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      The case for developing a cohesive systems approach to research across unhealthy commodity industries

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          Abstract

          Objectives

          Most non-communicable diseases are preventable and largely driven by the consumption of harmful products, such as tobacco, alcohol, gambling and ultra-processed food and drink products, collectively termed unhealthy commodities. This paper explores the links between unhealthy commodity industries (UCIs), analyses the extent of alignment across their corporate political strategies, and proposes a cohesive systems approach to research across UCIs.

          Methods

          We held an expert consultation on analysing the involvement of UCIs in public health policy, conducted an analysis of business links across UCIs, and employed taxonomies of corporate political activity to collate, compare and illustrate strategies employed by the alcohol, ultra-processed food and drink products, tobacco and gambling industries.

          Results

          There are clear commonalities across UCIs’ strategies in shaping evidence, employing narratives and framing techniques, constituency building and policy substitution. There is also consistent evidence of business links between UCIs, as well as complex relationships with government agencies, often allowing UCIs to engage in policy-making forums. This knowledge indicates that the role of all UCIs in public health policy would benefit from a common approach to analysis. This enables the development of a theoretical framework for understanding how UCIs influence the policy process. It highlights the need for a deeper and broader understanding of conflicts of interests and how to avoid them; and a broader conception of what constitutes strong evidence generated by a wider range of research types.

          Conclusion

          UCIs employ shared strategies to shape public health policy, protecting business interests, and thereby contributing to the perpetuation of non-communicable diseases. A cohesive systems approach to research across UCIs is required to deepen shared understanding of this complex and interconnected area and also to inform a more effective and coherent response.

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          Most cited references132

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          The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

          Summary Background Alcohol and drug use can have negative consequences on the health, economy, productivity, and social aspects of communities. We aimed to use data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 to calculate global and regional estimates of the prevalence of alcohol, amphetamine, cannabis, cocaine, and opioid dependence, and to estimate global disease burden attributable to alcohol and drug use between 1990 and 2016, and for 195 countries and territories within 21 regions, and within seven super-regions. We also aimed to examine the association between disease burden and Socio-demographic Index (SDI) quintiles. Methods We searched PubMed, EMBASE, and PsycINFO databases for original epidemiological studies on alcohol and drug use published between Jan 1, 1980, and Sept 7, 2016, with out language restrictions, and used DisMod-MR 2.1, a Bayesian meta-regression tool, to estimate population-level prevalence of substance use disorders. We combined these estimates with disability weights to calculate years of life lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 1990–2016. We also used a comparative assessment approach to estimate burden attributable to alcohol and drug use as risk factors for other health outcomes. Findings Globally, alcohol use disorders were the most prevalent of all substance use disorders, with 100·4 million estimated cases in 2016 (age-standardised prevalence 1320·8 cases per 100 000 people, 95% uncertainty interval [95% UI] 1181·2–1468·0). The most common drug use disorders were cannabis dependence (22·1 million cases; age-standardised prevalence 289·7 cases per 100 000 people, 95% UI 248·9–339·1) and opioid dependence (26·8 million cases; age-standardised prevalence 353·0 cases per 100 000 people, 309·9–405·9). Globally, in 2016, 99·2 million DALYs (95% UI 88·3–111·2) and 4·2% of all DALYs (3·7–4·6) were attributable to alcohol use, and 31·8 million DALYs (27·4–36·6) and 1·3% of all DALYs (1·2–1·5) were attributable to drug use as a risk factor. The burden of disease attributable to alcohol and drug use varied substantially across geographical locations, and much of this burden was due to the effect of substance use on other health outcomes. Contrasting patterns were observed for the association between total alcohol and drug-attributable burden and SDI: alcohol-attributable burden was highest in countries with a low SDI and middle-high middle SDI, whereas the burden due to drugs increased with higher S DI level. Interpretation Alcohol and drug use are important contributors to global disease burden. Effective interventions should be scaled up to prevent and reduce substance use disease burden. Funding Bill & Melinda Gates Foundation and Australian National Health and Medical Research Council.
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            The need for a complex systems model of evidence for public health

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              Manufacturing Epidemics: The Role of Global Producers in Increased Consumption of Unhealthy Commodities Including Processed Foods, Alcohol, and Tobacco

              In an article that forms part of the PLoS Medicine series on Big Food, David Stuckler and colleagues report that unhealthy packaged foods are being consumed rapidly in low- and middle-income countries, consistent with rapid expansion of multinational food companies into emerging markets and fueling obesity and chronic disease epidemics.
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                Author and article information

                Journal
                BMJ Glob Health
                BMJ Glob Health
                bmjgh
                bmjgh
                BMJ Global Health
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2059-7908
                2021
                16 February 2021
                : 6
                : 2
                : e003543
                Affiliations
                [1 ]departmentFaculty of Public Health and Policy , London School of Hygiene & Tropical Medicine , London, UK
                [2 ]SPECTRUM Consortium , UK
                [3 ]departmentDepartment of Public Health, Policy & Systems , University of Liverpool , Liverpool, UK
                [4 ]departmentDepartment of Anthropology , Goldsmiths University of London , London, UK
                [5 ]departmentGlobal Public Health Unit , University of Edinburgh , Edinburgh, UK
                [6 ]departmentPopulation Health Innovation Lab, Department of Public Health, Environments & Society , London School of Hygiene & Tropical Medicine , London, UK
                [7 ]departmentFaculty of Social Sciences , University of Ottawa , Ottawa, Ontario, Canada
                [8 ]departmentInstitute for Social Marketing and Health , University of Stirling , Stirling, UK
                [9 ]departmentTobacco Control Research Group, Department for Health , University of Bath , Bath, UK
                [10 ]departmentInstitute of Food and Resource Economics , University of Copenhagen , Frederiksberg, Denmark
                [11 ]departmentMRC/CSO Social and Public Health Sciences Unit , University of Glasgow School of Life Sciences , Glasgow, UK
                [12 ]departmentSchool of Public Health , Boston University , Boston, Massachusetts, USA
                [13 ]departmentOur Planet Our Health , Wellcome Trust , London, UK
                [14 ]departmentHealth Promotion and Community Health , American University of Beirut , Beirut, Lebanon
                [15 ]departmentSchool of Psychology , University of Birmingham , Birmingham, UK
                [16 ]King's College London , London, UK
                [17 ]departmentDepartment of Social and Policy Sciences , University of Bath , Bath, Bath and North East Somer, UK
                [18 ]Center for International Health Protection, Robert Koch Institute , Berlin, Germany
                Author notes
                [Correspondence to ] Professor Cécile Knai; cecile.knai@ 123456lshtm.ac.uk
                Author information
                http://orcid.org/0000-0001-6663-7379
                http://orcid.org/0000-0002-3398-0688
                Article
                bmjgh-2020-003543
                10.1136/bmjgh-2020-003543
                7888371
                33593757
                b5083457-fdee-434b-b97a-9d0c69c0c54e
                © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 25 July 2020
                : 22 October 2020
                : 11 November 2020
                Categories
                Original Research
                1506
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                public health,qualitative study
                public health, qualitative study

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