A Systems Thinking Approach to Inform Coherent Policy Action for NCD Prevention Comment on "How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention"

This is the final version. Available on open access from Kerman University of Medical Sciences via the DOI in this recordLencucha and Thow tackle the enormous public health challenge of developing non-communicable disease (NCD) policy coherence within a world structured and ruled by neoliberalism. Their work compliments scholarship on other causal mechanisms, including the commercial determinants of health, that have contributed to creating the risk commodity environment and barriers to NCD prevention policy coherence. However, there remain significant gaps in the understanding of how these causal mechanisms interact within a whole system. As such, public health researchers’ suggestions for how to effectively prevent NCDs through addressing the risk commodity environment tend to remain fragmented, incomplete and piecemeal. We suggest this is, in part, because conventional policy analysis methods tend to be reductionist, considering causal mechanisms in relative isolation and conceptualizing them as linear chains of cause and effect. This commentary discusses how a systems thinking approach offers methods that could help with better understanding the risk commodity environment problem, identifying a more comprehensive set of effective solutions across sectors and its utility more broadly for gaining insight into how to ensure recommended solutions are translated into policy, including though transformation at the paradigmatic level.Wellcome Trus

International trade and investment liberalization, corporate power and noncommunicable disease prevention policy: A case study of nutrition and alcohol policy non-decisions in South Africa

Introduction: Understanding how corporations can use trade and investment agreements to constrain public health policy action has been of growing concern over the past decade. However, few empirical studies have adopted a political economy approach to understand how trade, health and corporate actors’ strategic responses to trade and investment liberalization may affect health policy decisions, particularly in low- or middle-income country settings. Further, although power analysis is increasingly recognised as essential to understanding public health policy processes, trade and health research has largely not engaged with theories of power. This PhD therefore aims to apply an integrated political economy and power analysis approach to understand how corporate power – visible, hidden and invisible – linked to the international trade and investment systems influence non-communicable disease (NCD) prevention policy (non-)decisionsin South Africa, with a specific focus on nutrition and alcohol policy. Methods: A conceptual framework for analysing power in public health policymaking was constructed and two realist reviews of existing literature were conducted to map current evidence of how the international trade and investment systems facilitate corporate power in health policymaking. In-depth semi-structured interviews were then conducted with 39 stakeholders. Thematic analysis and qualitative system dynamic modelling (SDM) methods including purposive text analysis, model-building and validation were then applied to this interview data. Findings: Trade liberalization has stimulated government’s focus on export-driven value-added economic growth, facilitating food and alcohol corporations’ instrumental and structural power in NCD prevention policymaking. While corporations attempt to capture discursive power, it also emerges through deterministic mechanisms where internalization of the neoliberal paradigm generates policymaking norms that often prioritize economic/trade interests over health. No evidence was identified of corporations using South Africa’s bilateral investment treaty obligations to generate a chilling effect on nutrition and alcohol lregulation. However, food and alcohol corporations’ power to promote NCD prevention policy non-decisions has been enhanced by international trade agreements. System modelling illustrates significant inter-connectedness between the various mechanisms of power linked to trade and investment liberalization in diet-related NCD prevention policymaking. Feedback structures entrench existing power relations over time, preventing transformative policy action. Key leverage points to promote more progressive and cohesive NCD prevention policy action include capacity-building and increased co-ordination across government departments; shifting evidential requirements from health actors to corporations; requiring corporate actors to internalize the health costs they generate; reducing the social acceptability of corporations/products; and promoting an alternative to the neoliberal paradigm. Conclusions: By integrating political economy and power theory, this research contributes a new approach for analysing power in health policymaking. The empirical findings of this research suggest trade and health academics and advocates should move beyond a narrow focus on trade and investment rules/agreements and increase their attention to the system of power in health policymaking that is generated by neoliberal policy, including trade and investment liberalization, enabling corporations to prevent progressive action on NCDs. Methodologically, this work provides useful insights into the benefits and challenges of using qualitative system dynamics modelling to enhance understanding of public health policymaking

Discovery of a Second High Frequency QPO from the Microquasar GRS 1915+105

We report the discovery in archival Rossi X-ray Timing Explorer (RXTE) data of a 40 Hz quasiperiodic oscillation (QPO) in the hard X-ray flux from the galactic microquasar GRS 1915+105. The QPO is detected only in the hard X-ray band above 13 keV and was discovered in observations in which the previously known 67 Hz QPO is present. The 40 Hz QPO has a typical rms amplitude of 2 % in the 13 - 27 keV band, and a width of about 8.5 Hz (FWHM). We show that the 67 and 40 Hz QPOs are detected in the same observations in July and November, 1997. However, the QPO is not detected in observations from April, May and June, 1996 in which the 67 Hz QPO was first discovered. The frequency of the 67 Hz QPO is significantly higher in the 1997 observations by about 5 % compared with the 1996 data. The identification of the 40 Hz QPO makes GRS 1915+105 the second black hole binary to show a pair of simultaneous high frequency QPO (the other being GRO J1655-40). The similarities between the properties of the 67 Hz QPO in GRS 1915+105 and the recently discovered 450 Hz QPO in GRO J1655-40 suggest that the pairs of frequencies in these systems may be produced by the same physical mechanism, with the frequency differences between the two being likely due to different black hole masses in the two systems. We discuss the implications of our result for the mass and spin of GRS 1915+105 as well as for models of X-ray variability in black holes and neutron stars.Comment: 13 pages, 4 figures, AASTeX. Accepted for Publication in the Astrophysical Journal Letter

Spectroscopic Constants, Abundances, and Opacities of the TiH Molecule

Using previous measurements and quantum chemical calculations to derive the molecular properties of the TiH molecule, we obtain new values for its ro-vibrational constants, thermochemical data, spectral line lists, line strengths, and absorption opacities. Furthermore, we calculate the abundance of TiH in M and L dwarf atmospheres and conclude that it is much higher than previously thought. We find that the TiH/TiO ratio increases strongly with decreasing metallicity, and at high temperatures can exceed unity. We suggest that, particularly for subdwarf L and M dwarfs, spectral features of TiH near $\sim$0.52 \mic, 0.94 \mic, and in the $H$ band may be more easily measureable than heretofore thought. The recent possible identification in the L subdwarf 2MASS J0532 of the 0.94 \mic feature of TiH is in keeping with this expectation. We speculate that looking for TiH in other dwarfs and subdwarfs will shed light on the distinctive titanium chemistry of the atmospheres of substellar-mass objects and the dimmest stars.Comment: 37 pages, including 4 figures and 13 tables, accepted to the Astrophysical Journa

Expanding Public Health Policy Analysis for Transformative Change: The Importance of Power and Ideas; Comment on "What Generates Attention to Health in Trade Policy-Making? Lessons From Success in Tobacco Control and Access to Medicines: A Qualitative Study of Australia and the (Comprehensive and Progressive) Trans-Pacific Partnership"

This is the final version. Available on open access from the Kerman University of Medical Sciences via the DOI in this recordIt is increasingly recognised within public health scholarship that policy change depends on the nature of the power relations surrounding and embedded within decision-making spaces. It is only through sustained shifts in power in all its forms (visible, hidden and invisible) that previously excluded perspectives have influence in policy decisions. Further, consideration of the underlying neoliberal paradigm is essential for understanding how existing power dynamics and relations have emerged and are sustained. In their analysis of political and governance factors, Townsend et al have provided critical insight into future potential strategies for increasing attention to health concerns in trade policy. In this commentary we explore how incorporating theories of power more rigorously into similar political analyses, as well as more explicit critical consideration of the neoliberal political paradigm, can assist in analysing if and how strategies can effectively challenge existing power relations in ways that are necessary for transformative policy change.Wellcome Trus

Corporate power and the international trade regime preventing progressive policy action on non-communicable diseases: a realist review

This is the final version. Available on open access from Oxford University Press via the DOI in this recordTransnational tobacco, alcohol and ultra-processed food corporations use the international trade regime to prevent policy action on non-communicable diseases (NCDs); i.e. to promote policy 'non-decisions'. Understanding policy non-decisions can be assisted by identifying power operating in relevant decision-making spaces, but trade and health research rarely explicitly engages with theories of power. This realist review aimed to synthesize evidence of different forms and mechanisms of power active in trade and health decision-making spaces to understand better why NCD policy non-decisions persist and the implications for future transformative action. We iteratively developed power-based theories explaining how transnational health-harmful commodity corporations (THCCs) utilize the international trade regime to encourage NCD policy non-decisions. To support theory development, we also developed a conceptual framework for analysing power in public health policymaking. We searched six databases and relevant grey literature and extracted, synthesized and mapped the evidence against the proposed theories. One hundred and four studies were included. Findings were presented for three key forms of power. Evidence indicates THCCs attempt to exercise instrumental power by extensive lobbying often via privileged access to trade and health decision-making spaces. When their legitimacy declines, THCCs have attempted to shift decision-making to more favourable international trade legal venues. THCCs benefit from structural power through the institutionalization of their involvement in health and trade agenda-setting processes. In terms of discursive power, THCCs effectively frame trade and health issues in ways that echo and amplify dominant neoliberal ideas. These processes may further entrench the individualization of NCDs, restrict conceivable policy solutions and perpetuate policymaking norms that privilege economic/trade interests over health. This review identifies different forms and mechanisms of power active in trade and health policy spaces that enable THCCs to prevent progressive action on NCDs. It also points to potential strategies for challenging these power dynamics and relations.Wellcome Trus