School of Regulation and Global Governance, College of Asia and the Pacific, The Australian National University, Canberra, Australia.
The George Institute for Global Health, Sydney, Australia.
Global Health. 2023 Apr 28;19(1):31. doi: 10.1186/s12992-023-00931-y.
The commercial determinants of health (CDoH) drive the rise of NCDs globally, and their regulation requires multisectoral governance. Despite existing recommendations to strengthen institutional structures, protecting public health interests can be challenging amidst industry interference and conflicting policy priorities, particularly in low and middle-income countries (LMICs) where the need for rapid economic development is pronounced. Small island developing states (SIDS) face even more challenges in regulating CDoH because their unique socioeconomic, political, and geographic vulnerabilities may weaken institutional conditions that could aid health sector actors in protecting health interests. This study aims to explore the institutional conditions that shape health sector actors' capability to protect public health interests in tobacco governance in Fiji and Vanuatu.
We employed a qualitative, exploratory case study design. We applied the administrative process theory to inform data collection and analysis. Seventy interviews were completed in Fiji and Vanuatu from 2018 to 2019.
The findings show that the protection of health interests in tobacco governance were not supported by the institutional conditions in Fiji and Vanuatu. While the policy processes formally ensured a level playing field between actors, policies were often developed through informal mechanisms, and the safeguards to protect public interests from vested private interests were not implemented adequately. SIDS vulnerabilities and weak regulation of political parties contributed to the politicisation of government in both states, resulting in high-level government officials' questionable commitment to protect public health interests. The system of checks and balances usually embedded into democratic governments appeared to be muted, and policymakers had limited bureaucratic autonomy to elevate health interests in multisectoral policymaking amidst high-level government officials' frequent rotation. Finally, capacity constraints aggravated by SIDS vulnerabilities negatively impacted health sector actors' capability to analyse policy alternatives.
Health sector actors in Fiji and Vanuatu were not supported by institutional conditions that could help them protect public health interests in multisectoral governance to regulate CDoH originating from the tobacco industry. Institutional conditions in these states were shaped by SIDS vulnerabilities but could be improved by targeted capacity building, governance and political system strengthening.
商业驱动健康的决定因素（CDoH）在全球范围内推动了非传染性疾病的上升，其监管需要多部门治理。尽管现有的建议是加强体制结构，但在行业干扰和政策优先事项冲突的情况下，保护公共卫生利益可能具有挑战性，特别是在需要快速经济发展的低收入和中等收入国家（LMICs）中。小岛屿发展中国家（SIDS）在监管 CDoH 方面面临更大的挑战，因为其独特的社会经济、政治和地理脆弱性可能削弱有助于卫生部门行为者保护健康利益的体制条件。本研究旨在探讨体制条件，这些条件塑造了卫生部门行为者在斐济和瓦努阿图的烟草治理中保护公共卫生利益的能力。
我们采用了定性、探索性案例研究设计。我们应用行政过程理论来为数据收集和分析提供信息。2018 年至 2019 年期间，我们在斐济和瓦努阿图完成了 70 次访谈。
研究结果表明，斐济和瓦努阿图的体制条件不利于保护烟草治理中的公共卫生利益。虽然政策过程正式确保了行为者之间的公平竞争环境，但政策往往是通过非正式机制制定的，保护公共利益免受既得私人利益的保障措施没有得到充分实施。SIDS 的脆弱性和政党监管的薄弱导致两国政府的政治化，导致高级政府官员对保护公共卫生利益的承诺受到质疑。通常嵌入民主政府的制衡制度似乎被压制，政策制定者在高级政府官员频繁轮换的情况下，在多部门决策中提升健康利益的官僚自主权有限。最后，SIDS 脆弱性加剧的能力限制对卫生部门行为者分析政策替代方案的能力产生了负面影响。
斐济和瓦努阿图的卫生部门行为者没有得到体制条件的支持，这些条件可以帮助他们在多部门治理中保护公共卫生利益，以监管来自烟草行业的 CDoH。这些国家的体制条件受到 SIDS 脆弱性的影响，但可以通过有针对性的能力建设、治理和政治制度加强来改善。
