Globalization and Health最新文献

Background: Many low- and middle-income countries face a double burden of malnutrition, i.e., a co-occurrence of undernutrition with overweight, obesity, or other diet-related noncommunicable diseases. In an increasingly connected global food system, multinational and domestic food industry actors - through their commercial practices and corporate political activity - both contribute to the double burden of malnutrition and hold potential to address it. Systematic monitoring of relevant industry commitments and practices may help to hold industry accountable and foster constructive engagement. The Business Impact Assessment - Obesity and population-level nutrition (BIA-Obesity) tool has been developed to assess and benchmark food companies' commitments and practices related to obesity and support for healthy diets at a national level.

Methods: To enable the application of BIA-Obesity for countries facing a double burden of malnutrition, this study aimed to identify and select relevant best practice indicators for assessing food company commitments and practices regarding the double burden of malnutrition, with a focus on indicators not currently captured by the BIA-Obesity tool. A three-round Delphi study was conducted between April and October 2024, involving an international panel of experts.

Results: From 52 invited experts, 30 contributed to our expert panel (response rate 58%). Based on a systematic review, 16 best practice indicators addressing the double burden of malnutrition were proposed. Consensus (i.e., group agreement of 75% or higher) for inclusion was reached for 8 indicators covering the production, distribution and marketing of (i) breastmilk substitutes and (ii) complementary foods, (iii) breastfeeding support and (iv) parental leave for employees, (v) food fortification, (vi) use of traditional foods, (vii) use of discounts and donations, and (viii) healthy diets at work. One additional indicator on corporate strategy was included as an overarching indicator.

Conclusions: Food industry action may complement other efforts to address the double burden of malnutrition, such as public policies and investments. Tools like the extended BIA-Obesity framework can be used for a systematic monitoring of relevant industry commitments and practices and may help to disseminate and establish favourable industry practices as part of broader efforts to address the double burden of malnutrition in low- and middle-income countries.

Clinical trial number: Not applicable.

Academic publishing is one of several forces that shape what is recognized as global health knowledge. The peer review process is meant to ensure rigor and quality, yet it can reproduce political and structural inequalities, especially when research challenges dominant narratives. For researchers from marginalized and colonized communities, these dynamics determine whether their language, identity, and lived realities are permitted in scholarly spaces. When political, historical, and socio-legal context is minimized or replaced with state-sanctioned labels, the result is not neutrality but the silencing of essential truths that directly shape health and mental health. This Comment examines how editorial and peer review practices operate as gatekeeping mechanisms that privilege dominant geopolitical narratives and marginalize Indigenous and decolonial perspectives. Drawing on a recent case where a peer-reviewed article, recommended for publication, faced subsequent editorial demands to replace politically accurate terminology referring to Palestinians, we show how language policing functions as epistemic control. These are not isolated incidents: global publishing norms pressure scholars toward state-sanctioned labels and "neutral" frames, sidelining colonial and political determinants of health. In global health, that pressure produces an evidence base that overlooks the sociopolitical conditions; occupation, systemic violence, legal segregation, displacement, that shape exposure, access, care pathways, and outcomes, including mental health. It produces an appearance of neutrality that is methodologically incomplete and ethically fragile, with downstream consequences for research agendas, funding priorities, program design, and accountability. Confronting the politics of knowledge production in global health requires structural change, not just diversity statements. Safeguarding researchers' right to represent their communities in their own terms and embedding sociopolitical realities into analysis are essential. Without these changes, global health will continue to reproduce the inequalities it seeks to reduce, failing to generate knowledge that is genuinely global, representative, and just.

The Marrakesh Agreement, which established the World Trade Organization (WTO), permits WTO member countries to jointly decide to temporarily suspend certain obligations under the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement). The TRIPS Decision adopted at the 12th WTO Ministerial Conference in June 2022, following 20 months of extended negotiations during the COVID-19 pandemic, approved only a limited portion of the waiver proposal originally submitted by India and South Africa. Since the Decision was adopted, WTO members have faced a deadlock over whether to extend its scope to include COVID-19 diagnostics and therapeutics, despite being required by the Decision to reach a conclusion on this issue within six months. This paper re-examines the discussions surrounding the potential expansion of the Decision and argues that including COVID-19 diagnostics and therapeutics within its scope was both appropriate and necessary. In addition, the paper proposes ways to make effective use of TRIPS flexibilities during a pandemic, so that developing countries are not left dependent on unpredictable waiver negotiations. The paper also outlines possible approaches for reforming the waiver decision-making process, aiming to ensure that such decisions are made promptly and efficiently, without prolonged negotiations during times of emergency.Clinical trial number Not applicable.

The International Health Regulations (IHR) form the basis of the World Health Organization's governing framework for global health security and have a key role in preventing the international spread of disease. The COVID-19 pandemic rightfully brought the 'fitness for purpose' of the IHR (2005) into question, spurring WHO Member States to embark on a process of amending and improving the Regulations. This process concluded in mid-2024, with a package of substantive amendments adopted through Member State consensus. Global commentary during the COVID-19 pandemic spotlighted issues with both the letter and spirit of the Regulations, but one unifying theme was that of non-compliance. As such, much of the debate in the lead up to the amendment negotiations focused on the need for stronger enforcement and accountability mechanisms. However, the distinction between true IHR breaches and legitimate deviations was often ignored. Instead, these were frequently lumped together under the banner of 'non-compliance,' and with a predominantly negative slant; often as prelude to justification that stronger rules (and perhaps even punitive measures) were needed. The subtext was that the same rules must apply to all. There is little doubt that a legally binding instrument must have robust accountability mechanisms to underpin global collaboration and prevent pandemics. However, New Zealand's COVID-19 pandemic response - considered among the best in the world - illustrates why the balance between uniform compliance and State Party flexibility had to remain an essential consideration during the IHR amendment negotiations.

Background: Ultra-processed food companies in Thailand have rapidly expanded, and they play an important role in the domestic economy and public policy. These companies influence policy-making by building networks with political authorities and using various strategies to pursue their interests. Increased consumption of ultra-processed foods has been shown to be strongly associated with obesity and other non-communicable diseases (NCDs), which are a growing public health concern in Thailand. This study investigated the commercial determinants of health (CDOH) strategies of the major ultra-processed food companies in Thailand.

Methods: This study employed document review to classify CDOH's strategies of ultra-processed food companies in Thailand. The authors searched publicly available information by 15 ultra-processed food companies, including both national and transnational companies, between January 2019 and December 2024. In addition, 30 semi-structured interviews were conducted with field experts to provide additional insights to support the findings from the document review. Thematic analysis was used to interpret the data.

Results: National ultra-processed food companies in Thailand employ all seven strategies of CDOH, namely: (1) Political, (2) Scientific, (3) Marketing, (4) Supply chain and waste management, (5) Labour and employment, (6) Financial, and (7) Reputation management strategies. Transnational companies employed all but one of the seven strategies (labour and employment).

Conclusions: The wide array of CDOH strategies used to shape public policy and opinion may hinder efforts to protect the health of Thais from obesity and diet-related NCDs. To counter this, the authors recommend systematic monitoring of CDOH strategies, stronger accountability for the ultra-processed food companies, mandatory lobbyist registration, stricter management of conflict of interest between government officials and food companies, and strict enforcement of relevant legislation.

Background: Environmental and public health impacts are critical in the food processing industry. To demonstrate responsiveness to stakeholder expectations, firms foreground sustainability reporting through frameworks such as Environmental, Social, and Governance (ESG) and Corporate Social Responsibility (CSR). Yet the sustainability rhetoric usually centers on visible, marketable, and peripheral dimensions, including packaging, energy use, and philanthropy. In contrast, domains within their core operations, including product composition, nutritional quality, and marketing ethics, receive limited attention. Subsequently, concerns over the commercial determinants of health rise, particularly for vulnerable populations.

Methods: The study follows an embedded mixed-methods design to examine whether sustainability disclosures align with firms' innovation strategies. Using 2023 data from 90 multinational or export-oriented food processing firms, hierarchical and multiple regression models assess the effects of ESG sub-dimensions and CSR scores on R&D expenditure, controlling for market capitalization (MC). To complement the quantitative analysis, the study includes a qualitative examination of selected firms, illustrating how sustainability-innovation gaps manifest in practice.

Results: Findings reveal no systematic alignment between sustainability and innovation strategies. The environmental dimension shows a marginally positive yet statistically insignificant relationship with R&D, while social, governance, and CSR metrics exhibit no meaningful association. MC remains the strongest predictor of R&D, highlighting that financial and organizational capacity drives innovation rather than sustainability commitment. Notably, CSR aligns more closely with environmental than social performance, indicating a selective legitimacy orientation. Firm-level evidence also reflects the patterns of symbolic compliance, illustrating how strong ESG scores can coexist with weak sustainability integration.

Conclusion: The weak coupling between sustainability communication and innovation behavior exposes a structural gap between corporate legitimacy efforts and tangible outcomes for sustainable development. Firms that prioritize reputational visibility over substantive innovation reinforce health inequities and constrain systemic reform. To enhance environmental and public health outcomes, both corporate and regulatory strategies should move beyond symbolic compliance toward outcome-based accountability. Such a shift can better incentivize innovation that enhances nutritional quality, strengthens social equity, and protects environmental integrity.