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Understanding the politics of the commercial determinants of health is a new area of scholarly inquiry. More than ever, policymakers and public health researchers realize that industries, including tobacco, alcohol, soda, and ultra-processed food corporations, have had a considerable amount of political power and health policy influence, facilitated through favorable international and domestic economic contexts. Although government decision-making is considered to have a key influence on the health of populations, corporate power is often a key influence on government decision-making. Using the lens of political science and the nature of corporate influence on political processes and stakeholders, this chapter discusses how best to advance population health science and practice.

Addressing the politics of corporate political activity and policy interference in response to non-communicable diseases (NCDs) is a new area of scholarly research. The objective of this article is to explain how, in Mexico and Brazil, the ultra-processed foods and beverages industry succeeded in creating the political and social conditions conducive for their on-going regulatory policy influence and manipulation of scientific research. In addition to establishing partnerships within and outside of government, industry representatives have succeeded in hampering civic opposition by establishing allies within academia and society. Ministries of Health have simultaneously neglected to work closely with civil society, while legislative representatives have continued to benefit from industry campaign contributions. Findings from this article suggest that ultra-processed foods and beverages industries wield on-going regulatory policy influence in Mexico and Brazil, and that government is still not fully committed to working with civil society on these issues.

The inclusion of social determinants of health offers a more comprehensive lens to fully appreciate and effectively address health. However, decision-makers across sectors still struggle to appropriately recognise and act upon these determinants, as illustrated by the ongoing COVID-19 pandemic. Consequently, improving the health of populations remains challenging. This paper seeks to draw insights from the literature to better understand decision-making processes affecting health and the potential to integrate data on social determinants. We summarised commonly cited conceptual approaches across all stages of the policy process, from agenda-setting to evaluation. Nine conceptual approaches were identified, including two frameworks, two models and five theories. From across the selected literature, it became clear that the context, the actors and the type of the health issue are critical variables in decision-making for health, a process that by nature is a dynamic and adaptable one. The majority of these conceptual approaches implicitly suggest a possible role for data on social determinants of health in decision-making. We suggest two main avenues to make the link more explicit: the use of data in giving health problems the appropriate visibility and credibility they require and the use of social determinants of health as a broader framing to more effectively attract the attention of a diverse group of decision-makers with the power to allocate resources. Social determinants of health present opportunities for decision-making, which can target modifiable factors influencing health—i.e. interventions to improve or reduce risks to population health. Future work is needed to build on this review and propose an improved, people-centred and evidence-informed decision-making tool that strongly and explicitly integrates data on social determinants of health. Supplementary Information The online version contains supplementary material available at 10.1007/s11524-021-00560-z.

Noncommunicable diseases (NCDs) represent a significant global public health burden. As more countries experience both epidemiologic transition and increasing urbanization, it is clear that we need approaches to mitigate the growing burden of NCDs. Large and growing urban environments play an important role in shaping risk factors that influence NCDs, pointing to the ineluctable need to engage sectors beyond the health sector in these settings if we are to improve health. By way of one example, the transportation sector plays a critical role in building and sustaining health outcomes in urban environments in general and in megacities in particular. We conducted a qualitative comparative case study design. We compared Bus Rapid Transit (BRT) policies in 3 megacities-Lagos (Africa), Bogotá (South America), and Beijing (Asia). We examined the extent to which data on the social determinants of health, equity considerations, and multisectoral approaches were incorporated into local politics and the decision-making processes surrounding BRT. We found that all three megacities paid inadequate attention to health in their agenda-setting, despite having considerable healthy transportation policies in principle. BRT system policies have the opportunity to improve lifestyle choices for NCDs through a focus on safe, affordable, and effective forms of transportation. There are opportunities to improve decision-making for health by involving more available data for health, building on existing infrastructures, building stronger political leadership and commitments, and establishing formal frameworks to improve multisectoral collaborations within megacities. Future research will benefit from addressing the political and bureaucratic processes of using health data when designing public transportation services, the political and social obstacles involved, and the cross-national lessons that can be learned from other megacities.

One of Russia’s ongoing public health challenges is the HIV/AIDS epidemic. Using qualitative methods focused on elite interviews and document analysis, the article argues that despite widespread re...

Public health researchers concerned with the commercial industry's influence over health policy have contributed to the development of a new field of inquiry, Corporative Political Activity (CPA). While the CPA literature has improved our understanding of the tactics that industries use to influence health policy and outcomes, ironically, this literature appears to have fallen short of thoroughly engaging those social science disciplines focusing on the relationship between industry and government in the policymaking process, such as political science. The purpose of this article is to reveal how political science theory and method can generate new research questions for CPA scholars; propose alternative qualitative methodological approaches to causal inference, with a focus on historical and temporal analysis; and establish adequacy in causal mechanisms. The application of political science theories and methods may assist CPA researchers in their efforts to explain the durability and efficacy of CPA political tactics at the domestic government level, which of these tactics are more important, while providing greater depth into explaining how and why industries continue to obstruct policymaking. The author then propose an alternative political science analytical framework, Political Analysis of Corporate Political Activity (PACPA), that may provide a more thorough understanding of the politics of the commercial sector's policy influence. This framework integrates the political science literature highlighting the political and institutional contexts shaping interest group activities and policymaking influence along with the CPA literature discussing these issues, through a historically-based qualitative case study approach emphasizing the causal mechanisms behind industry's political activities. With respect to methodology, this article relied on an analysis of qualitative documents through a variety of on-line search engines and the author's extensive knowledge of the topic. Select case studies were used as illustrations supporting the author's claims. This research began in November 2020 and concluded in June 2021.

In the Americas, next to the United States, Brazil and Mexico have the highest prevalence of type-2 diabetes. In contrast to most studies, this article compares and analyzes the politics behind the implementation of type-2 diabetes self-care management programs (DSM), which is a new area of scholarly research. This article claims that Brazil outpaced Mexico with respect to the implementation of effective DSM programs, the product of positive policy spillover effects associated with the president and governing political party’s popular anti-poverty programs, and the enduring legacy of centralized ministry of health financial and human resource assistance to primary care programs in a context of decentralization. Brazil also benefited from having a strong partnership with international health agencies. None of these factors was present in Mexico. Findings suggest that more research needs to go into understanding the complex political and inter-governmental contexts facilitating DSM program implementation, which is a neglected area of research.

In response to non-communicable diseases (NCDs) in Latin America, governments have introduced impressive prevention programmes However, the purpose of this article is to better explain why several governments have yet to address arguably the ‘root of the problem’: i.e. implementing effective regulatory policies restricting the food industries’ ability to market and sale their products. Introducing a political science analytical framework merging international relations and domestic politics theory, this article claims that most governments have failed to achieve this process because of their reluctance to transfer their beliefs in human rights to health from the area of NCD prevention to regulation, thus achieving what the author refer to as ‘normative transferability’. The research design for this study entailed a documentary analysis of 44 qualitative primary and secondary documentary data sources (combined), i.e. articles, books, policy reports and the usage of these data sources for a comparative case study analysis of Chile, Brazil and Mexico. These qualitative data sources were also used to illustrate the potential efficacy of the author’s proposed analytical framework, developed from the political science and public policy literature. Quantitative epidemiological data from the World Health Organization global health observatory were used to provide a contextual backdrop of the obesity and diabetes situation in these countries. Comparing these three countries, Chile was the only one capable of achieving ‘normative transferability’ due to a strong linkage between activists, supportive institutions and policy advocates within government viewing regulatory policy as a human right to protection from aggressive industry marketing and sales tactics. To better understand differences between nations in achieving normative transferability processes and effective NCD regulatory policy outcomes, political scientists and public health scholars should work together to develop alternative analytical frameworks in the commercial determinants of health.

IntroductionUnderstanding the international and domestic political factors influencing the evolution of type 2 diabetes policies and primary care institutions is a new area of scholarly research. This article contributes to this area of inquiry by illustrating how a government’s shifting foreign policy aspirations, that is, to establish the government’s reputation as an internationally recognised leader in type 2 diabetes policy, and presidential electoral incentives provide alternative insights into the evolution of type 2 diabetes treatment policies and primary care institutional reforms.MethodsI conduct a single-case study analysis with the usage of qualitative data; quantitative statistical data on epidemiological trends and government policy spending is also provided as supportive evidence.ResultsThe case of Brazil illustrates how a reduction in foreign policy commitment to international reputation building in health as well as presidential electoral incentives to use diabetes policy as an electoral strategy account for a decline in sustaining policy and primary care institutional innovations in response to type 2 diabetes.ConclusionFuture scholars interested in understanding the lack of sustainability and effectiveness in type 2 diabetes programmes should consider investigating the complex international and domestic political factors influencing political interests, incentives and commitment to reform.

In recent years, several emerging economies have introduced national health insurance programs ensuring access to health care while offering financial protection from out-of-pocket and catastrophic expenses. Nevertheless, in several nations these expenses continue to increase. While recent research has emphasized the lack of funding, poor policy design and corruption as the main culprits, little is known about the politics of establishing federal regulatory agencies ensuring that state governments adhere to national insurance reimbursement and coverage procedures. This article fills in this lacuna by providing an alternative perspective, one that accounts for differences between nations in the creation of regulatory institutions, with an emphasis instead on governing elite strategies to campaign on access to health care during transitions to democracy, civil societal mobilization, constitutional constraints and the national electoral incentives to overcome ineffective decentralization processes. The cases of Indonesia and China are introduced as examples of how and why their differences in this political process accounted for Indonesia’s success and China’s failure to ensure financial protection.

In response to Mexico’s burgeoning industrial epidemics of obesity and type-2 diabetes, triggered in part by sugar-sweetened carbonated beverages’ ability to readily market their products and influence consumption, the government has responded through a variety of non-communicable disease (NCD) policies. Nevertheless, major industries, such as Coca-Cola, have been able to continuously obstruct the prioritization of those policies targeting the consumption, marketing and sale of their products. To better understand why this has occurred, this article introduces a political science agenda-setting framework and applies it to the case of Coca-Cola in Mexico. Devised from political science theory and subsequently applied to the case of Coca-Cola in Mexico, my framework, titled Institutions, Interests, and Industry Civic Influence (IPIC), emphasizes Coca-Cola’s access to institutions, supportive presidents and industry efforts to hamper civic mobilization and pressures for greater regulation of the soda industry. Methodologically, I employ qualitative single case study analysis, combining an analysis of 26 case study documents and seven in-depth stake-holder interviews. My proposed analytical framework helps to underscore the fact that Coca-Cola’s influence is not solely shaped by the corporation’s increased economic importance, but more importantly, its access to politicians, institutions and strategies to divide civil society. Additionally, my proposed framework provides several real-world policy recommendations for how governments and civil society can restructure their relationship with the soda industry, such as the government’s creation of laws prohibiting the industry’s ability to influence NCD policy and fund scientific research.

The BRICS (Brazil, Russia, India, China and South Africa) have emerged as potentially robust economies with considerable international influence. Nevertheless, essentially all of these nations have fallen short of simultaneously developing strong economies and health care systems, contributing to the emergence of health care inequalities, such as inadequate access to medicine, health care treatment and out-of-pocket spending. This is puzzling considering that most of these nations’ economies burgeoned during the 1990s and early-2000s, thus potentially providing additional revenue for health care spending, while constitutional guarantees of universal access to health care and the presence of democratic electoral institutions in most nations should have incentivized governments to successfully address these inequality issues. Nevertheless, with the exception of South Africa, this study finds that waning political commitment to health care spending, increased foreign aid commitments and tenuous state-civil societal relationships accounted for these ongoing inequality challenges.

By early-2016, the international community began to pressure Brazil for a stronger policy response to Zika. In contrast to what was seen in the past, however, these international pressures did not elicit such a response. In this article, we explore why this was the case, reviewing the government’s policy response and the broader political and economic context shaping this response. The authors used single case study analysis and qualitative sources, such as books, journal articles, and government policy reports to support their empirical claims. We found that despite increased international pressures from the WHO, domestic political factors and economic recession hampered the government’s ability to strengthen its health systems response to Zika. Consequently, those states most afflicted by Zika have seen policy initiatives that lack sufficient funding, administrative and human resource capacity. This study revealed that despite a government’s deep foreign policy history of positively responding to international pressures through a stronger policy response to health epidemics, a sudden change in government, rising political instability, and economic recession can motivate governments to abandon this foreign policy tradition and undermine its response to new public health threats.

Background To date, few studies have assessed how Brazil’s universal healthcare system’s (SUS, Sistema Único de Saúde) systemic, infrastructural, and geographical challenges affect individuals’ abilities to access organ transplantation services and receive quality treatment. Discussion In this article we evaluated the existing literature to examine the impact that SUS has had on an increasingly important healthcare sector: organ transplantation services. We assess how equity challenges within the transplantation system can be explained by wider problems within SUS. Findings suggest stark disparities in access to transplantation services both within and across Brazil’s regions. We found that these regional differences are partially due to logistical challenges, especially in loosely populated areas but are also a consequence of disparities in resource allocations within SUS and under-capacitated health care facilities affecting transplantation services. Summary We suggest that Brazil needs to improve its health outcome measurement system for organ transplantations and epidemiological surveillance, to gain more comprehensive and comparable data. Finally, we recommend policy strategies to reduce barriers to access to transplantation services by increasing transplantation service coverage in some areas and investing in emerging technologies.

The BRIC nations (Brazil, Russia, India, and China) have differed in their government response to health epidemics. It is argued that Brazil eventually outpaced her emerging counterparts in response to AIDS (Acquired Immune Deficiency Syndrome) due to the presence of political institutional, civil societal, and foreign policy strategies that both sustained and encouraged the introduction of innovative policies. The concept of historical policy backlash is introduced in order to explain how the BRIC’ differences in their historic roles as foreign aid donors in health shaped their incentive to either focus on domestic AIDS policy or foreign aid strategies at the expense of domestic policy. This article therefore represents the first attempt to combine comparative political–historical, social, and international processes to account for differences in the BRIC nations willingness and capacity to respond to AIDS.

In recent years, several emerging nations with burgeoning economies and in transition to democracy have pursued health policy innovations. As these nations have integrated into the world economy through bilateral trade and diplomacy, they have also become increasingly exposed to international pressures and norms and focused on more effective, equitable health care systems. There are several lessons learned from the case studies of Brazil, Ghana, India, China, Vietnam, and Thailand in this special issue on the global and domestic politics of health policy in emerging nations. For the countries examined, although sensitive to international preferences, domestic governments preferred to implement policy on their own and at their own pace. During the policy-making and implementation process, international and domestic actors played different roles in health policy making vis-à-vis other reform actors — at times the state played an intermediary role. In several countries, civil society also played a central role in designing and implementing policy at all levels of government. International institutions also have a number of mechanisms and strategies in their tool box to influence a country's domestic health governance, and they use them, particularly in the context of an uncertain state or internal discordance within the state.

Why do governments pursue obesity legislation? And is the case of Brazil unique compared with other nations when considering the politics of policy reform? Using a nested analytic approach to comparative research, I found that theoretical frameworks accounting for why nations implement obesity legislation were not supported with cross-national statistical evidence. I then turned to the case of Brazil's response to obesity at three levels of government, national, urban, and rural, to propose alternative hypotheses for why nations pursue obesity policy. The case of Brazil suggests that the reasons that governments respond are different at these three levels. International forces, historical institutions, and social health movements were factors that prompted national government responses. At the urban and rural government levels, receiving federal financial assistance and human resource support appeared to be more important. The case of Brazil suggests that the international and domestic politics of responding to obesity are highly complex and that national and subnational political actors have different perceptions and interests when pursuing obesity legislation.

Amidst the growing literature on global health, much has been written recently about the Brazil, Russia, India, China, South Africa (BRICS) countries and their involvement and potential impact in global health, particularly in relation to development assistance. Rather less has been said about countries' motivations for involvement in global health negotiations, and there is a notable absence of evidence when their motivations are speculated on. This article uses an existing framework linking engagement in global health to foreign policy to explore differing levels of engagement by BRICS countries in the global health arena, with a particular focus on access to medicines. It concludes that countries' differing and complex motivations reinforce the need for realistic, pragmatic approaches to global health debates and their analysis. It also underlines that these analyses should be informed by analysis from other areas of foreign policy.

This article argues that Brazil’s success in responding to the AIDS epidemic rested in the government’s pursuit of a reversal of decentralization, which entailed the government’s delegation of policy-making autonomy, funding, and discretionary fiscal transfers to the national AIDS program. AIDS bureaucrats achieved this by establishing close partnerships with social health movements and AIDS nongovernmental organizations advocating policy ideas with a historically proven track record of success while resembling similar social health movements in the past. This partnership, in turn, provided AIDS bureaucrats with the legitimacy and influenced needed for policy reform.

During the 1990s, Brazil and Russia diverged in their policy response to AIDS. This is puzzling considering that both nations were globally integrated emerging economies transitioning to democracy. This article examines to what extent international pressures and partnerships with multilateral donors motivated these governments to increase and sustain federal spending and policy reforms. Contrary to this literature, the cases of Brazil and Russia suggest that these external factors were not important in achieving these outcomes. Furthermore, it is argued that Brazil's policy response was eventually stronger than Russia's and that it had more to do with domestic political and social factors: specifically, AIDS officials’ efforts to cultivate a strong partnership with NGOs, the absence of officials’ moral discriminatory outlook towards the AIDS community, and the government's interest in using policy reform as a means to bolster its international reputation in health.

This article analyses changes and continuities in Brazilian international actions in the field of public health, aiming at understanding how the Brazilian foreign policy in health during President Dilma Rousseff's first term (2011-2014) was developed. Available data from President Luiz Inácio Lula da Silva (2003-2010) years and Dilma's first term were used for comparative purposes. Emphasis was given on South-South cooperation projects, more specifically the Union of South American Countries (USAN, Unión de Naciones Suramericanas - Unasur) and to the Community of Portuguese-speaking Countries (CPLP). Brazilian behavior in international fora, such as the World Health Organization, was analyzed as well, with the purpose of understanding how such behavior evolved. In addition, domestic issues were considered. In this case, the coordination among different actors of the Brazilian Executive Power received due attention. Findings suggest that there has been downfall and even decline in the Government's foreign health policy. Resumo Este artigo analisa mudanças e continuidades nas ações internacionais do Brasil no campo da saúde pública, buscando compreender o desenvolvimento da política externa brasileira em saúde durante o primeiro mandato da Presidente Dilma Rousseff (2011-2014). Dados relativos à presidência de Luiz Inácio Lula da Silva (2003-2010) e do primeiro mandato de Dilma foram usados para fins de comparação. Projetos da Cooperação Sul-Sul receberam ênfase, mais especificamente os da União das Nações Sul-Americanas (Unasul, Unión de Naciones Suramericanas - Unasur) e da Comunidade dos Países de Língua Portuguesa (CPLP). O comportamento do Brasil em órgãos internacionais, como a Organização Mundial de Saúde (OMS), também foi analisado, com o propósito de compreender como tal comportamento evoluiu. Além disso, foram considerados os problemas internos. Neste caso, a coordenação entre diferentes atores do Poder Executivo brasileiro recebeu a devida atenção. Os resultados sugerem que houve uma retração ou até mesmo um declínio da política externa em saúde do país.

Contrary to the once-popular notion of the central bureaucracy withering away as an outcome of decentralization, scholars have shown that in cases of local policy success, national bureaucrats have instead redefined their roles, strengthening their focus on monitoring and accountability. Yet building national capacity for effective oversight presents a challenge within a context of strong subnational autonomy such as Brazil. Comparing the dynamics of decentralization across two areas of health policy, AIDS and tuberculosis, this article presents one strategy utilized by federal bureaucrats to increase their regulatory capacity: seeking resources located outside the formal political arena. Specifically, national bureaucrats utilize international resources to mobilize local civic groups as policy watchdogs, thus increasing the accountability of subnational politicians both to the center and to the public. Copyright 2012, Oxford University Press.

Objectives This article introduces the benefits of applying social science theories discussing institutional stasis and change to better measure, explain, and compare elite behavior within health administration and decentralization processes. A new comparative method based on these theories is introduced, as well as methods for collecting and analyzing data. Methods A literature review of health governance, health system governance, and path dependency and institutional change theory was conducted to reveal the limitations of health governance approaches explaining elite behavior. Next, path dependency and institutional change theory was applied to case studies in order to demonstrate their utility in explaining institutional stasis and change. Results Current approaches to analyzing and comparing elite behavior in the health governance frameworks are limited in their ability to accurately explain the willingness of elites to pursue more efficient institutional and policy designs. Current indicators measuring elite behavior are also too static, failing to account for periodic resistance to change and the conditions for it. Conclusions By applying path dependency and institutional change theory, the policy community can obtain greater insight into the willingness and thus capacity of institutions to pursue innovations while developing alternative analytic frameworks and databases that better measure and predict this process.

Using a temporal approach dividing the reform process into two periods, this article explains how both Brazil and the United States were slow to respond to AIDS. However, Brazil eventually outpaced the United States in its response due to international rather than democratic pressures. Since the early 1990s, Brazil's success has been attributed to “strategic internationalization”: the concomitant acceptance and rejection of global pressure for institutional change and antiretroviral treatment, respectively. The formation of tripartite partnerships among donors, AIDS officials, and nongovernmental organizations has allowed Brazil to avoid foreign aid dependency, while generating ongoing incentives for influential AIDS officials to incessantly pressure Congress for additional funding. Given the heightened international media attention, concern about Brazil's reputation has contributed to a high level of political commitment. By contrast, the United States' more isolationist relationship with the international community, its focus on leading the global financing of AIDS efforts, and the absence of tripartite partnerships have prevented political leaders from adequately responding to the ongoing urban AIDS crisis. Thus, Brazil shows that strategically working with the international health community for domestic rather than international influence is vital for a sustained and effective response to AIDS.