Power and Other Commercial Determinants of Health: An Empirical Study of the Australian Food, Alcohol, and Gambling Industries

Background: Commercial determinants of health (CDoH) represent a critical frame for exploring undue corporate and commercial influence over health. Power lenses are integral to understanding CDoH. Impacts of food, alcohol, and gambling industries are observable CDoH outcomes. This study aims to inform understanding of the systems and institutions of commercial and/or corporate forces working within the Australian food, alcohol, and gambling industries that influence health and well-being, including broader discourses materialised via these systems and institutions. Methods: Twenty semi-structured interviews were conducted with key-informants on Australian public policy processes. Interviewees were current and former politicians, political staff members, regulators and other public servants, industry representatives, lobbyists, journalists, and researchers with expertise and experience of the Australian food, alcohol, and/ or gambling industries. Interviews sought participants’ perceptions of Australian food, alcohol, and gambling industries’ similarities and differences, power and influence, relationships, and intervention opportunities and needs. Results: Strategies and tactics used by Australian food, alcohol and gambling industries are similar, and similar to those of the tobacco industry. They wield considerable soft (eg, persuasive, preference-shaping) and hard (eg, coercive, political, and legal/economic) power. Perceptions of this power differed considerably according to participants’ backgrounds. Participants framed their understanding of necessary interventions using orthodox neoliberal discourses, including limiting the role of government, emphasising education, consumer freedom, and personal choice. Conclusion: Food, alcohol, and gambling industries exercise powerful influences in Australian public policy processes, affecting population health and well-being. Per Wood and colleagues’ framework, these manifest corporate, social, and ecological outcomes, and represent considerable instrumental, structural, and discursive power. We identify power as arising from discourse and material resources alike, along with relationships and complex industry networks. Addressing power is essential for reducing CDoH harms. Disrupting orthodox discourses and ideologies underpinning this should be a core focus of public health (PH) advocates and researchers alike.

o How to they try to differentiate themselves from other industries? How would you say these industries affect the health and wellbeing of the population?

Perceptions of food/alcohol/gambling industry power
Within this work we are also interested in exploring the perceived power of the food/alcohol/gambling industries in Australia.Notably, power often falls within categories of hard power (coercive power, including legal and/or economic threats, use of force, etc.) and soft power (persuasive power, shaping preferences, influencing through perceived legitimate or moral authority, etc.).  Could you briefly describe previous roles have you held that have provided insight into the food, alcohol and/or gambling industries in Australia? Can you briefly describe your knowledge of and/or experience with the Australian food, What are some of your perceptions of the integration of the food/alcohol/gambling industries in Australia?
alcohol, and gambling industries?Perceptions of the food/alcohol/gambling industries  Briefly, how would you describe the food/alcohol/gambling industries in Australia?o Please provide a couple of sentences on overall perceptions 

Perceptions of food/alcohol/gambling industry influence (i.e., what they do)
Do you have any particular examples of hard (coercive) power?Do you have any particular examples of soft (persuasive) power?-including public perception, often unseen influence  Where do you think this power come from?How is it reinforced?-i.e.systems of power  What does this power do/achieve?What are the implications of these relationships for policy/regulation?What are the implications of these relationships for public health and wellbeing?Do you think the food/alcohol/gambling industries have influence over public health and public policy decisions?oHow much influence do they have? What are these influences? How do these come about? Do you have any particular examples? What are the outcomes of these influences?(from your perspective) How would you describe the power held by the food/alcohol/gambling industries?o Social power o Political influence o Regulatory o Financial  

Perceptions of mechanisms/relationships reinforcing food/alcohol/gambling industry influence (i.e., how they do it
)  What influence does the food/alcohol/gambling industry have over public policy and public health? How is this the case? What are the mechanisms that reinforce this? o Regulatory, legal, social, political, commercial, etc.  What role do relationships have in this influence? Can you describe any particular examples of this?  What are the outcomes of this for public health and wellbeing?(from your perspective) Perceptions

of opportunities and needs for intervention
 Do you see any opportunities or needs are there for intervention?(from your perspective) o What should be done? What do you perceive as opportunities for intervention to reduce the influence of the food/alcohol/gambling industries in public policy and public health?o What can be done? What should be some key features of these interventions? What is working well that should be enhanced?How?  What could be the consequences if these are not addressed?o For policy, regulation, public health, etc.What do you think are the most important areas of intervention in order to minimise or prevent harm and maximise benefits to public health? Which intervention(s) would be most important to implement?Why? o Timely o Cost-benefit o Simplicity o Addressing systems of harm o Trigger points within systems o Addressing multiple harms at once  What would you prioritise first?Why?  Which intervention(s) could have the greatest impact?