Policy Points: Worldwide, more than 70% of all deaths are attributable to noncommunicable diseases (NCDs), nearly half of which are premature and apply to individuals of working age. Although such deaths are largely preventable, effective solutions continue to elude the public health community. One reason is the considerable influence of the “commercial determinants of health”: NCDs are the product of a system that includes powerful corporate actors, who are often involved in public health policymaking. This article shows how a complex systems perspective may be used to analyze the commercial determinants of NCDs, and it explains how this can help with (1) conceptualizing the problem of NCDs and (2) developing effective policy interventions. Context The high burden of noncommunicable diseases (NCDs) is politically salient and eminently preventable. However, effective solutions largely continue to elude the public health community. Two pressing issues heighten this challenge: the first is the public health community's narrow approach to addressing NCDs, and the second is the involvement of corporate actors in policymaking. While NCDs are often conceptualized in terms of individual‐level risk factors, we argue that they should be reframed as products of a complex system. This article explores the value of a systems approach to understanding NCDs as an emergent property of a complex system, with a focus on commercial actors. Methods Drawing on Donella Meadows's systems thinking framework, this article examines how a systems perspective may be used to analyze the commercial determinants of NCDs and, specifically, how unhealthy commodity industries influence public health policy. Findings Unhealthy commodity industries actively design and shape the NCD policy system, intervene at different levels of the system to gain agency over policy and politics, and legitimize their presence in public health policy decisions. Conclusions It should be possible to apply the principles of systems thinking to other complex public health issues, not just NCDs. Such an approach should be tested and refined for other complex public health challenges.
BackgroundCorporations use a range of strategies to dispute their role in causing public health harms and to limit the scope of effective public health interventions. This is well documented in relation to the activities of the tobacco industry, but research on other industries is less well developed. We therefore analysed public statements and documents from four unhealthy commodity industries to investigate whether and how they used arguments about complexity in this way.MethodsWe analysed alcohol, food, soda and gambling industry documents and websites and minutes of reports of relevant health select committees, using standard document analysis methods.ResultsTwo main framings were identified: (i) these industries argue that aetiology is complex, so individual products cannot be blamed; and (ii) they argue that population health measures are ‘too simple’ to address complex public health problems. However, in this second framing, there are inherent contradictions in how industry used ‘complexity’, as their alternative solutions are generally not, in themselves, complex.ConclusionThe concept of complexity, as commonly used in public health, is also widely employed by unhealthy commodity industries to influence how the public and policymakers understand health issues. It is frequently used in response to policy announcements and in response to new scientific evidence (particularly evidence on obesity and alcohol harms). The arguments and language may reflect the existence of a cross-industry ‘playbook’, whose use results in the undermining of effective public health policies – in particular the undermining of effective regulation of profitable industry activities that are harmful to the public’s health.
This brief article reviews the findings of Fair Game (2014) and discusses their implications for journals publishing gambling research. Drawing parallels with critiques in tobacco and alcohol, it adds to the growing number of voices arguing for reform of the gambling field.
BackgroundResearch has demonstrated that the promotion of gambling, particularly within sport, may have a significant impact on positively shaping young people’s attitudes towards gambling. While some governments have implemented restrictions to limit young people’s exposure to gambling advertising, few studies have investigated where young people recall seeing gambling advertising, and whether they perceive that advertising restrictions have gone far enough in reducing exposure to these promotions.MethodMixed methods, interviewer-assisted surveys were conducted with n = 111 young people aged 11–16 years, who were self-reported fans of basketball in Victoria, Australia. Interviews were conducted at basketball stadiums between May and July 2018. The study assessed media viewing patterns; recall and awareness of the timing, placement, and content of gambling advertising; the impact of gambling advertising restrictions; and attitudes towards sporting organisations’ roles in the promotion of gambling.ResultsThe majority of young people recalled seeing gambling advertising on television (n = 101, 91.0%), with most recalling advertising within sporting matches or games (n = 79, 71.2%). Most young people recalled seeing gambling advertising in the early evening before 8:30 pm (n = 75, 67.6%). Just over half of young people described seeing gambling advertisements on social media (n = 61, 55.0%), and over a third (n = 40, 36.0%) recalled gambling advertising on YouTube, predominantly before watching sporting or gaming videos. The majority stated that they continued to watch sport after 8:30 pm (n = 93, 83.7%), which is when restrictions on advertising in live sport in Australia end. The majority (n = 88, 79.3%) stated that there were too many gambling advertisements in sport. Three quarters believed that sporting codes should do more to prevent young people from being exposed to advertising for gambling in sport (n = 84, 75.7%).ConclusionsThere is now a clear body evidence that current regulatory systems for gambling advertising are ineffective, with further restrictions urgently needed across a range of media channels to prevent exposure to promotions that may encourage young people’s interest and involvement in gambling.
Background: While the prevalence of women's participation in gambling is steadily increasing, there is a wellrecognised male bias in gambling research and policy. Few papers have sought to synthesise the literature relating to women and gambling-related harm and provide practical suggestions to guide future research, policy, and practice which take into account the specific nuances associated with women's gambling. Methods: A narrative literature review was conducted to review the evidence base on women's gambling behaviours and experiences of harm. Drawing from strategies used effectively in other areas of public health, key elements for a gendered approach to harm prevention were identified and adapted into practical public health research, policy and practice strategies. Results: Results indicated a lack of research that explores women's gambling. Few studies have examined the impact of gambling on the lives of women, with limited understanding of the factors that influence women's engagement with gambling products, and the impact of industry tactics. A gendered approach was identified as a strategy used successfully in other areas of public health to shift the focus onto women and to ensure they are considered in research. In tobacco control, increasing trends in women's smoking behaviour were combatted with targeted research, policy and practical initiatives. These key elements were adapted to create a conceptual framework for reducing and preventing gambling harm in women. The framework provides regulatory direction and a research agenda to minimise gambling-related harm for women both in Australia and internationally. Evidence-based policies should be implemented to focus on the influence of gender and associated factors to address gambling-related harm. Practical interventions must take into account how women conceptualise and respond to gambling risk in order to develop specific harm prevention programs which respond to their needs. Conclusion: A gendered approach to gambling harm prevention shifts the focus onto the unique factors associated with women's gambling and specific ways to prevent harm. As seen in other areas of public health, such a framework enables harm measures, policies, and interventions to be developed that are salient to girls and women's lives, experiences and circumstances.
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