Public health advocacy strategies to influence policy agendas: lessons from a narrative review of success in trade policy

Our plain-English summary of Public health advocacy strategies to influence policy agendas: lessons from a narrative review of success in trade policy, by B. Townsend, B.F. Tenni, S. Goldman, et al (Globalization and Health, 2023).

The study

• Authors: B. Townsend, B.F. Tenni, S. Goldman, D. Gleeson
• Journal: Globalization and Health
• Published: 2023;19(1):60
• Type of article: Review
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Despite accumulating evidence of the implications of trade policy for public health, trade and health sectors continue to operate largely in silos. Numerous barriers to advancing health have been identified, including the dominance of a neoliberal paradigm, powerful private sector interests, and constraints associated with policymaking processes. Scholars and policy actors have recommended improved governance practices for trade policy, including: greater transparency and accountability; intersectoral collaboration; the use of health impact assessments; South-South networking; and mechanisms for civil society participation. These policy prescriptions have been generated from specific cases, such as the World Trade Organization's Doha Declaration on TRIPS and Public Health or specific instances of trade-related policymaking at the national level. There has not yet been a comprehensive analysis of what enables the elevation of health goals on trade policy agendas. This narrative review seeks to address this gap by collating and analysing known studies across different levels of policymaking and different health issues.

Results: Sixty-five studies met the inclusion criteria and were included in the review. Health issues that received attention on trade policy agendas included: access to medicines, food nutrition and food security, tobacco control, non-communicable diseases, access to knowledge, and asbestos harm. This has occurred in instances of domestic and regional policymaking, and in bilateral, regional and global trade negotiations, as well as in trade disputes and challenges. We identified four enabling conditions for elevation of health in trade-related policymaking: favourable media attention; leadership by trade and health ministers; public support; and political party support. We identified six strategies successfully used by advocates to influence these conditions: using and translating multiple forms of evidence, acting in coalitions, strategic framing, leveraging exogenous factors, legal strategy, and shifting forums.

Conclusion: The analysis demonstrates that while technical evidence is important, political strategy is necessary for elevating health on trade agendas. The analysis provides lessons that can be explored in the wider commercial determinants of health where economic and health interests often collide.

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

In plain English

This article was a narrative review of how health goals get onto trade policy agendas, not a study of asbestos disease. The authors searched four databases for English-language studies and included 65 documents. Most concerned access to medicines (42), and one concerned asbestos harm. The authors identified four helpful conditions: favourable media attention, leadership by trade and health ministers, public support, and political party support. No study identified all four. They also identified six advocacy strategies: using and translating evidence (the most common, in 27 studies), acting in coalitions, strategic framing, leveraging exogenous (outside) factors, legal strategy, and shifting forums. From the single asbestos study, the review reported two things as key to an asbestos trade ban: public health experts debunking industry claims, and a coalition of asbestos victims, health NGOs, trade unions and health experts. The review called this ban Canada's in one passage and Quebec's in another. The authors concluded that technical evidence is important but political strategy is necessary.

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 with systematic database search and thematic synthesis of included studies
• Who was studied: 65 included documents (57 journal articles, 6 book chapters, 2 books) that studied conditions or strategies that raised health goals in trade-related policymaking. They were found by searching Web of Science, Scopus, PubMed and Global Health in November 2019, with an update in November 2022, and only English-language works were included.
• Exposure: Not an exposure study. Asbestos harm was the health issue in one of the 65 included studies. No fiber types, products, jobs or doses were described.
• Main results:
  • Access to medicines was the most studied health issue among the included studies (n = 42). The others were food (n = 9), tobacco control (n = 7), non-communicable disease risk factors (n = 4), access to knowledge (n = 1), asbestos harm (n = 1) and public health in general (n = 7).
  • The authors identified four conditions for elevating health on trade agendas: favourable media attention, leadership by trade and health ministers, public support, and political party support.
  • No included study identified all four conditions; 16% identified three.
  • The authors identified six strategies: using and translating multiple forms of evidence, acting in coalitions, strategic framing, leveraging exogenous factors, legal strategy, and shifting forums.
  • The most common strategy was using and translating multiple forms of evidence, identified in 27 studies.
  • In the asbestos study, public health experts' debunking of industry claims was described as a turning point for advocacy that led to Canada's trade ban on asbestos.
  • A transnational coalition of asbestos victims, health NGOs, trade unions and health experts was described as crucial for securing Quebec's trade ban on asbestos on health grounds.
• The authors' conclusion: The authors concluded that while technical evidence is important, political strategy is necessary to influence the conditions for elevating health on trade agendas.
• Limitations the authors state:
  • The review was limited to peer-reviewed studies published in English.
  • Studies that did not use the search terms in their title, abstract or keywords may have been missed.
  • Because the review relied on how the included studies' authors reported what was important, it could only partly probe relationships between conditions and between strategies.

Topics

Medical terms in this study, explained in our Lexicon: Bilateral.

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