Unpacking policy formulation and industry influence: the case of the draft control of marketing of alcoholic beverages bill in South Africa
TL;DR: It is shown that achieving policy coherence across government departments poses a major challenge to achieving effective health policy formulation and that networks of actors with commercial and financial interests use diverse strategies to influence policy formulation processes to avoid regulation.
Abstract: Alcohol is a major contributor to the Non-Communicable Disease burden in South Africa. In 2000, 7.1% of all deaths and 7% of total disability-adjusted life years were ascribed to alcohol-related harm in the country. Regulations proposed to restrict alcohol advertising in South Africa present an evidence-based upstream intervention. Research on policy formulation in low- and middle-income countries is limited. This study aims to describe and explore the policy formulation process of the 2013 draft Control of Marketing of Alcoholic Beverages Bill in South Africa between March 2011 and May 2017. Recognising the centrality of affected actors in policy-making processes, the study focused on the alcohol industry as a central actor affected by the policy, to understand how they-together with other actors-may influence the policy formulation process. A qualitative case study approach was used, involving a stakeholder mapping, 10 in-depth interviews, and review of approximately 240 documents. A policy formulation conceptual framework was successfully applied as a lens to describe a complex policy formulation process. Key factors shaping policy formulation included: (1) competing and shared values-different stakeholders promote conflicting ideals for policymaking; (2) inter-department jostling-different government departments seek to protect their own functions, hindering policy development; (3) stakeholder consultation in democratic policymaking-policy formulation requires consultations even with those opposed to regulation and (4) battle for evidence-evidence is used strategically by all parties to shape perceptions and leverage positions. This research (1) contributes to building an integrated body of knowledge on policy formulation in low- and middle-income countries; (2) shows that achieving policy coherence across government departments poses a major challenge to achieving effective health policy formulation and (3) shows that networks of actors with commercial and financial interests use diverse strategies to influence policy formulation processes to avoid regulation.
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TL;DR: In this paper, the authors compared consumption and harms, alcohol policy developments and alcohol industry activities over time and across the four sub-regions of Sub-Saharan Africa, focusing mainly on the period 2000-2016.
Abstract: Issues Sub-Saharan Africa (SSA) has long been characterised as a region with weak alcohol policies, high proportions of abstainers and heavy episodic drinkers (among drinkers), and as a target for market expansion by global alcohol producers. However, inter-regional analyses of these issues are seldom conducted. Approach Focusing mainly on the period 2000-2016, we compare alcohol consumption and harms, alcohol policy developments and alcohol industry activities over time and across the four sub-regions of SSA. Key findings Per-capita consumption of alcohol and alcohol-related disease burden have increased in Central Africa but stabilised or reduced in other regions, although they are still high. Most countries have implemented tax policies, but they have seldom adopted other World Health Organization 'best buys' for cost-effective alcohol control policies. Countries range from having minimal alcohol controls to having total bans (e.g. some Muslim-majority countries); and some, such as Botswana, have attempted stringent tax policies to address alcohol harm. Alcohol producers have continued their aggressive marketing and policy interference activities, some of which have been highlighted and, in a few instances, resisted by civil society and public health advocates, particularly in southern Africa. Implications Increased government support and commitment are needed to be able to adopt and implement effective alcohol policies and respond to pressures from alcohol companies to which SSA remains a target market. Conclusion SSA needs effective alcohol control measures in order to reverse the trajectory of worsening alcohol harms observed in some countries and reinforce improvements in alcohol harms observed in others.
32 citations
TL;DR: This realist review aimed to synthesize evidence of different forms and mechanisms of power active in trade and health decision-making spaces to understand better why NCD policy non-decisions persist and the implications for future transformative action.
Abstract: Transnational tobacco, alcohol and ultra-processed food corporations use the international trade regime to prevent policy action on non-communicable diseases (NCDs); i.e. to promote policy 'non-decisions'. Understanding policy non-decisions can be assisted by identifying power operating in relevant decision-making spaces, but trade and health research rarely explicitly engages with theories of power. This realist review aimed to synthesize evidence of different forms and mechanisms of power active in trade and health decision-making spaces to understand better why NCD policy non-decisions persist and the implications for future transformative action. We iteratively developed power-based theories explaining how transnational health-harmful commodity corporations (THCCs) utilize the international trade regime to encourage NCD policy non-decisions. To support theory development, we also developed a conceptual framework for analysing power in public health policymaking. We searched six databases and relevant grey literature and extracted, synthesized and mapped the evidence against the proposed theories. One hundred and four studies were included. Findings were presented for three key forms of power. Evidence indicates THCCs attempt to exercise instrumental power by extensive lobbying often via privileged access to trade and health decision-making spaces. When their legitimacy declines, THCCs have attempted to shift decision-making to more favourable international trade legal venues. THCCs benefit from structural power through the institutionalization of their involvement in health and trade agenda-setting processes. In terms of discursive power, THCCs effectively frame trade and health issues in ways that echo and amplify dominant neoliberal ideas. These processes may further entrench the individualization of NCDs, restrict conceivable policy solutions and perpetuate policymaking norms that privilege economic/trade interests over health. This review identifies different forms and mechanisms of power active in trade and health policy spaces that enable THCCs to prevent progressive action on NCDs. It also points to potential strategies for challenging these power dynamics and relations.
28 citations
Cites background from "Unpacking policy formulation and in..."
...Over the past few decades, public health researchers have exposed multiple strategies used by transnational health-harmful commodity corporations (THCCs) to prevent regulation of health-harmful commodities (Jiang and Ling, 2013; Ulucanlar et al., 2014; Gilmore et al., 2015; Balwicki et al., 2016; Bertscher et al., 2018; Mccambridge et al., 2018; Hawkins et al., 2019)....
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TL;DR: The study reaffirms the centrality of social values within HPSR and highlights significant evidence gaps, as well as suggesting strategies for future work on social values in H PSR.
Abstract: Because health systems are conceptualized as social systems, embedded in social contexts and shaped by human agency, values are a key factor in health system change. As such, health systems software-including values, norms, ideas and relationships-is considered a foundational focus of the field of health policy and systems research (HPSR). A substantive evidence-base exploring the influence of software factors on system functioning has developed but remains fragmented, with a lack of conceptual clarity and theoretical coherence. This is especially true for work on 'social values' within health systems-for which there is currently no substantive review available. This study reports on a systematic mixed-methods evidence mapping review on social values within HPSR. The study reaffirms the centrality of social values within HPSR and highlights significant evidence gaps. Research on social values in low- and middle-income country contexts is exceedingly rare (and mostly produced by authors in high-income countries), particularly within the limited body of empirical studies on the subject. In addition, few HPS researchers are drawing on available social science methodologies that would enable more in-depth empirical work on social values. This combination (over-representation of high-income country perspectives and little empirical work) suggests that the field of HPSR is at risk of developing theoretical foundations that are not supported by empirical evidence nor broadly generalizable. Strategies for future work on social values in HPSR are suggested, including: countering pervasive ideas about research hierarchies that prize positivist paradigms and systems hardware-focused studies as more rigorous and relevant to policy-makers; utilizing available social science theories and methodologies; conceptual development to build common framings of key concepts to guide future research, founded on quality empirical research from diverse contexts; and using empirical evidence to inform the development of operationalizable frameworks that will support rigorous future research on social values in health systems.
16 citations
Cites background from "Unpacking policy formulation and in..."
..., 2011b), such as in the case of the formulation of policies to control the marketing of alcoholic beverages in South Africa, where various forms of evidence were accepted by different actors depending on their values and interests (Bertscher et al., 2018)....
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TL;DR: In this article, a fit-for-purpose nutrient profiling model (NPM) was developed in South Africa to support the fight against obesity and NCDs in the country, and the Chile 2019 NPM was identified as suitable to adapt, and total sugar, saturated fat, sodium and non-sugar sweetener were identified as appropriate to restrict.
Abstract: South Africa (SA) is facing a rising prevalence of obesity and diet-related chronic diseases. The government is seeking to develop effective, evidence-based policy measures to address this. A well-designed, fit-for-purpose nutrient profiling model (NPM) can aid policy development. The aim of this study was to develop a fit-for-purpose NPM in SA. Steps included: (1) determining the purpose and target population; (2) selecting appropriate nutrients and other food components to include; (3) selecting a suitable NPM type, criteria and base; and (4) selecting appropriate numbers and thresholds. As part of the evaluation, the nutritional composition of packaged foods containing nutritional information (n = 6747) in the SA food supply chain was analyzed, a literature review was undertaken and various NPMs were evaluated. Our findings indicated that it is most appropriate to adapt an NPM and underpin regulation with a restrictive NPM that limits unhealthy food components. The Chile 2019 NPM was identified as suitable to adapt, and total sugar, saturated fat, sodium and non-sugar sweetener were identified as appropriate to restrict. This NPM has the potential to underpin restrictive policies, such as front-of-package labelling and child-directed marketing regulations in SA. These policies will support the fight against obesity and NCDs in the country.
7 citations
References
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Book•
01 Oct 1984
TL;DR: In this article, buku ini mencakup lebih dari 50 studi kasus, memberikan perhatian untuk analisis kuantitatif, membahas lebah lengkap penggunaan desain metode campuran penelitian, and termasuk wawasan metodologi baru.
Abstract: Buku ini menyediakan sebuah portal lengkap untuk dunia penelitian studi kasus, buku ini menawarkan cakupan yang luas dari desain dan penggunaan metode studi kasus sebagai alat penelitian yang valid. Dalam buku ini mencakup lebih dari 50 studi kasus, memberikan perhatian untuk analisis kuantitatif, membahas lebih lengkap penggunaan desain metode campuran penelitian, dan termasuk wawasan metodologi baru.
78,012 citations
Book•
12 Jan 1994
TL;DR: This book presents a step-by-step guide to making the research results presented in reports, slideshows, posters, and data visualizations more interesting, and describes how coding initiates qualitative data analysis.
Abstract: Matthew B. Miles, Qualitative Data Analysis A Methods Sourcebook, Third Edition. The Third Edition of Miles & Huberman's classic research methods text is updated and streamlined by Johnny Saldana, author of The Coding Manual for Qualitative Researchers. Several of the data display strategies from previous editions are now presented in re-envisioned and reorganized formats to enhance reader accessibility and comprehension. The Third Edition's presentation of the fundamentals of research design and data management is followed by five distinct methods of analysis: exploring, describing, ordering, explaining, and predicting. Miles and Huberman's original research studies are profiled and accompanied with new examples from Saldana's recent qualitative work. The book's most celebrated chapter, "Drawing and Verifying Conclusions," is retained and revised, and the chapter on report writing has been greatly expanded, and is now called "Writing About Qualitative Research." Comprehensive and authoritative, Qualitative Data Analysis has been elegantly revised for a new generation of qualitative researchers. Johnny Saldana, The Coding Manual for Qualitative Researchers, Second Edition. The Second Edition of Johnny Saldana's international bestseller provides an in-depth guide to the multiple approaches available for coding qualitative data. Fully up-to-date, it includes new chapters, more coding techniques and an additional glossary. Clear, practical and authoritative, the book: describes how coding initiates qualitative data analysis; demonstrates the writing of analytic memos; discusses available analytic software; suggests how best to use the book for particular studies. In total, 32 coding methods are profiled that can be applied to a range of research genres from grounded theory to phenomenology to narrative inquiry. For each approach, Saldana discusses the method's origins, a description of the method, practical applications, and a clearly illustrated example with analytic follow-up. A unique and invaluable reference for students, teachers, and practitioners of qualitative inquiry, this book is essential reading across the social sciences. Stephanie D. H. Evergreen, Presenting Data Effectively Communicating Your Findings for Maximum Impact. This is a step-by-step guide to making the research results presented in reports, slideshows, posters, and data visualizations more interesting. Written in an easy, accessible manner, Presenting Data Effectively provides guiding principles for designing data presentations so that they are more likely to be heard, remembered, and used. The guidance in the book stems from the author's extensive study of research reporting, a solid review of the literature in graphic design and related fields, and the input of a panel of graphic design experts. Those concepts are then translated into language relevant to students, researchers, evaluators, and non-profit workers - anyone in a position to have to report on data to an outside audience. The book guides the reader through design choices related to four primary areas: graphics, type, color, and arrangement. As a result, readers can present data more effectively, with the clarity and professionalism that best represents their work.
41,986 citations
"Unpacking policy formulation and in..." refers methods in this paper
...A thematic analysis was used to analyse the data (Miles and Huberman 1994)....
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TL;DR: The burden of mortality and disease attributable to alcohol, both globally and for ten large countries, is quantified and concludes that alcohol consumption is one of the major avoidable risk factors, and actions to reduce burden and costs associated with alcohol should be urgently increased.
3,123 citations
TL;DR: The relationship between age at first use of alcohol and the prevalence of lifetime alcohol abuse and alcohol dependence, among all U.S. adults and within subgroups defined by sex and race is examined.
1,791 citations
TL;DR: This paper assess the eff ectiveness of self-regulation, public-private partnerships, and public regulation models of interaction with unhealthy commodity industries and conclude that unhealthy commodity industry should have no role in the formation of national or international NCD policy.
1,308 citations