How does better regulation shape EU health policy? A case study of unhealthy advertising regulation

Abstract Introduction Better Regulation is a meta-regulatory tool designed to improve regulatory quality and reduce regulatory burden in the development of EU policy. Despite concerns by civil society that its operation may have a chilling effect on regulatory protections, its impact on health policy has not been researched systematically. Using provisions on high fat, sugar and salt (HFSS) food and alcohol advertising to children within the revision of the audiovisual media services directive (AVMSD) as a case study, we explore how the operation of Better Regulation affects EU health policy processes. Methods We employ a qualitative process tracing approach based on policy documents, Freedom of Information requests, media reporting, and expert interview data. Results After an evaluation in 2016, the revised AVMSD maintained a reliance on self- and co-regulation of alcohol and HFSS food advertising to children, despite significant evidence supportive of statutory measures and pressure from the public health community to strengthen provisions. This result aligns with calls from commercial actors to retain the status quo. Preliminary results indicate that pathways via which Better Regulation guidelines may have contributed to this outcome include, for instance, the structure and approach used in the impact assessment and the related scrutiny process, the design of the consultation strategy, and the evaluation criteria of the AVMSD proposal. Conclusions Considering how policymaking infrastructure - as a key political determinant of health - may shape the processes and dynamics underlying decision-making can support those working towards a policy environment which protects human and environmental health. In examining EU alcohol and HFSS food advertising provisions within the AVMSD revision through a focus on Better Regulation processes, we contribute a novel perspective towards explaining how measures to improve regulatory quality interact with actors’ agency to shape policy outputs. Key messages • The Better Regulation agenda should be understood as a key political determinant of health at the EU level. • Understanding the ways in which governance tools such as Better Regulation can shape health policy is important for those engaged in promoting effective and evidence-informed public health action.


Background:
Alcohol drinking during pregnancy has harmful consequences. Warnings displayed on alcohol bottles are an effective measure to inform people about these risks and have been put in place in France. However, the alcohol industry (AI) resisted this measure when it was introduced in 2007 and during an expansion project in 2018. This study aims to identify arguments used by the AI against warnings targeting pregnant women.

Methods:
A documentary method was used to analyse these arguments disseminated by the AI and its partners (elected representatives of wine-producing regions, etc.) in the French mainstream press (the national, regional and specialised press) from 2000 to 2020 through the Europresse documentary database. A quantitative analysis (number and evolution of press articles, mapping of the actors of AI who expressed themselves) and an inductive thematic content analysis (analytical framework of the arguments identified) using NVivo Software were carried out.

Results:
Among the 85 articles included in this study, a majority of the arguments used by the AI are against this measure. It argues that this measure (1) is a questionable measure because ineffective in changing behaviours, (2) will have counterproductive effects (on women and on the economy); and (3) there are other preferred alternatives than warnings (targeted prevention programs, etc.). A minority is nevertheless in favour of this measure. Among the actors who expressed themselves, a large majority comes from the winegrowing sector.

Conclusions:
The analysis of these arguments will add new insights about AI lobbying against warnings, by analyzing the arguments over a 20 years period covering a failure and a success of industry lobbying. It will also be useful for public health advocacy to better counter this lobbying influence and these arguments, which are not necessarily evidence based.

Key messages:
Warnings displayed on alcohol bottles are an effective measure which is challenged by the alcohol industry. Analysing the arguments disseminated by the alcohol industry is useful for public health advocacy in order to counter them.

Introduction:
Better Regulation is a meta-regulatory tool designed to improve regulatory quality and reduce regulatory burden in the development of EU policy. Despite concerns by civil society that its operation may have a chilling effect on regulatory protections, its impact on health policy has not been researched systematically. Using provisions on high fat, sugar and salt (HFSS) food and alcohol advertising to children within the revision of the audiovisual media services directive (AVMSD) as a case study, we explore how the operation of Better Regulation affects EU health policy processes.

Methods:
We employ a qualitative process tracing approach based on policy documents, Freedom of Information requests, media reporting, and expert interview data.

Results:
After an evaluation in 2016, the revised AVMSD maintained a reliance on self-and co-regulation of alcohol and HFSS food advertising to children, despite significant evidence supportive of statutory measures and pressure from the public health community to strengthen provisions. This result aligns with calls from commercial actors to retain the status quo.
Preliminary results indicate that pathways via which Better Regulation guidelines may have contributed to this outcome include, for instance, the structure and approach used in the impact assessment and the related scrutiny process, the design of the consultation strategy, and the evaluation criteria of the AVMSD proposal.

Conclusions:
Considering how policymaking infrastructure -as a key political determinant of health -may shape the processes and dynamics underlying decision-making can support those working towards a policy environment which protects human and environmental health. In examining EU alcohol and HFSS food advertising provisions within the AVMSD revision through a focus on Better Regulation processes, we contribute a novel perspective towards explaining how measures to improve regulatory quality interact with actors' agency to shape policy outputs.

Key messages:
The Better Regulation agenda should be understood as a key political determinant of health at the EU level. Understanding the ways in which governance tools such as Better Regulation can shape health policy is important for those engaged in promoting effective and evidence-informed public health action. In Germany, the responsibility for public health is divided both between federal levels and between sectors, and there is no national or general strategy for public health. However, a strategy is essential for achieving the overarching goal of ensuring the best possible health for all people, including preventing and addressing significant health challenges such as pandemics and climate change.
In 2016, Zukunftsforum Public Health (Future Forum Public Health) was established with the primary goal to enhance coherence and collaboration between public health stakeholders from academia, policy and practice. According to the principle of health in all policies, it also aims to promote collaboration across federal levels and political sectors. Within the platform provided by Future Forum, the public health community agreed that a strategy was necessary for strengthening and uniting the disparate field of German public health even though no official mandate for developing a strategy existed. Thus, Future Forum launched a grassroots process to identify key elements for a strong and resilient public health system, based on the essential public health operations (EPHOs), as defined by WHO Europe. For each of the ten EPHOs, the key issues paper ''Towards a Public Health Strategy -Together for Better Health in Germany'' presents a description of the current situation and challenges, an introduction to the key players, a definition of the aims and objectives, and concrete proposals on how to achieve these. Through its participative nature, the process of developing the key issues itself was an important factor for strengthening the public health community. This process highlights that even where national public health strategies and structures are missing, grassroots public health movements can be effective in strengthening the public health community as well as producing a visible set of recommendations for a resilient public health system. Key messages: Based on WHO's essential public health operations, Future Forum Public Health developed a key issues paper with guidelines for a resilient public health system. The participative process leading to the key issues paper was itself an important factor for networking and strengthening Germany's public health community.