A framework of NGO inside and outside strategies in the commercial determinants of health: findings from a narrative review

Our plain-English summary of A framework of NGO inside and outside strategies in the commercial determinants of health: findings from a narrative review, by B. Townsend, T.D. Johnson, R. Ralston, et al (Globalization and Health, 2023).

The study

• Authors: B. Townsend, T.D. Johnson, R. Ralston, K. Cullerton, J. Martin, J. Collin, F. Baum, L. Arnanz, R. Holmes, S. Friel
• Journal: Globalization and Health
• Published: 2023;19(1):74
• Type of article: Review
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Public health scholarship has uncovered a wide range of strategies used by industry actors to promote their products and influence government regulation. Less is known about the strategies used by non-government organisations to attempt to influence commercial practices. This narrative review applies a political science typology to identify a suite of 'inside' and 'outside' strategies used by NGOs to attempt to influence the commercial determinants of health.

Methods: We conducted a systematic search in Web of Science, ProQuest and Scopus. Articles were eligible for inclusion if they comprised an empirical study, explicitly sought to examine 'NGOs', were in English, and identified at least one NGO strategy aimed at commercial and/or government policy and practice.

Results: One hundred forty-four studies met the inclusion criteria. Eight industry sectors were identified: extractive, tobacco, food, alcohol, pharmaceuticals, weapons, textiles and asbestos, and a small number of general studies. We identified 18 types of NGO strategies, categorised according to the target (i.e. commercial actor or government actor) and type of interaction with the target (i.e. inside or outside). Of these, five NGO 'inside' strategies targeted commercial actors directly: 1) participation in partnerships and multistakeholder initiatives; 2) private meetings and roundtables; 3) engaging with company AGMs and shareholders; 4) collaborations other than partnerships; and 5) litigation. 'Outside' strategies targeting commercial actors through the mobilisation of public opinion included 1) monitoring and reporting; 2) protests at industry sites; 3) boycotts; 4) directly engaging the public; and 5) creative use of alternative spaces. Four NGO 'inside' strategies directly targeting government actors included: 1) lobbying; 2) drafting legislation, policies and standards; 3) providing technical support and training; and 4) litigation. NGO 'outside' strategies targeting government included 1) protests and public campaigns; 2) monitoring and reporting; 3) forum shifting; and 4) proposing and initiating alternative solutions. We identified three types of NGO impact: substantive, procedural, and normative.

Conclusion: The analysis presents a matrix of NGO strategies used to target commercial and government actors across a range of industry sectors. This framework can be used to guide examination of which NGO strategies are effective and appropriate, and which conditions enable NGO influence.

© 2023. BioMed Central Ltd., part of Springer Nature.

In plain English

This was a narrative review, not a study of asbestos exposure or disease. The authors searched three research databases (Web of Science, ProQuest and Scopus) in March 2022 for peer-reviewed empirical studies on how non-government organisations (NGOs) try to influence companies and governments on commercial practices that affect health. They included 144 studies. Half concerned the extractive sector, followed by tobacco (22%) and food (17%). The other sectors covered were alcohol, pharmaceuticals, weapons, textiles and asbestos, and one country-level study concerned asbestos in China. The authors sorted NGO activity into 18 strategies. Each was grouped by whether the NGO targeted a company or a government, and by whether it dealt with the target directly ('inside', such as lobbying or litigation) or worked through public pressure ('outside', such as protests or boycotts). Most included studies did not report the impact of particular strategies. Among the review's examples of substantive impact, NGOs successfully lobbied Hong Kong to include mesothelioma as a disease for compensation. The authors stated that their review could not show which strategies cause impact.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of peer-reviewed literature, using a systematic database search, screening against inclusion criteria, and thematic synthesis
• Who was studied: 144 peer-reviewed, English-language empirical studies of NGO strategies, published from 1 January 1980 onward and found in Web of Science, ProQuest and Scopus in a search run on 9 March 2022
• Exposure: No asbestos exposure was studied. The review examined NGO strategies across industry sectors, and asbestos was one of the eight sectors covered by the included studies.
• Main results:
  • Of the 144 included studies, 135 were qualitative, 2 were quantitative and 7 used mixed methods
  • Half of the included studies concerned the extractive sector, followed by tobacco (22%), food (17%) and general, meaning a range of sectors (9%)
  • One included country-level study concerned asbestos in China
  • The authors identified 18 NGO strategies, classified as 'inside' or 'outside' and as targeting government or commercial actors
  • 25 of the included studies (17%) attributed a substantive impact to NGOs, meaning a significant influence on commercial practices or government policy and regulation
  • Among the review's examples of substantive impact, NGOs successfully lobbied Hong Kong to change policy so that mesothelioma was included as a disease for compensation
• The authors' conclusion: The authors concluded that their analysis presents a matrix of NGO strategies aimed at commercial and government actors across industry sectors. They said it offers a suite of strategies for investigating why, how and under what conditions particular strategies are effective or appropriate.
• Limitations the authors state:
  • The structured search may have missed articles that did not use the selected key terms
  • The review relied on study authors identifying NGOs as their focus, so it may have missed papers that used other terms such as 'advocates'
  • Most included studies did not identify the type of NGO, so the strategies could not be broken down by NGO type
  • The authors could not assess the impact of particular NGO strategies, and this type of study did not allow causal identification of which strategies lead to impact

Related studies

• Public health advocacy strategies to influence policy agendas: lessons from a narrative review of success in trade policy — B. Townsend, B.F. Tenni, et al. (2023)
• Examination of the health effects of asbestos and methods of mitigating such impacts: testimony at a U.S. Senate hearing — L. Reinstein (2007)
• Justice for asbestos victims and the politics of compensation: the French experience — A. Thébaud-Mony (2003)
• Canada, chrysotile and cancer: Health Canada's Asbestos International Expert Panel report — L.T. Stayner (2008)
• Heroism in occupational health — B. Castleman (2001)
• In Australia, patients and government at odds over mesothelioma treatment costs — V. Burkitt (2007)

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