of the first and followed over two years our research cohort to obtain an insight of the natural evolution of seasonal influenza vaccination uptake in GPs’ customer base.
Health promotion and patients’ health education are an important part of a GP’s commitments as patients’ health behaviours are crucial factors in life expectancy and good health. Most waiting-rooms have therefore been implemented with audio-visual aids (posters, pamphlets or screens) for health promotion purposes. Posters and pamphlets are present in practically all primary care practices. Few studies have assessed the effect of audio-visual aids in primary care.
Our first objectives, as to scan this research field, was to identify, describe and appraise studies that had investigated the effects of audio-visual aids on health promotion in primary health care waiting-rooms and to identify which factors influence their effect through a systematic literature review.
Databases were searched by two independent researchers using predefined keywords. Additional records were extracted from the reference lists of the selected articles. The selection of the reports was performed on the title and abstract, followed by complete reading and assessment. Bias and level of evidence were analysed.
We collected 909 records. Most of them were not in primary care settings. Fourteen peer-reviewed reports fully meeting the inclusion criteria were retained for analysis. Good quality studies were scarce as it appeared difficult to distinguish the specific effect of the aids from the motivation of investigators. Eight of these articles using videos or slideshows on TV screens or tablets indicated effects: three of them showed a significant improvement of patient knowledge with acceptable evidence and three on health behaviour with surrogate endpoints didn’t show a clear association with the studied outcome. Audio-visual aids seemed to be used or noticed by patients and could induce conversations with physicians. The relevant factors that might influence these effects (duration of exposure, conception quality, theme, target population and time spent in the waiting-room) were insufficiently investigated. Finally, if audio-visual aids broadcasting messages using screens might enhance patients’ knowledge, no effect of posters and pamphlets in waiting rooms was demonstrated. A change in health behaviour remained controversial.
As most GPs use advertising with posters and pamphlets in their waiting rooms for patient’s education purposes without clear evidence of their use, we sought to demonstrate the effect of an advertising campaign using these two media. Patients vaccinated against seasonal influenza have been gradually lessening between 2009 and 2014, and mandatory health insurance companies have implemented in France an advertising campaign using posters and pamphlets displayed in primary care waiting rooms to promote seasonal influenza vaccination uptake, together with incentives in mass-media.
We designed a trial with the objective of assessing the effect of this advertising campaign for influenza vaccination using posters and pamphlets in GPs’ waiting rooms.
This registry based 2/1 cluster randomized controlled trial (RCT), a cluster gathering the enlisted patients aged over 16 years, of 75 GPs, run during the 2014-2015 influenza vaccination campaign. It compared patient’s awareness in 50 GPs’ standard waiting rooms exposed to a lot of information (control group) versus that of patients, spending their time in waiting rooms from 25 GPs, who had received and displayed (in addition to mandatory information) only those pamphlets and one poster about the influenza vaccination campaign (intervention group). The main outcome was the number of vaccination units delivered in community pharmacies. Data were extracted from the SIAM-ERASME claim database of the main mandatory Health Insurance Fund of Lille-Douai (France). The association between the intervention (yes/no) and the main outcome was assessed through a generalized estimating equation.
Seventy-five GPs enrolled 10,597 patients of 65 years and over, or of 16 years and over suffering from long lasting diseases (intervention/control as of 3781/6816 patients) from October 15, 2014 to February 28, 2015. No difference was found regarding the number of influenza vaccination units delivered in community pharmacies (Relative Risk =1.01; 95% Confidence interval: 0.97 to 1.05; p=0.561). A vaccination performed on the previous year increased revaccination probability (RR=5.63; 95%CI: [5.21 to 6.10] p<0.001). Effects of the monothematic campaign promoting vaccination against influenza using a poster and pamphlets displayed in GPs’ waiting rooms could not be demonstrated.
Unexpected, vaccination uptake rose by 3% in both arms of the RCT whereas public health data based on the “generalist sample of beneficiaries” and the SNIIRAM warehouse database indicated a simultaneous decrease of 2%. We wondered if the design of the trial had led to a Hawthorne effect (HE). Searching the literature, we noticed that the definition of the HE was unclear. In medical sciences, the meaning of the HE was drifting towards the interaction of artefacts in an experimental environment. In social sciences, and mainly in psychology, it was more closely bound to the Hawthorne experiments conducted from 1924 to 1933 and the definition given in 1953 by Festinger; for these reasons, its existence was disputed.
Our objectives were 1) to refine a definition of the HE in medical sciences and for primary care and 2) to evaluate its size and to draw consequences for primary care research.
We designed a PRISMA 2020 review and meta-analysis between January 2012 and March 2022. We included original reports defining the HE and reports measuring it without setting limitations. Definitions of the HE were collected and summarized. Main published outcomes were extracted and measures were analysed to evaluate odds ratios (OR) in primary care and close circumstances.
The search led to 180 records, reduced after review on title and abstract and on full reading of the remaining reports to 74 on definition and 15 on quantification. Our refined definition of HE is “an aware or unconscious complex behaviour change in a study environment, related to the complex interaction of four biases affecting the study subjects and investigators: selection bias, commitment and congruence bias, conformity and social desirability bias and observation and measurement bias”. Its size varies in time and depends on the education and professional position of the investigators and subjects, the study environment, and the outcome. There are overlap areas between the HE, placebo effect and regression towards the mean. In binary outcomes, the overall OR of the HE computed in primary care was 1.41 (95% CI: [1.13;1.75]; I²=97%), but the significance of the HE disappears in well-designed studies.
We concluded that the HE results from a complex system of interacting phenomena and appears to some degree in all experimental research. Its size can considerably be reduced by refining study designs, for instance by the submission of research projects to registry platforms. Further, the chance that the increase of the vaccination uptake in both arms of the RCT was related to a HE appeared to be negligible.
As noted above, to conduct our RCT, we used a different database than the SNIIRAM warehouse claim database to collect our data. The SNIIRAM warehouse database merges data from all different mandatory French Health Insurance regimes and is used for public health surveys. By the time of the trial, there was a sufficient number of GPs left on our randomisation list to recruit 100 more GPs that were naïve to the RCT, and thus completely exempt of influence that might lead to a HE. Searching for an explanation of the rise in influenza vaccination uptake, it was possible to follow our trial cohort during three years using the SNIIRAM warehouse database and to constitute a posteriori a second control group, naïve to the trial, as described by Zelen in 1979.
So, in 2019 we deepened the investigations explaining the increased uptake, conducting a registry-based 4/2/1 cluster RCT designed by Zelen with two extra years of follow-up of the study cohort. The study population included 23,024 patients, registered with 175 GPs, eligible to benefit from a free influenza vaccination, that is, aged 65 years and over or 16 years and over with a chronic condition. The main outcome remained the number of vaccination units delivered in community pharmacies per study group. Data were extracted from the SNIIRAM warehouse claim database for the Lille-Douai district (Northern France).
No difference in vaccination uptake was found in the Zelen versus the control group of the initial RCT, closing the debate about the usefulness of posters and pamphlets as health promotion vectors in primary care waiting rooms. Overall, the proportion of vaccinated patients increased in the cohort from 51.4% to 70.4% over the three years. Being vaccinated the previous year was a strong predictor of being vaccinated in a subsequent year. The increase in vaccination uptake can be explained by a cohort effect, especially among people of 65 years and older, reaching 75% of influenza vaccination coverage as determined by the WHO. Health promotion and the promotion of primary health care may play an important role in this increase. However, if promoting health behaviour of patients matches with the commitment and congruence, and conformity and social desirability expected from general practitioners and primary care teams, to reach their objectives these teams also have to meet the expectations of patients who feel concerned by their health outcomes, like sexagenarians regarding the prevention of influenza.
The limitation of this health promotion approach in primary care is the population, mainly represented by persons with a low level of health literacy, whose life priorities don’t meet their health outcomes. This population, roughly representing one quarter of the global population, is difficult to reach by primary health teams, generally shares a low life expectancy in good health, is barely participating in primary healthcare research projects and not represented in routine collected databases (claim databases or databases collecting data in primary care electronic medical records), constituting a research blind spot. One of the most important challenges for the next years in primary healthcare practice and research will be to reach these populations and integrate them in health pathways meeting their expectations: deprived communities, patients at risk of developing chronic conditions or their complications, prefrail or frail aging persons, or young persons not in education, employment or training (NEET).
... These foods are often energy-dense products, low in dietary fiber, micronutrients, and phytochemicals [28]. However, they often look, smell, and taste good due to a combination of flavors, colors, thickeners, sweeteners, emulsifiers, sodium, and other additives that make them appealing to consumers, particularly children [29]. ...
... Safeguarding populations' health usually takes place at the national level, but as transnational corporations are part of the global economic system, the need for international collective action to address the NCD pandemic has been growing. At the global level, there have been calls from researchers, professional organizations, and some governments for a binding international treaty to reduce the harmful use of alcohol and related problems, similar to the WHO FCTC [29]. This will require strong political commitments from governments to address industry interference, strengthen the leadership role of WHO in global health, and recognize the damaging impact of the commercial determinants of health [16]. ...
Noncommunicable diseases (NCDs) are the leading cause of premature mortality worldwide. Corporate interests are sometimes well-aligned with public health, but profiteering from the consumption of products that are known to be the major contributors to the noncommunicable disease burden undermines public health. This paper describes the key industry actors shaping the NCD landscape; highlights the unhealthy commodities’ impact on health and the growing burden of NCDs; and outlines challenges and opportunities to reduce exposure to those risk factors.
Corporations deploy a wide array of strategies to maximize profits at the expense of health, including sophisticated marketing techniques, interference in the policy-making process, opposition and distortion of research and evidence, and whitewashing of health-harming activities through corporate social responsibility initiatives. There can be no shared value for industries that sell goods that harm health irrespective of consumption patterns (such as tobacco and likely alcohol), so government actions such as regulation and legislation are the only viable policy instruments. Where shared value is possible (for example, with the food industry), industry engagement can potentially realign corporate interests with the public health interest for mutual benefit. Deliberate, careful, and nuanced approaches to engagement are required.
... This is consistent with broader CDoH literature. 22,23,44,45 Only a few PH-focused participants described ecological implications of unsustainable food systems and broader unsustainable production systems. This is consistent with short-term framings of harms noted here and more broadly as discussed further below. ...
... These approaches, including restrictions on lobbying, political donations, revolving doors, gifts, and others, with proper enforcement of these, have been discussed widely in the CDoH literature. 45,52,53,54,55,56 However, Australia has relatively weak requirements for transparency in these areas, and weak enforcement of existing regulation. 57,58 The lack of transparency and the lack of consequence for those breaching or noncompliant with regulation in these areas is a prominent barrier to reducing the exertion of instrumental power in these areas. ...
Background:
Commercial determinants of health (CDoH) represent a critical frame for exploring undue corporate and commercial influence over health. Power lenses are integral to understanding CDoH. Impacts of food, alcohol, and gambling industries are observable CDoH outcomes. This study aims to inform understanding of the systems and institutions of commercial and/or corporate forces working within the Australian food, alcohol, and gambling industries that influence health and well-being, including broader discourses materialised via these systems and institutions.
Methods:
Twenty semi-structured interviews were conducted with key-informants on Australian public policy processes. Interviewees were current and former politicians, political staff members, regulators and other public servants, industry representatives, lobbyists, journalists, and researchers with expertise and experience of the Australian food, alcohol, and/ or gambling industries. Interviews sought participants' perceptions of Australian food, alcohol, and gambling industries' similarities and differences, power and influence, relationships, and intervention opportunities and needs.
Results:
Strategies and tactics used by Australian food, alcohol and gambling industries are similar, and similar to those of the tobacco industry. They wield considerable soft (eg, persuasive, preference-shaping) and hard (eg, coercive, political, and legal/economic) power. Perceptions of this power differed considerably according to participants' backgrounds. Participants framed their understanding of necessary interventions using orthodox neoliberal discourses, including limiting the role of government, emphasising education, consumer freedom, and personal choice.
Conclusion:
Food, alcohol, and gambling industries exercise powerful influences in Australian public policy processes, affecting population health and well-being. Per Wood and colleagues' framework, these manifest corporate, social, and ecological outcomes, and represent considerable instrumental, structural, and discursive power. We identify power as arising from discourse and material resources alike, along with relationships and complex industry networks. Addressing power is essential for reducing CDoH harms. Disrupting orthodox discourses and ideologies underpinning this should be a core focus of public health (PH) advocates and researchers alike.
... The high palatability, availability and the aggressive marketing of ultra-processed foods make them preferred substitutes for children. Another exacerbating factor is that the introduction of these products has been occurring very early in children's diets, even before 12 months of age (Moodie et al., 2013) [10] . Ultra-processed foods, especially energy-dense foods high in sugar, fat and salt, is gradually displacing homeprepared meals and the consumption of fresh fruit and vegetables in typical diets. ...
Background: Ultra-Processed Foods are packaged formulation resulting from several sequences of industrial processes; they are manufactured entirely from substance derived from foods and additives used to imitate sensory properties of foods and disguise unpalatable aspects of the final product. Objectives: This study examines the consumption of ultra-processed foods and dietary patterns of children (6-12years) in Obowo L.G.A, Imo State. Methods: The study was a cross-sectional study. A multi-stage sampling technique was used to select a total of 440 respondents for the survey. Data on socioeconomic/demographic characteristics, consumption of ultra-processed foods and dietary pattern of the respondents were collected using structured and validated questionnaires. The IBM SPSS version 23.0 was used to analyze the data. Data obtained were described using frequency and percentage. Results: Half (50.8%) of the respondents were females. Majority of the respondents (70.3%) were between the ages of 10-11years and 90.2% of them were Christians. Most of the respondent's fathers (70.7%) completed only secondary education, while 60.9% of their mothers completed only secondary education. Majority of their fathers (70.7%) were traders and earned between ₦50,000-₦69,000 in a month, while most of their mothers (90.2%) were traders and earned between ₦50,000-₦69,000 in a month. Majority of the children (70.7%) were fed three times daily. Majority (70.7%) of the respondents consumed ultra-processed foods/drinks and most of them (59.0%) consumed it because it was always available. Most of the school children (88.3%) consumed snacks. Conclusion: This study showed a high daily consumption of some ultra-processed foods like instant noodles, biscuit and soft drinks by the children. There is need to raise awareness on healthy eating behaviors targeted at school children.
... The contemporary lifestyle prevalent in our society has contributed to a surge in the prevalence of overweight and obesity, leading to the escalation of chronic degenerative ailments, including Type II Diabetes Mellitus (DM2), coronary heart disease, arterial hypertension, and even cancer. Furthermore, there exists a direct correlation between DM2 and the mortality rate associated with COVID-19 [1,2] . ...
Diabetes mellitus (DM2) was considered a more common comorbidity and was associated with high mortality due to metabolic disease in the COVID-19 pandemic. For this reason, glibenclamide (GLI) was commonly prescribed for its control. However, it has been found in environmentally relevant concentrations in various water reservoirs due to its high consumption. Common carp (Cyprinus carpio), besides its nutritional properties and economic importance, is also considered a good bioindicator for assessing environmental health and pollutants presence; nonetheless, there are currently insufficient studies on the effect of GLI on the physicochemical and textural properties of the muscle of this bioindicator species. In this study, the effect of this drug at two environmentally relevant concentrations (50 and 1,000 ng/L) at five exposure times (every 24 up to 96 h) on the quality of carp muscle was investigated. Parameters such as carbonylated proteins, lipid peroxidation, total sulfhydryl content, water holding capacity, pH, electrophoretic profile, and texture profile analysis were determined. Regardless of the concentration of GLI used, the evaluated parameters showed significant muscle damage; therefore, it must be emphasized that this emerging pollutant not only damages environment, but also affects edible species present in different water reservoirs.
... Through the 19th-20th centuries sugar consumption increased exponentially [113], while attention now focuses on ultra-processed foods [120]. Both of these dietary components have been linked with obesity and the risk of non-communicable disease [124,125]. A significant proportion of global agriculture produces products that are quintessentially addictive (tobacco, tea, coffee) and highly profitable, and yet contribute negligibly to meeting dietary energy requirements [126]. ...
There is growing concern with social disparities in health, whether relating to gender, ethnicity, caste, socio-economic position or other axes of inequality. Despite addressing inequality, evolutionary biologists have had surprisingly little to say on why human societies are prone to demonstrating exploitation. This article builds on a recent book, ‘The Metabolic Ghetto’, describing an overarching evolutionary framework for studying all forms of social inequality involving exploitation. The dynamic ‘producer-scrounger’ game, developed to model social foraging, assumes that some members of a social group produce food, and that others scrounge from them. An evolutionary stable strategy emerges when neither producers nor scroungers can increase their Darwinian fitness by changing strategy. This approach puts food systems central to all forms of human inequality, and provides a valuable lens through which to consider different forms of gender inequality, socio-economic inequality and racial/caste discrimination. Individuals that routinely adopt producer or scrounger tactics may develop divergent phenotypes. This approach can be linked with life history theory to understand how social dynamics drive health disparities. The framework differs from previous evolutionary perspectives on inequality, by focussing on the exploitation of foraging effort rather than inequality in ecological resources themselves. Health inequalities emerge where scroungers acquire different forms of power over producers, driving increasing exploitation. In racialized societies, symbolic categorization is used to systematically assign some individuals to low-rank producer roles, embedding exploitation in society. Efforts to reduce health inequalities must address the whole of society, altering producer–scrounger dynamics rather than simply targeting resources at exploited groups.
... This is mainly due to their greater accessibility compared to traditional, "wholesome" foods [11,12]. UPFs have been defined as "industrial formulations composed entirely or predominantly of substances extracted from food (e.g., oils, fats, sugars, starch, and proteins), derived from food components (e.g., hydrogenated fats and modified starch), or synthesized in the laboratory from food substrates or other organic sources (e.g., flavor enhancers, colorants, and various food additives used to make the product hyper-pathetic)" [13]. Habitual ingestion of UPFs has been found to be associated with several chronic diseases. ...
The correlation between health and diet has always been a subject of interest in the field of dermatology and medicine in general. However, studies in the literature are still scarce, and need further investigation in the field of inflammatory skin diseases. In this paper, we report a case of a patient with atopic dermatitis whose complete recovery occurred only after combining dupilumab therapy with a Mediterranean diet regimen.
... Those in favour of voluntary mechanisms argue that partnership approaches are effective, obviating the need for regulation [22]. Others, however, reject voluntary initiatives as ineffective or incompatible with public health goals (Moodie et al., 2013;Capewell and Capewell, 2018;Knai et al., 2018), promoting a more interventionist role for the state [23]. ...
Despite evidence that dietary population health interventions are effective and widely accepted, they remain the topic of intense debate centring on the appropriate role of the state. This review sought to identify how the role of the state in intervening in individuals’ food practices is conceptualized across a wide range of literatures. We searched 10 databases and 4 journals for texts that debated dietary population health interventions designed to affect individuals’ health-affecting food practices. Two co-authors independently screened these texts for eligibility relative to inclusion and exclusion criteria. Thirty-five texts formed our final corpus. Through critical reflexive thematic analysis (TA), we generated 6 themes and 2 subthemes concerning choice, responsibility for health, balancing benefits and burdens of intervention, the use of evidence, fairness, and the legitimacy of the state’s actions. Our analysis found that narratives that aim to prevent effective regulation are entrenched in academic literatures. Discourses that emphasized liberty and personal responsibility framed poor health as the result of ‘lifestyle choices’. Utilitarian, cost-benefit rationales pervaded arguments about how to best balance the benefits and burdens of state intervention. Claims about fairness and freedom were used to evoke powerful common meanings, and evidence was used politically to bolster interests, particularly those of the food industry. This review identifies and critically analyses key arguments for and against population dietary public health policies. Our findings should motivate public health researchers and practitioners to avoid unreflexively embracing framings that draw on the languages and logics of free market economics.
... The ultraprocessed foods are manufactured with substances extracted from foods or synthesized in laboratories (dyes, flavorings, and other additives), high amounts of fat, sugar, and salt and a high energy density and low fiber content (5). Besides that, these food products are also extremely palatable and habit-forming, convenient, sold in large portion sizes, and aggressively advertised and marketed (6)(7)(8). ...
Introduction. We propose the following hypothesis: ultraprocessed foods in the global food supply contribute to the worldwide increase in obesity. Objective. To analyze the association between a higher consumption of ultraprocessed foods and the obesity in adulthood in the United States. Materials and methods. United States National Survey of Health and Nutrition Examination (NHANES) (2009-2018) data were used. We included subjects of both sexes, aged between 18-64 years old, with anthropometric, health, income, race/ethnicity and physical activity (PA) data. The association between the ultraprocessed food intake and obesity was calculated using a binomial logistic regression. In addition, we also evaluated a subsample with subjects who did not consume more than their adequate daily energy requirements. Results. We evaluated 13,310 subjects in total, and 4,788 in our subsample. Of these 33% were committed to obesity, and in the subsample the prevalence was even higher, around 49%. In our analysis, we found five factors (ultraprocessed food consumption, sex, age, race/ethnicity, and sedentary lifestyle) that were positively associated with the development of obesity. Compared to subjects who consumed less than 20% of ultraprocessed foods, subjects who consumed between 20 to 40% of ultraprocessed food had 16% more odds of developing obesity [95%CI:1.06–1.26]. For the subsample, the odds were even higher, being around 27% [95%CI:1.11–1.46]. Conclusions. Our results showed a positive association between obesity and the amount of ultraprocessed food consumption, even though, in those who consumed no more than their adequate daily energy requirements.
... Based on the unbridled rise of ultra-processed foods within the global food supply, there is an urgent need to dissect the policies and practices that have allowed such unhealthy products to dominate commercial landscapes and household purchasing. This includes a deeper understanding of the tactics used by multinational food/beverage corporations, many of which are derived from the marketing-lobbying playbook of tobacco companies [222,223]. This deeper analysis is part of the emerging concept known as the commercial determinants of health [111,224]. ...
Global food systems are a central issue for personal and planetary health in the Anthropocene. One aspect of major concern is the dramatic global spread of ultra-processed convenience foods in the last 75 years, which is linked with the rising human burden of disease and growing sustainability and environmental health challenges. However, there are also calls to radically transform global food systems, from animal to plant-derived protein sources, which may have unintended consequences. Commercial entities have moved toward this “great plant transition” with vigor. Whether motivated by profit or genuine environmental concern, this effort has facilitated the emergence of novel ultra-processed “plant-based” commercial products devoid of nutrients and fiber, and sometimes inclusive of high sugar, industrial fats, and synthetic additives. These and other ingredients combined into “plant-based” foods are often assumed to be healthy and lower in calorie content. However, the available evidence indicates that many of these products can potentially compromise health at all scales—of people, places, and planet. In this viewpoint, we summarize and reflect on the evidence and discussions presented at the Nova Network planetary health meeting on the “Future of Food”, which had a particular focus on the encroachment of ultra-processed foods into the global food supply, including the plant-sourced animal protein alternatives (and the collective of ingredients therein) that are finding their way into global fast-food chains. We contend that while there has been much uncritical media attention given to the environmental impact of protein and macronutrient sources—meat vs. novel soy/pea protein burgers, etc.—the impact of the heavy industrial processing on both human and environmental health is significant but often overlooked, including effects on cognition and mental health. This calls for a more nuanced discourse that considers these complexities and refocuses priorities and value systems towards mutualistic solutions, with co-benefits for individuals, local communities, and global ecology.
... They may also contain chemicals acquired through contact materials, such as sophisticated packaging (e.g., bisphenol), and neo-formed contaminants generated during food processing (e.g., acrylamide, acrolein) [154]. UPFs are engineered to be highly rewarding and they are easily accessible, inexpensive, heavily marketed, and habit forming [155]. These characteristics make UPFs different from processed foods, which are identified by the NOVA classification as being made by adding culinary ingredients (e.g., sugar, oil, salt) to simple unprocessed or minimally processed natural foods. ...
Binge-eating disorder (BED) is a highly prevalent disorder. Subthreshold BED conditions (sBED) are even more frequent in youth, but their significance regarding BED etiology and long-term prognosis is unclear. A better understanding of brain findings associated with BED and sBED, in the context of critical periods for neurodevelopment, is relevant to answer such questions. The present narrative review starts from the knowledge of the development of emotional self-regulation in youth, and the brain circuits supporting emotion-regulation and eating behaviour. Next, neuroimaging studies with sBED and BED samples will be reviewed, and their brain-circuitry overlap will be examined. Deficits in inhibition control systems are observed to precede, and hyperactivity of reward regions to characterize, sBED, with overlapping findings in BED. The imbalance between reward/inhibition systems, and the implication of interoception/homeostatic processing brain systems should be further examined. Recent knowledge of the potential impact that the high consumption of ultra-processed foods in paediatric samples may have on these sBED/BED-associated brain systems is then discussed. There is a need to identify, early on, those sBED individuals at risk of developing BED at neurodevelopmental stages when there is a great possibility of prevention. However, more neuroimaging studies with sBED/BED pediatric samples are needed.
... Our analysis specifically drew on the increasing volume of research that highlights how corporations use framing tactics to further their commercial objectives as part of broader political strategies [33][34][35][36][37]. This analysis consequently aligns with wider research frameworks, including the commercial determinants of health field, where framing analysis is frequently employed as a way to critically examine industry political practices [34]. ...
The pharmaceutical industry's promotion of opioids in North America has been well-documented. Yet despite the clear consequences of improperly classifying pharmaceutical company messaging and frequently permissive approaches that allow the pharmaceutical industry to self-regulate its own advertising, there has been scarce investigation to date of how pharmaceutical industry stakeholders interpret definitions of "advertising." This study explores how variations of "marketing" and "advertising" are strategically framed by the different actors involved in the manufacturing and distribution of pharmaceutical opioids. We employed a framing analysis of industry responses to Health Canada's letter to Canadian manufacturers and distributors of opioids requesting their commitment to voluntarily cease all marketing and advertising of opioids to health care professionals. Our findings highlight companies' continuing efforts to frame their messaging as "information" and "education" rather than "advertising" in ways that serve their interests. This study also calls attention to the industry's continual efforts to promote self-regulation and internal codes of conduct within a highly permissive federal regulatory framework with little concern for violations or serious consequences. While this framing often occurring out of public sight, this study highlights the subtle means through which the industry attempts to frame their promotion strategies away from "marketing". These framing strategies have significant consequences for the pharmaceutical industry's capacity to influence healthcare professionals, patients, and the general public.
... The tendency to advocate for a whole-of-society approach and promote public-private partnerships without establishing a robust system for managing conflicts of interest is the worst possible combination from the perspective of many NGOs and public health advocates [30]. Given the relative lack of evidence that industry selfregulation or public-private partnerships are effective in reducing NCDs risk factors, the current form of multistakeholder collaboration that is guiding global NCDs policies toward voluntary action and public-private partnerships rather than government regulation is worrying [31]. Suzuki et al., in an analysis of the influence of stakeholders on political declarations on NCDs, found that NGOs, academia, and low and middle-income countries (LMICs) countries generally pursue "stricter" governance of NCDs risk factors, while the private sector and highincome countries generally oppose more restrictions on commercial activities and promote a whole-of-society approach that includes cooperation with the private sector [30]. ...
Background and aim
Understanding the characteristics of global policy actors and the political context in which they address diplomatic issues in the field of NCDs can play an important role in advancing NCD-related goals. The purpose of this study was to identify and analyze the network of global health actors in the field of NCDs in Iran.
Methods
This study was conducted in 2020 using a qualitative methodology and framework analysis. In-depth semi-structured interviews were conducted with subject-matter experts from all levels of diplomacy, including global, regional, and national, who had managerial, administrative, and academic experience.
Findings
A total of 21 interviews were conducted with individuals who met the inclusion criteria. Following the framework of the World Health Network, the findings were divided into three general areas: the features of the network and the actors; the policy environment; and the characteristics of the issue.
Conclusion
A successful and sustainable program to combat NCDs requires the participation of multiple actors from governments, the private sector, and civil society at international, national, and local levels. The Global Network for Prevention and Control of NCDs should enhance the effectiveness of NCDs policies by highlighting the need to simultaneously improve the internal factors of the network, including relationships among the actors; external factors, including the policy environment; and the complex nature of NCDs.
... UPF, such as soft drinks, instant meals and confectionery, are produced by various processing techniques, and additives are used to produce durable, appetizing, ready-to-eat packaged foods 8 . UPF differ in composition compared to less processed foods as they are generally high in energy and contain higher levels of sodium, sugars and saturated fat 9,10 . ...
Objective: To investigate whether periconceptional maternal intake of ultra-processed foods (UPF) impairs first-trimester utero-placental vascular development, and whether macronutrients and dietary patterns substantiate the associations. Design: Prospective observational cohort. Setting: Academic hospital. Population or Sample: Ongoing pregnancies. Methods: 93 women completed a food frequency questionnaire from which we calculated percentage of energy intake from UPF, intake of energy and macronutrients and adherence to dietary patterns. We performed sequential three-dimensional power Doppler ultrasounds of the first-trimester utero-placental vasculature. VOCAL software, Virtual Reality segmentation and a skeletonization algorithm were applied to measure placental volume (PV), utero-placental vascular volume (uPVV) and generate the utero-placental vascular skeleton (uPVS). Absolute vascular morphology was quantified by assigning a morphologic characteristic to each voxel in the uPVS (end-, bifurcation-, crossing- or vessel point) and used to calculate density of vascular branching. Main Outcome Measures: PV, uPVV, uPVS characteristics and density of vascular branching. Results: Fully adjusted linear mixed models showed a 10%/day higher UPF intake was associated with increased first-trimester density of vascular branching (bifurcation points: β =0.465√n, 95%CI=0.148;0.782). Higher carbohydrate intake of 10g/day was associated with increased trajectories of uPVV (β=0.017, 95%CI=0.001;0.032) and uPVS (end points (β=0.286, 95%CI=0.062;0.511), bifurcation points (β=0.004, 95%CI=0.003;0.006), vessel points (β=0.772, 95%CI=0.137;1.408). The associations were substantiated by the adherence to the “Snack” dietary pattern. Conclusions: Periconceptional maternal intake of UPF is associated with impaired first-trimester utero-placental vascular development, whereas the intake of carbohydrates and strong adherence to a ‘Snack’ dietary pattern, is positively associated with first-trimester utero-placental vascular development.
... Data collection and analysis were informed by theories and frameworks of the CDoH [24,[52][53][54][55][56][57][58]. We additionally adapted a corporate health and social impact assessment (HSIA) framework, developed by Baum and colleagues, to incorporate literature on the cultural aspects of Aboriginal health and wellbeing [59,60]. ...
Background
The health and wellbeing impacts of commercial activity on Indigenous populations is an emerging field of research. The alcohol industry is a key driver of health and social harms within Australia. In 2016 Woolworths, the largest food and beverage retailer in Australia, proposed to build a Dan Murphy’s alcohol megastore in Darwin, near three ‘dry’ Aboriginal communities. This study examines the tactics used by Woolworths to advance the Dan Murphy’s proposal and understand how civil society action can overcome powerful commercial interests to protect Aboriginal and Torres Strait Islander health and wellbeing.
Methods
Data from 11 interviews with Aboriginal and non-Aboriginal informants were combined with data extracted from media articles and government, non-government and industry documents. Thematic analysis was informed by an adapted corporate health impact assessment framework.
Results
Woolworths employed several strategies including lobbying, political pressure, litigation, and divisive public rhetoric, while ignoring the evidence suggesting the store would increase alcohol-related harm. The advocacy campaign against the proposal highlighted the importance of Aboriginal and non-Aboriginal groups working together to counter commercial interests and the need to champion Aboriginal leadership. Advocacy strategies included elevating the voices of community Elders in the media and corporate activism via Woolworths’ investors.
Conclusions
The strategies used by the coalition of Aboriginal and non-Aboriginal groups may be useful in future advocacy campaigns to safeguard Aboriginal and Torres Strait Islander health and wellbeing from commercial interests.
... CPA is a major obstacle to reducing the burden of NCDs globally. [6][7][8][9] The release of millions of internal tobacco industry (TI) documents through litigation in the 1990s provided unique insights into CPA, igniting a wave of research on TI behaviour. 10 Systematic reviews used to make sense of this extensive literature, largely in the form of country case studies, show the TI consistently uses the same strategies across time and place. ...
Background:
Non-communicable diseases (NCDs) kill 41 million people a year. The products and services of unhealthy commodity industries (UCIs) such as tobacco, alcohol, ultra-processed foods and beverages and gambling are responsible for much of this health burden. While effective public health policies are available to address this, UCIs have consistently sought to stop governments and global organisations adopting such policies through what is known as corporate political activity (CPA). We aimed to contribute to the study of CPA and development of effective counter-measures by formulating a model and evidence-informed taxonomies of UCI political activity.
Methods:
We used five complementary methods: critical interpretive synthesis of the conceptual CPA literature; brief interviews; expert co-author knowledge; stakeholder workshops; testing against the literature.
Results:
We found 11 original conceptualisations of CPA; four had been used by other researchers and reported in 24 additional review papers. Combining an interpretive synthesis of all these papers and feedback from users, we developed two taxonomies - one on framing strategies and one on action strategies. The former identified three frames (policy actors, problem, and solutions) and the latter six strategies (access and influence policy-making, use the law, manufacture support for industry, shape evidence to manufacture doubt, displace, and usurp public health, manage reputations to industry's advantage). We also offer an analysis of the strengths and weaknesses of UCI strategies and a model that situates industry CPA in the wider social, political, and economic context.
Conclusion:
Our work confirms the similarity of CPA across UCIs and demonstrates its extensive and multi-faceted nature, the disproportionate power of corporations in policy spaces and the unacceptable conflicts of interest that characterise their engagement with policy-making. We suggest that industry CPA is recognised as a corruption of democracy, not an element of participatory democracy. Our taxonomies and model provide a starting point for developing effective solutions.
... Other university engagements are with food, beverages, and alcohol corporations and industries that can act as vectors of non-communicable diseases including obesity and cardiovascular disease; especially affecting low and middle-income countries. 21 Harms to population health are outcomes of "toxic" environments, with health outcomes determined by the influence of corporate activities over the social environment in which people live and work. 16 The term industrial epidemic has also been used to describe health harms associated with various products across the scope of industry sectors. ...
... There is a direct link between the increasing sales of ultra-processed fast foods and beverages, the aggressive marketing and promotion strategies used by Big Food TNCs (to promote the perception that these products are desirable) and the global epidemic of obesity and its link to NCDs. TNCs are commercial determinants of health (CDoH) and drivers of these epidemics, undermining NCD prevention and control (Moodie et al., 2013;Mialon, 2020). ...
This iconic book has had a significant influence in providing students of public health, health professionals in training, and health and development activists, amongst others, with a new perspective on health and development. It answers the questions that preoccupy the concerned health or development worker, as well as the general public—why do people, especially children, still die in large numbers throughout the world, from wholly preventable diseases? Why is it that appropriate provision for health care is not available to every individual in the world? What changes can be made to improve this situation? This book provides an accessible and deeply insightful analysis of the impact of the economic and political forces that shape the population health outcomes of communities, in particular the health of the world’s poor within and across countries. It investigates the impact of poverty and underdevelopment on people’s lives as a root cause of ill-health. It calls on health care workers to expand their work beyond only providing medical care, and to also focus on addressing the social determinants of health and issues of social justice. Comprehensive Primary Health Care, community health workers and civil society activist groups are championed as solutions.
... Furthermore, Siga classification classifies foods based on its processing; combining the four NOVA groups with four other new reductionist subgroups that consider the impact of processing on the food/ingredient matrix, the content of added salt, sugar and fat, nature and number of ultra-processing markers, and levels of risky additives [116,118]. ...
Obesity and overweight are a major public health problem globally. Diet quality is critical for proper child development, and an unhealthy diet is a preventable risk factor for noncommunicable diseases (NCDs), such as obesity. Consumption of sugar-sweetened beverages and ultra-processed foods (UPFs) in childhood may increase the BMI/BMI z-score, body fat percentage, or likelihood of overweight. A strict feeding regulation system allows for sufficient food to be consumed to meet ongoing metabolic demands while avoiding overconsumption. This narrative review explores the issues of obesity and the regulation of food intake related to reward systems and UPF consumption. Nutrient composition alone cannot explain the influence of UPFs on the risk of obesity. Furthermore, the non-nutritional properties of UPFs may explain the mechanisms underlying the relationship with obesity and NCDs. UPFs are designed to be highly palatable, appealing, and energy dense with a unique combination of the main taste enhancer ingredients to generate a strong rewarding stimulus and influence the circuits related to feeding facilitation. How individual UPF ingredients influence eating behavior and reward processes remains not fully elucidated. To increase the knowledge on the relationship between UPFs and pediatric obesity, it may be useful to limit the rapid growth in the prevalence of obesity and subsequent related complications, and to develop new strategies for appropriate food and nutrition policies.
Science and technology are developing rapidly, causing changes in teaching modes based on different needs and situations. This study aims to determine the effect of the flipped classroom model, integrated with the socio-scientific issues (FCM-SSI) on critical thinking skills and scientific attitudes of junior high school students on additive and addictive substances and to determine the differences in each aspect of critical thinking skills and scientific attitudes after intervention with FCM-SSI. Through quasi-experimental research with a pretest-posttest design, 182 students participated as samples. The experimental group had 91 students exposed to the FCM-SSI, and the control group had 91 students with traditional learning. For data collection, critical thinking skills test with essay questions and a scientific attitude test using a scientific attitude scale were used. Data were analyzed using MANOVA to see the effects of the learning model and ANOVA to see differences in each aspect. The statistical analysis results with a value of sig 0.000 ≤ 0.05 indicate that FCM-SSI affects students' critical thinking skills and scientific attitudes. The most influential aspect of critical thinking skills is the analytical aspect, and openness is the most influential aspect of scientific attitude. Thus, the FCM-SSI model is highly recommended to be used in science learning because it can improve students' critical thinking skills and scientific attitudes.
Background
Commercial advertising and sponsorship drive the consumption of harmful commodities. Local authorities (LAs) have considerable powers to reduce such exposures. This study aimed to characterize local commercial policies across all English LAs.
Methods
We conducted a census of all English LAs (n = 333) to identify local commercial policies concerning advertising and sponsorship of tobacco, alcohol, less healthy foods and gambling, through online searches and Freedom of Information requests. We explored policy presence, commodity frequency and type, and associations with LA characteristics (region, urban/rural and deprivation).
Results
Only a third (106) of LAs in England had a relevant policy (32%). These included restrictions on tobacco (91%), gambling (79%), alcohol (74%) and/or less healthy foods (24%). Policy prevalence was lowest in the East of England (22%), North East (25%) and North West (27%), higher in urban areas (36%) than rural areas (28%) and lower in the least (27%) compared with the most (38%) deprived areas. Definitions in policies varied, particularly for alcohol and less healthy foods.
Conclusions
English LAs currently underutilize their levers to reduce the negative impacts of harmful commodity industry marketing, particularly concerning less healthy foods. Standardized guidance, including clarity on definitions and application, could inform local policy development.
Background: In recent years, interactions between nutrition professionals (NP) and the food industry, such as sponsorship arrangements, have raised concerns, particularly as these may negatively impact the trustworthiness and credibility of the nutrition profession. This study aimed to map the literature and identify knowledge gaps regarding interactions between NP and industry. We sought to examine the nature of such interactions and NP perspectives about these, as well as the risks and solutions.
Methods: We conducted a scoping review according to a pre-registered protocol, searching eight electronic databases and grey literature sources in March 2021 to identify documents for inclusion. Two independent reviewers screened citations for inclusion and conducted data extraction. Quantitative and qualitative syntheses were conducted.
Results: We identified 115 documents for analysis, published between 1980 to 2021, with a majority from the United States (n=59, 51%). Only 32% (n=37) were empirical studies. The food industry was the most frequent industry type discussed (n=91, 79%). We identified 32 types of interactions between NP and industry, such as continuing education provided by industry and sponsorship of professional bodies and health and nutrition organizations. The financial survival of nutrition organizations and continuing education access for NP were the most frequently cited advantages of industry-NP interactions. On the other hand, undermining public trust, NP credibility and public health nutrition recommendations were pointed out as risks of these interactions. Following a code of ethics, policies, or guidelines was the most frequently proposed solution for managing these interactions.
Conclusions: Despite the increasing attention given to this issue, few empirical papers have been published to date. There is a need for more research to better and systematically document industry interactions with NP and the impacts associated with these, as well as more research on effective management strategies.
Background: Global ultra-processed food (UPF) consumption has risen rapidly. The development and prognosis of depression and anxiety remain unclarified. Herein, we aimed to examine the association between UPF consumption and the incidence and progression trajectory of depression and anxiety. Methods: In our study, participants were recruited between 2006 and 2010. UPF consumption was expressed as UPF servings, energy ratio, and weight ratio. The relationships between UPF consumption and depression or anxiety were assessed using the Cox proportional hazards model. Multi-state models were used to explore the association between UPF consumption and the risks of all transitions from a healthy state to depression or anxiety and then to all-cause mortality. Results: Among the 183 474 participants, 5453 were diagnosed with depression and 6763 with anxiety during the follow-up of 13.1 years. The participants in the highest quartile (Q4) of UPF servings, energy ratio, and weight ratio had an increased risk of depression compared to those in the lowest quartile (Q1), with hazard ratios (HRs) and 95% confidence intervals [CIs] of 1.22 (1.13-1.31), 1.13 (1.05-1.22), and 1.26 (1.17-1.36), respectively. Similarly, participants in Q4 of UPF consumption had a higher risk of anxiety, with HRs (95% CIs) of 1.13 (1.06-1.21), 1.13 (1.05-1.21), and 1.11 (1.04-1.19), compared to those in Q1. The study also found a significant association between UPF consumption and all-cause mortality, which disappeared for participants with depression or anxiety. Conclusions: Our findings revealed that UPF consumption is associated with depression or anxiety.
Objective:
Post-traumatic stress disorder (PTSD) commonly co-occurs with substance use disorders (SUDs). Past studies suggest PTSD is also associated with food addiction (compulsive intake of highly processed foods containing refined carbohydrates and/or added fat). However, research investigating gender differences has been limited (e.g., restricted samples) and mixed. We aim to investigate the risk of co-occurring PTSD and food addiction in a community sample for all participants and stratified by gender. Additionally, we conducted risk ratios for problematic substance use and obesity to allow for within-sample comparisons.
Method:
We utilized a sample of 318 participants recruited from Amazon Mechanical Turk (mean age = 41.2, 47.8% men, 78.0% white) to address existing gaps in the literature on PTSD and food addiction. We calculated risk ratios (adjusted for sociodemographic covariates) using modified Poisson regression with 95% confidence intervals. Results were also gender stratified.
Results:
Risk of food addiction (Risk Ratio (RR) = 6.42, 95% CI [4.10, 10.07], problematic alcohol use (RR) = 3.86, 95% CI [2.25,6.62], problematic smoking (RR) = 3.93, 95% CI [2.22, 6.97], and problematic nicotine vaping (RR) = 5.41, 95% CI [2.41, 11.14] were higher for those meeting criteria for PTSD. Risk of problematic cannabis use, and risk of obesity were not significantly higher for those meeting criteria for PTSD. Gender-stratified results suggest risk of food addiction may be higher for men (RR) = 8.54, 95% CI [4.49, 16.25] compared to women (RR) = 4.32, 95% CI [2.16, 8.62].
Discussion:
Food addiction, but not obesity, appears to co-occur with PTSD more strongly than other types of problematic substance use (alcohol, cannabis, cigarettes, nicotine vaping). This risk appears to be particularly high for men compared to women. Assessing for food addiction in those with PTSD, particularly in men, may assist in identifying high-risk groups.
Besin işleme; bireylere güvenilir ve uzun ömürlü besinler sağlamasının yanında lezzet ve görünüşü iyileştirmek adına uygulanan çeşitli uygulamaları da kapsayan işlemler bütünüdür. Ülkemizde çoğunlukla ambalajlı ve tüketime hazır tüm ürünler işlenmiş besin ana başlığı altında sınıflandırılmakta ve yapılan çalışmalarda katılımcıların işlenmiş besin kavramını sağlıksız, enerji içeriği yüksek ve besleyici değeri düşük besinler olarak ifade ettiği belirtilmektedir. Ancak besin işleme metotları arasında pastörizasyon, sterilizasyon, soğutma, dondurma gibi besin güvenliğinin ve raf ömrünün artırılmasına yönelik işlemler ile beraber besinlerin bazı mikro besin ögeleri ve biyoaktif bileşenler ile zenginleştirilmesi işlemleri de yer almaktadır. Bunların yanında, çoğunlukla düşük maliyetli, tüketimi artırmaya yönelik, enerji içeriğini artırıcı ve besin değerini azaltıcı çeşitli işlemler de tüm dünyada yaygın olarak kullanılmaktadır. Yapılan pek çok çalışma işlenmiş besin tüketimi ile obezite, diyabet, metabolik sendrom ve bazı kanser türleri gibi çeşitli bulaşıcı olmayan kronik hastalıklar arasında ilişki göstermiştir. Farklı epidemiyolojik çalışmalarda işlenmiş besinler, yapılan değişimin kapsamı, doğası, işlemin yeri ve amacına göre farklı şekillerde sınıflandırılmaktadır. Bu derleme kapsamında yapılan literatür taramasında dünyada kabul gören çeşitli besin işleme sınıflandırma sistemleri incelenmiş ve ülkemizde yapılan çalışmalarda kullanılmak üzere terim önerileri sunulmuştur. Buna göre çeşitli sınıflandırma sistemleri içinden NOVA sınıflama sisteminin özellikle besinlerin sağlık etkisinin araştırıldığı çalışmalar açısından daha kapsamlı ve uygulanabilir bir sistem olduğu belirtilmektedir. NOVA sistemi bir sözcüğün kısaltması değil, isimlendirilmesidir. Bu sisteme göre besinler dört temel gruba ayrılmaktadır. Bu terimlerin Türkçe terminolojideki karşılıkları açısından önerilerimiz işlenmemiş/yalın işlenmiş, yemeklerde kullanılan işlenmiş içerikler, işlenmiş besinler ve yoğun işlenmiş besinler ve içecekler olarak verilmiştir. Bu şekilde bir uygulamanın yapılan çalışmalarda yaygınlaşması hem tüketiciler açısından kolay ve anlaşılabilir, hem de araştırmacılar açısından toplum bazlı beslenme önerileri geliştirmek açısından faydalı olacaktır.
La transformation des systèmes alimentaires pour qu’ils deviennent sains et durables dans le contexte actuel de crise en santé publique et d’urgence climatique s’avère être désormais une nécessité évidente. Une telle entreprise demande l’élaboration de politiques publiques rationnelles et efficaces afin de permettre la création d’environnements favorables aux comportements alimentaires sains et durables. Or, des activités d’influence menées par l’industrie bioalimentaire peuvent miner ou ralentir le développement de telles politiques. Celles-ci, connues sous le vocable d’activités politiques corporatives (APC), ont été observées et documentées à l’international et, tout récemment, au Canada à l’aide d’un cadre de surveillance et de responsabilisation des actions du secteur privé développé par le réseau INFORMAS. Cet article vise à sensibiliser les professionnel(le)s de la nutrition face aux enjeux associés à l’influence des activités politiques corporatives sur les politiques publiques, la recherche et la pratique en nutrition. L’importance et les enjeux liés aux APC sont d’abord discutés. Le cadre de surveillance des APC est ensuite présenté et suivi de quelques exemples de ces activités documentés à l’international. Une étude de cas concernant les APC identifiées lors du processus de révision du Guide Alimentaire Canadien (GAC) de 2019 est ensuite présentée. Enfin, des recommandations sont offertes pour une meilleure intégration des enjeux associés aux APC dans la formation des professionnel(le)s nutritionnistes afin de développer une pensée critique et une réflexivité envers cette problématique.
Deceit and Denial details the attempts by the chemical and lead industries to deceive Americans about the dangers that their deadly products present to workers, the public, and consumers. Gerald Markowitz and David Rosner pursued evidence steadily and relentlessly, interviewed the important players, investigated untapped sources, and uncovered a bruising story of cynical and cruel disregard for health and human rights. This resulting exposé is full of startling revelations, provocative arguments, and disturbing conclusions--all based on remarkable research and information gleaned from secret industry documents. This book reveals for the first time the public relations campaign that the lead industry undertook to convince Americans to use its deadly product to paint walls, toys, furniture, and other objects in America's homes, despite a wealth of information that children were at risk for serious brain damage and death from ingesting this poison. This book highlights the immediate dangers ordinary citizens face because of the relentless failure of industrial polluters to warn, inform, and protect their workers and neighbors. It offers a historical analysis of how corporate control over scientific research has undermined the process of proving the links between toxic chemicals and disease. The authors also describe the wisdom, courage, and determination of workers and community members who continue to voice their concerns in spite of vicious opposition. Readable, ground-breaking, and revelatory, Deceit and Denial provides crucial answers to questions of dangerous environmental degradation, escalating corporate greed, and governmental disregard for its citizens' safety and health. After eleven years, Markowitz and Rosner update their work with a new epilogue that outlines the attempts these industries have made to undermine and create doubt about the accuracy of the information in this book.
Every day, we make decisions on topics ranging from personal investments to schools for our children to the meals we eat to the causes we champion. Unfortunately, we often choose poorly. The reason, the authors explain, is that, being human, we all are susceptible to various biases that can lead us to blunder. Our mistakes make us poorer and less healthy; we often make bad decisions involving education, personal finance, health care, mortgages and credit cards, the family, and even the planet itself. Thaler and Sunstein invite us to enter an alternative world, one that takes our humanness as a given. They show that by knowing how people think, we can design choice environments that make it easier for people to choose what is best for themselves, their families, and their society. Using colorful examples from the most important aspects of life, Thaler and Sunstein demonstrate how thoughtful "choice architecture" can be established to nudge us in beneficial directions without restricting freedom of choice. Nudge offers a unique new take-from neither the left nor the right-on many hot-button issues, for individuals and governments alike. This is one of the most engaging and provocative books to come along in many years. © 2008 by Richard H. Thaler and Cass R. Sunstein. All rights reserved.
Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time.
METHODS We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden.
FINDINGS In 2010, the three leading risk factors for global disease burden were high blood pressure (7·0% [95% uncertainty interval 6·2-7·7] of global DALYs), tobacco smoking including second-hand smoke (6·3% [5·5-7·0]), and alcohol use (5·5% [5·0-5·9]). In 1990, the leading risks were childhood underweight (7·9% [6·8-9·4]), household air pollution from solid fuels (HAP; 7·0% [5·6-8·3]), and tobacco smoking including second-hand smoke (6·1% [5·4-6·8]). Dietary risk factors and physical inactivity collectively accounted for 10·0% (95% UI 9·2-10·8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0·9% (0·4-1·6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania.
INTERPRETATION Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children.
FUNDING Bill & Melinda Gates Foundation.
Background: The purpose of this research was to identify, through alcohol industry documents, similarities between tobacco and alcohol companies in approaches to evidence and counter-arguments to public health measures. Method: A search of the tobacco document archives through the World Wide Web for alcohol industry documents was conducted. Alcohol-related search terms were entered into search fields of the tobacco document archives. Results: The documents show that alcohol and tobacco companies have worked closely together, have shared information, share similar concerns and have used similar arguments to defend their products and prevent or delay restrictions being placed on their products. Conclusion: This paper provides evidence that alcohol and tobacco companies are similar in a number of ways and there is scope to use these similarities in developing more effective public health approaches to addressing alcohol consumption and related harms.
In an article that forms part of the PLoS Medicine series on Big Food, Kelly Brownell offers a perspective on engaging with the food industry, and argues that governments and the public health community should be working for regulation, not collaboration.
In an article that forms part of the PLoS Medicine series on Big Food, Carlos Monteiro and Geoffrey Cannon provide a perspective from Brazil on the rise of multinational food companies and the displacement of traditional food systems, and offer suggestions for the public health response.
In an article that forms part of the PLoS Medicine series on Big Food, David Stuckler and colleagues report that unhealthy packaged foods are being consumed rapidly in low- and middle-income countries, consistent with rapid expansion of multinational food companies into emerging markets and fueling obesity and chronic disease epidemics.
In an article that forms part of the PLoS Medicine series on Big Food, guest editors David Stuckler and Marion Nestle lay out why more examination of the food industry is necessary, and offer three competing views on how public health professionals might engage with Big Food.
In an article that forms part of the PLoS Medicine series on Big Food, Andrew Cheyne and colleagues compare soda companies' corporate social responsibility (CSR) campaigns - which are designed to bolster the image and popularity of their products and to prevent regulation - with the tobacco industry's CSR campaigning.
In many instances, the politics of public health is directly related to the problem of state power. This is especially true for automobile injuries and the 64-year history of the effort to reduce their number in the United States. This article looks at the continual redefinition of the automotive injury problem through these phases: (1) 1920–60, when the automobile manufacturers controlled prevention programs that defined the driver as the cause of accidents, (2) 1960–79, when federal regulations targeted vehicle technology as the best source of prevention strategies, and (3) 1979 to the present, when, during the Reagan years, the framework shifted toward defining health and injury prevention as economic commodities. Throughout this history the dominance of a market ideology in U.S. political culture has largely defined both the character of public health programs to reduce injuries and the capacity of the state to curtail industrial power to design hazardous technologies.
Objective:
Ageing and urbanization leading to sedentary lifestyles have been the major explanations proposed for a dramatic rise in diabetes worldwide and have been the variables used to predict future diabetes rates. However, a transition to Western diets has been suggested as an alternative driver. We sought to determine what socio-economic and dietary factors are the most significant population-level contributors to diabetes prevalence rates internationally.
Design:
Multivariate regression models were used to study how market sizes of major food products (sugars, cereals, vegetable oils, meats, total joules) corresponded to diabetes prevalence, incorporating lagged and cumulative effects. The underlying social determinants of food market sizes and diabetes prevalence rates were also studied, including ageing, income, urbanization, overweight prevalence and imports of foodstuffs.
Setting:
Data were obtained from 173 countries.
Subjects:
Population-based survey recipients were the basis for diabetes prevalence and food market data.
Results:
We found that increased income tends to increase overall food market size among low- and middle-income countries, but the level of food importation significantly shifts the content of markets such that a greater proportion of available joules is composed of sugar and related sweeteners. Sugar exposure statistically explained why urbanization and income have been correlated with diabetes rates.
Conclusions:
Current diabetes projection methods may estimate future diabetes rates poorly if they fail to incorporate the impact of nutritional factors. Imported sugars deserve further investigation as a potential population-level driver of global diabetes.
Recent attempts by large tobacco companies to represent themselves as socially responsible have been widely dismissed as image management. Existing research supports such claims by pointing to the failings and misleading nature of corporate social responsibility (CSR) initiatives. However, few studies have focused in depth on what tobacco companies hoped to achieve through CSR or reflected on the extent to which these ambitions have been realised.
Iterative searching relating to CSR strategies was undertaken of internal British American Tobacco (BAT) documents, released through litigation in the US. Relevant documents (764) were indexed and qualitatively analysed. In the past decade, BAT has actively developed a wide-ranging CSR programme. Company documents indicate that one of the key aims of this programme was to help the company secure access to policymakers and, thereby, increase the company's chances of influencing policy decisions. Taking the UK as a case study, this paper demonstrates the way in which CSR can be used to renew and maintain dialogue with policymakers, even in ostensibly unreceptive political contexts. In practice, the impact of this political use of CSR is likely to be context specific; depending on factors such as policy élites' understanding of the credibility of companies as a reliable source of information.
The findings suggest that tobacco company CSR strategies can enable access to and dialogue with policymakers and provide opportunities for issue definition. CSR should therefore be seen as a form of corporate political activity. This underlines the need for broad implementation of Article 5.3 of the Framework Convention on Tobacco Control. Measures are needed to ensure transparency of interactions between all parts of government and the tobacco industry and for policy makers to be made more aware of what companies hope to achieve through CSR.
In recent years, 10 major multinational food and beverage companies have worked together within the International Food and Beverage Alliance (IFBA) to increase their commitments to public health. Current IFBA commitments include initiatives to improve the nutrition quality of products and how these products are advertised to children. The impact and magnitude of IFBA member contributions to the total market share of packaged foods and beverages consumed remain incompletely understood, however.
In order to evaluate this impact, we examined packaged food and soft drink company shares provided by Euromonitor, an international independent market analysis company. Packaged foods include baby food, bakery, canned/preserved food, chilled/processed food, confectionery, dairy, dried processed food, frozen processed food, ice cream, meal replacement, noodles, oils and fats, pasta, ready meals, sauces, dressings and condiments, snack bars, soup, spreads, and sweet and savoury snacks. Soft drinks include carbonates, packaged fruit/vegetable juice, bottled water, functional drinks, concentrates, ready-to-drink tea, ready-to-drink coffee and Asian specialty drinks. We calculated the market shares for IFBA companies, globally and within nine countries--the US, China, India, Egypt, South Africa, Brazil, Mexico, Turkey and the UK.
Worldwide, the top ten packaged food companies account for 15.2% of sales, with each individual company contributing less than 3.3%. The top ten soft drink companies account for 52.3% of sales worldwide; Coca-Cola and PepsiCo lead with 25.9% and 11.5% of sales, respectively.
Although the top ten soft drink companies account for half of global sales, the top ten packaged food companies account for only a small proportion of market share with most individual companies contributing less than 3.3% each. Major multinational companies need to be joined by the myriad of small- and medium-sized enterprises in developing and implementing programs to improve the health of the public, globally. Without full participation of these companies, the impact of commitments made by IFBA members and other major multinational food and beverage companies will remain limited.
It has been proposed that alcohol industry 'social aspects/public relations' organizations (SAPROs) serve the agenda of lending credibility to industry claims of corporate responsibility while promoting ineffective industry-friendly interventions (such as school-based education or TV advertising campaigns) and creating doubt about interventions which have a strong evidence base (such as higher taxes on alcoholic beverages). This paper investigated whether submissions to Australia's National Preventative Health Taskforce (NPHT) from alcohol industry bodies regarding the Australian SAPRO, Drinkwise, have used this organization to demonstrate corporate responsibility while promoting industry-friendly interventions.
Submissions to the Australian National Preventative Health Taskforce (NPHT) discussion paper Australia, the healthiest country by 2020 (n = 375) were examined to identify those with primary alcohol content. A thematic analysis of the resulting 33 submissions was conducted to determine which organization, institution or individual discussed Drinkwise.
Australia.
Nine of the 33 submissions discussed Drinkwise; all were submitted by the alcohol industry or its affiliates. Every industry submission referred to Drinkwise either as providing evidence of social responsibility or by suggesting the industry-friendly actions of Drinkwise as alternatives to those recommended by the NPHT report.
Drinkwise has been used by the alcohol industry to create an impression of social responsibility while promoting interventions that maintain profits and campaigning against effective interventions such as higher taxes on alcohol.
David Stuckler and colleagues examine five large private global health
foundations and report on the scope of relationships between these tax-exempt
foundations and for-profit corporations including major food and pharmaceutical
companies.
Adam Oliver (doi:10.1136/bmj.d2168) maintains that nudges may help people to make healthier choices, but Geof Rayner and Tim Lang worry that government proposals are little more than publicly endorsed marketing
BACKGROUND:Internal tobacco industry document searches have led to the discovery of hitherto unpublisheddocuments that provide insights into the drinks industry. The documents uncover key concerns andstrategies for the drinks industry with focus on the Miller Brewing Company and the Beer Institute.METHODS:The identification of the Philip Morris 1996 CEO Issues Book from the tobacco document archives led to asystematic search for alcohol-related documents. The search was conducted by entering alcohol-relatedterms into search fields of tobacco document archive sites available on the World Wide WebRESULTS:Key areas of concern for the Miller Brewing Company, the Beer Institute, and more broadly, the alcoholindustry include developments of legislative and regulatory controls such as tax increases, advertisingrestrictions and blood alcohol content lowering and public perceptions of harms relating to drunk driving,binge drinking and underage alcohol consumption. Strategies proposed by the Miller Brewing Companyand the Beer Institute to combat these concerns include ally development and maintenance and thepromotion of personal responsibility.CONCLUSIONS:These once confidential internal documents provide new evidence on the drinks industry’s concernsabout possible alcohol control measures and the strategies used to help overcome these concerns. The document findings justify the public health community’s cynicism about the alcohol industry whileproviding a new source of information to assist development in the regulation and control of the drinksindustry.
High platelet reactivity while receiving clopidogrel has been linked to cardiovascular events after percutaneous coronary intervention (PCI), but a treatment strategy for this issue is not well defined.
To evaluate the effect of high-dose compared with standard-dose clopidogrel in patients with high on-treatment platelet reactivity after PCI.
Randomized, double-blind, active-control trial (Gauging Responsiveness with A VerifyNow assay-Impact on Thrombosis And Safety [GRAVITAS]) of 2214 patients with high on-treatment reactivity 12 to 24 hours after PCI with drug-eluting stents at 83 centers in North America between July 2008 and April 2010.
High-dose clopidogrel (600-mg initial dose, 150 mg daily thereafter) or standard-dose clopidogrel (no additional loading dose, 75 mg daily) for 6 months.
The primary end point was the 6-month incidence of death from cardiovascular causes, nonfatal myocardial infarction, or stent thrombosis. The key safety end point was severe or moderate bleeding according to the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO) definition. A key pharmacodynamic end point was the rate of persistently high on-treatment reactivity at 30 days.
At 6 months, the primary end point had occurred in 25 of 1109 patients (2.3%) receiving high-dose clopidogrel compared with 25 of 1105 patients (2.3%) receiving standard-dose clopidogrel (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.58-1.76; P = .97). Severe or moderate bleeding was not increased with the high-dose regimen (15 [1.4%] vs 25 [2.3%], HR, 0.59; 95% CI, 0.31-1.11; P = .10). Compared with standard-dose clopidogrel, high-dose clopidogrel provided a 22% (95% CI, 18%-26%) absolute reduction in the rate of high on-treatment reactivity at 30 days (62%; 95% CI, 59%-65% vs 40%; 95% CI, 37%-43%; P < .001).
Among patients with high on-treatment reactivity after PCI with drug-eluting stents, the use of high-dose clopidogrel compared with standard-dose clopidogrel did not reduce the incidence of death from cardiovascular causes, nonfatal myocardial infarction, or stent thrombosis.
clinicaltrials.gov Identifier: NCT00645918.
To assess time trends in the contribution of processed foods to food purchases made by Brazilian households and to explore the potential impact on the overall quality of the diet.
Application of a new classification of foodstuffs based on extent and purpose of food processing to data collected by comparable probabilistic household budget surveys. The classification assigns foodstuffs to the following groups: unprocessed/minimally processed foods (Group 1); processed culinary ingredients (Group 2); or ultra-processed ready-to-eat or ready-to-heat food products (Group 3).
Eleven metropolitan areas of Brazil.
Households; n 13,611 in 1987-8, n 16,014 in 1995-5 and n 13,848 in 2002-3.
Over the last three decades, the household consumption of Group 1 and Group 2 foods has been steadily replaced by consumption of Group 3 ultra-processed food products, both overall and in lower- and upper-income groups. In the 2002-3 survey, Group 3 items represented more than one-quarter of total energy (more than one-third for higher-income households). The overall nutrient profile of Group 3 items, compared with that of Group 1 and Group 2 items, revealed more added sugar, more saturated fat, more sodium, less fibre and much higher energy density.
The high energy density and the unfavourable nutrition profiling of Group 3 food products, and also their potential harmful effects on eating and drinking behaviours, indicate that governments and health authorities should use all possible methods, including legislation and statutory regulation, to halt and reverse the replacement of minimally processed foods and processed culinary ingredients by ultra-processed food products.
This paper describes a new food classification which assigns foodstuffs according to the extent and purpose of the industrial processing applied to them. Three main groups are defined: unprocessed or minimally processed foods (group 1), processed culinary and food industry ingredients (group 2), and ultra-processed food products (group 3). The use of this classification is illustrated by applying it to data collected in the Brazilian Household Budget Survey which was conducted in 2002/2003 through a probabilistic sample of 48,470 Brazilian households. The average daily food availability was 1,792 kcal/person being 42.5% from group 1 (mostly rice and beans and meat and milk), 37.5% from group 2 (mostly vegetable oils, sugar, and flours), and 20% from group 3 (mostly breads, biscuits, sweets, soft drinks, and sausages). The share of group 3 foods increased with income, and represented almost one third of all calories in higher income households. The impact of the replacement of group 1 foods and group 2 ingredients by group 3 products on the overall quality of the diet, eating patterns and health is discussed.
Cost-effectiveness analyses are important tools in efforts to prioritise interventions for obesity prevention. Modelling facilitates evaluation of multiple scenarios with varying assumptions. This study compares the cost-effectiveness of conservative scenarios for two commonly proposed policy-based interventions: front-of-pack 'traffic-light' nutrition labelling (traffic-light labelling) and a tax on unhealthy foods ('junk-food' tax).
For traffic-light labelling, estimates of changes in energy intake were based on an assumed 10% shift in consumption towards healthier options in four food categories (breakfast cereals, pastries, sausages and preprepared meals) in 10% of adults. For the 'junk-food' tax, price elasticities were used to estimate a change in energy intake in response to a 10% price increase in seven food categories (including soft drinks, confectionery and snack foods). Changes in population weight and body mass index by sex were then estimated based on these changes in population energy intake, along with subsequent impacts on disability-adjusted life years (DALYs). Associated resource use was measured and costed using pathway analysis, based on a health sector perspective (with some industry costs included). Costs and health outcomes were discounted at 3%. The cost-effectiveness of each intervention was modelled for the 2003 Australian adult population.
Both interventions resulted in reduced mean weight (traffic-light labelling: 1.3 kg (95% uncertainty interval (UI): 1.2; 1.4); 'junk-food' tax: 1.6 kg (95% UI: 1.5; 1.7)); and DALYs averted (traffic-light labelling: 45,100 (95% UI: 37,700; 60,100); 'junk-food' tax: 559,000 (95% UI: 459,500; 676,000)). Cost outlays were AUD81 million (95% UI: 44.7; 108.0) for traffic-light labelling and AUD18 million (95% UI: 14.4; 21.6) for 'junk-food' tax. Cost-effectiveness analysis showed both interventions were 'dominant' (effective and cost-saving).
Policy-based population-wide interventions such as traffic-light nutrition labelling and taxes on unhealthy foods are likely to offer excellent 'value for money' as obesity prevention measures.
Drawing on published tobacco document research and related sources, this article applies Farnsworth and Holden's conceptual framework for the analysis of corporate power and corporate involvement in social policy (2006) to the transnational tobacco companies (TTCs). An assessment is made of TTCs' structural power, the impact upon their structural position of tobacco control (TC) policies, and their use of agency power. The analysis suggests that, as a result of the growth of TC policies from the 1950s onwards, TTCs have had to rely on political agency to pursue their interests and attempt to reassert their structural position. The collapse of the Eastern bloc and the liberalisation of East Asian economies presented new structural opportunities for TTCs in the 1980s and 1990s, but the development of globally coordinated TC policies facilitated by the World Health Organisation's Framework Convention on Tobacco Control has the potential to constrain these.
Although the content of alcohol advertisements is restricted, Gerard Hastings and colleagues find that advertisers are still managing to appeal to young people and promote drinking
In this paper, we describe an analysis of alcohol policy initiatives sponsored by alcohol producer SABMiller and the International Center on Alcohol Policies, an alcohol industry-funded organization. In a number of sub-Saharan countries these bodies have promoted a 'partnership' role with governments to design national alcohol policies.
A comparison was conducted of four draft National Alcohol Policy documents from Lesotho, Malawi, Uganda and Botswana using case study methods.
The comparison indicated that the four drafts are almost identical in wording and structure and that they are likely to originate from the same source.
The processes and the draft policy documents reviewed provide insights into the methods, as well as the strategic and political objectives of the multi-national drinks industry. This initiative reflects the industry's preferred version of a national alcohol policy. The industry policy vision ignores, or chooses selectively from, the international evidence base on alcohol prevention developed by independent alcohol researchers and disregards or minimizes a public health approach to alcohol problems. The policies reviewed maintain a narrow focus on the economic benefits from the trade in alcohol. In terms of alcohol problems (and their remediation) the documents focus upon individual drinkers, ignoring effective environmental interventions. The proposed policies serve the industry's interests at the expense of public health by attempting to enshrine 'active participation of all levels of the beverage alcohol industry as a key partner in the policy formulation and implementation process'.
The Corporate Play Book, Health and Democracy: The Snack Food and Beverage Industry’s Tactics in Context.
Chapter 6, Part 2
By William H. Wiist
In Stuckler, David and Karen Siegel. 2011. Sick Societies: Responding to the Global Challenge of Chronic Disease. Oxford: Oxford University Press.
Abstract
In this chapter the food industry’s tactics and potentially adverse effects on public health are evaluated. Lessons from the tobacco and other industries are applied to the food industry, using material from from PepsiCo’s proposals. Our analysis suggests that food companies may be replicating several of the tactics used by tobacco companies to promote a positive image and influence research as part of an effort to reduce the prospects for public regulation and taxation. A series of Recommendations are offered about how public health practitioners should engage with the food industry to promote healthy transformation with industry while avoiding potential conflicts-of-interest and adverse influences on the public’s health and democracy.
Table 6.3. Twenty-three questions to ask about the food and beverage industry: Corporate operations, Products, testing and standards.
Table 6.4. Thirty-six examples of the corporate play book: Public relations, distortion of science, political influence, financial tactics, legal and regulatory tactics, products and services.
Table 6.5. Forty-one examples of actions corporations could take to gain the trust of potential public health partners, government and human citizens.
This article summarizes the contents of Alcohol: No Ordinary Commodity-Research and public policy (Babor et al. 2003). The first part of the book describes why alcohol is no ordinary commodity, and presents epidemiological data on the global burden of alcohol-related problems. The second part of the book reviews the scientific evidence for strategies and interventions designed to prevent or minimize alcohol-related harm: pricing and taxation, regulating the physical availability of alcohol, modifying the drinking context, drinking-driving countermeasures, regulating alcohol promotion, education and persuasion strategies and treatment services. The final section considers the policymaking process on the local, national and international levels, and provides a synthesis of evidence-based strategies and interventions from a policy perspective.
Objectives:
We estimated the relationship between soft drink consumption and obesity and diabetes worldwide.
Methods:
We used multivariate linear regression to estimate the association between soft drink consumption and overweight, obesity, and diabetes prevalence in 75 countries, controlling for other foods (cereals, meats, fruits and vegetables, oils, and total calories), income, urbanization, and aging. Data were obtained from the Euromonitor Global Market Information Database, the World Health Organization, and the International Diabetes Federation. Bottled water consumption, which increased with per-capita income in parallel to soft drink consumption, served as a natural control group.
Results:
Soft drink consumption increased globally from 9.5 gallons per person per year in 1997 to 11.4 gallons in 2010. A 1% rise in soft drink consumption was associated with an additional 4.8 overweight adults per 100 (adjusted B; 95% confidence interval [CI] = 3.1, 6.5), 2.3 obese adults per 100 (95% CI = 1.1, 3.5), and 0.3 adults with diabetes per 100 (95% CI = 0.1, 0.8). These findings remained robust in low- and middle-income countries.
Conclusions:
Soft drink consumption is significantly linked to overweight, obesity, and diabetes worldwide, including in low- and middle-income countries.
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The ten largest food and beveragecorporations control over half of the food sales inthe United States and their share may be increasing.Using data from a range of secondary sources, weexamine these corporations and their boards ofdirectors. Social and demographic characteristics ofboard members gleaned from corporate reports, thebusiness press, and elsewhere are presented.Information on interlocking corporate directorates andother common ties among members of the boards ofdirectors show that US based food and beveragecorporations are tied together through a web ofindirect interlocks.
When I hear businessmen speak eloquently about the “social responsibilities of business in a free-enterprise system”, I am
reminded of the wonderful line about the Frenchman who discovered at the age of 70 that he had been speaking prose all his
life. The businessmen believe that they are defending free enterprise when they declaim that business is not concerned “merely”
with profit but also with promoting desirable “social” ends; that business has a “social conscience” and takes seriously its
responsibilities for providing employment, eliminating discrimination, avoiding pollution and whatever else may be the catchwords
of the contemporary crop of reformers. In fact they are — or would be if they or anyone else took them seriously -preaching
pure and unadulterated socialism. Businessmen who talk this way are unwitting puppets of the intellectual forces that have
been undermining the basis of a free society these past decades.
In this article, I document strategies used by alcohol producers to influence national and global science and policy.
Their strategies include producing scholarly publications with incomplete, distorted views of the science underlying alcohol policies; pressuring national and international governmental institutions; and encouraging collaboration of public health researchers with alcohol industry–funded organizations and researchers.
I conclude with a call for an enhanced research agenda drawing on sources seldom used by public health research, more focused resourcing of global public health bodies such as the World Health Organization to counterbalance industry initiatives, development of technical assistance and other materials to assist countries with effective alcohol-control strategies, and further development of an ethical stance regarding collaboration with industries that profit from unhealthy consumption of their products.
Carbonated soft drinks and other beverages make up an increasing percentage of energy intake, and there are rising public health concerns about the links between consumption of sugar-sweetened beverages and weight gain, obesity, and other cardiometabolic problems. In response, the food and beverage industry claims to be reformulating products, reducing package or portion sizes and introducing healthier options. Comparative analysis on various changes and their potential effects on public health are needed. We conduct a case study using the two largest and most influential producers of sweetened beverages, The Coca-Cola Company and PepsiCo Inc., who together control 34% of the global soft drink market, examining their product portfolios globally and in three critical markets (the United States, Brazil and China) from 2000 to 2010. On a global basis, total revenues and energy per capita sold increased, yet the average energy density (kJ 100 mL(-1) ) sold declined slightly, suggesting a shift to lower-calorie products. In the United States, both total energy per capita and average energy density of beverages sold decreased, while the opposite was true in the developing markets of Brazil and China, with total per capita energy increasing greatly in China and, to a lesser extent, in Brazil.