School of Regulation and Global Governance (RegNet), Australian National University, Canberra, Australia.
Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia.
Soc Sci Med. 2017 Mar;177:141-149. doi: 10.1016/j.socscimed.2017.01.047. Epub 2017 Jan 24.
Effective obesity prevention requires a synergistic mix of population-level interventions including a strong role for government and the regulation of the marketing, labelling, content and pricing of energy-dense foods and beverages. In this paper we adopt the agenda of the Australian Federal Government (AFG) as a case study to understand the factors generating or hindering political priority for such 'regulatory interventions' between 1990 and 2011. Using a theoretically-guided process tracing method we undertook documentary analysis and conducted 27 interviews with a diversity of actors involved in obesity politics. The analysis was structured by a theoretical framework comprising four dimensions: the power of actors involved; the ideas the actors deploy to interpret and portray the issue; the institutional and political context; and issue characteristics. Despite two periods of sustained political attention, political priority for regulatory interventions did not emerge and was hindered by factors from all four dimensions. Within the public health community, limited cohesion among experts and advocacy groups hampered technical responses and collective action efforts. An initial focus on children (child obesity), framing the determinants of obesity as 'obesogenic environments', and the deployment of 'protecting kids', 'industry demonization' and 'economic costs' frames generated political attention. Institutional norms within government effectively selected out regulatory interventions from consideration. The 'productive power' and activities of the food and advertising industries presented formidable barriers, buttressed by a libertarian/neolibertarian rhetoric emphasizing individual responsibility, a negative view of freedom (as free from 'nanny-state' intervention) and the idea that regulation imposes an unacceptable cost on business. Issue complexity, the absence of a supportive evidence base and a strict 'evidence-based' policy-making approach were used as rationales to defer political priority. Overcoming these challenges may be important to future collective action efforts attempting to generate and sustain political priority for regulatory interventions targeting obesity.
有效的肥胖预防需要协同运用人群层面的干预措施，包括政府发挥强有力的作用，以及对高能量食品和饮料的营销、标签、成分和定价进行监管。本文以澳大利亚联邦政府（AFG）的议程为案例研究，以了解 1990 年至 2011 年间，产生或阻碍此类“监管干预”的政治优先事项的因素。我们采用理论指导的过程追踪方法，对相关文件进行了分析，并对参与肥胖政治的各种行为体进行了 27 次访谈。分析的结构由一个理论框架组成，该框架包含四个维度：所涉行为体的权力；行为体用来解释和描绘问题的观点；制度和政治背景；以及问题特征。尽管有两个时期持续受到关注，但监管干预的政治优先事项并未出现，并受到来自所有四个维度的因素的阻碍。在公共卫生界，专家和宣传团体之间凝聚力有限，阻碍了技术应对和集体行动的努力。最初关注儿童（儿童肥胖），将肥胖的决定因素框定为“致肥胖环境”，并采用“保护孩子”、“妖魔化行业”和“经济成本”框架，引起了政治关注。政府内部的制度规范有效地将监管干预排除在考虑之外。食品和广告行业的“生产力”和活动构成了巨大的障碍，而强调个人责任、对自由的负面看法（即不受“保姆式国家”干预的自由）以及监管给企业带来不可接受成本的自由市场/新自由主义言论则为这些障碍提供了支持。问题的复杂性、缺乏支持性的证据基础以及严格的“基于证据”的决策方法被用作推迟政治优先事项的理由。克服这些挑战，对于未来为针对肥胖问题的监管干预措施争取和维持政治优先事项的集体行动努力可能很重要。
