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Unhealthy diets are increasing contributors to poor health and mortality in low- and middle-income countries (LMICs). Government interventions targeting the structural drivers of unhealthy diets are needed to prevent these illnesses, including nutrition labelling regulations that create healthier food environments. Yet, implementation remains slow and uneven. One explanation for slow implementation highlights the role of politics, including powerful ideological discourse and its strategic deployment by economically powerful actors. In this article, we advance research on the politics of nutrition policies by analysing political discourse on nutrition labelling regulations within an influential and under-studied global institution: the World Trade Organization (WTO). We identified WTO Technical Barriers to Trade (TBT) Committee meeting minutes with reference to nutrition labelling policies proposed by Thailand, Chile, Indonesia, Peru, Ecuador, Bolivia, and Uruguay (2007–2019; n = 47). We analysed the frames, narratives, and normative claims that feature in inter-country discourse within TBT meetings and examined how actors mobilize ideological and material sources of power via these statements. We find that informal government challenges to nutrition labelling proposals within the Committee featured a narrative that individualized the causes of and solutions to poor diet, downplayed harms from industrialised food products, and framed state regulation as harmful and unjust. These non-technical claims mobilised neoliberal ideology and rhetoric to contest the normative legitimacy of members' proposals and to de-socialize and de-politicize poor diets. Furthermore, high-income countries (HICs) re-framed policy goals to focus on individual determinants of poor nutrition whilst calling for their preferred policies to be adopted. Patterns of discourse within TBT meetings also had striking similarities with arguments raised by multi-national food corporations elsewhere. Our findings suggest that non-technical and ideological arguments raised during TBT meetings serve as inconspicuous tools through which nutrition labelling policies in LMICs are undermined by HICs, industry, and the powerful ideology of neoliberalism.

The Codex Alimentarius has approved ongoing work for international guidance on front-of-pack (FoP) nutrition labelling, which is a core intervention for prevention of diet-related noncommunicable disease. This guidance will have implications for national policy decision-making regarding this important public health issue. However, FoP nutrition labelling is also a trade and commerce policy issue. In this study, we analyze the global governance of FoP nutrition labelling and current policy processes, to inform public health policy and advocacy. We present findings from a qualitative governance and institutional analysis, based on key informant interviews with 28 global actors. The study found that Codex guidance was perceived as likely to have a high impact on FoP nutrition labelling globally. However, a small and highly interconnected &ldquo ; regime complex&rdquo ; of international institutions surrounds FoP nutrition labelling at the global level, and influence on Codex discussions is being exerted differentially by actors at the national and global level, particularly by government and industry actors. There are thus risks associated with conflicts of interests in the development of global guidance on FoP nutrition labelling. There are also opportunities for more strategic and coordinated public health engagement.

Tobacco, alcohol and unhealthy foods are key contributors to non-communicable diseases globally. Public health advocates have been proactive in recent years, developing systems to monitor and mitigate both health harms and influence by these industries. However, establishing and implementating strong government regulation of these unhealthy product-producing industries remains challenging. The relevant regulatory instruments lie not only with ministries of health but with agriculture, finance, industry and trade, largely driven by economic concerns. These policy sectors are often unreceptive to public health imperatives for restrictions on industry, including policies regarding labelling, marketing and excise taxes. Heavily influenced by traditional economic paradigms, they have been more receptive to industry calls for (unfettered) market competition, the rights of consumers to choose and the need for government to allow industry free rein; at most to establish voluntary standards of consumer protection, and certainly not to directly regulate industry products and practices. In recent years, the status quo of a narrow economic rationality that places economic growth above health, environment or other social goals is being re-evaluated by some governments and key international economic agencies, leading to windows of opportunity with the potential to transform how governments approach food, tobacco and alcohol as major, industry-driven risk factors. To take advantage of this window of opportunity, the public health community must work with different sectors of government to(1) reimagine policy mandates, drawing on whole-of-government imperatives for sustainable development, and (2) closely examine the institutional structures and governance processes, in order to create points of leverage for economic policies that also support improved health outcomes.

In their recent article Roache and Gostin outline why governments and public health advocates should embrace soda taxes. The evidence is strong and continues to grow: such taxes can change consumer behavior, generate significant revenue and incentivize product reformulation. In essence, such taxes are an important and now well-established instrument of fiscal and public health policy. In this commentary we expand on their arguments by considering how the worldwide adoption of such taxes might be further accelerated. First, we identify where in the world taxes have been implemented to date and where the untapped potential remains greatest. Second, drawing upon recent case study research on country experiences we describe several conditions under which governments may be more likely to make taxation a political priority in the future. Third, we consider how to help strengthen the technical and legal capacities of governments to design and effectively administer taxes, with emphasis on low-and middle-income countries. We expect the findings to be most useful to public health advocates and policy-makers seeking to promote healthier diets and good nutrition.

AbstractMalnutrition remains a global challenge and is hampering the achievement of Sustainable Development Goals. At the United Nations, governments have committed to taking action on food systems and nutrition. Government intervention in this space will necessarily intersect trade and health policy. This Practitioner Commentary considers the implications for policymakers in the trade and health communities. We argue that there is an opportunity for 'soft guidance' to play an important role in helping governments navigate potential tensions between trade and nutrition policies.

AbstractThe interaction of international investment agreements and public health is marked by ambivalence. Investment treaties can help attract investment into the health sector but also enable international legal claims by foreign investors against public health measures. This paper seeks to better understand their relationship by systematically mapping the purpose of health inclusions in bilateral investment treaties (BITs) between 1959 and 2021. We find that health‐related clauses, present in 18% of all BITs, are used both as a shield and a sword. Most health mentions protect host countries from claims against public health measures, yet an increasing number of recent BITs, primarily from developing countries, also pursue an offensive public health agenda by advancing health safety at work and health‐related corporate social responsibility of investors.

Abstract Society continues to be confronted with the deep inadequacies of the current global order. Rampant income inequality between and within countries, dramatic disparities in access to resources, as seen during the COVID pandemic, persistent degradation of the environment, and numerous other problems are tied to existing systems of economy and government. Current global economic systems are implicated in perpetuating these problems. The Sustainable Development Goals (SDGs) were born out of the recognition that dramatic changes were needed to address these intersecting challenges. There is general recognition that transformation of global systems and the relationship between sectors is needed. We conduct a structured, theoretically-informed analysis of SDG documents produced by United Nations agencies with the aim of examining the framing of economic policy goals, a historically dominant domain of consideration in development policy, in relation to health, social and environmental goals. We apply a novel typology to categorize the framing of policy goals. This analysis identified that the formal discourse associated with the SDGs marks a notable change from the pre-SDG development discourse. The 'transformational' agenda issued in the SDG documents is in part situated in relation to a critique of previous and existing approaches to development that privilege economic goals over health, social and environmental goals, and position economic policy as the solution to societal concerns. At the same time, we find that there is tension between the aspiration of transformation and an overwhelming focus on economic goals. This work has implications for health governance, where we find that health goals are still often framed as a means to achieve economic policy goals. Health scholars and advocates can draw from our analysis to critically examine how health fits within the transformational development agenda and how sectoral policy goals can move beyond a crude emphasis on economic growth.

Addressing the global challenge of malnutrition in all its forms will require policy measures to improve food environments, yet progress has been patchy and often slow, particularly for regulatory measures. International trade and investment agreements (TIAs) may limit governments' "policy space" for public health regulation. Constraints have been particularly apparent for public health measures targeting unhealthy commodities, including ultra-processed foods. Challenges and disputes regarding food environment regulation under TIAs (even if successfully defended) can entail significant drain of human and financial resources, and political capital. Lack of awareness or understanding of the implication of TIAs on policy space for regulation can contribute to regulatory chill and policy inertia. Governments lacking capacity to interpret their "legally available" policy space may want to err on the side of caution when there is perceived risk of a formal dispute—even if such threats are unfounded. This paper draws on analysis of literature, trade and investment dispute documentation, and data from inter-disciplinary expert interviews (n= 22) to present a new conceptual framework for the potential impacts of TIAs on policy space for regulating food environments. The analysis that underpins the framework focusses on the key policy domains of fiscal policies, front-of-pack nutrition labeling, restrictions on marketing to children, nutrient limits, and product bans. Analysis indicates that regulatory context and stakeholder influence, policy design, and mechanisms associated with TIA rules and provisions intersect in ways contributing to policy space outcomes. This new framework can provide a basis for rapidly assessing policy coherence between TIAs and food environment regulations in these domains. It can also be used to identify areas where further legal analysis would strengthen the development and defense of regulatory proposals. The framework may be applied to nutrition regulation more broadly, given the common themes that emerged across the different domains due to common interests of stakeholders, notably the food industry. It thus provides a basis for analyzing the political economy of regulation to address the commercial determinants of health in relation to unhealthy food and beverages.

Background
Pharmacists have important roles in consumers' access to medicines and healthcare. Pharmacy policy advocates have recognised that evidence is important but often insufficient for policy change to support expanded roles of pharmacists, but there has been minimal exploration of why this is the case.

Aims and objectives
To characterise, classify, and describe the types of knowledge that were considered and used in these two pharmacy policy issues in Australia: codeine up-scheduling and pharmacist-administered vaccinations.

Methods
Using documentary data and semi-structured interviews, we identified the research-based, practical, and political knowledge used in these policy processes, drawing on Head's 'three lenses of evidence-based policy'. We used a 'programmatic approach' to analyse how evidence is used in policymaking, where the use and framing of evidence is considered in light of policy actors' institutional roles and goals.

Findings
Practical knowledge demonstrating pharmacists' ability to conduct clinical activities and political knowledge of institutional processes and acceptability were used for both issues; however, research evidence was more identifiable in up-scheduling. Evidence was prioritised and used differently depending on stakeholders' goals.

Discussion and conclusions
Our analysis offers insights for the Australian pharmacy sector advocating for policies to benefit individual and public health. Although medicines regulation and pharmacy practice are phenomena that exist globally, institutional and policymaking contexts differ by country. The pharmacy sector needs to consider these contexts to effectively engage policymakers and optimise evidence use in developing and implementing desired policies.