United Nations bodies call for legal responses to restrict children’s exposure to unhealthy food marketing; however, few governments have introduced legislative controls. This research studies the underlying political economy influences that impacted the introduction of legal responses. We used a multiple case study methodology to examine the political economy influences on the policy process in three contexts (Chile, Canada and the UK). Data from documentary evidence and 21 semi-structured key informant interviews were analysed using a political economy framework studying the institutions, interests, ideas and the associated power dynamics that shaped the policy process. The prevailing neoliberal ideologies and overarching institutional paradigm, in which all actors were operating, meant any form of government intervention had to be justified, evidence-based and no more intrusive on commercial enterprise and public life than necessary. The neoliberal paradigm permeated each of the political economy elements (institutions, ideas and interests). In addition, its influence was observed in all stages of the policy process, from introduction through to adoption of the resulting law or regulation, and experienced in both the executive and legislative branches of government. A paradigm shift away from the protection and primacy of commercial enterprise and limited government interference would reduce the barriers governments face when introducing legislative responses to unhealthy food marketing. These dynamics may be tempered if institutional, actor and discursive power is harnessed in support of the legitimate public health measure, which would involve a strong mandate for the ministry responsible and a dedicated and influential policy entrepreneur. - Provides an insight into how three different governments legislated unhealthy food marketing. - Provides lessons for other governments about what challenges those countries faced and how they overcame them. - Considers the political reality behind policy making that impacts on how evidence-based policy making occurs.

OBJECTIVE:Governments are seeking to regulate food environments to promote health by restricting sales and marketing of processed foods high in fat, sugar and sodium. We aimed to evaluate whether the legal instruments in member states of the Western Pacific Region (WPR) mandate the declaration of nutrient composition for nutrients of concern in relation to Codex Alimentarius and non-communicable disease (NCD) prevention. DESIGN:We undertook content analysis of legal instruments governing food quality and safety, documenting mandates for nutrient declarations in the WPR. Legal instruments were purposefully sourced through a systematic search of regional legal databases and Google. We performed qualitative and quantitative analysis, using an adapted version of Reeve and Magnusson's Framework for Analysing and Improving the Performance of Regulatory Instruments. SETTING:Legal instruments governing food quality and safety in twenty-eight member states of the WPR. RESULTS:There was substantial variation in the nutrient declaration mandates within legal instruments, with only three out of twenty-eight countries mandating nutrient declarations in full alignment with Codex recommendations (energy, protein, available carbohydrate, fat, saturated fat, sodium and total sugars). Just four countries mandated the display of sodium, sugar, saturated fat and trans-fats, in line with NCD prevention recommendations. Sodium labelling was mandated in ten countries, sugar in seven and saturated fat in six. CONCLUSIONS:There is scope for countries to strengthen legal instruments for nutrient declarations to better support diet-related NCD prevention efforts. Regional support agencies can play a key role in promoting greater policy coherence and alignment with international best practice.

BackgroundSexual and gender minority people have been found to drink more heavily than heterosexual and cisgender populations. Alcohol companies target rainbow communities by promoting alcoholic products through various promotional strategies. The current study examined the discourses that alcohol companies employed in their publicly available material when discussing LGBTQ+ people and rainbow communities.MethodsEight online websites containing alcohol and marketing content were identified. Across these websites, 4,353 alcohol-related documents were published from 2017-2023. We searched within these documents for texts that were freely available and included terms related to LGBTQ+ populations, leading to 53 texts that were downloaded and analysed using discourse analysis.ResultsAlcohol companies used three primary discourses when outlining their engagement with LGBTQ+ communities, namely 'exceptional support and pioneering philanthropy', 'genuine allyship' and 'shared values'. These discourses functioned to enable companies to overcome seemingly contradictory constructions of being authentic and genuine allies, while also being profitable businesses that are building their market share and profits.ConclusionsThe alcohol industry deflects accusations of rainbow-washing through discursive constructions that highlight their genuine and committed dedication to rainbow communities. These normalise alcohol within these communities, and function to enhance and promote alcohol brands while obscuring their negative consequences.

Food and nonalcoholic beverage marketing is implicated in poor diet and obesity in children. The rapid growth and proliferation of digital marketing has resulted in dramatic changes to advertising practices and children's exposure. The constantly evolving and data-driven nature of digital food marketing presents substantial challenges for researchers seeking to quantify the impact on children and for policymakers tasked with designing and implementing restrictive policies. We outline the latest evidence on children's experience of the contemporary digital food marketing ecosystem, conceptual frameworks guiding digital food marketing research, the impact of digital food marketing on dietary outcomes, and the methods used to determine impact, and we consider the key research and policy challenges and priorities for the field. Recent methodological and policy developments represent opportunities to apply novel and innovative solutions to address this complex issue, which could drive meaningful improvements in children's dietary health.

Although the creators of the world wide web never intended it to be regulated by state intervention, the rapid evolution of the online environment has necessitated regulation of certain aspects of the digital ecosystem. Harmful commodity marketing (e.g., alcohol, vaping and unhealthy food and beverage product marketing) on social media and in digital spaces has been linked to adverse health outcomes and there have been calls for its regulation. In this commentary we explain why this is important and consider how such regulation could be achieved.

Despite assurances of government action, the burden of non-communicable diseases (NCDs) and overweight and obesity is continuing to grow at an alarming rate both globally and in Europe. The NOURISHING and MOVING policy frameworks outline a comprehensive set of policy actions across 6 domains and 16 policy areas in which national governments should take action to promote healthy diets and physical activity. Monitoring and benchmarking these policies is important for assessing progress on obesity and NCD prevention. This paper describes the participatory process for developing benchmarking tools structured around the policy areas of the NOURISHING and MOVING policy frameworks. They consist of a set of indicators and policy attributes that assess government support in promoting healthy nutrition and physical activity. They are adolescent relevant as they capture policy actions that target or impact adolescents. The benchmarking tools are designed to monitor progress on national government action on nutrition and physical activity based on aspirational standards. They will be applied in 27 European countries initially and are aimed at policymakers, researchers, and civil society, to track progress, develop the research infrastructure on effectiveness of NCD prevention policies at population level, and support advocacy efforts.

Drawing on current global food marketing policies and the academic literature, we illustrate why and how existing legislative approaches can be strengthened to better achieve the goal of protecting children from the harmful impacts of unhealthy food and non-alcoholic beverage marketing. Around the world, governments are starting to implement legislative actions to protect children from exposure to unhealthy food and non-alcoholic beverage marketing. However, the scope of these approaches is limited and unlikely to meet their objective of safeguarding children from harmful marketing practices. The key opportunities for strengthening legislative design include increasing the age threshold of a child to 18 years; the broadening of focus from ‘child-directed’ marketing to all marketing that children are exposed to; designing tailored regulations for multiple settings, media and techniques; strengthening underlying food classification systems; balancing a comprehensive approach with stepwise regulatory implementation; and strengthening monitoring and enforcement systems. Our review and recommendations can aid policymakers when designing legislative approaches to protect children from the harmful impacts of unhealthy food and non-alcoholic beverage marketing.

Background The insidious and pervasive nature of marketing of unhealthy food and beverages has been identified as one of several strategies the unhealthy food and beverage industry uses to exert their influence on population food choices and diet. Regulating the food and beverage industry's marketing practices is one mechanism to mitigate this commercial determinant of health. This paper seeks to understand the main barriers and enablers that governments face when attempting to design an appropriate regulatory system. Methods 14 semi-structured expert interviews were undertaken with participants across different jurisdictions (Ireland, United Kingdom, Chile, Canada, Norway, Portugal and Brazil) who were involved in introducing marketing restrictions; and a purposive documentary analysis was carried out. A thematic analysis of this data was conducted informed by the Health Policy Triangle. Results Multiple common technical and political issues were experienced by governments regarding the form and substance of the policy design regardless of the jurisdictional context. Such issues included: whether to introduce a mandatory approach; what age group to protect; what nutrient classification system to use; how to define “marketing to children”; and what mediums, settings and techniques to cover. The actors opposing regulation challenged the form and substance of each design element. However, having a strong political mandate to introduce regulation; multiple actors working together, including multiple government ministries, academics and civil society actors; and a strong evidence base supporting the policy design helped policymakers navigate the technical and political challenges faced when designing the regulatory approach. Conclusion Despite the different political contexts and actors involved in different jurisdictions internationally, there are many commonalities in the challenges and enabling factors faced by governments. Understanding the technical and political challenges experienced by governments and how these governments overcame those challenges is critical to improve capacity around designing more effective regulations to improve population's diets, and therefore NCDs.

Introduction United Nations (UN) agencies are influential global health actors that can introduce legal instruments to call on Member States to act on pressing issues. This paper examines the deployment and strength of global health law instruments used by UN actors to call on Member States to restrict the exposure of children to unhealthy food and beverage marketing. Methods Global health law instruments were identified from a review of four UN agencies that have a mandate over children’s exposure to marketing of unhealthy food and beverage products namely: the World Health Organization (WHO); the Food and Agriculture Organization (FAO); the United Nations General Assembly (UNGA) and the UN Office of the High Commissioner for Human Rights (OHCHR). Data on marketing restrictions were extracted and coded and descriptive qualitative content analysis was used to assess the strength of the instruments. Results A wide range of instruments have been used by the four agencies: seven by the WHO; two by the FAO; three by the UNGA; and eight by the UN human rights infrastructure. The UN human rights instruments used strong, consistent language and called for government regulations to be enacted in a directive manner. In contrast, the language calling for action by the WHO, FAO and UNGA was weaker, inconsistent, did not get stronger over time and varied according to the type of instrument used. Conclusion This study suggests that a child rights-based approach to restricting unhealthy food and beverage marketing to children would be supported by strong human rights legal instruments and would allow for more directive recommendations to Member States than is currently provided by WHO, FAO and UNGA. Strengthening the directives in the instruments to clarify Member States’ obligations using both WHO and child rights mandates would increase the utility of global health law and UN actors’ influence.

Background Children’s exposure to unhealthy food and beverage marketing has a direct impact on their dietary preference for, and consumption of, unhealthy food and drinks. Most children spend time online, yet marketing restrictions for this medium have had slow uptake globally. A voluntary Children’s and Young People’s Advertising (CYPA) Code was implemented in Aotearoa, New Zealand (NZ) in 2017. This study explores the Code’s limitations in protecting children from harmful food and beverage marketing practices on digital platforms accessible to children. Methods A cross-sectional content analysis of company websites ( n = 64), Facebook pages ( n = 32), and YouTube channels ( n = 15) of the most popular food and beverage brands was conducted between 2019 and 2021 in NZ. Brands were selected based on market share, web traffic analysis and consumer engagement (Facebook page ‘Likes’ and YouTube page views). Analysis focused on volume and type of food posts/videos, level of consumer interaction, nutritional quality of foods pictured (based on two different nutrient profile models), and use of specific persuasive marketing techniques. Results Eighty-one percent of websites ( n = 52) featured marketing of unhealthy food and beverages. Thirty-five percent of websites featuring unhealthy food and beverages used promotional strategies positioning their products as ‘for kids’; a further 13% used ‘family-oriented’ messaging. Several websites featuring unhealthy products also had designated sections for children, ‘advergaming,’ or direct messaging to children. Eighty-five percent of all food and drink company Facebook posts and YouTube videos were classified as unhealthy. Twenty-eight percent of Facebook posts for unhealthy products featured persuasive promotional strategies, and 39% premium offers. Nearly 30% of YouTube videos for unhealthy food and beverages featured promotional strategies, and 13% premium offers. Ten percent of Facebook posts and 13% of YouTube videos of unhealthy food and beverages used marketing techniques specifically targeting children and young people. Conclusions The voluntary CYPA Code has been in effect since 2017, but the inherent limitations and loopholes in the Code mean companies continue to market unhealthy food and beverages in ways that appeal to children even if they have committed to the Code. Comprehensive and mandatory regulation would help protect children from exposure to harmful marketing.

Abstract Background The World Cancer Research Fund International's (WCRF International) analysis of global research shows a strong link between diet, physical activity, and risk of cancer. To address this, WCRF International has developed a package of policy resources to promote healthy diets and physical activity to support reporting, categorising and monitoring of policy actions. The MOVING policy framework was developed as a complement to the well-established NOURISHING framework of diet-related policies-outlining a comprehensive set of areas in which governments should take action to promote physical activity. The new framework forms the basis for the MOVING database of implemented policy actions. Methods For the MOVING framework, literature reviews were undertaken, and the results were distilled into policy categories on which academics and policy experts provided feedback. The framework is the basis for a specific inclusion criteria and search strategy to determine how policy actions will be collected, reviewed and categorised for the MOVING database. A comprehensive scanning methodology was designed to identify all relevant policies across the MOVING policy areas. Relevant policies are then verified with in-country experts and uploaded to the database. This methodology was tested, refined and will be applied to 27 European countries. Results The MOVING policy framework comprises six policy areas within four policy domains and details the areas where governments should take action to promote physical activity. The framework forms the structure for a new database of global physical activity policies, which was launched in the summer of 2020. The MOVING database currently includes 234 policy actions from 12 countries. The MOVING database is a logical and practical tool, allowing users to search for policy actions categorised in the structure of the MOVING framework. Conclusion The MOVING physical activity framework and database are innovative tools that support reporting, categorising and monitoring of physical activity policy actions that will work alongside the NOURISHING framework and database. These physical activity policy tools allow stakeholders such as researchers, civil society organizations and policy makers to quickly identify both gaps and strengths in government action and therefore assess where there is scope for improvement within and across countries.

Purpose of Review A key driver of unhealthy diets in children is the marketing of unhealthy foods and beverages. Attempts to regulate children's exposure to unhealthy food marketing through government-led policies are challenged by commercial interests. Parents shoulder the responsibility of counteracting the effects of omnipresent unhealthy food marketing that children are exposed to within the food environment. In this narrative review we aimed to synthesise the evidence over the last 10 years on parents' perceptions of children's exposure to unhealthy food marketing and parents support for policies to restrict this marketing. Recent Findings The evidence indicates that unhealthy food marketing leads parents to feel undermined in their ability to provide healthy foods to their children. Despite this concern, parents tend to underestimate the levels of exposure to, and impacts of, unhealthy food marketing to their children, especially in the digital ecosystem. Summary The voices and support of parents represent a significant opportunity to accelerate policy action on food marketing. Increasing awareness among parents and caregivers to the high levels and harmful impacts of children's exposure to unhealthy food marketing, focusing on their right not to be undermined by such action, may drive support for policy change. Further research is needed to understand parents' attitudes and perceptions related to their children's exposure to contemporary unhealthy food marketing, specifically in digital environments, and the perspectives of fathers and parents from low and middle-income countries.

Background: Considering the large health burden of physical inactivity, effective physical activity promotion is a “best buy” for noncommunicable disease and obesity prevention. The MOVING policy framework was developed to promote and monitor government policy actions to increase physical activity as part of the EU Horizon 2020 project “Confronting Obesity: Co-creating policy with youth (CO-CREATE).” Method: A scanning exercise, documentary review of key international policy documents, and thematic analysis of main recommendations were conducted. Themes were reviewed as part of a consultation with physical activity experts. Results: There were 6 overarching policy framework areas: M—make opportunities and initiatives that promote physical activity in schools, the community, and sport and recreation; O—offer physical activity opportunities in the workplace and training in physical activity promotion across multiple professions; V—visualize and enact structures and surroundings that promote physical activity; I—implement transport infrastructure and opportunities that support active societies; N—normalize and increase physical activity through public communication that motivates and builds behavior change skills; and G—give physical activity training, assessment, and counseling in health care settings. Conclusions: The MOVING framework can identify policy actions needed, tailor options suitable for populations, and assess whether approaches are sufficiently comprehensive.

Background The INFORMAS [International Network for Food and Obesity/Non-communicable Diseases (NCDs) Research, Monitoring and Action Support] Healthy Food Environment Policy Index (Food-EPI) was developed to evaluate the degree of implementation of widely recommended food environment policies by national governments against international best practice, and has been applied in New Zealand in 2014, 2017 and 2020. This paper outlines the 2020 Food-EPI process and compares policy implementation and recommendations with the 2014 and 2017 Food-EPI. Methods In March-April 2020, a national panel of over 50 public health experts participated in Food-EPI. Experts rated the extent of implementation of 47 "good practice" policy and infrastructure support indicators compared to international best practice, using an extensive evidence document verified by government officials. Experts then proposed and prioritized concrete actions needed to address the critical implementation gaps identified. Progress on policy implementation and recommendations made over the three Food-EPIs was compared. Results In 2020, 60% of the indicators were rated as having "low" or "very little, if any" implementation compared to international benchmarks: less progress than 2017 (47%) and similar to 2014 (61%). Of the nine priority actions proposed in 2014, there was only noticeable action on one (Health Star Ratings). The majority of actions were therefore proposed again in 2017 and 2020. In 2020 the proposed actions were broader, reflecting the need for multisectoral action to improve the food environment, and the need for a mandatory approach in all policy areas. Conclusions There has been little to no progress in the past three terms of government (9 years) on the implementation of policies and infrastructure support for healthy food environments, with implementation overall regressing between 2017 and 2020. The proposed actions in 2020 have reflected a growing movement to locate nutrition within the wider context of planetary health and with recognition of the social determinants of health and nutrition, resulting in recommendations that will require the involvement of many government entities to overcome the existing policy inertia. The increase in food insecurity due to COVID-19 lockdowns may provide the impetus to stimulate action on food polices.

Food policies can make healthier foods more accessible for the population. In this study, progress on implementing recent policies and commitments of the government and food companies was monitored. Sub-studies were conducted following INFORMAS (International Network for Obesity/non-communicable diseases, Research, Monitoring and Action Support) protocols: benchmarking government implementation of healthy food policies; the impact of a voluntary advertising code on the exposure of children to unhealthy food marketing; the impact of healthy food and drink policies on retailers in district health boards and on the beverage environments in leisure centres; supermarket retail environments; food composition and display of the ‘Health Star Rating’; and commitments of food companies to nutrition. The level of implementation of food policy by the New Zealand government has not improved over nine years. The voluntary Children and Young People’s Advertising Code is too weak to have an impact on the exposure of children to unhealthy food marketing. Improvements to the beverage environment in leisure centres occurred where sufficient support was available, and all District Health Boards adopted a healthy food policy. There is considerable variation in the actions of the major food companies: in 2019 the Health Star Rating was displayed on 94% of private label products but only 25% of packaged foods overall; one-third of supermarkets did not have a check-out free of junk food, and two-thirds of the major food companies improved on their nutrition commitments since 2017. New Zealand’s food environments are largely unhealthy and policy implementation is low. Where policies, codes and commitments by government and food industry do exist, the progress on implementing these is patchy and there are many remaining gaps. There is considerable scope for the government, food companies, and local setting to make major changes towards a healthier, more equitable food environment with food policy in the form of mandatory regulations required to ensure real progress.

Adequate levels of physical activity are important for population health. Policy databases can track, monitor, and compare the development and implementation of physical activity policy actions and are populated by different methods. The new MOVING database, developed through the Confronting Obesity: Co-creating Policy with Youth (CO-CREATE) project, collates governmental policy actions designed to increase physical activity and is populated by an in-depth scan of implemented national policy actions. This paper presents lessons learned from conducting the policy scan across 27 European countries. Policy actions were identified using a structured search protocol from preselected sources, assessed against pre-specified inclusion criteria and verified by an in-country expert. 625 eligible national implemented policy actions were identified. Challenges included policy actions falling out of scope, a lack of available information on policy actions, difficulty in identifying policy actions using specific search terms, and increased resource requirements for translation of policy actions into English. The scan indicated improvements, which informed protocol modifications. Identifying the challenges and opportunities around conducting a policy scan is necessary to understand and assess the reliability, validity, and utility of a policy database. The policy scan will help to deliver a comprehensive picture of physical activity policy actions across Europe.

Introduction Introducing legislation that restricts companies from exposing children to marketing of unhealthy food and beverage products is both politically and technically difficult. To advance the literature on the technical design of food marketing legislation, and to support governments around the world with legislative development, we aimed to describe the legislative approach from three governments. Methods A multiple case study methodology was adopted to describe how three governments approached designing comprehensive food marketing legislation (Chile, Canada and the United Kingdom). A conceptual framework outlining best practice design principles guided our methodological approach to examine how each country designed the technical aspects of their regulatory response, including the regulatory form adopted, the substantive content of the laws, and the implementation and governance mechanisms used. Data from documentary evidence and 15 semi-structured key informant interviews were collected and synthesised using a directed content analysis. Results All three countries varied in their legislative design and were therefore considered of variable strength regarding the legislative elements used to protect children from unhealthy food marketing. When compared against the conceptual framework, some elements of best practice design were present, particularly relating to the governance of legislative design and implementation, but the scope of each law (or proposed laws) had limitations. These included: the exclusion of brand marketing; not protecting children up to age 18; focusing solely on child-directed marketing instead of all marketing that children are likely to be exposed to; and not allocating sufficient resources to effectively monitor and enforce the laws. The United Kingdom’s approach to legislation is the most comprehensive and more likely to meet its regulatory objectives. Conclusions Our synthesis and analysis of the technical elements of food marketing laws can support governments around the world as they develop their own food marketing restrictions. An analysis of the three approaches illustrates an evolution in the design of food marketing laws over time, as well as the design strengths offered by a legislative approach. Opportunities remain for strengthening legislative responses to protect children from unhealthy food marketing practices.

Background: Concerns have been raised that health and societal causes surrounding the COVID-19 pandemic were misappropriated by companies to promote their unhealthy products to vulnerable populations during a time of increased stress and hardship (i.e., COVID-washing). Social media is a common medium for unhealthy foods and beverage marketing due to lack of regulation and low levels of monitoring. Purpose: This study aimed to investigate the timing, nature and extent of COVID-washing on public social media accounts by New Zealand's major food and drink brands in the initial stage of the pandemic after the first case was detected in New Zealand and when stay-at-home lockdown restrictions (Level 4 and 3 Alert levels) were in place. Methods: A content analysis of social media posts from February to May 2020 by the twenty largest confectionery, snacks, non-alcoholic beverages, and quick-service restaurant (fast-food) brands was undertaken. COVID-19 related posts were identified and classified to investigate the timing, themes and engagement with social media marketing campaigns, flagging those that may breach New Zealand's Advertising Standards. Results: 14 of 20 unhealthy food and drink brands referenced COVID-19 in posts during the 4-month period, peaking during nationwide lockdown restrictions. Over a quarter of all posts by the 14 brands (n = 372, 27.2%) were COVID-19 themed. Fast-food brands were most likely to use COVID-19 themed posts (n = 251/550 posts, 46%). Fast-food brands also had the highest number of posts overall during the pandemic and the highest engagement. The most commonly-used theme, present in 36% of all social media posts referring to COVID-19, was to draw on feelings of community support during this challenging time. Suggesting brand-related isolation activities was also common (23%), and the message that “consumption helps with coping” (22%). Six posts were found to potentially breach one of New Zealand's advertising standards codes by promoting excessive consumption or targeting children. Conclusion: COVID-washing was used by unhealthy food and drinks brands to increase brand loyalty and encourage consumption. The current Advertising Standards system is ineffective and must be replaced with a government-led approach to effectively regulate social media advertising to protect all New Zealanders, particularly in times of crisis.

New Zealand has the second highest overweight and obese child population in the Organisation for Economic Co-operation and Development (OECD). This paper evaluates whether New Zealand’s self-regulatory controls on the advertising of unhealthy food and beverages to children and young people adequately protects children from the exposure to, and power of, such marketing in order to limit its impact on children’s food and beverage preferences. First, an analysis of the relevant New Zealand Advertising Standards Authority (ASA) Codes was conducted, including the ASA Complaints Board and Appeals Board decisions from 2017–2019 to determine the application of the Codes in practice. Second, a public health law framework was applied to the self-regulatory system. Of the 16 complaints assessed, 12 were not upheld, and only one was upheld under the Children and Young People’s Advertising Code (CYPA Code). Three complaints were upheld under the Advertising Standards Code (ASC) but not the CYPA Code. An analysis of the Codes and their interpretation by the Complaints Board found that many facets of the public health law framework were not met. The self-regulatory system does not adequately protect children from the exposure to, and power of, unhealthy food and beverage marketing, and government-led, comprehensive, and enforceable marketing restrictions are required.