Showing papers by "Cécile Knai published in 2017"

'Nothing can be done until everything is done': the use of complexity arguments by food, beverage, alcohol and gambling industries.

Abstract: Background Corporations 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. Methods We analysed alcohol, food, soda and gambling industry documents and websites and minutes of reports of relevant health select committees, using standard document analysis methods. Results Two 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. Conclusion The 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.

Barriers to breastfeeding in Lebanon: A policy analysis.

Abstract: Although the issue of breastfeeding in Lebanon has risen on the political agenda, the country does not meet international recommendations for early breastfeeding practices. This study analysed barriers to dissemination, implementation, and enforcement of key policies to improve early breastfeeding practices. We conducted interviews with stakeholders in breastfeeding policy in Lebanon and used a framework approach for analysing data. We found a disconnect between policy endorsement and translation on the ground, weak engagement of professional associations and governmental institutions, undue influence by the breast milk substitute industry, and competing priorities-most notably the current refugee crisis. This study highlights the potential policy opportunities to counter these barriers and points to the role of international organisations and grassroots advocacy in pushing, monitoring, and implementing policies that protect breastfeeding, where government capacity is limited, and the private sector is strong.

Change in non-alcoholic beverage sales following a 10-pence levy on sugar-sweetened beverages within a national chain of restaurants in the UK: interrupted time series analysis of a natural experiment.

Abstract: BACKGROUND: This study evaluates changes in sales of non-alcoholic beverages in Jamie’s Italian, a national chain of commercial restaurants in the UK, following the introduction of a £0.10 per-beverage levy on sugar-sweetened beverages (SSBs) and supporting activity including beverage menu redesign, new products and establishment of a children’s health fund from levy proceeds. METHODS: We used an interrupted time series design to quantify changes in sales of non-alcoholic beverages 12 weeks and 6 months after implementation of the levy, using itemised electronic point of sale data. Main outcomes were number of SSBs and other non-alcoholic beverages sold per customer. Linear regression and multilevel random effects models, adjusting for seasonality and clustering, were used to investigate changes in SSB sales across all restaurants (n=37) and by tertiles of baseline restaurant SSB sales per customer. RESULTS: Compared with the prelevy period, the number of SSBs sold per customer declined by 11.0% (−17.3% to −4.3%) at 12 weeks and 9.3% (−15.2% to −3.2%) at 6 months. For non-levied beverages, sales per customer of children’s fruit juice declined by 34.7% (−55.3% to −4.3%) at 12 weeks and 9.9% (−16.8% to −2.4%) at 6 months. At 6 months, sales per customer of fruit juice increased by 21.8% (14.0% to 30.2%) but sales of diet cola (−7.3%; −11.7% to −2.8%) and bottled waters (−6.5%; −11.0% to −1.7%) declined. Changes in sales were only observed in restaurants in the medium and high tertiles of baseline SSB sales per customer. CONCLUSIONS: Introduction of a £0.10 levy on SSBs alongside complementary activities is associated with declines in SSB sales per customer in the short and medium term, particularly in restaurants with higher baseline sales of SSBs.

An evaluation of a public-private partnership to reduce artificial trans fatty acids in England, 2011-16

Abstract: The Public Health Responsibility Deal (RD) is a public-private partnership in England involving voluntary pledges between government, and business and other public organizations to improve public health. One such voluntary pledge refers to the reduction of trans fatty acids (TFAs) in the food supply in England by either pledging not to use artificial TFAs or pledging artificial TFA removal. This paper evaluates the RD's effectiveness at encouraging signatory organizations to remove artificially produced TFAs from their products. We analysed publically available data submitted by RD signatory organizations. We analysed their plans and progress towards achieving the TFAs pledge, comparing 2015 progress reports against their delivery plans. We also assessed the extent to which TFAs reductions beyond pre-2011 levels could be attributed to the RD. Voluntary reformulation via the RD has had limited added value, because the first part of the trans fat pledge simply requires organizations to confirm that they do not use TFAs and the second part, that has the potential to reduce use, has failed to attract the participation of food producers, particularly those producing fast foods and takeaways, where most remaining use of artificial TFAs is located. The contribution of the RD TFAs pledges in reducing artificial TFAs from England's food supply beyond pre-2011 levels appears to be negligible. This research has wider implications for the growing international evidence base voluntary food policy, and offers insights for other countries currently undertaking work to remove TFAs from their food supply.

Community Alcohol Partnerships with the alcohol industry: what is their purpose and are they effective in reducing alcohol harms?

Abstract: Local initiatives to reduce alcohol harms are common. One UK approach, Community Alcohol Partnerships (CAPs), involves partnerships between the alcohol industry and local government, focussing on alcohol misuse and anti-social behaviour (ASB) among young people. This study aimed to assess the evidence of effectiveness of CAPs. We searched CAP websites and documents, and databases, and contacted CAPs to identify evaluations and summarize their findings. We appraised these against four methodological criteria: (i) reporting of pre-post data; (ii) use of comparison area(s); (iii) length of follow-up; and (iv) baseline comparability of comparison and intervention areas. Out of 88 CAPs, we found three CAP evaluations which used controlled designs or comparison areas, and further data on 10 other CAPs. The most robust evaluations found little change in ASB, though few data were presented. While CAPs appear to affect public perceptions of ASB, this is not a measure of the effectiveness of CAPs. Despite industry claims, the few existing evaluations do not provide convincing evidence that CAPs are effective in reducing alcohol harms or ASB. Their main role may be as an alcohol industry corporate social responsibility measure which is intended to limit the reputational damage associated with alcohol-related ASB.

Television food advertising to children in Malta.

Abstract: To undertake a cross-sectional survey of the extent and nature of food and beverage advertising to children on Maltese national television stations. Seven national free-to-air channels were recorded for seven consecutive days in March 2014 between 07:00 and 22:00 h. Advertisements were coded according to predefined categories, with a focus on advertisements aired during 'peak' children's viewing times, defined as periods during which more than 25% of children were likely to be watching television on any channel. Food and beverage advertisements were classified as core (healthy), non-core (unhealthy) or miscellaneous foods. Malta. Whole population, with a focus on children. Food and drinks were the most heavily advertised product category (26.9% of all advertisements) across all channels. The proportion of non-core food/drink advertisements was significantly greater during peak compared with non-peak children's viewing times (52 vs 44.6%; p ≤ 0.001). A majority of advertisements aimed at children are for non-core foods, and are typically shown during family-oriented programmes in the late evening rather than being restricted to children's programmes. 'Taste', 'enjoyment' and 'peer status' were the primary persuasive appeals used in adolescent and child-focused advertisements. This first content analysis of television advertising in Malta suggests that there is scope for the implementation of statutory regulation regarding advertising of foods high in fat, sugar and salt (HFSS) during times when children are likely to watch television, rather than during children's programmes only. Ongoing, systematic monitoring is essential for evaluation of the effectiveness of regulations designed to reduce children's exposure to HFSS food advertising on television.