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Abstract Conflicts of interest (COIs) have the potential to create bias in research, policy and practice. Although disclosure cannot fully protect individuals and public policy from vested interests, it is an important step to support trust in scientific and public discourse, and transparency in decision-making. However, COIs are often unreported, underreported or difficult to identify. This study aimed to assess the extent to which COIs are voluntarily declared by those who make submissions to government inquiries relating to health, focusing on the 2024 Australian Senate inquiry into perimenopause and menopause. There was no guidance or formal requirement to provide COI declarations in written submissions to the inquiry. However, a statement about COI declarations was given by the Chair of the inquiry at the start of public hearings in which verbal testimony was given. All 284 written submissions and 163 verbal testimonies were reviewed to identify the number and nature of COIs declared. Only 1% of written submissions and 6% of verbal testimonies provided a COI statement. The amount and nature of information provided in COI declarations varied widely. To ensure transparency in decisions made as a result of public inquiries, governments should require that COIs be declared for all submissions. An explicit standardized guide is needed, with clear parameters about the type of detail needed for these declarations. Processes for dealing with COIs should also be clear in any reports or recommendations that are made from the evidence presented at such inquiries.

Abstract The discourses promoted by powerful commercial actors whose business activities are damaging to health undermine the potential for the transformational changes urgently needed to address pressing public health and environmental threats globally. This piece provides an analysis of corporate discursive practices and the mechanisms through which they contaminate scientific and policy debates and harm public and environmental health. We refer to this phenomenon as ‘discursive pollution’ to reflect the parallels between the effects of informational strategies and the commercial activities of harmful industries. It aims to contribute to the literature on the commercial determinants of health by offering a cross-industry perspective of discursive practices and the contradictions that underpin industry-favourable discourses. We propose how the health community can facilitate the construction of alternative discourses by revealing the contradictions and assumptions underpinning industry-favourable discourses.

Abstract Unhealthy commodity industries (UCIs) such as tobacco, alcohol, gambling, ultra-processed food and beverage producers are known to influence policy-making to advance their interests, often to the detriment of public health goals. This study mapped the complex system underpinning UCI’s influence on public health policy formulation in the UK and identified potential interventions to shift the system towards being able to better attain public health goals. We conducted a participatory systems mapping workshop with ten experts to build a causal loop diagram (CLD) and identify potential interventions to address UCI’s influence on public health policy development. The resulting CLD depicts a highly interconnected and reinforcing system driving UCI’s involvement in public health policy formulation across five thematic areas. Among the most connected elements were the ‘dominance of market mechanisms’, ‘perception of partnership as good governance principle’, ‘industry involvement lending perceived legitimacy to the policy formulation process’, ‘industry is seen as part of the solution’ and ‘industry ties to policy-makers’. Participants identified a total of 22 interventions within this system. Analysis of the CLD and interventions identified the potential for two key paradigmatic changes in this complex system: de-normalizing the perception of unhealthy commodity industry actors as legitimate stakeholders in policy formulation; and prioritizing public health and wellbeing objectives over profit and economic gain. In order to shift the system towards better attaining public health goals, interventions should reinforce each other and be supportive of these two key paradigmatic shifts.

Abstract Commercial activity has positive and negative effects on health. Adverse commercial impacts on health are underpinned by corporate power and economic models and policy that prioritize economic growth, rather than a wellbeing economy that prioritizes health, equity and sustainability. Health in all policies (HiAP) aims to ensure that all policies promote health and health equity, using processes including health impact assessment (HIA). We aimed to explore the potential for HiAP and HIA to help address commercial determinants of health and promote a wellbeing economy. We completed a scoping review to identify how HiAP approaches, including HIA, could address commercial determinants, including challenges and implications for practice. This found synergy between the concepts of wellbeing economy and HiAP. However, corporate interests have sometimes co-opted HiAP to influence policy. We found some examples of HIAs of transnational corporations and international trade and investment agreements. We reviewed HIA frameworks for guidance to practitioners on managing corporate influence. This identified little guidance on identifying and managing corporate and other conflicts of interest or managing power differentials between stakeholders. We also mapped wellbeing economy outcomes against health determinants considered in selected HIA frameworks. This found that HIA frameworks with a comprehensive checklist of health determinants prompt consideration of most wellbeing economy outcomes. HIA could support the transition to a wellbeing economy if applied routinely to economic policies, but ideational change is also needed. HIA frameworks should provide guidance on corporate conflicts of interest and power differentials.

Abstract Flavoured oral nicotine pouches, manufactured and marketed by global tobacco companies, such as Philip Morris International (PMI) and British American Tobacco, entered the Australian market in 2024. Despite it being illegal for Australian retailers to sell nicotine pouches, the products have been seized in government enforcement raids of Australian retailers, and have also been promoted to young people by Australian social media influencers. The Australian Federal Government has recognized and expressed concern about the rising profile of nicotine pouches in Australia and the promotion of these products as unproven vaping and smoking cessation aids. Yet to date, there has been no published research on nicotine pouches in Australia. Using focus group and interview data collected in early 2024 as part of Generation Vape, an ongoing Australian national study into adolescent and young adult vaping and smoking, we explored their attitudes to and perceptions of nicotine pouches, including first-hand experiences and drivers of use. The participants perceived an increase in the use and popularity of oral nicotine pouches, including PMI’s Zyn brand, for reasons including claimed sport performance enhancement, vaping cessation and as part of partying and clubbing culture. Some participants perceived nicotine pouches to be a ‘healthier’ alternative to smoking or vaping. It is critical that research on nicotine pouches is collected now to inform public health policy and to prevent the proliferation of a new class of addictive recreational nicotine products in Australia.

Abstract Global food system governance increasingly relies on multistakeholder initiatives (MSIs) that aim to include those who are affected by and/or affected by an issue. Multistakeholderism’s perceived legitimacy is premised on both its outcomes (output legitimacy) and processes (input legitimacy), the latter in turn based on four key rationales: inclusiveness, procedural fairness, consensual orientation and transparency. To date, evidence on the ineffectiveness of MSI’s outcomes undermines its claims to output legitimacy. While individual case study assessments have also raised concerns over their processes, documenting instances of power asymmetries and corporate capture, there has hitherto been no comprehensive assessment of the input legitimacy of multistakeholderism. This work addresses that gap through interviews with 31 participants working either in or on MSIs. Participants noted significant challenges related to input legitimacy, including that (i) inclusion was often based on pre-existing networks of an MSI’s founders—most of whom were based in the global North—and risked excluding less well-resourced or marginalized actors; (ii) pre-existing power imbalances, both internal and external to the MSI, considerably influenced its processes and structures; (iii) goal-setting was complicated by conflicts of interest and (iv) reliance on informal processes limited transparency. The similarities in challenges across MSIs indicate that these are not attributable to shortcomings of individual MSIs but are instead indicative of wider system constraints. Rather than rely on multistakeholderism as a ‘good’ governance norm, our findings add to evidence that MSIs do not meet output legitimacy and signal that the legitimacy of MSIs in their current form should be questioned.

Abstract Gambling sponsorship of professional sport, particularly relating to online wagering, has been a key focus of global regulatory reform efforts to address the normalization of gambling. In Australia, gambling companies and venues (including community clubs and hotels) also sponsor and develop relationships with community (non-professional) sports teams and clubs. In-depth interviews (n = 24) were conducted with senior leaders in community sporting organizations in Australia with an aim of understanding the factors that shape decisions about accepting or refusing gambling sponsorships and partnerships. A reflexive approach to thematic analysis was used to construct three themes from the data. First, participants considered the alignment of values between the sponsor and the community sporting organization. While most stated that gambling and sport should not be aligned through sponsorship, some forms of sponsorship (for example from community clubs) were perceived as less harmful than others (such as online wagering). Second, some thought that while there were ethical ways to engage with gambling sponsors such as not promoting sponsors’ products, they were concerned about how gambling sponsorship might have an overall impact on the community. Third, was the impact of gambling sponsorships on the organization’s reputation, and balancing this with a need for financial stability. Decisions to accept (or reject) gambling sponsorship were influenced by a range of perceived risks and benefits. Addressing the acceptance of gambling sponsorships among community sporting organizations could involve several approaches to interventions, including regulation, formal policies to guide sponsorship decisions and education about the risks of accepting these sponsorships.

Abstract Public health researchers have investigated how youth are exposed to and influenced by traditional forms of commercial marketing from health-harming industries. Limited research has investigated youth opinions about the broader marketing and public relations strategies of these industries. This study aimed to understand youth perceptions of the impact and influence of a range of marketing and public relations strategies used by health harming industries. An online qualitative survey was conducted with n = 518, 16- to 24-year-olds living in Victoria, Australia. Participants were asked to consider the broad influence of marketing from health harming industries on youth, including the impacts of social media promotions, corporate social responsibility strategies including sponsorship and political donations, as well as their views on marketing restrictions. Reflexive thematic analysis was used to construct themes from the data. Participants stated that excessive marketing strategies had a significant influence on youth consumption of health harming products. Most felt that social media marketing had the most appeal and influence on youth. Most were critical of these strategies and were supportive of strong restrictions on marketing for health-harming products. However, many participants held more positive views about corporate social responsibility strategies, which they perceived could offset the negative impacts of these industries on health. Increased focus is needed from the public health and health promotion communities to ensure that youth are protected from the influence of the range of marketing strategies that are used by health-harming industries to promote their products and resist regulatory reform.

Abstract Public health actors have expressed concerns over the entry of the tobacco industry into the UK e-cigarette market. It is important to be aware of the tobacco industry’s involvement and stated aims for e-cigarettes in the UK, given their historical attempts to divert attention from and escape responsibility for the harms caused by combustible cigarettes. The use of e-cigarettes amongst young people in the UK has remained constant, despite the law prohibiting sales to adolescents and claims by manufacturers and others that they are designed solely as a tool to quit smoking. This study sought to examine how tobacco-related organizations in the UK e-cigarette market frame the use of e-cigarettes. Publicly available materials between September 2015 and June 2023 were collected from four transnational tobacco companies which have invested in the e-cigarette category, and from a UK e-cigarette trade association. A qualitative framing analysis of materials was conducted guided by relevant frameworks from the Commercial Determinants of Health literature. The analysis identified seven framings used by tobacco-related organizations relevant to e-cigarette usage in the UK. These were: co-opting of harm reduction; consumer choice; following the ‘evidence’; insufficient evidence; the right kind of regulation; ‘us’ and ‘them’ rhetoric and marketing and advertising. By highlighting tobacco-related organizations’ e-cigarette framings and contradictions, this study raises awareness of the rhetorical strategies used by the industry which aim to relegitimize tobacco companies in the political and public spheres.

Abstract Through the commercial determinants of health framework, gambling has been identified as a powerful threat to health. This research critically examines cryptocurrency, which is promoted and sold as a highly gamblified product. Using the commercial determinants of health framework, the multifaceted ways in which cryptocurrency firm operations may impact health outcomes are highlighted. Political influence is exerted through substantial donations, with high-profile cases illustrating the sector’s attempts to sway policy, whilst cryptocurrencies often operate in unregulated markets. Marketing strategies mirror those of traditional harmful industries, deploying immense advertising budgets and celebrity endorsements to promote highly speculative and risky financial products. Cryptocurrency mining, demanding considerable energy consumption, causes significant environmental damage. Financial practices include hundreds of outright frauds targeting low- and middle-income countries. Cryptocurrency investment, with 24/7 access and promises of huge wealth, mirrors gambling and is likely to result in public health harms through the same mechanisms as other forms of gambling. Despite the supposed potential of blockchain technology for improving payment and contract systems, the lack of realization of these benefits contrasts sharply with the immediate and growing costs associated with cryptocurrency speculation. Cryptoassets are a case study for the need for health promotion professionals to critically evaluate new technologies and advocate for regulatory measures to protect public health in the face of novel, high-risk products that overlap gambling and finance.