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Background: Spokespeople play a significant role in communicating public health information yet there is little research understanding the characteristics of those who provide such messaging., Methods: One hundred and four health professionals (70% female) recruited through professional association mailing lists in Australia completed a brief online quantitative and qualitative survey., Results: Participants reported characteristics they believed to be important for spokespeople, those that they believed their organisation considered important, and those they thought engendered public trust. Knowledge of public health issues, public speaking skills, and willingness to speak on behalf of the organisation were identified as important characteristics (by at least 70%). Qualitative results showed some participants distinguished between perceived, as well as actual, expertise, and described the potential for public health university programs to include public speaking and communication skills. Participants also identified an individual's role in the organisation was considered important in their organisation's selection of a spokesperson, particularly in relation to seniority and leadership., Conclusions: The study provides an initial description and priority considerations from health professionals about key characteristics of effective spokespeople. Findings suggest possible avenues for training and support for spokespeople and the need for further research regarding the characteristics of who are effective spokespeople. SO WHAT?: Findings suggest possible avenues for training and support for spokespeople and the need for further research regarding the characteristics of who are effective spokespeople., (© 2023 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

Objective: Food systems are a major contributor to climate change, producing one-third of global greenhouse gas emissions. However, public knowledge of food systems' contributions to climate change is low. One reason for low public awareness may be limited media coverage of the issue. To investigate this, we conducted a media analysis examining coverage of food systems and their contribution to climate change in Australian newspapers., Design: We analysed climate change articles from twelve Australian newspapers between 2011 and 2021, sourced from Factiva. We explored the volume and frequency of climate change articles that mentioned food systems and their contributions to climate change, as well as the level of focus on food systems., Setting: Australia., Participants: N/A., Results: Of the 2892 articles included, only 5 % mentioned the contributions of food systems to climate change, with the majority highlighting food production as the main contributor, followed by food consumption. Conversely, 8 % mentioned the impact of climate change on food systems., Conclusions: Though newspaper coverage of food systems' effects on climate change is increasing, coverage of the issue remains limited. As newspapers play a key role in increasing public and political awareness of matters, the findings provide valuable insights for advocates wishing to increase engagement on the issue. Increased media coverage may raise public awareness and encourage action by policymakers. Collaboration between public health and environmental stakeholders to increase public knowledge of the relationship between food systems and climate change is recommended.

Competing Interests: None declared.

This case study describes the delivery and achievements of the public health nutrition programme in Queensland, Australia, over more than three decades. Analysis of publicly available documents related to statewide nutrition policy and programmes from 1983 to 2014 identified key inputs and programme impacts and outcomes, including an increase in fruit and vegetable intake by 1.1 serves per person per day and rates of exclusive breastfeeding for the first 6 months quadrupled. Mapping factors and milestones against a framework on determinants of political priority highlighted correlation with effective nutrition promotion policy and practice. Identified enablers included the influence of policy champions and advocates, quality of governance, focus on whole-of-population approaches, and periods of political will and economic prosperity. Key barriers included changes of ideology with government leadership; lack of commitment to long-term implementation and evaluation; and limited recognition of and support for preventive health and nutrition promotion. The case study shows that a coordinated, well-funded, intersectoral approach to improve nutrition and prevent chronic disease and malnutrition in all its forms can be achieved and produce promising impacts at state level, but that sustained effort is required to secure and protect investment. Political support for long-term investment in nutrition is essential to reduce the high cost of all diet-related diseases. Public health leadership to better prepare for risks around political cycles, secure adequate resources for evaluation, and better communicate impacts and outcomes may help protect future investments and achievements., (© The Author(s) 2021. Published by Oxford University Press.)

The issue of public health and policy communities engaging with food sector companies has long caused tension and debate. Ralston and colleagues' article 'Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool' further examines this issue. They found widespread food industry opposition, not just to the details of the World Health Organization (WHO) tool, but to the very idea of it. In this commentary we reflect on this finding and the arguments for and against interacting with the food industry during different stages of the policy process. While involving the food industry in certain aspects of the policy process without favouring their business goals may seem like an intractable problem, we believe there are opportunities for progress that do not compromise our values as public health professionals. We suggest three key steps to making progress., (© 2022 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Competing Interests: None declared

Objective: Junk-food marketing contributes significantly to childhood obesity, which in turn imposes major health and economic burdens. Despite this, political priority for addressing junk-food marketing has been weak in many countries. Competing interests, worldviews and beliefs of stakeholders involved with the issue contribute to this political inertia. An integral group of actors for driving policy change are parliamentarians, who champion policy and enact legislation. However, how parliamentarians interpret and portray (i.e. frame) the causes and solutions of public health nutrition problems is poorly understood. The present study aimed to understand how Australian parliamentarians from different political parties frame the problem of junk-food marketing., Design: Framing analysis of transcripts from the Australian Government's Parliamentary Hansard, involving development of a theoretical framework, data collection, coding transcripts and thematic synthesis of results., Settings: Australia., Participants: None., Results: Parliamentarian framing generally reflected political party ideology. Liberal parliamentarians called for minimal government regulation and greater personal responsibility, reflecting the party's core values of liberalism and neoliberalism. Greens parliamentarians framed the issue as systemic, highlighting the need for government intervention and reflecting the core party value of social justice. Labor parliamentarians used both frames at varying times., Conclusions: Parliamentarians' framing was generally consistent with their party ideology, though subject to changes over time. This project provides insights into the role of framing and ideology in shaping public health policy responses and may inform communication strategies for nutrition advocates. Advocates might consider using frames that resonate with the ideologies of different political parties and adapting these over time.

Influencing public policy change can be difficult and complex, particularly for those with limited power and resources. For any one issue there may be several groups, including the commercial sector and public health advocates advocating from different policy perspectives. However, much of the public health advocacy literature and tools available for those wanting to improve their practice is based on research from one specific perspective of an issue. This approach deprives advocates of potential insight into the most effective levers for this complex and difficult process. To provide a more comprehensive insight into effective levers for influencing public health policy change, a conceptual model for poorly-resourced advocates was developed. The model was developed through the integration and synthesis of policy process and network theories with the results from three studies conducted previously by the authors: a systematic literature review; a social network analysis of influential actors in Australian nutrition policy; plus in-depth interviews with a sample of these actors who had diverse perspectives on influencing nutrition policy. Through understanding the key steps in this model advocates will be better equipped to increase political and public will, and affect positive policy change.

Objective: To progress nutrition policy change and develop more effective advocates, it is useful to consider real-world factors and practical experiences of past advocacy efforts to determine the key barriers to and enablers of nutrition policy change. The present review aimed to identify and synthesize the enablers of and barriers to public policy change within the field of nutrition., Design: Electronic databases were searched systematically for studies examining policy making in public health nutrition. An interpretive synthesis was undertaken., Setting: International, national, state and local government jurisdictions within high-income, democratic countries., Results: Sixty-three studies were selected for inclusion. Numerous themes were identified explaining the barriers to and enablers of policy change, all of which fell under the overarching category of 'political will', underpinned by a second major category, 'public will'. Sub-themes, including pressure from industry, neoliberal ideology, use of emotions and values, and being visible, were prevalent in describing links between public will, political will and policy change., Conclusions: The frustration around lack of public policy change in nutrition frequently stems from a belief that policy making is a rational process in which evidence is used to assess the relative costs and benefits of options. The findings from the present review confirm that evidence is only one component of influencing policy change. For policy change to occur there needs to be the political will, and often the public will, for the proposed policy problem and solution. The review presents a suite of enablers which can assist health professionals to influence political and public will in future advocacy efforts.

Objective: Poor dietary intake is the most important behavioural risk factor affecting health globally. Despite this, there has been little investment in public health nutrition policy actions. Policy process theories from the field of political science can aid understanding why policy decisions have occurred and identify how to influence ongoing or future initiatives. The present review aims to examine public health nutrition policy literature and identify whether a policy process theory has been used to analyse the process., Design: Electronic databases were searched systematically for studies examining policy making in public health nutrition in high-income, democratic countries., Setting: International, national, state and local government jurisdictions within high-income, democratic countries., Subjects: Individuals and organisations involved in the nutrition policy-making process., Results: Sixty-three studies met the eligibility criteria, most were conducted in the USA and a majority focused on obesity. The analysis demonstrates an accelerating trend in the number of nutrition policy papers published annually and an increase in the diversity of nutrition topics examined. The use of policy process theory was observed from 2003; however, it was utilised by only 14 % of the reviewed papers., Conclusions: There is limited research into the nutrition policy process in high-income countries. While there has been a small increase in the use of policy process theory from 2003, an opportunity to expand its use is evident. We suggest that nutrition policy making would benefit from a pragmatic approach that ensures those trying to influence or understand the policy-making process are equipped with basic knowledge around these theories.

Policy PointsOur research reveals the similarities and differences among the lobbying activities of tobacco, alcohol, gambling, and ultraprocessed food industries, which are often a barrier to the implementation of public health policies.Over 23 years, we found that just six organizations dominated lobbying expenses in the tobacco and alcohol sectors, whereas the gambling sector outsourced most of their lobbying to professional firms.Databases like OpenSecrets are a useful resource to monitor the commercial determinants of health. Context: Commercial lobbying is often a barrier to the development and implementation of public health policies. Yet, little is known about the similarities and differences in the lobbying practices of different industry sectors or types of commercial actors. This study compares the lobbying practices of four industry sectors that have been the focus of much public health research and advocacy: tobacco, alcohol, gambling, and ultraprocessed foods. Methods: Data on lobbying expenditures and lobbyist backgrounds were sourced from the OpenSecrets database, which monitors lobbying in the United States. Lobbying expenditure data were analyzed for the 1998–2020 period. We classified commercial actors as companies or trade associations. We used Power BI software to link, analyze, and visualize data sets. Findings: We found that the ultraprocessed food industry spent the most on lobbying ($1.15 billion), followed by gambling ($817 million), tobacco ($755 million), and alcohol ($541 million). Overall, companies were more active than trade associations, with associations being least active in the tobacco industry. Spending was often highly concentrated, with two organizations accounting for almost 60% of tobacco spending and four organizations accounting for more than half of alcohol spending. Lobbyists that had formerly worked in government were mainly employed by third‐party lobby firms. Conclusions: Our study shows how comparing the lobbying practices of different industry sectors offers a deeper appreciation of the diversity and similarities of commercial actors. Understanding these patterns can help public health actors to develop effective counterstrategies. [ABSTRACT FROM AUTHOR]

The article discusses the lack of political transparency in Australia and the potential influence of commercial actors on public health policy decisions. Lobbying is identified as an important strategy used by both health advocates and business sector actors to influence policy making. However, the extent of public health lobbying is overshadowed by the business sector, leading to stalled or weakened public health policies. The article highlights the need for improved transparency in lobbying and other political practices to hold governments accountable and ensure that public health voices are not drowned out. The limitations of current data sources on commercial political activities in Australia are also discussed. The article concludes by emphasizing the importance of making information about commercial political activities more accessible and transparent to challenge undue influence and promote government accountability. [Extracted from the article]

What is unknown about commercial lobbying is far greater than what is known. These omissions distort our understanding of the extent and nature of business influence on politics. Especially when businesses engage in practices that harm health, it is crucial for public health advocates to understand corporate lobbying to counter its influence. Our study proceeded in three phases. First, based on an international audit, we developed a list of the categories of information about lobbying that could be disclosed under four groups (lobby firms, lobbyists, organizations and activities) and benchmarked Australian lobbyist registers against this list. Second, we manually extracted data from lobbyist registers in eight jurisdictions, cleaned the data and created a relational model for analysis. Finally, we classified a sample of organizations as public health organizations or harmful industries to compare their activities. We identified 61 possible categories of information about lobbying in international lobbyist registers. When applied to Australian lobbyist registers, Queensland covered the widest range of categories (13, 21%), though many lacked detail and completeness. Australian lobbyist registers provided data on 462 third-party lobby firms across Australia, currently employing 1036 lobbyists and representing 4101 organizations. Several of these represented harmful industries, with gambling interests hiring the most third-party lobby firms. Ultimately, Australian lobbyist registers do not provide enough information to understand the full extent of lobbying activities taking place. Political transparency is important for public health actors to be able to monitor corporate political activity and to protect policy-making from vested interests. [ABSTRACT FROM AUTHOR]

Alcohol labelling laws and policy are contentious and highly politicized. Very few countries have been able to implement health warnings on alcohol labels due to complex legal and governance systems and coordinated industry lobbying. In 2020, Australia and New Zealand implemented a mandatory and evidence-based legal standard for pregnancy warning labels on alcohol products. This article discusses some of the challenges faced in achieving policy change and how these barriers were overcome by public health advocacy groups to build the evidence, counter industry conflicts of interest, consumer test health messages, mobilize community support and gather political support. Reflecting on the decades of ineffective regulation and politicization of this health issue, lessons for other countries include the importance of creating and maintaining relationships with decision makers and regularly updating them with evidence and recommendations, highlighting industry failures and tactics, building broad-based coalitions and sharing lived-experiences. [ABSTRACT FROM AUTHOR]

Background: Poor diet is the leading preventable risk factor contributing to the burden of disease in Australia. A range of cost-effective, comprehensive population-focussed strategies are available to address these dietary-related diseases. However, despite evidence of their effectiveness, minimal federal resources are directed to this area. To better understand the limited public health nutrition policy action in Australia, we sought to identify the key policy brokers in the Australian nutrition policy network and consider their level of influence over nutrition policymaking.Methods: A social network analysis involving four rounds of data collection was undertaken using a modified reputational snowball method to identify the nutrition policy network of individuals in direct contact with each other. Centrality measures, in particular betweenness centrality, and a visualisation of the network were used to identify key policy brokers.Results: Three hundred and ninety (390) individual actors with 1917 direct ties were identified within the Australian nutrition policy network. The network revealed two key brokers; a Nutrition Academic and a General Health professional from a non-government organisation (NGO), with the latter being in the greatest strategic position for influencing policymakers.Conclusion: The results of this social network analysis illustrate there are two dominant brokers within the nutrition policy network in Australia. However their structural position in the network means their brokerage roles have different purposes and different levels of influence on policymaking. The results suggest that brokerage in isolation may not adequately represent influence in nutrition policy in Australia. Other factors, such as direct access to decision-makers and the saliency of the solution, must also be considered. [ABSTRACT FROM AUTHOR]

Issue addressed: Screening for cancer of the cervix, breast and bowel can reduce morbidity and mortality. Low participation rates in cancer screening have been identified among migrant communities internationally. Attempting to improve low rates of cancer screening, the Ethnic Communities Council of Queensland developed a pilot Cancer Screening Education Program for breast, bowel and cervical cancer. This study determines the impact of education sessions on knowledge, attitudes and intentions to participate in screening for culturally and linguistically diverse (CALD) communities living in Brisbane, Queensland.Methods: Seven CALD groups (Arabic-speaking, Bosnian, South Asian (including Indian and Bhutanese), Samoan and Pacific Island, Spanish-speaking, Sudanese and Vietnamese) participated in a culturally-tailored cancer screening education pilot program that was developed using the Health Belief Model. A pre- and post-education evaluation session measured changes in knowledge, attitudes and intention related to breast, bowel and cervical cancer and screening. The evaluation focussed on perceived susceptibility, perceived seriousness and the target population's beliefs about reducing risk by cancer screening.Results: There were 159 participants in the three cancer screening education sessions. Overall participants' knowledge increased, some attitudes toward participation in cancer screening became more positive and intent to participate in future screening increased (n=146).Conclusion: These results indicate the importance of developing screening approaches that address the barriers to participation among CALD communities and that a culturally-tailored education program is effective in improving knowledge, attitudes about and intentions to participate in cancer screening.So what?: It is important that culturally-tailored programs are developed in conjunction with communities to improve health outcomes. [ABSTRACT FROM AUTHOR]