1Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082

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Mechanisms for addressing and managing the influence of corporations on public health policy, research and practice: a scoping review

Melissa Mialon ,1,2 Stefanie Vandevijvere,3 Angela Carriedo- Lutzenkirchen,4 Lisa Bero,5 Fabio Gomes,6 Mark Petticrew,7 Martin McKee ,7 David Stuckler,8 Gary Sacks9

To cite: Mialon M, Vandevijvere S, Carriedo- Lutzenkirchen A, et al. Mechanisms for addressing and managing the influence of corporations on public health policy, research and practice: a scoping review. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082

► Prepublication history and additional material for this paper are available online. To view these files, please visit the journal online (http:// dx. doi. org/ 10. 1136/ bmjopen- 2019- 034082).

Received 05 September 2019Revised 05 March 2020Accepted 18 May 2020

For numbered affiliations see end of article.

Correspondence toDr Melissa Mialon; melissa_ mialon@ hotmail. fr

Original research

© Author(s) (or their employer(s)) 2020. Re- use permitted under CC BY- NC. No commercial re- use. See rights and permissions. Published by BMJ.

AbstrACtObjective We identified mechanisms for addressing and/or managing the influence of corporations on public health policy, research and practice, as well as examples of where these mechanisms have been adopted from across the globe.Design We conducted a scoping review. We conducted searches in five databases on 4 June 2019. Twenty- eight relevant institutions and networks were contacted to identify additional mechanisms and examples. In addition, we identified mechanisms and examples from our collective experience working on the influence of corporations on public health policy, research and practice.setting We identified mechanisms at the national, regional and global levels.results Thirty- one documents were included in our review. Eight were peer- reviewed scientific articles. Nine discussed mechanisms to address and/or manage the influence of different types of industries; while other documents targeted specific industries. In total, we identified 49 mechanisms for addressing and/or managing the influence of corporations on public health policy, research and practice, and 43 of these were adopted at the national, regional or global level. We identified four main types of mechanisms: transparency; management of interactions with industry and of conflicts of interest; identification, monitoring and education about the practices of corporations and associated risks to public health; prohibition of interactions with industry. Mechanisms for governments (n=17) and academia (n=13) were most frequently identified, with fewer for the media and civil society.Conclusions We identified several mechanisms that could help address and/or manage the negative influence of corporations on public health policy, research and practice. If adopted and evaluated more widely, many of the mechanisms described in this manuscript could contribute to efforts to prevent and control non- communicable diseases.trial registration details The protocol was registered with the Open Science Framework on 27 May 2019 (https:// osf. io/ xc2vp).

bACkgrOunDThere is growing evidence, coupled with public awareness, that the economic power of corporations, particularly that of large trans-nationals, has led to the defeat, delay and weakening of public health policies around the world.1–3 Perhaps the best evidence of the harmful influence of corporations on public health policy is in the field of tobacco control. In the 1990s, during litigation in the USA, leading tobacco companies released large quantities of internal documents,4 5 revealing how, over decades, they sought to deny the threat that tobacco posed to health and to thwart measures to reduce smoking.6–8 Recent research has shown that influence of tobacco industry has resulted in a policy shift towards industry interests in some regions, such as the European Union.9 Tobacco continues to kill millions.10 An emerging body of evidence is revealing the use of similar corporate efforts to defeat, delay and weaken the public health

strengths and limitations of this study

► This review is the first attempt to develop an inven-tory of mechanisms for addressing and managing the influence of corporations on public health policy, research and practice.

► Many of the mechanisms identified in our review have been developed with no restriction on the type of industries targeted.

► The list compiled here is non- exhaustive and by na-ture, subject to changes, as an increasing number of governments and other institutions take measures to prevent undue influence from industry.

► Not all mechanisms have yet been thoroughly evalu-ated; therefore, we did not assess the validity of the included studies.

► Mechanisms at the subnational level have not been included in our study.

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policies and influence research and practice, from a range of sectors including the alcohol, food, gambling, oil and pharmaceutical industries, among others.1 11–15 These corporate practices that have a negative impact on health, and that are used across industries, are increas-ingly referred to as ‘commercial determinants of health’ in the literature.16

Industry efforts to influence public policy, research and practice are often referred to as ‘corporate political activity’ (CPA). The CPA includes: coalition management (influence on third parties such as health organisations, communities and the media); information management (manipulation of the evidence base, through the funding of research, ghost- writing, and so on); direct and indirect involvement in policy- making; litigation or the threat of legal actions; and discursive strategies seeking to frame the dominant narrative in their favour.8

Several institutions have been established to monitor the influence of corporations on public health policy, research and practice, such as Corporate Europe Obser-vatory in Europe and US Right to Know in the USA (see online supplementary file 1 for a non- exhaustive list of such organisations). Major reviews of the determi-nants of health also increasingly and explicitly examine the influence of corporations on public health policy, research and practice.3 Approaches have recently been developed to analyse this influence systematically. The ‘Corporate Permeation Index’ developed by Lima and Galea measures “the extent to which corporations are embedded in the political, legal, social, economic and cultural fabric of a country”.17 This index seeks to quan-tify the penetration of corporations in a given country, and was recently implemented for 148 countries over the period 2010–5.17 The results showed extensive inter-national variation.17 The WHO, as well as institutions in academia and civil society, have made recommendations to identify and monitor the influence of the tobacco industry on public health policy, research and prac-tice.18–20 Mialon et al built on this work and developed a step- by- step approach to monitor the CPA of the food industry within countries, using publicly available infor-mation.11 To date, the approach has been implemented in more than 20 countries.21–27 One commonly identified drawback of such approaches is that they are limited by a lack of relevant and comprehensive publicly available information for most industries other than tobacco, where millions of internal documents are now freely avail-able to the public.21 23 24 27 Evidence of this influence for other industries is typically sparse and not systematically compiled. It is obtained from a range of sources, including internal documents, primarily leaked by whistle- blowers, publicly available information (eg, from media releases, companies websites, data on lobbying, and so on) and interviews with those who interact with these companies.

National health authorities and civil society organisa-tions have increasingly been concerned with the weak-ening, delay and obstruction of public health policies due to harmful corporate practices.2 28 29 There is also

increasing awareness and acceptance among the public health community, particularly in high- income countries, that interactions with these industries require extreme caution, and, at the minimum, transparency coupled with a detailed understanding of their mode of operation.30 31 The public health community looks for inspiration to the WHO Framework Convention on Tobacco Control (FCTC),32 with recent calls for a Framework Convention on Food Systems (FCFS)3 and a Framework Convention on Alcohol Control (FCAC).33 Article 5.3 of the FCTC bars any interactions between governments and the tobacco industry except for implementing tobacco control, led by public health officials.32 As of December 2018, 181 coun-tries had ratified the WHO FCTC, covering 90% of the world population.34 The extent of implementation of key FCTC regulatory measures in countries is significantly associated with lower smoking prevalence.35 However, the tobacco industry, often through pseudo- scientific front groups, still wields influence that allows it to avoid or water down regulatory initiatives.36

The demand for mechanisms to protect the policy process from undue corporate influence is growing. One example of how this became evident is when, in 2012, Member States requested the World Health Assembly (Resolution WHA65.6) to develop risk assessment, disclo-sure and management tools to safeguard against conflicts of interest (COI) in policy development and implementa-tion of nutrition programmes.37 The WHO also recently declared that it would no longer partner with alcohol industry actors during the development of policies to reduce harmful drinking.38 The need for guidance on how to address and manage undue influence from corpo-rations is also evident in research and practice.39 40

Identification and monitoring of the industry influence on public health policy, research and practice is a neces-sary but insufficient step in protecting and promoting public health. It is essential that international organisa-tions, governments, academia, the media and the civil society are equipped to tackle potential threats to global health. Our study objective was, therefore, to identify mechanisms for addressing and/or managing the influ-ence of corporations on public health policy, research and practice, as well as examples of where these mecha-nisms have been adopted.

MethODsWe conducted a scoping review, where we searched scientific publications (peer- reviewed articles, letters to the editor, commentaries, and so on) and reports from governments, international organisations and civil society. We excluded books, as well as presentations from conferences, and other events where no full articles were available.

A scoping review was deemed to be the most suitable method for this study as we intended to summarise evidence from a heterogeneous body of research, from academia, governments, civil society organisations and

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other actors in public health.41 A scoping review also advances knowledge in an emerging field of research, which is the case for mechanisms to address the influ-ence of corporations on public health.41 In addition, it helps examine the nature of available research and research gaps in the literature, which could inform future research.41

We used the Preferred Reporting Items for System-atic Reviews and Meta- Analyses (PRISMA) Extension for Scoping Reviews (PRISMA- ScR, see online supplemen-tary file 2) to prepare our scoping review protocol and our manuscript. The protocol was revised by the research team and registered with the Open Science Framework on 27 May 2019 (https:// osf. io/ xc2vp).

In our scoping review, the term ‘mechanism’ refers to: policies, regulations, guidelines, codes of conduct, frame-works, standards, initiatives or other tools to address and/or manage the influence of corporations on public health policy, research and practice.

The terms ‘industry’ and ‘corporations’ are employed interchangeably in this manuscript to refer to the manu-facturers, wholesalers, retailers, distributors, food service providers, as well as producers of raw material. We also include those organisations acting on their behalf, overtly or covertly, including some trade associations, public rela-tions firms, ‘philanthropic’ organisations, research insti-tutions and other individuals and groups.

Database searchesSearch strategyThe development of the search strategy was informed by previous systematic and scoping reviews that analysed the influence of corporations on public health policy, research and practice7 12 13 or that presented mechanisms to address and/or manage that influence (for the food industry, for example40). We used keywords and Medical Subject Headings (MeSH) terms. The search strategy was developed with the help of a librarian at the University of Antioquia, Colombia.

We conducted systematic searches in five databases: ► Web of Science Core Collection (Web of Knowledge

interface); ► BIOSIS (Web of Knowledge interface); ► MEDLINE (Web of Knowledge interface); ► Embase (Embase interface); ► Scopus (Scopus interface).The terms used in the search strategy were tailored to the

requirements of each database and included ((corporat* or industr* or compan* or business* or firm*) AND (address* or manag* or ‘guid*’ or ‘codes of conduct’ or framework* or standard* or governance)). In addition, we searched the following key terms in the titles only, as a broader search yielded too many irrelevant results: ((diet or nutrition or food or obesity or alcohol or drink or pharma* or gambl* or tobacco or smok* or cigarette* or oil or ‘public health’) AND (interact* or conflict* or ‘public*private” or poli* or legislat* or lobb*)).

Our search strategy for Web of Science Core Collection (Web of Knowledge interface) was:

TO= ((corporat* or industr* or compan* or business* or firm*) AND (address* or manag* or “guid*” or “codes of conduct” or framework* or standard* or governance)) AND TI= ((diet or nutrition or food or obesity or alcohol or drink or pharma* or gambl* or tobacco or smok* or cigarette* or oil or “public health”) AND (interact* or conflict* or “public*private” or poli* or legislat* or lobb*))

Indexes=SCI- EXPANDED, SSCI, A&HCI, CPCI- S, CPCI- SSH, BKCI- S, BKCI- SSH, ESCI, CCR- EXPANDED, IC Timespan=2003 to 2019

The search strategies for other databases are presented in online supplementary file 3. Databases were searched on 4 June 2019.

Eligibility criteriaTo be included in this review, publications had to:

► Be published in 2003 and later, when the WHO- FCTC came into effect;

► Be published in English, French, Spanish, Portuguese, or Italian—languages for which members of our team had at least working proficiency;

► Analyse, use, compare, propose or evaluate one or several mechanisms for addressing and/or managing the influence of corporations on public health policy, research and/or practice;

► Focus on the influence of the alcohol, food, gambling, oil, pharmaceutical and/or tobacco industries on public health policy, research and practice;

► Focus on mechanisms at the international, regional (eg, Europe) or national level.

Selection of sources of evidenceAll citations identified were downloaded and imported to the web- based bibliographic manager F1000 Workspace, where duplicate citations were removed. Data extraction and analysis were led by the first author. MM screened all titles and abstracts, when available, for eligibility. GS double- screened 10% of the material. MM then obtained the full- texts of potential eligible material. When publi-cations were not available online, MM contacted the first authors of the materials to obtain a copy of the documents (n=13). MM assessed the eligibility of that material against the eligibility criteria. GS assessed the eligibility of 10% of the documents. Disagreement was resolved by consensus after discussion between MM and GS. For documents that were included in our review, MM searched their bibliographic reference sections (back-ward searches) and searched documents that were citing them; using Scopus (forward searches) to identify addi-tional relevant material.

Additional searchesTwenty- eight institutions and networks working on the industry influence on public health policy, research and practice, as detailed in online supplementary file 1, were

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contacted in May 2019 to identify additional mechanisms and examples. These institutions were identified through the authors’ networks. Only one of these institutions answered our requests. In addition, we identified mecha-nisms and examples of their adoption from our collective experience working on the influence of corporations on public health policy, research and practice.

We included documents from the grey literature, including from international agencies (eg, WHO, World Bank, and so on), national government agencies, univer-sities, academic journals, international professionals asso-ciations, the media, research funders and civil society organisations.

Data charting process and data itemsData was charted by MM in an Excel table, and the vari-ables for which data were sought were:

► Whether or not the study was funded by corporations or had authors that were employed by corporations in the alcohol, food, gambling, oil, pharmaceutical or tobacco industries (as disclosed in the documents identified through our searches);

► Individuals and institutions targeted by the mecha-nism: governments and international organisations (with details about specific institutions targeted by the mechanisms within these organisations); academia (including researchers, universities, scientific jour-nals, research funders, ethics review boards, and so on), the media and the civil society;

► Details about the mechanism for addressing and/or managing the influence of corporations on public health policy, research and practice, including the type of mechanism described;

► Information about specific examples where the mechanism has been adopted, either fully or to some extent, including the name of the country, the name of the policy and the URL.

synthesis of resultsWe identified four broad types of mechanisms for addressing and managing the influence of corporations on public health policy, research and practice, through our interpretation of the data, and as presented at the beginning of our results section. Most mechanisms iden-tified in this review pertain to one or more of these four broad categories

We present the results of our review in two tables: one table with mechanisms for governments and interna-tional organisations and one table with mechanisms for academia, the media and civil society. We decided to first present data for individuals and institutions in govern-ments as they may have a legal obligation to address undue influence from corporations and conflicts of interest, while this might not be the case for other actors in public health.

We then grouped each mechanism by institution (ministries, universities, academic journals, and so on), in no specific order. Where multiple mechanisms targeting

particular aspects of corporate influence were identi-fied, we only included the most stringent mechanisms, as determined by ourselves.

We also include examples where these mechanisms have been adopted, fully or to some extent, as identified in the documents collected during our systematic searches or as identified through additional searches. The URLs for the examples included in our scoping review are available in online supplementary file 4. We made a particular effort to represent a broad range of countries from different regions of the globe in these examples, although our list is non- exhaustive.

exclusion criteriaWe excluded documents funded by corporations or whose authors were employed by corporations in the alcohol, food, gambling, oil, pharmaceutical and tobacco indus-tries (as disclosed in the documents identified through our searches), as these represented an inherent COI in the development of mechanisms to address and/or manage the influence of these industries.

In our analysis, we excluded mechanisms: ► that were proposed or developed by the industries

mentioned above when these were presented among other mechanisms in non- industry funded documents (eg, reports from multi- stakeholders platforms);

► only addressing marketing practices, for example: – the sponsorship of sport; – the interactions between pharmaceutical com-

panies and doctors, pharmacists and other healthcare professionals (including during their training) when those have the sole purpose of sell-ing products.

► targeted at corporations for managing their interac-tions with government, academia, the media and the civil society;

► targeting corporate practices that are almost univer-sally illegal, such as criminal activity and bribery of government officials, although we recognise that these other forms of influence exist. These are beyond the scope of this manuscript.

We also excluded documents that did not analyse, use, compare, propose or evaluate a mechanism per se, but instead discussed its adoption in a specific context (for example the adoption in nine countries of a transparency policy for the interactions between healthcare profes-sionals and the pharmaceutical industry42). In this case, we used these examples in our results section to illustrate instances where a mechanism was adopted.

Patient and public involvement statementPatients and the public were not involved in this research.

resultsThe PRISMA flow diagram for our scoping review is presented in figure 1. In total, 2015 documents were iden-tified in the databases searches (excluding duplicates).

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Figure 1 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta- Analyses) flow diagram.

After screening of their titles and abstracts, 1998 docu-ments were excluded and 17 were included. In addition, 6 documents were identified through backward searches and 12 documents were found through additional searches. No new documents were identified through forward searches. In total, 35 full- texts were included for analysis. Subsequently, two articles were excluded because they did not present mechanisms for addressing and/or managing the industry influence; one article was excluded because we could not retrieve its full- text, despite contacting its first author; and one article was excluded because it only discussed marketing practices.

In total, 31 documents were included in our scoping review. All references included in our scoping review came from high- income countries, in particular the USA (n=9). Eight documents were published by international organisations based in France, Switzerland and the USA. Only eight documents were peer- reviewed articles. Other documents included letters to the editors, commentaries and other pieces in scientific/clinical journals, as well as reports by national and international organisations. Nine documents discussed mechanisms to address and/or manage the influence of all sorts of industries. The other documents targeted specific industries (these categories are not mutually exclusive): six for the alcohol industry; seven for the food industry; five for the gambling industry; five for the pharmaceutical industry; and six for the tobacco industry. None of the documents discussed mechanisms to address and/or manage the influence of the oil industry. Most documents included mecha-nisms for governments (n=17) and academia (including researchers, universities, scientific journals, research funders, ethics review boards, and so on) (n=13). Three documents proposed mechanisms for civil society and

one for the media. We found many examples where these mechanisms have been adopted, as described below.

Many of the mechanisms identified in our review, as discussed in the sections below, focus on the management of COI. COI provisions might not be sufficient to reduce industry influence and that interactions with industry can be ethically problematic and may influence public health policy, research and practice even when COI poli-cies are not implemented.43 44 We identified four main types of mechanisms to address undue influence from corporations (categories are not mutually exclusive): (i) managing the interactions with industry and COI; (ii) increasing transparency about these interactions and COI; (iii) identifying, monitoring and educating third parties in academia, civil society and the media about the practices of corporations and associated risks to public health; and (iv) prohibiting any interaction with industry. There are other types of mechanisms discussed in the literature, such as the protection of whistle- blowers, or mandatory taxes for companies to be used by an inde-pendent organisation to fund public health research and practice, as detailed below.

governments and international organisationsInternational organisations and governments have a mandate to protect and promote public health. Govern-ments are in charge of the initiation, development, implementation and evaluation of public health policies. As such, they are a primary target of corporations whose profits might be threatened by such policies, during all phases of the policy cycle but in particular during initia-tion and development of policies.

In our scoping review, we identified 23 mechanisms for addressing and/or managing the influence of corpora-tions on governments and international organisations (table 1).

There are growing concerns about how international organisations, including the WHO, engage with corpora-tions and in response, the WHO has recently addressed some of these concerns, most notably in its Framework for Engagement with non- State Actors (FENSA).37 45 There is criticism of FENSA, as it could be interpreted as an invi-tation for increased collaboration between the WHO and industry, suggesting that this is acceptable if managed as per WHO guidelines.46

The Organisation for Economic Co- operation and Devel-opment (OECD) published several documents that are rele-vant for the current scoping review, including guidelines for the management of conflicts of interest.47 48 In 2017, it developed a framework for ‘Preventing Policy Capture’.49 It also published a series of reports on lobbying regula-tion50 and on the funding of political parties and elections campaigns.51

The World Bank developed a ‘Public Accountability Mechanisms Initiative’, which includes specific recommen-dations and “provides assessments of countries’ in- law and in- practice efforts to enhance the transparency of public administration and the accountability of public officials”.52

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Tab

le 1

M

echa

nism

s fo

r ad

dre

ssin

g an

d/o

r m

anag

ing

the

influ

ence

of c

orp

orat

ions

on

pub

lic h

ealth

pol

icy

(non

- exh

aust

ive)

Ind

ivid

uals

and

in

stit

utio

nsM

echa

nism

s id

enti

fied

thr

oug

h o

ur s

cop

ing

rev

iew

Typ

e o

f m

echa

nism

Exa

mp

les

whe

re t

hese

mec

hani

sms

have

bee

n ad

op

ted

(f

ully

or

to s

om

e ex

tent

)Tr

ansp

aren

cyM

anag

emen

t

Iden

tifi

cati

on,

m

oni

tori

ng a

nd

educ

atio

nP

rohi

bit

ion

Oth

er t

ype

Min

istr

ies

and

rel

ated

ag

enci

es in

cha

rge

of h

ealth

, agr

icul

ture

, ed

ucat

ion,

env

ironm

ent

and

tra

de/

ind

ustr

yP

arlia

men

t an

d S

enat

e

Pub

lic h

ealth

pla

n or

str

ateg

y th

at e

xplic

itly

incl

udes

the

p

rote

ctio

n of

pub

lic h

ealth

pol

icie

s fr

om in

dus

try

inte

rest

s,

incl

udin

g th

e p

ossi

bili

ty t

o ch

alle

nge

dem

onst

rab

le in

dus

try

influ

ence

62 6

3

XX

A s

et o

f pol

icie

s re

late

d t

o co

nflic

ts o

f int

eres

t:47

48

►

info

rmat

ion

abou

t w

hom

to

acce

pt

fund

ing

from

, bas

ed

on a

ris

ks a

naly

sis

►

a cl

ear

and

rea

listic

des

crip

tion

of c

ircum

stan

ces

and

re

latio

nshi

ps

that

can

lead

to

a co

nflic

t- of

- int

eres

t49

►

info

rmat

ion

abou

t ho

w in

tera

ctio

ns w

ith c

orp

orat

ions

(a

nd t

hird

par

ties

actin

g on

beh

alf o

f the

ind

ustr

y)

and

con

flict

s of

inte

rest

, bot

h at

the

ind

ivid

ual

and

inst

itutio

nal l

evel

s, w

ill b

e re

por

ted

, rev

iew

ed,

doc

umen

ted

, mon

itore

d a

nd m

anag

ed (i

nclu

din

g re

stric

ted

, if n

eces

sary

62–6

4 ), as

wel

l san

ctio

ns in

cas

e of

no

n- co

mp

lianc

e w

ith t

he p

olic

y52

►

req

uire

men

ts fo

r go

vern

men

t of

ficia

ls t

o d

ecla

re

and

div

est

them

selv

es o

f dire

ct in

tere

sts

in s

pec

ific

ind

ustr

ies

rela

ted

to

heal

th (e

g, t

obac

co in

dus

try)

62 6

3

►

rest

rictio

ns o

n go

vern

men

t in

stitu

tions

and

the

ir b

odie

s fr

om h

avin

g fin

anci

al in

tere

sts

in s

pec

ific

ind

ustr

ies

rela

ted

to

heal

th (e

g, t

obac

co in

dus

try)

, unl

ess

they

are

re

spon

sib

le fo

r m

anag

ing

a go

vern

men

t’s o

wne

rshi

p

inte

rest

in a

Sta

te- o

wne

d c

omp

any62

63

►

rest

rictio

ns o

n go

vern

men

t in

stitu

tions

and

the

ir b

odie

s fr

om a

ccep

ting

cont

ribut

ions

(fina

ncia

l or

in- k

ind

) fr

om s

pec

ific

ind

ustr

ies

rela

ted

to

heal

th (e

g, t

obac

co

ind

ustr

y) o

r fr

om t

hose

wor

king

to

furt

her

its in

tere

sts,

ex

cep

t fo

r co

mp

ensa

tions

due

to

lega

l set

tlem

ents

or

man

dat

ed b

y la

w o

r le

gally

bin

din

g an

d e

nfor

ceab

le

agre

emen

ts62

63

Offi

cial

s th

at s

houl

d b

e co

vere

d b

y th

e ab

ove

mec

hani

sm

incl

ude:

min

iste

rs; s

enio

r p

ublic

ser

vant

s; c

usto

ms

offic

ers;

co

ntra

ct m

anag

ers;

pro

secu

tors

; tax

offi

cial

s; ju

dge

s;

pro

cure

men

t of

ficia

ls; m

inis

teria

l cab

inet

sta

ff; a

udito

rs47

XX

XX

►

Bra

zil -

Pre

sid

ency

of t

he R

epub

lic -

Cod

e of

Con

duc

t fo

r S

enio

r Fe

der

al A

dm

inis

trat

ion

►

Col

omb

ia -

Con

gres

s of

Col

omb

ia -

Law

190

of 1

995,

ar

ticle

15

- R

egim

e of

civ

il se

rvan

ts

►E

urop

ean

Uni

on (E

U) -

Gui

del

ines

on

the

pre

vent

ion

and

m

anag

emen

t of

CO

I in

EU

dec

entr

alis

ed a

genc

ies

►

Fran

ce -

Pen

al C

ode

- A

rtic

le 4

32–1

2 (in

div

idua

l co

nflic

ts o

f int

eres

t)

►M

exic

o -

Cha

mb

er o

f Dep

utie

s of

the

Hig

h C

ongr

ess

of t

he U

nion

- G

ener

al S

ecre

tary

- S

ecre

taria

t of

P

arlia

men

tary

Ser

vice

s -

Law

of A

dm

inis

trat

ive

resp

onsi

bili

ties

of c

ivil

serv

ants

(ind

ivid

ual c

onfli

cts

of

inte

rest

)

►N

epal

- T

obac

co P

rod

uct

Con

trol

and

Reg

ulat

ory

Dire

ctiv

e 20

14 -

Cha

pte

r 3:

Con

trol

ling

Inte

rfer

ence

in

Pol

icy-

Mak

ing

and

Imp

lem

enta

tion

- C

ond

uct

of P

ublic

A

genc

y O

ffici

als

►

Phi

lipp

ines

: –

Civ

il S

ervi

ce C

omm

issi

on -

Dep

artm

ent

of H

ealth

-

Join

t M

emor

and

um C

ircul

ar n

o. 2

010–

01 o

n P

rote

ctio

n of

the

Bur

eauc

racy

aga

inst

Tob

acco

In

dus

try

Inte

rfer

ence

. –

Dep

artm

ent

of H

ealth

- M

emor

and

um N

o.

2010

–012

6 on

Pro

tect

ion

of t

he D

epar

tmen

t of

H

ealth

, inc

lud

ing

all o

f its

Age

ncie

s, R

egio

nal

Offi

ces,

Bur

eaus

or

Sp

ecia

lised

/Att

ache

d O

ffice

s/U

nits

, aga

inst

Tob

acco

Ind

ustr

y In

terf

eren

ce.

►

Uga

nda

- M

inis

try

of H

ealth

- T

obac

co C

ontr

ol A

ct

(201

5) -

Par

t V

III -

Pro

tect

ion

of t

obac

co c

ontr

ol p

olic

ies

from

com

mer

cial

and

oth

er v

este

d in

tere

sts

of t

he

tob

acco

ind

ustr

y

►W

HO

: –

Art

icle

5.3

of t

he F

ram

ewor

k C

onve

ntio

n on

To

bac

co C

ontr

ol –

Fram

ewor

k fo

r E

ngag

emen

t w

ith n

on- S

tate

Act

ors

(FE

NS

A)

Pub

lic fi

nanc

ial d

iscl

osur

e (c

omb

inat

ion

of in

com

e, a

sset

s,

liab

ilitie

s, b

usin

ess

activ

ities

and

inco

mp

atib

ilitie

s w

ith

pub

lic m

and

ates

) for

ind

ivid

uals

in g

over

nmen

t. T

his

wou

ld

incl

ude

sanc

tions

if t

hese

dis

clos

ures

are

not

fille

d o

r co

ntai

n om

issi

ons

or m

isle

adin

g in

form

atio

n48

XX

►

Col

omb

ia -

Con

gres

s of

Col

omb

ia -

Law

190

of 1

995,

ar

ticle

15

- R

egim

e of

civ

il se

rvan

ts

►E

U -

Eur

opea

n P

arlia

men

t -

Dec

lara

tions

of i

nter

ests

-

Mem

ber

s of

the

Eur

opea

n P

arlia

men

t

►Fr

ance

- H

igh

Aut

horit

y fo

r Tr

ansp

aren

cy in

Pub

lic L

ife

►M

exic

o -

Cha

mb

er o

f Dep

utie

s of

the

Hig

h C

ongr

ess

of t

he U

nion

- G

ener

al S

ecre

tary

- S

ecre

taria

t of

P

arlia

men

tary

Ser

vice

s -

Fed

eral

Law

for

adm

inis

trat

ive

resp

onsi

bili

ties

of p

ublic

ser

vant

s, A

rtic

le 8

, XV

Pol

icy

on m

and

ator

y w

aitin

g p

erio

ds

afte

r th

e te

rmin

atio

n of

em

plo

ymen

t b

efor

e in

div

idua

ls fr

om a

com

pan

y th

at

is r

egul

ated

by

a go

vern

men

t ag

ency

can

wor

k in

thi

s go

vern

men

t ag

ency

and

vic

e ve

rsa48

62

63 6

5

X

►U

SA

- S

tate

Leg

isla

tive

Pro

hib

ition

s on

“R

evol

ving

D

oors

”, a

‘pra

ctic

e of

pub

lic o

ffici

als

or e

mp

loye

es

aban

don

ing

pub

lic s

ervi

ce fo

r lo

bb

ying

pos

ition

s’

Con

tinue

d

on October 7, 2020 by guest. P

rotected by copyright.http://bm

jopen.bmj.com

/B

MJ O

pen: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. D

ownloaded from

7Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082

Open access

Ind

ivid

uals

and

in

stit

utio

nsM

echa

nism

s id

enti

fied

thr

oug

h o

ur s

cop

ing

rev

iew

Typ

e o

f m

echa

nism

Exa

mp

les

whe

re t

hese

mec

hani

sms

have

bee

n ad

op

ted

(f

ully

or

to s

om

e ex

tent

)Tr

ansp

aren

cyM

anag

emen

t

Iden

tifi

cati

on,

m

oni

tori

ng a

nd

educ

atio

nP

rohi

bit

ion

Oth

er t

ype

Pro

ced

ural

gui

del

ines

for

com

mitt

ees

or a

dvi

sory

gro

ups

rela

ted

to

pub

lic h

ealth

on:

►

size

►

cons

titue

ncy

►

mem

ber

ship

►

role

►

mem

ber

s d

utie

s an

d r

ight

s

►p

ublic

dis

clos

ure

of t

he c

omp

ositi

on o

f the

gro

up

►p

ublic

dis

clos

ure

of t

he m

inut

es o

f the

mee

tings

►

pub

lic d

iscl

osur

e of

the

dec

lara

tions

of c

onfli

cts

of

inte

rest

for

all m

emb

ers

►

pot

entia

l exc

lusi

on o

f ind

ivid

uals

who

hav

e a

confl

ict

of in

tere

st66

That

mig

ht in

clud

e a

pro

hib

ition

for

any

per

son

emp

loye

d b

y sp

ecifi

c in

dus

trie

s re

late

d t

o he

alth

(eg,

tob

acco

ind

ustr

y) o

r an

y en

tity

wor

king

to

furt

her

thei

r in

tere

sts

to b

e a

mem

ber

of

any

gov

ernm

ent

bod

y, c

omm

ittee

or

advi

sory

gro

up t

hat

sets

or

imp

lem

ents

pub

lic h

ealth

pol

icy62

63

XX

XX

►

Bra

zil:

–B

razi

lian

Hea

lth R

egul

ator

y A

genc

y (A

nvis

a) -

D

ecre

e on

con

flict

of i

nter

est

rela

ted

to

wor

king

gr

oup

s –

Tob

acco

Con

trol

Inte

r- M

inis

teria

l Com

mis

sion

►

EU

- E

urop

ean

Food

Saf

ety

Aut

horit

y -

Dec

lara

tions

of

inte

rest

s -

Pan

el o

n nu

triti

on

►M

exic

o: –

Cha

mb

er o

f Dep

utie

s of

the

Hig

h C

ongr

ess

of

the

Uni

on -

Gen

eral

Sec

reta

ry -

Sec

reta

riat

of

Par

liam

enta

ry S

ervi

ces

- R

egul

atio

n of

the

Sci

entifi

c C

ounc

il fo

r th

e H

ealth

Ris

ks R

egul

ator

y A

genc

y –

Min

istr

y of

Hea

lth -

Eth

ics

and

Pre

vent

ion

of

Con

flict

s of

Inte

rest

Com

mitt

ee

Pol

icy

for

the

rece

ipt

of g

ifts

and

of d

onat

ions

to

ind

ivid

uals

in

gov

ernm

ent

(incl

udin

g p

rohi

biti

ons)

, as

wel

l as

pub

lic

dis

clos

ure

of t

he li

st o

f suc

h d

onat

ions

whe

n th

ese

are

per

mitt

ed48

62

63

XX

XX

►

Aus

tral

ia -

Aus

tral

ian

Pub

lic S

ervi

ce C

omm

issi

on -

Sec

t 4.

12 G

ifts

and

ben

efits

►

Bra

zil -

Cod

e of

Con

duc

t fo

r S

enio

r Fe

der

al

Ad

min

istr

atio

n 20

14

►C

anad

a -

Offi

ce o

f the

Con

flict

of I

nter

est

and

Eth

ics

Com

mis

sion

er -

Reg

istr

y of

gift

s

►E

U -

Eur

opea

n P

arlia

men

t -

Reg

iste

r of

gift

s -

8th

par

liam

enta

ry t

erm

Min

iste

rs’ a

nd o

ther

gov

ernm

ent

offic

ials

and

em

plo

yees

’ d

iary

pub

lic d

iscl

osur

es, w

ith a

n in

dic

atio

n of

dat

es, t

imes

, or

gani

satio

ns a

nd in

div

idua

ls m

et, a

s w

ell a

s p

urp

ose

and

m

inut

es o

f all

mee

tings

49 6

2 63

66

XX

►

Bra

zil:

–A

nvis

a -

Age

nda

of s

enio

r of

ficia

ls –

Pre

sid

ency

of t

he R

epub

lic -

Age

nda

of t

he

Pre

sid

ent

of t

he R

epub

lic: (

agen

da

avai

lab

le fo

r ot

her

gove

rnm

ent

offic

ials

)

►C

anad

a -

Gov

ernm

ent

of C

anad

a -

Mee

tings

and

co

rres

pon

den

ce o

n he

alth

y ea

ting

►

EU

- E

urop

ean

Par

liam

ent

- C

omm

ittee

s -

Dra

ft

agen

das

Pub

lic d

iscl

osur

e of

cor

resp

ond

ence

(inc

lud

ing

emai

ls)

and

tra

nscr

iptio

ns o

f tel

epho

ne c

onve

rsat

ions

bet

wee

n co

rpor

atio

ns (a

nd t

hird

par

ties

actin

g on

beh

alf o

f the

in

dus

try)

and

ind

ivid

uals

and

inst

itutio

ns in

gov

ernm

ent62

63

XX

►

Can

ada

- G

over

nmen

t of

Can

ada

- M

eetin

gs a

nd

corr

esp

ond

ence

on

heal

thy

eatin

g

►R

ussi

an F

eder

atio

n -

pub

lic d

iscl

osur

e is

incl

uded

in

the

Fed

eral

Law

N 1

5- FZ

of F

ebru

ary

23, 2

013

On

Pro

tect

ing

the

Hea

lth o

f Citi

zens

from

the

Effe

cts

of

Sec

ond

hand

Tob

acco

Sm

oke

and

the

Con

seq

uenc

es o

f To

bac

co C

onsu

mp

tion

Pub

lic d

iscl

osur

e of

the

list

and

con

tent

of s

ubm

issi

ons

(cur

rent

and

clo

sed

) to

pub

lic c

onsu

ltatio

ns o

n p

ublic

he

alth

issu

es, a

s w

ell a

s d

edic

ated

per

sonn

el t

o re

view

the

ev

iden

ce in

the

se s

ubm

issi

ons66

XX

►

Aus

tral

ia -

Aus

tral

ian

Nat

iona

l Hea

lth a

nd M

edic

al

Res

earc

h C

ounc

il (N

HM

RC

) - P

ublic

sub

mis

sion

s -

Op

en p

ublic

con

sulta

tions

►

EU

- E

urop

ean

Com

mis

sion

- C

onsu

ltatio

ns -

Pub

lic

Hea

lth

►U

SA

- U

S F

ood

and

Dru

g A

dm

inis

trat

ion

–Cod

e of

Fe

der

al R

egul

atio

ns T

itle

21 -

Foo

d a

nd D

rugs

Man

dat

ory

tax

for

com

pan

ies

to b

e us

ed b

y an

ind

epen

den

t or

gani

satio

n (g

over

nmen

t ag

ency

for

exam

ple

) to

fund

pub

lic

heal

th r

esea

rch

and

pra

ctic

e67

X

►M

ongo

lia -

Tob

acco

Con

trol

Act

, 200

5 (re

vise

d 2

012)

-

Cha

pte

r Th

ree

- Fi

nanc

ing

of t

obac

co c

ontr

ol a

ctiv

ities

: A

rtic

le 1

0 -

Hea

lth P

rom

otio

n Fo

und

atio

n: ‘T

he

Foun

dat

ion

shal

l be

com

pris

ed b

y th

e b

udge

t, e

qua

l to

2 p

erce

nt o

f tob

acco

exc

ise

tax.

’

Tab

le 1

C

ontin

ued

Con

tinue

d

on October 7, 2020 by guest. P

rotected by copyright.http://bm

jopen.bmj.com

/B

MJ O

pen: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. D

ownloaded from

8 Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082

Open access

Ind

ivid

uals

and

in

stit

utio

nsM

echa

nism

s id

enti

fied

thr

oug

h o

ur s

cop

ing

rev

iew

Typ

e o

f m

echa

nism

Exa

mp

les

whe

re t

hese

mec

hani

sms

have

bee

n ad

op

ted

(f

ully

or

to s

om

e ex

tent

)Tr

ansp

aren

cyM

anag

emen

t

Iden

tifi

cati

on,

m

oni

tori

ng a

nd

educ

atio

nP

rohi

bit

ion

Oth

er t

ype

Pub

lic a

vaila

bili

ty o

f com

pan

ies’

fina

ncia

l rep

orts

XX

►

Can

ada

- A

lber

ta S

ecur

ities

Com

mis

sion

- S

yste

m fo

r E

lect

roni

c D

ocum

ent

Ana

lysi

s an

d R

etrie

val (

SE

DA

R)

►

US

A -

US

Sec

urity

and

Com

mis

sion

Exc

hang

e: E

dga

r, co

mp

any

filin

gs

Pub

lic d

iscl

osur

e of

lega

l dis

put

es a

nd c

orre

spon

din

g d

ecis

ions

in w

hich

cor

por

atio

ns w

ere

and

are

invo

lved

XX

►

Bra

zil -

Sup

rem

e C

ourt

por

tal

►

Chi

le -

Sup

rem

e C

ourt

por

tal

Form

al fr

eed

om o

f Inf

orm

atio

n (F

OI)

req

uest

pro

cess

with

:

►p

roce

dur

es fo

r ac

cess

ing

info

rmat

ion,

incl

udin

g ju

stifi

able

and

rea

sona

ble

sea

rch

and

ret

rieva

l fee

s fo

r no

n- p

erso

nal i

nfor

mat

ion

►

narr

ow a

nd e

xplic

itly

iden

tified

lim

itatio

ns t

o d

iscl

osur

e re

qui

rem

ents

►

enfo

rcem

ent

mec

hani

sm

►d

ead

lines

for

the

rele

ase

of in

form

atio

n

►sa

nctio

ns fo

r no

n- co

mp

lianc

e

►p

roac

tive

dis

clos

ure

for

cert

ain

typ

e of

info

rmat

ion52

X

►A

ustr

alia

- N

HM

RC

- F

reed

om o

f Inf

orm

atio

n

►C

hile

- M

inis

try

Gen

eral

Sec

reta

riat

of t

he P

resi

den

cy -

La

w n

°20

285

on a

cces

s to

pub

lic in

form

atio

n

►C

olom

bia

– P

resi

den

cy o

f the

Rep

ublic

of C

olom

bia

-

Law

171

2 of

199

4 on

tra

nsp

aren

cy a

nd r

ight

to

acce

ss

to n

atio

nal p

ublic

info

rmat

ion

►

EU

- E

urop

ean

Com

mis

sion

- P

ublic

acc

ess

to

doc

umen

ts

►In

dia

- R

ight

to

Info

rmat

ion

Act

, 200

5

►M

exic

o -

Cha

mb

er o

f Dep

utie

s of

the

Hig

h C

ongr

ess

of t

he U

nion

- G

ener

al S

ecre

tary

- S

ecre

taria

t of

P

arlia

men

tary

Ser

vice

s -

Fed

eral

Law

of t

rans

par

ency

an

d a

cces

s to

pub

lic in

form

atio

n

►S

outh

Afr

ica

- S

outh

Afr

ican

Gov

ernm

ent

- P

rom

otio

n of

A

cces

s to

Info

rmat

ion

Act

2 o

f 200

0

FOI d

iscl

osur

e lo

g, c

onta

inin

g in

form

atio

n w

hich

has

bee

n re

leas

ed in

res

pon

se t

o an

FO

I acc

ess

req

uest

X

►A

ustr

alia

- N

HM

RC

- F

reed

om o

f Inf

orm

atio

n D

iscl

osur

e Lo

g

►B

razi

l - T

rans

par

ency

por

tal

►

Chi

le -

Tra

nsp

aren

cy p

orta

l

►Ire

land

- D

epar

tmen

t of

Hea

lth -

Fre

edom

of I

nfor

mat

ion

Req

uest

Log

►

UK

- H

ouse

of L

ord

s: F

OI R

eque

st L

ogs

- U

K P

arlia

men

t

Pol

icy

whi

ch a

ims

to m

inim

ise

ind

ustr

y in

volv

emen

t in

hea

lth

pol

icy-

mak

ing62

63

XX

►

Mon

golia

- T

obac

co C

ontr

ol A

ct, 2

005

(revi

sed

201

2) -

C

hap

ter

1: A

rtic

le 4

. Sta

te P

olic

y on

Tob

acco

Con

trol

►

Nep

al -

Tob

acco

Pro

duc

t C

ontr

ol a

nd R

egul

ator

y D

irect

ive

2014

- C

hap

ter

3: C

ontr

ollin

g In

terf

eren

ce in

P

olic

y- M

akin

g an

d Im

ple

men

tatio

n -

Man

ufac

ture

r an

d

Rel

ated

Par

ties

Pro

hib

ited

to

Par

ticip

ate

in T

obac

co

Pro

duc

t C

ontr

ol a

nd R

egul

ator

y Ta

sk

►U

gand

a -

Min

istr

y of

Hea

lth -

Tob

acco

Con

trol

Act

(2

015)

- P

art

VIII

- P

rote

ctio

n of

tob

acco

con

trol

pol

icie

s fr

om c

omm

erci

al a

nd o

ther

ves

ted

inte

rest

s of

the

to

bac

co in

dus

try

Pol

icy

to r

ejec

t p

artn

ersh

ips,

incl

udin

g in

res

earc

h, w

ith

spec

ific

ind

ustr

ies

(eg,

tob

acco

ind

ustr

y)62

63

68X

►

Mon

golia

- T

obac

co C

ontr

ol A

ct, 2

005

(revi

sed

201

2) -

C

hap

ter

2: A

rtic

le 8

. Ban

on

adve

rtis

ing,

pro

mot

ion

and

sp

onso

rshi

p o

f tob

acco

pro

duc

ts

►N

epal

- T

obac

co P

rod

uct

Con

trol

and

Reg

ulat

ory

Dire

ctiv

e 20

14 -

Cha

pte

r 3:

Con

trol

ling

Inte

rfer

ence

in

Pol

icy-

Mak

ing

and

Imp

lem

enta

tion

- P

rohi

biti

on o

n P

artn

ersh

ips

and

Par

ticip

atio

ns

►U

gand

a -

Min

istr

y of

Hea

lth -

Tob

acco

Con

trol

Act

(2

015)

- P

art

VIII

- P

rote

ctio

n of

tob

acco

con

trol

pol

icie

s fr

om c

omm

erci

al a

nd o

ther

ves

ted

inte

rest

s of

the

to

bac

co in

dus

try

Tab

le 1

C

ontin

ued

Con

tinue

d

on October 7, 2020 by guest. P

rotected by copyright.http://bm

jopen.bmj.com

/B

MJ O

pen: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. D

ownloaded from

9Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082

Open access

Ind

ivid

uals

and

in

stit

utio

nsM

echa

nism

s id

enti

fied

thr

oug

h o

ur s

cop

ing

rev

iew

Typ

e o

f m

echa

nism

Exa

mp

les

whe

re t

hese

mec

hani

sms

have

bee

n ad

op

ted

(f

ully

or

to s

om

e ex

tent

)Tr

ansp

aren

cyM

anag

emen

t

Iden

tifi

cati

on,

m

oni

tori

ng a

nd

educ

atio

nP

rohi

bit

ion

Oth

er t

ype

Reg

ulat

ion

to r

estr

ict

dire

ct in

dus

try

cont

ribut

ions

to

civi

l so

ciet

y or

gani

satio

ns69

X

►M

ongo

lia -

Tob

acco

Con

trol

Act

, 200

5 (re

vise

d 2

012)

-

Cha

pte

r 2:

Art

icle

8. B

an o

n ad

vert

isin

g, p

rom

otio

n an

d

spon

sors

hip

of t

obac

co p

rod

ucts

- ‘I

t sh

all b

e p

rohi

bite

d

to p

rovi

de

finan

cial

, mat

eria

l aid

s an

d c

ontr

ibut

ions

to

soci

al, h

ealth

, wel

fare

and

env

ironm

enta

l org

anis

atio

ns

by

the

tob

acco

ind

ustr

y or

thr

ough

ano

ther

or

gani

satio

ns u

nder

the

nam

e of

“S

ocia

l res

pon

sib

ility

”’

Pro

tect

ion

of w

hist

le- b

low

ers

and

inve

stig

ativ

e re

por

ters

,47 4

8 w

hich

cou

ld in

clud

e:

►gu

aran

tee

of c

onfid

entia

lity

►

secu

re c

omm

unic

atio

n

►le

gal a

ssis

tanc

e

►ci

vil a

nd c

rimin

al s

anct

ions

aga

inst

the

per

pet

rato

rs o

f re

talia

tion

agai

nst

whi

stle

- blo

wer

s

X

►A

fric

a -

Pla

tfor

m t

o P

rote

ct W

hist

le- B

low

ers

in A

fric

a

►C

anad

a -

Gov

ernm

ent

of C

anad

a -

Just

ice

Law

s w

ebsi

te -

Crim

inal

Cod

e

►Fr

ance

- M

aiso

n d

es la

nceu

rs d

’ale

rte

(Hou

se o

f w

hist

le- b

low

ers)

Lob

byi

ng r

egul

atio

n47 4

9 50

62

63 w

hich

:

►p

rovi

des

a c

lear

and

una

mb

iguo

us d

efini

tion

of lo

bb

yist

an

d lo

bb

ying

act

iviti

es t

arge

ted

by

regu

latio

n50

►

set

stan

dar

ds

for

exp

ecte

d b

ehav

iour

, for

exa

mp

le, t

o av

oid

mis

use

of c

onfid

entia

l inf

orm

atio

n, c

onfli

ct o

f in

tere

st a

nd p

reve

nt r

evol

ving

doo

r p

ract

ices

►

incl

udes

pro

ced

ures

for

secu

ring

com

plia

nce,

in a

co

here

nt s

pec

trum

of s

trat

egie

s an

d m

echa

nism

s,

incl

udin

g m

onito

ring

and

enf

orce

men

t

►in

clud

es a

5- y

ear

ban

on

lob

byi

ng fo

r fo

rmer

min

iste

rs,

min

iste

rial s

taffe

rs a

nd s

enio

r p

ublic

ser

vant

s

►in

clud

es m

and

ator

y p

enal

ties

in c

ase

of t

he p

rovi

sion

of

fals

e or

mis

lead

ing

info

rmat

ion

in a

ccor

dan

ce w

ith

natio

nal l

aw

XX

X

►C

hile

- M

inis

try

Gen

eral

Sec

reta

riat

of t

he P

resi

den

cy

- P

latf

orm

Lob

by

Law

- C

ode

of g

ood

pra

ctic

es fo

r lo

bb

yist

s

Pub

lic d

iscl

osur

e of

lob

byi

sts

and

info

rmat

ion

on o

bje

ctiv

es,

ben

efici

arie

s, fu

ndin

g so

urce

s an

d t

arge

ts49

50

62 6

3 70

XX

►

Aus

tral

ia -

Aus

tral

ian

Gov

ernm

ent

Lob

byi

sts

Reg

iste

r

►C

hile

- M

inis

try

Gen

eral

Sec

reta

riat

of t

he P

resi

den

cy -

P

latf

orm

Lob

by

Law

- R

egis

try

of lo

bb

yist

s

►Fr

ance

- H

igh

Aut

horit

y fo

r Tr

ansp

aren

cy in

Pub

lic L

ife -

R

egis

try

of L

obb

yist

s

►U

SA

- O

ffice

of t

he c

lerk

- H

ouse

of R

epre

sent

ativ

es -

Lo

bb

ying

Dis

clos

ure

Pol

icy

that

pro

hib

its g

over

nmen

t to

end

orse

, sup

por

t,

par

tner

with

or

par

ticip

ate

in in

dus

try

spon

sore

d a

ctiv

ities

, in

clud

ing

‘cor

por

ate

soci

al r

esp

onsi

bili

ty’ (

eg, t

obac

co

ind

ustr

y)62

63

X

►N

epal

- T

obac

co P

rod

uct

Con

trol

and

Reg

ulat

ory

Dire

ctiv

e 20

14 -

Cha

pte

r 3:

Con

trol

ling

Inte

rfer

ence

in

Pol

icy

Mak

ing

and

Imp

lem

enta

tion

- P

rohi

biti

on o

n A

ssum

ing

Org

aniz

atio

nal S

ocia

l Res

pon

sib

ility

- –

‘The

pub

lic a

genc

y of

ficia

ls a

re p

rohi

bite

d fr

om

par

ticip

atin

g in

any

tob

acco

ind

ustr

y sp

onso

red

p

rogr

amm

es t

o ac

cep

t as

sist

ance

or

awar

ds,

as

wel

l as

par

ticip

ate

in n

atio

nal a

nd in

tern

atio

nal

pro

gram

mes

like

mee

tings

, trip

s, t

rain

ing,

sem

inar

s an

d c

onfe

renc

es o

rgan

ised

with

invi

tatio

n an

d

assi

stan

ce fr

om t

obac

co in

dus

trie

s.’

►

‘It is

pro

hib

ited

to

acce

pt

tob

acco

ind

ustr

y as

sist

ance

or

col

lab

orat

ion

offe

red

in t

he n

ame

of e

duc

atio

nal

dev

elop

men

t, e

thni

c or

soc

ial c

lass

up

liftm

ent

or

sup

por

ting

emer

genc

y se

rvic

es; a

nd m

anuf

actu

rers

an

d r

elat

ed p

artie

s ar

e p

rohi

bite

d fr

om p

rovi

din

g su

ch

assi

stan

ce’

Tab

le 1

C

ontin

ued

Con

tinue

d

on October 7, 2020 by guest. P

rotected by copyright.http://bm

jopen.bmj.com

/B

MJ O

pen: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. D

ownloaded from

10 Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082

Open access

Ind

ivid

uals

and

in

stit

utio

nsM

echa

nism

s id

enti

fied

thr

oug

h o

ur s

cop

ing

rev

iew

Typ

e o

f m

echa

nism

Exa

mp

les

whe

re t

hese

mec

hani

sms

have

bee

n ad

op

ted

(f

ully

or

to s

om

e ex

tent

)Tr

ansp

aren

cyM

anag

emen

t

Iden

tifi

cati

on,

m

oni

tori

ng a

nd

educ

atio

nP

rohi

bit

ion

Oth

er t

ype

Aw

aren

ess

rais

ing

activ

ities

to

info

rm a

nd e

duc

ate

all

bra

nche

s of

gov

ernm

ent

and

the

pub

lic a

bou

t th

e na

ture

of

harm

ful p

rod

ucts

, the

nee

d t

o p

rote

ct p

ublic

hea

lth p

olic

ies

from

com

mer

cial

and

oth

er v

este

d in

tere

sts

of c

orp

orat

ions

(e

g, t

obac

co in

dus

try)

and

the

str

ateg

ies

and

tac

tics

used

by

the

ind

ustr

y to

inte

rfer

e w

ith t

he s

ettin

g an

d im

ple

men

tatio

n of

pub

lic h

ealth

pol

icie

s:

►go

vern

men

tal a

dm

inis

trat

ive

circ

ular

s (c

ircul

ars)

;

►m

eetin

gs, w

orks

hop

s, p

rese

ntat

ions

and

con

sulta

tions

(m

eetin

gs);

►

trai

ning

bas

ed m

easu

res

(trai

ning

), in

whi

ch a

war

enes

s ra

isin

g is

em

bed

ded

in t

he t

rain

ing

of c

ivil

serv

ants

and

le

gal a

dvi

ser

of g

over

nmen

t m

inis

trie

s;

►in

tra-

gove

rnm

enta

l ad

voca

cy b

y he

alth

min

istr

ies

(or

spec

ific

agen

cies

) aim

ed a

t p

rovi

din

g in

telli

genc

e to

ot

her

par

ts o

f gov

ernm

ent

targ

eted

by

the

ind

ustr

y in

the

con

text

of s

pec

ific

pol

icy

confl

icts

(int

ra-

gove

rnm

enta

l ad

voca

cy);

►

ongo

ing

cam

pai

gns

by

natio

nal,

regi

onal

and

loca

l he

alth

offi

cial

s ai

med

at

high

light

ing

the

pol

icy

valu

e of

pro

tect

ing

heal

th p

olic

y fr

om in

dus

try

inte

rfer

ence

(c

amp

aign

ing)

;

►m

ass

med

ia c

amp

aign

s w

hich

use

loca

l tel

evis

ion

adve

rtis

emen

ts, n

ewsp

aper

art

icle

s, r

adio

cal

l in

show

s an

d w

ebsi

tes

to r

aise

aw

aren

ess

of in

dus

try

inte

rfer

ence

am

ong

the

gene

ral p

ublic

(pub

lic a

war

enes

s ra

isin

g).48

62

63 6

8

X

►D

jibou

ti -

Law

n°1

75/A

N/0

7/5

L C

once

rnin

g O

rgan

izat

ion

for

the

Pro

tect

ion

of H

ealth

aga

inst

the

Tob

acco

Hab

it -

Cha

pte

r V

III: E

duc

atio

n, c

omm

unic

atio

n an

d p

ublic

aw

aren

ess

►

Nep

al -

Tob

acco

Pro

duc

t C

ontr

ol a

nd R

egul

ator

y D

irect

ive

2014

Cha

pte

r 4:

Dev

elop

Pub

lic A

war

enes

s an

d M

ake

Pub

lic P

lace

s S

mok

e an

d T

obac

co

Con

sum

ptio

n Fr

ee

►P

anam

a -

Min

istr

y of

Hea

lth -

Res

olut

ion

No.

745

on

the

Nat

iona

l Com

mis

sion

for

the

Stu

dy

of T

obac

co

Pol

itica

l par

ties

and

co

mm

issi

ons

in c

harg

e of

el

ectio

ns c

amp

aign

s

Reg

ulat

ion

of t

he fu

ndin

g of

pol

itica

l par

ties

and

ele

ctio

ns

cam

pai

gns:

49 5

1 62

63

►

timel

y, r

elia

ble

, acc

essi

ble

and

inte

lligi

ble

pub

lic

dis

clos

ure

of d

onat

ions

►

pro

hib

ition

s fo

r ce

rtai

n ty

pe

of p

rivat

e co

ntrib

utio

ns

such

as

fore

ign

inte

rest

s or

cor

por

atio

ns

►in

form

atio

n ab

out

third

par

ties

actin

g on

beh

alf o

f the

in

dus

try

►

limits

on

don

atio

ns

►lim

its o

n an

onym

ous

don

atio

ns

►sa

nctio

ns fo

r vi

olat

ors

of t

he la

w

►in

dep

end

ent

and

effi

cien

t ov

ersi

ght

XX

XX

►

Bra

zil -

Sup

erio

r E

lect

oral

Cou

rt:

–A

ccou

ntab

ility

of c

and

idat

es a

nd p

oliti

cal p

artie

s –

Dis

clos

ure

of E

lect

ion

Can

did

atur

es A

ccou

nts

►

Chi

le -

Ele

ctor

al S

ervi

ce -

Don

atio

nsFr

ance

- N

atio

nal A

ssem

bly

- F

inan

cing

of p

oliti

cal l

ife:

par

ties

and

ele

ctor

al c

amp

aign

s

CO

I, co

nflic

ts o

f int

eres

t.

Tab

le 1

C

ontin

ued

on October 7, 2020 by guest. P

rotected by copyright.http://bm

jopen.bmj.com

/B

MJ O

pen: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. D

ownloaded from

11Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082

Open access

Many countries and international organisations have internal policies and procedures to manage COI, some of which require the disclosure of these interests to the public. There are, in addition, existing tools that can help in assessing risks to individuals and institutions in public health when they are considering engaging with corpora-tions, such as the Purpose, Extent, Relevant- harm, Iden-tifiers, Link (PERIL) indicators53 or the decision- making tool developed by the WHO for the prevention and management of COI in nutrition programmes.54

For 22 of the 23 mechanisms identified in our scoping review, we found evidence of their adoption, in different parts of the world, to various degrees. Many of the examples identified in table 1 refer to the interactions of governments and international organisations with the tobacco industry, following the ratification of the WHO FCTC. However, no country, to date, has entirely restricted the influence of corporations on public policy.

Academia, the media and the civil societyWe identified, through our systematic searches, 26 mech-anisms for addressing and managing the influence of corporations on academia, the media and the civil society (table 2).

Individuals and institutions in academia, the media and the civil society (including public health professionals, civil society organisations, and so on) often engage with corporations, through the sponsorship of events, funding of research project, scientific awards or other types of interactions. These are standard practices, and while there are multiple reasons for them to happen, the scar-city of public funding and the vast resources of corpora-tions are often mentioned.43 There is, however, growing concern that the influence of the industry poses threats to the independence, integrity and credibility of these individuals and institutions.29 55–61

We found examples, from across the world, where these 21 of these 26 mechanisms have been adopted. Some universities refuse funding from the tobacco industry; some make transparent interactions between their staff members, students and corporations. Many institutions in academia and civil society have conflicts of interest poli-cies, which is also the case for some scientific journals and professionals associations. The provision of education in universities, conferences and other meetings and to jour-nalists was also cited.

DisCussiOnOur searches identified 49 mechanisms for addressing and/or managing the influence of corporations on public health policy, research and practice. The primary purposes of the mechanisms identified are to manage conflicts of interest and increase the transparency of public- private interactions. Based on publicly available information, we found that 43 of these mechanisms had been adopted, although we could not confirm that they

had all been implemented and had been determined to be effective.

There is currently limited research in this area, with only a few peer- reviewed scientific articles published in the literature. We also noted that there is a lack of research from low- income or middle- income countries. We identified limited evidence on mechanisms targeted at the media and the civil society, compared with those targeted at governments and academia. We found no information for schools on ways to address and manage the influence of corporations on their institutions, in relation to public health (for example, through the provi-sion of health or nutrition education or physical activity programmes). We identified limited information about mechanisms that could address the influence of corpo-rations; most mechanisms seek to manage that influence (through transparency, for example). Managing the influence of corporations is an important first step, but is not sufficient, or could even be counterproductive in some circumstances.44

To our knowledge, this review is the first attempt to develop an inventory of mechanisms to address and manage the influence of corporations on public health policy, research and practice. Among its strengths is its breadth. Although we limited our searches to mecha-nisms developed to address and/or manage the influence of the alcohol, food, gambling, oil, pharmaceutical and tobacco industries, many of the mechanisms identified in our review were developed with no restriction on the type of industries targeted. Hence this inventory may help in building efforts to address and/or manage the influence of all types of industries.

The list compiled here is non- exhaustive and by nature, subject to changes, as an increasing number of govern-ments and other institutions take measures to prevent undue influence from industry. It rather was intended to be a first attempt to identify mechanisms that exist across the globe, as well as examples where these mechanisms have been adopted. It thus provides a firm footing for further work in this area.

In this scoping review, we did not assess the quality of the included studies, as we only used them to identify mechanisms. In addition, mechanisms at the subnational level were not included here and might be the subject of future investigations. Moreover, we excluded work funded by the industry, but it is possible that some authors did not declare their sources of funding in the publications. In this case, their work is included in our analysis, which represents a COI with regards to the issues at stake.

Ideally, corporations should refrain from influencing public health policy, research and practice. Governments, international organisations, academia, the media and the civil society should avoid interacting with corporations whose interests risk damaging their independence, integ-rity and credibility.43 However, in reality, these interactions often are the default approach in public health, prob-ably driven by a strong influence exerted by businesses.43 These interactions, the reasons for them to happen and

on October 7, 2020 by guest. P

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pen: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. D

ownloaded from

12 Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082

Open access

Tab

le 2

M

echa

nism

s fo

r ad

dre

ssin

g an

d/o

r m

anag

ing

the

influ

ence

of c

orp

orat

ions

on

pub

lic h

ealth

res

earc

h an

d p

ract

ice

(non

- exh

aust

ive)

Ind

ivid

uals

and

in

stit

utio

nsM

echa

nism

s id

enti

fied

thr

oug

h o

ur s

cop

ing

rev

iew

Typ

e o

f m

echa

nism

Exa

mp

les

whe

re t

hese

mec

hani

sms

have

bee

n ad

op

ted

(ful

ly o

r to

so

me

exte

nt)

Tran

spar

ency

Man

agem

ent

Iden

tifi

cati

on,

m

oni

tori

ng a

nd

educ

atio

nP

rohi

bit

ion

Oth

er

typ

e

Uni

vers

ities

and

oth

er

rese

arch

inst

itutio

ns*

Pol

icy

on c

onfli

cts

of in

tere

st a

nd e

xter

nal e

ngag

emen

t th

at

incl

udes

:40 6

8 71

–74

►

a cl

ear

and

rea

listic

des

crip

tion

of c

ircum

stan

ces

and

re

latio

nshi

ps

that

can

lead

to

a co

nflic

t- of

- int

eres

t

►in

form

atio

n ab

out

who

m t

o ac

cep

t fu

ndin

g fr

om (i

nclu

din

g re

stric

tions

on

fund

ing

from

sp

ecifi

c in

dus

trie

s, s

uch

as t

he

tob

acco

ind

ustr

y), b

ased

on

a ris

ks a

naly

sis

►

info

rmat

ion

abou

t ho

w c

onfli

cts

of in

tere

st, b

oth

at t

he

ind

ivid

ual a

nd in

stitu

tiona

l lev

els,

will

be

add

ress

ed (a

nd

avoi

ded

, if n

eces

sary

), re

por

ted

, rev

iew

ed, d

ocum

ente

d,

man

aged

or

elim

inat

ed, a

s w

ell s

anct

ions

in c

ase

of n

on-

com

plia

nce

with

the

pol

icy

►

req

uire

men

ts fo

r fu

ll d

iscl

osur

e of

fund

ing

sour

ces

and

fin

anci

al in

tere

sts

in r

esea

rch

pub

licat

ions

and

med

ia

rele

ases

►

req

uire

men

ts fo

r co

ntin

uous

rep

ortin

g fr

om p

roje

cts

with

ind

ustr

y fu

ndin

g if

inst

itutio

nal p

olic

y p

erm

its a

ctiv

e m

anag

emen

t of

ob

viou

s co

nflic

ts o

f int

eres

ts

►no

mon

ey s

houl

d b

e ac

cep

ted

if it

exp

licitl

y co

nstr

ains

the

ca

pab

ility

of i

nstit

utio

ns t

o d

o th

eir

wor

k w

ithou

t in

terf

eren

ce

from

the

fund

er71

►

Inst

itutio

ns s

houl

d n

ot a

ccep

t m

oney

, if d

oing

so

pus

hes

them

to

be

som

ethi

ng t

hat

is n

ot c

onsi

sten

t w

ith t

heir

mis

sion

(eg,

to

pro

mot

e th

e he

alth

of t

he p

ublic

)71 7

4

XX

XX

►

Aus

tral

ia –

Dea

kin

Uni

vers

ity -

‘the

Uni

vers

ity m

ust

not

acce

pt

dire

ct o

r in

dire

ct fu

ndin

g fr

om o

r en

ter

into

any

par

tner

ship

or

othe

r ar

rang

emen

t w

ith t

he t

obac

co in

dus

try,

an

orga

nisa

tion

in t

he t

obac

co in

dus

try

or fr

om a

foun

dat

ion

that

acc

epts

fu

nds

from

the

tob

acco

ind

ustr

y.’

–Th

e U

nive

rsity

of S

ydne

y -

ban

on

acce

pta

nce

of fu

ndin

g fr

om t

obac

co c

omp

anie

s –

The

Uni

vers

ity o

f Syd

ney,

Cha

rles

Per

kins

Cen

tre

- E

ngag

emen

t w

ith in

dus

try

guid

elin

es

►U

SA

- A

mer

ican

Ass

ocia

tion

of U

nive

rsity

Pro

fess

ors

- R

ecom

men

ded

Prin

cip

les

to G

uid

e A

cad

emy-

Ind

ustr

y R

elat

ions

hip

s

►U

SA

- N

atio

nal I

nstit

utes

of H

ealth

- F

inan

cial

Con

flict

of I

nter

est

Pub

lic d

iscl

osur

e an

d r

epor

ting

to t

he in

stitu

tion’

s co

nflic

t of

in

tere

st c

omm

ittee

of:

►

the

dec

lara

tions

of c

onfli

cts

of in

tere

sts

of in

div

idua

ls,

thro

ugho

ut a

ll st

ages

of d

esig

n, im

ple

men

tatio

n an

d

rep

ortin

g66 6

8 71

74–

77

►

fund

ing

sour

ces

and

oth

er d

onat

ions

from

cor

por

atio

ns (a

nd

third

par

ties

actin

g on

beh

alf o

f the

ind

ustr

y) t

o in

div

idua

ls

and

inst

itutio

ns

►fe

llow

ship

s, a

war

ds

and

oth

er p

rizes

from

cor

por

atio

ns (a

nd

third

par

ties

actin

g on

beh

alf o

f the

ind

ustr

y) t

o in

div

idua

ls

and

inst

itutio

ns

X

X

►A

ustr

alia

–Th

e U

nive

rsity

of S

ydne

y -

Sch

ool o

f Mol

ecul

ar B

iosc

ienc

e -

Sch

olar

ship

s an

d P

rizes

–Fl

ind

ers

Uni

vers

ity -

Sch

ool o

f Hea

lth S

cien

ce –

Stu

den

t p

rizes

►

US

A -

The

Uni

vers

ity o

f Cal

iforn

ia -

Gen

eral

Uni

vers

ity P

olic

y-

AP

M -

025

reg

ard

ing

acad

emic

ap

poi

ntee

s -

Con

flict

of

Com

mitm

ent

and

Out

sid

e A

ctiv

ities

of F

acul

ty M

emb

ers

Pol

icy

on a

cad

emic

free

dom

, aut

onom

y an

d c

ontr

ol71

X

►

Fran

ce -

Ed

ucat

ion

Cod

e, L

952-

2 on

aca

dem

ic fr

eed

om

►N

ew Z

eala

nd -

Ed

ucat

ion

Act

198

9 N

o 80

, Pub

lic A

ct 1

61

Aca

dem

ic fr

eed

om

Pol

icy

on a

cad

emic

pub

licat

ion

right

s40 6

8 74

X

►

US

A -

Sta

ndfo

rd U

nive

rsity

- S

tand

ford

Uni

vers

ity in

dus

tria

l co

ntra

cts

offic

e -

Res

earc

her’s

Gui

de

to W

orki

ng w

ith In

dus

try

Pro

visi

on o

f ed

ucat

ion

to s

tud

ents

on

how

to

eval

uate

in

form

atio

n p

rovi

ded

by

corp

orat

ions

X

►U

SA

- S

truc

ture

d P

harm

aceu

tical

Rep

rese

ntat

ive

Inte

ract

ions

an

d C

ount

erd

etai

ling

sess

ions

as

Com

pon

ents

of M

edic

al

Res

iden

t E

duc

atio

n78

Con

tinue

d

on October 7, 2020 by guest. P

rotected by copyright.http://bm

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/B

MJ O

pen: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. D

ownloaded from

13Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082

Open access

Ind

ivid

uals

and

in

stit

utio

nsM

echa

nism

s id

enti

fied

thr

oug

h o

ur s

cop

ing

rev

iew

Typ

e o

f m

echa

nism

Exa

mp

les

whe

re t

hese

mec

hani

sms

have

bee

n ad

op

ted

(ful

ly o

r to

so

me

exte

nt)

Tran

spar

ency

Man

agem

ent

Iden

tifi

cati

on,

m

oni

tori

ng a

nd

educ

atio

nP

rohi

bit

ion

Oth

er

typ

e

Res

earc

h fu

ndin

g co

mm

ittee

s, p

anel

s or

b

oard

s

Pol

icy

to e

nsur

e th

at:75

►

rese

arch

prio

ritie

s an

d t

he d

istr

ibut

ion

of fu

ndin

g is

d

eter

min

ed b

y re

sear

cher

s w

ho h

ave

not

rece

ived

dire

ct o

r in

dire

ct (t

hrou

gh t

hird

inst

itutio

ns) f

und

ing

from

cor

por

atio

ns

►ac

adem

ic r

evie

wer

s sh

ould

not

incl

ude

thos

e w

ho h

ave

acce

pte

d fu

ndin

g in

the

pas

t 3

year

s fr

om in

dus

try

who

hav

e a

confl

ict

of in

tere

st in

the

res

earc

h to

be

cond

ucte

d

X

X

►U

K -

Nat

iona

l Hea

lth S

ervi

ce (N

HS

) Eng

land

- M

anag

ing

Con

flict

s of

Inte

rest

: Sta

tuto

ry G

uid

ance

for

Clin

ical

Com

mis

sion

Gro

ups

and

Con

flict

s of

inte

rest

man

agem

ent

tem

pla

tes,

incl

udin

g re

gist

ers

of g

ifts

and

hos

pita

lity

►

UK

– W

ellc

ome

- C

onfli

cts

of in

tere

st p

olic

y

►U

SA

- N

atio

nal I

nstit

utes

of H

ealth

(NIH

) - F

inan

cial

Con

flict

s of

In

tere

st fo

r A

war

dee

s -

stan

dar

d o

per

atin

g p

roce

dur

e

Pol

icy

for

gove

rnm

ent

to c

ond

uct

clin

ical

tria

ls a

nd o

ther

res

earc

h ac

tiviti

es in

volv

ing

pat

ient

s or

to

choo

se t

he r

esea

rche

rs w

ho

wou

ld d

esig

n an

d c

ond

uct

the

test

s79

X

Pub

lic r

egis

try

of a

ll cl

inic

al t

rials

and

oth

er r

esea

rch

activ

ities

in

volv

ing

pat

ient

s w

ith in

form

atio

n on

the

stu

dy

des

ign,

met

hod

s an

d fu

ll re

sults

.40 6

6 72

79–

81

Pub

licat

ion

of a

ll re

leva

nt d

ata,

out

com

es a

nd r

esul

ts o

f clin

ical

tr

ials

and

oth

er r

esea

rch

activ

ities

invo

lvin

g p

atie

nts,

incl

udin

g nu

ll re

sults

, ad

vers

e ef

fect

s an

d s

top

pin

g ru

les,

ad

min

istr

ated

an

d m

onito

red

by

an in

dep

end

ent

inst

itutio

n.66

68

79–8

1

X

XX

►

US

A -

Clin

ical

Tria

ls.g

ov -

a p

ublic

dat

abas

e op

erat

ed b

y th

e N

IH

(mos

t cl

inic

al t

rials

are

con

duc

ted

by

pha

rmac

eutic

al c

omp

anie

s)

Eth

ics

revi

ew b

oard

sP

olic

y to

ass

ess

the

app

rop

riate

ness

of f

und

er–r

esea

rche

r re

latio

nshi

ps72

X

►

Ger

man

y -

Inst

itute

for

Ther

apy

Res

earc

h M

unic

h -

Pol

icy

on

Com

pet

ing

Inte

rest

s

►In

tern

atio

nal -

Wor

ld M

edic

al A

ssoc

iatio

n D

ecla

ratio

n of

H

elsi

nki -

Eth

ical

Prin

cip

les

for

Med

ical

Res

earc

h In

volv

ing

Hum

an S

ubje

cts

- E

thic

s C

omm

ittee

s -

‘Thi

s co

mm

ittee

mus

t b

e tr

ansp

aren

t in

its

func

tioni

ng, m

ust

be

ind

epen

den

t of

the

re

sear

cher

, the

sp

onso

r an

d a

ny o

ther

und

ue in

fluen

ce a

nd m

ust

be

dul

y q

ualifi

ed’

Tab

le 2

C

ontin

ued

Con

tinue

d

on October 7, 2020 by guest. P

rotected by copyright.http://bm

jopen.bmj.com

/B

MJ O

pen: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. D

ownloaded from

14 Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082

Open access

Ind

ivid

uals

and

in

stit

utio

nsM

echa

nism

s id

enti

fied

thr

oug

h o

ur s

cop

ing

rev

iew

Typ

e o

f m

echa

nism

Exa

mp

les

whe

re t

hese

mec

hani

sms

have

bee

n ad

op

ted

(ful

ly o

r to

so

me

exte

nt)

Tran

spar

ency

Man

agem

ent

Iden

tifi

cati

on,

m

oni

tori

ng a

nd

educ

atio

nP

rohi

bit

ion

Oth

er

typ

e

Aca

dem

ic jo

urna

lsP

olic

y to

rej

ect

man

uscr

ipts

fund

ed b

y or

writ

ten

by

cont

ribut

ors

from

sp

ecifi

c in

dus

trie

s (a

nd t

hird

par

ties

actin

g on

beh

alf o

f the

in

dus

try)

82 8

3

X

►In

tern

atio

nal -

Coc

hran

e p

olic

y on

com

mer

cial

sp

onso

rshi

p o

f C

ochr

ane

Rev

iew

s an

d C

ochr

ane

Gro

up

►In

tern

atio

nal -

Jou

rnal

of H

uman

Lac

tatio

n d

oes

no p

ublis

h re

sear

ch fu

nded

by

com

pan

ies

that

are

not

com

plia

nt w

ith W

HO

C

ode

on t

he M

arke

ting

of B

reas

t- M

ilk S

ubst

itute

s

►In

tern

atio

nal -

Tob

acco

con

trol

, BM

J, H

eart

, Tho

rax,

BM

J O

pen

, P

LoS

Med

icin

e, P

LoS

One

, PLo

S B

iolo

gy, J

ourn

al o

f Hea

lth

Psy

chol

ogy,

jour

nals

pub

lishe

d b

y th

e A

mer

ican

Tho

raci

c S

ocie

ty

- d

o no

t p

ublis

h re

sear

ch fu

nded

by

the

tob

acco

ind

ustr

y

Pol

icy

to d

isco

urag

e in

div

idua

ls fr

om e

ngag

ing

in in

dus

try-

led

‘g

host

- writ

ing’

or

ghos

t au

thor

ship

77

X

►N

euro

logy

Jou

rnal

s -

Aut

hors

hip

and

Dis

clos

ures

►

Ann

als

of In

tern

al M

edic

ine

- E

xorc

isin

g G

host

s an

d U

nwel

com

e G

uest

s

Pol

icy

for

add

ress

ing,

man

agin

g, t

hrou

gh d

ecla

ratio

ns a

nd

dis

clos

ure,

con

flict

s of

inte

rest

s fo

r ed

itors

68 7

2 75

XX

X

►In

tern

atio

nal -

the

BM

J -

Sta

ff d

ecla

ratio

ns

►In

tern

atio

nal -

Pub

lic H

ealth

Nut

ritio

n -

Ed

itors

con

flict

of i

nter

est

stat

emen

ts

►In

tern

atio

nal S

ocie

ty o

f Ad

dic

tion

Jour

nal E

dito

rs -

dec

lara

tions

of

con

flict

s of

inte

rest

for

cont

ribut

ors

and

ed

itors

Pol

icy

incl

udin

g:

►a

man

dat

ory

dec

lara

tion

and

dis

clos

ure

of c

onfli

cts

of

inte

rest

s fo

r co

ntrib

utor

s (w

hich

wou

ld in

clud

e d

etai

ls

abou

t co

nflic

ts w

ith t

hird

par

ties

actin

g on

beh

alf o

f the

in

dus

try)

68 7

2 73

75

77 8

2 83

►

a p

ositi

ve s

tate

men

t th

at a

ll co

ntrib

utor

s in

a p

ublic

atio

n ha

d

com

ple

te c

ontr

ol o

ver

the

rese

arch

pro

cess

72 7

7

►

a st

atem

ent,

in t

he m

etho

ds

sect

ion,

ab

out

the

role

of t

he

fund

ing

sour

ce in

the

des

ign,

con

duc

t, a

naly

sis

and

rep

ortin

g of

the

dat

a73 7

7

►

add

ition

al s

tep

s th

at w

ill b

e un

der

take

n b

y th

e jo

urna

l to

obta

in t

he m

ost

mea

ning

ful d

iscl

osur

es fr

om a

utho

rs, s

uch

as q

uick

sea

rch

of t

he t

obac

co in

dus

try

doc

umen

ts fo

r th

e na

mes

of a

utho

rs o

f pap

ers

on t

obac

co o

r th

e in

vita

tion

of

a p

eer

revi

ewer

with

tob

acco

ind

ustr

y d

ocum

ent

rese

arch

ex

per

ienc

e73

X

XX

►

Inte

rnat

iona

l Com

mitt

ee o

f Med

ical

Jou

rnal

Ed

itors

(IC

MJE

) -

Con

flict

of I

nter

est

form

Pol

icy

that

req

uire

s th

at a

ll tr

ials

be

regi

ster

ed a

t th

e tim

e of

in

itiat

ion

of t

he s

tud

y83X

X

X

►U

SA

- A

mer

ican

Jou

rnal

of C

linic

al N

utrit

ion

- in

form

atio

n fo

r au

thor

s: fo

rmat

and

sty

le r

equi

rem

ents

Pol

icy

to e

nsur

e th

at a

dve

rtis

ing

reve

nue

is in

dep

end

ent

of

corp

orat

ions

tha

t ha

ve a

con

flict

of i

nter

est

with

the

jour

nal’s

m

ain

mis

sion

79

X

►In

tern

atio

nal -

BM

J -

The

BM

J an

d s

iste

r jo

urna

ls n

o lo

nger

car

ry

adve

rtis

emen

ts fo

r b

reas

tmilk

sub

stitu

tes

Tab

le 2

C

ontin

ued

Con

tinue

d

on October 7, 2020 by guest. P

rotected by copyright.http://bm

jopen.bmj.com

/B

MJ O

pen: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. D

ownloaded from

15Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082

Open access

Ind

ivid

uals

and

in

stit

utio

nsM

echa

nism

s id

enti

fied

thr

oug

h o

ur s

cop

ing

rev

iew

Typ

e o

f m

echa

nism

Exa

mp

les

whe

re t

hese

mec

hani

sms

have

bee

n ad

op

ted

(ful

ly o

r to

so

me

exte

nt)

Tran

spar

ency

Man

agem

ent

Iden

tifi

cati

on,

m

oni

tori

ng a

nd

educ

atio

nP

rohi

bit

ion

Oth

er

typ

e

Pro

fess

iona

l as

soci

atio

ns a

nd c

ivil

soci

ety

orga

nisa

tions

†

Pol

icy

or c

ode

of c

ond

uct72

incl

udin

g in

form

atio

n ab

out:

►

who

m t

o ac

cep

t fu

ndin

g fr

om, i

nclu

din

g b

ans

on t

he

acce

pta

nce

of fu

ndin

g fr

om s

pec

ific

ind

ustr

ies

(eg,

tob

acco

in

dus

try)

(inc

lud

ing

third

par

ties

actin

g on

beh

alf o

f the

in

dus

try)

bas

ed o

n a

risks

ana

lysi

s69 8

2

►

how

con

flict

s of

inte

rest

, bot

h at

the

ind

ivid

ual a

nd

inst

itutio

nal l

evel

s, w

ill b

e ad

dre

ssed

(and

avo

ided

if

nece

ssar

y), r

epor

ted

, rev

iew

ed, d

ocum

ente

d, m

anag

ed o

r el

imin

ated

, as

wel

l san

ctio

ns in

cas

e of

non

- com

plia

nce

with

th

e p

olic

y84

►

ind

ivid

uals

sho

uld

not

sol

icit

or a

ccep

t gi

fts

from

sp

ecifi

c in

dus

trie

s (e

g, t

obac

co in

dus

try)

(and

thi

rd p

artie

s ac

ting

on b

ehal

f of t

he in

dus

try)

tha

t m

ight

influ

ence

or

app

ear

to

influ

ence

ob

ject

ivity

, ind

epen

den

ce o

r fa

irnes

s in

clin

ical

and

p

rofe

ssio

nal j

udge

men

t84

►

no m

oney

sho

uld

be

acce

pte

d if

it e

xplic

itly

cons

trai

ns

the

cap

abili

ty o

f the

inst

itutio

ns t

o d

o th

eir

wor

k w

ithou

t in

terf

eren

ce fr

om t

he fu

nder

71

►

inst

itutio

ns s

houl

d n

ot a

ccep

t m

oney

if d

oing

so

pus

hes

them

to

be

som

ethi

ng t

hat

is n

ot c

onsi

sten

t w

ith t

heir

mis

sion

to

pro

mot

e th

e he

alth

of t

he p

ublic

71 8

0 85

X

XX

X

►C

anad

a -

In 2

017,

the

Can

adia

n M

edic

al A

ssoc

iatio

n’s

pol

icy

on

phy

sici

ans’

inte

ract

ions

with

ind

ustr

y w

as fo

rmal

ly a

dop

ted

by

22

out

of 6

0 C

anad

ian

med

ical

ass

ocia

tions

►

Inte

rnat

iona

l Net

wor

k on

Brie

f Int

erve

ntio

ns fo

r A

lcoh

ol &

Oth

er

Dru

gs (I

NE

BR

IA) -

Pos

ition

Sta

tem

ent

on t

he a

lcoh

ol in

dus

try

►

Inte

rnat

iona

l Soc

iety

of B

ehav

iora

l Nut

ritio

n an

d P

hysi

cal A

ctiv

ity

(ISB

NPA

) - P

artn

ersh

ip, s

pon

sors

hip

and

don

atio

n p

olic

y

►U

K -

Roy

al C

olle

ge o

f Pae

dia

tric

s an

d C

hild

Hea

lth (R

CP

CH

) -

RC

PC

H s

tate

men

t on

rel

atio

nshi

p w

ith fo

rmul

a m

ilk c

omp

anie

s

►W

orld

Ob

esity

Fin

anci

al R

elat

ions

hip

Pol

icyW

orld

Pub

lic H

ealth

an

d N

utrit

ion

Ass

ocia

tion

(WP

HN

A) –

Con

flict

of i

nter

est

and

et

hics

pol

icy

Gov

erna

nce

wor

ksho

ps:

gov

erna

nce

boa

rds

are

assi

sted

in

thei

r d

elib

erat

ions

on

ind

ustr

y in

volv

emen

ts b

y p

rese

ntat

ions

or

wor

ksho

ps

to r

aise

the

ir aw

aren

ess

of t

he is

sues

and

hel

p

them

rea

ch a

n in

form

ed p

ositi

on o

n th

e ex

tent

of i

ndus

try

invo

lvem

ent69

X

Pub

lic d

iscl

osur

e of

:69

►

fund

ing

(or

othe

r d

onat

ions

) rec

eive

d fr

om c

orp

orat

ions

(and

th

ird p

artie

s ac

ting

on b

ehal

f of t

he in

dus

try)

to

ind

ivid

uals

an

d in

stitu

tions

►

list

of fe

llow

ship

s, a

war

ds

and

oth

er p

rizes

fund

ed b

y/re

ceiv

ed fr

om c

orp

orat

ions

(and

thi

rd p

artie

s ac

ting

on b

ehal

f of

the

ind

ustr

y)

►ag

reem

ents

mad

e w

ith c

orp

orat

ions

(and

thi

rd p

artie

s ac

ting

on b

ehal

f of t

he in

dus

try)

The

abov

e st

rate

gies

cou

ld b

e m

and

ated

by

law

, with

sub

stan

tial

fines

for

thos

e w

ho fa

il to

com

ply

.

X

X

►U

SA

- A

mer

ican

Aca

dem

y of

Nut

ritio

n an

d D

iete

tics

- M

eet

our

spon

sors

Mon

itorin

g of

influ

ence

of c

omm

erci

al in

tere

sts

on p

ublic

hea

lth:

annu

al r

epor

ts a

nd in

tern

atio

nal c

omp

aris

ons62

80

XS

ee o

nlin

e su

pp

lem

enta

ry fi

le 1

for

a lis

t of

inst

itutio

ns w

orki

ng o

n th

e in

fluen

ce o

f cor

por

atio

ns o

n p

ublic

hea

lth p

olic

y, r

esea

rch

and

p

ract

ice,

som

e of

whi

ch a

re im

ple

men

ting

this

mec

hani

sm

Tab

le 2

C

ontin

ued

Con

tinue

d

on October 7, 2020 by guest. P

rotected by copyright.http://bm

jopen.bmj.com

/B

MJ O

pen: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. D

ownloaded from

16 Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082

Open access

Ind

ivid

uals

and

in

stit

utio

nsM

echa

nism

s id

enti

fied

thr

oug

h o

ur s

cop

ing

rev

iew

Typ

e o

f m

echa

nism

Exa

mp

les

whe

re t

hese

mec

hani

sms

have

bee

n ad

op

ted

(ful

ly o

r to

so

me

exte

nt)

Tran

spar

ency

Man

agem

ent

Iden

tifi

cati

on,

m

oni

tori

ng a

nd

educ

atio

nP

rohi

bit

ion

Oth

er

typ

e

Con

fere

nces

and

ot

her

mee

tings

in

pub

lic h

ealth

Pol

icy

incl

udin

g in

form

atio

n ab

out:

75 8

6 87

►

Ind

ivid

uals

and

inst

itutio

n re

spon

sib

le fo

r th

e co

nten

t,

qua

lity

and

sci

entifi

c in

tegr

ity o

f act

iviti

es. T

his

nece

ssita

tes

elim

inat

ing

com

mer

cial

bia

s fo

r or

aga

inst

any

pro

duc

t an

d

mai

ntai

ning

con

trol

ove

r p

lann

ing,

pro

gram

me

des

ign,

facu

lty

sele

ctio

n, e

duc

atio

nal m

etho

ds,

mat

eria

ls a

nd e

valu

atio

ns

►w

hom

to

acce

pt

fund

ing

from

and

how

to

doc

umen

t ag

reem

ents

mad

e w

ith c

orp

orat

ions

, bas

ed o

n a

risks

an

alys

is

►ho

w c

onfli

cts

of in

tere

st, b

oth

at t

he in

div

idua

l and

in

stitu

tiona

l lev

els,

will

be

add

ress

ed (a

nd a

void

ed, i

f ne

cess

ary)

, rep

orte

d, r

evie

wed

, doc

umen

ted

, man

aged

or

elim

inat

ed, a

s w

ell s

anct

ions

in c

ase

of n

on- c

omp

lianc

e w

ith

the

pol

icy

►

way

s to

avo

id fo

cus

on a

sin

gle

pro

duc

t or

com

pan

y (in

clud

ing

thro

ugh

bra

nded

item

s, e

xhib

it ha

lls a

nd b

ooth

s,

use

of b

rand

or

trad

e na

mes

)

►co

ntro

l of t

he a

cces

s to

reg

istr

ants

’ mai

ling

add

ress

es

►re

view

of e

duc

atio

nal m

ater

ials

and

whe

ther

or

not

to b

an

the

dis

trib

utio

n of

pro

mot

iona

l mat

eria

ls in

ed

ucat

iona

l se

ssio

ns

►w

hich

par

ty is

res

pon

sib

le fo

r ge

nera

l ove

rsig

ht t

o en

sure

com

plia

nce

with

pol

icy,

as

wel

l as

sanc

tions

for

non-

com

plia

nce

XX

XX

X

►IS

BN

PA -

pol

icy

for

spon

sors

of a

nnua

l mee

tings

►

WP

HN

A -

Wor

ld N

utrit

ion

Con

gres

s 20

16 -

Con

flict

of i

nter

est

and

eth

ics

pol

icy

Pub

lic d

iscl

osur

e of

:75 8

7

►

dec

lara

tions

of c

onfli

cts

of in

tere

st fo

r co

nfer

ence

org

anis

ers

and

all

par

ticip

ants

►

list

of s

pon

sors

, nat

ure

of s

pon

sors

hip

, as

wel

l as

agre

emen

ts m

ade

with

sp

onso

rs

►lis

t of

pre

sent

atio

ns m

ade

by

ind

ivid

uals

from

, or

sup

por

ted

b

y, c

orp

orat

ions

(and

thi

rd p

artie

s ac

ting

on b

ehal

f of t

he

ind

ustr

y)

►lis

t of

aw

ard

s an

d o

ther

priz

es fr

om c

orp

orat

ions

(and

thi

rd

par

ties

actin

g on

beh

alf o

f the

ind

ustr

y)

►lis

t of

boo

ths

X

X

►La

tin A

mer

ica

- S

ocie

dad

Lat

inoa

mer

ican

a d

e N

utric

ión

(SLA

N) -

C

onfli

ct o

f Int

eres

t p

olic

y

►U

SA

- O

bes

ity W

eek

2018

ab

stra

cts

(incl

udin

g so

urce

s of

fu

ndin

g)

Pro

visi

on o

f ed

ucat

ion

to p

artic

ipan

ts o

n ho

w t

o ev

alua

te

info

rmat

ion

pro

vid

ed b

y co

rpor

atio

ns

X

Tab

le 2

C

ontin

ued

Con

tinue

d

on October 7, 2020 by guest. P

rotected by copyright.http://bm

jopen.bmj.com

/B

MJ O

pen: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. D

ownloaded from

17Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082

Open access

Ind

ivid

uals

and

in

stit

utio

nsM

echa

nism

s id

enti

fied

thr

oug

h o

ur s

cop

ing

rev

iew

Typ

e o

f m

echa

nism

Exa

mp

les

whe

re t

hese

mec

hani

sms

have

bee

n ad

op

ted

(ful

ly o

r to

so

me

exte

nt)

Tran

spar

ency

Man

agem

ent

Iden

tifi

cati

on,

m

oni

tori

ng a

nd

educ

atio

nP

rohi

bit

ion

Oth

er

typ

e

Med

iaE

duc

atio

n an

d c

ertifi

catio

n p

rogr

amm

es t

o b

e d

evel

oped

for

jour

nalis

ts w

ho r

epor

t on

hea

lth, w

hich

wou

ld e

mp

hasi

se t

he

risks

of c

onfli

cts

of in

tere

st88

X

Cod

es o

f eth

ics:

88

►

req

uirin

g th

at jo

urna

lists

dis

clos

e fin

anci

al o

r in

- kin

d s

upp

ort

rele

vant

to

each

art

icle

or

com

men

tary

pie

ce

►sp

ecify

ing

the

rela

tions

hip

s th

at a

re n

ot a

ccep

tab

le (e

g,

jour

nalis

ts r

epor

ting

on p

rod

ucts

or

serv

ices

pro

duc

ed b

y co

mp

anie

s in

whi

ch t

hey

hold

sha

res,

or

com

pan

ies

pay

ing

for

the

trav

el e

xpen

ses

of jo

urna

lists

’ fam

ilies

)

►op

pos

ing

ind

ustr

y- sp

onso

red

priz

es a

nd e

duc

atio

nal

end

owm

ents

Whe

re c

ount

ries

regu

late

jour

nalis

m, t

he a

bov

e st

rate

gies

cou

ld

be

man

dat

ed b

y la

w, w

ith s

ubst

antia

l fine

s fo

r th

ose

who

fail

to

com

ply

XX

XX

►

Inte

rnat

iona

l - A

ssoc

iatio

n of

Hea

lth C

are

Jour

nalis

ts -

Sta

tem

ent

of P

rinci

ple

s of

the

Ass

ocia

tion

of H

ealth

Car

e Jo

urna

lists

Pub

licly

acc

essi

ble

reg

iste

r of

rel

atio

nshi

ps

bet

wee

n in

dus

try

(and

thi

rd p

artie

s ac

ting

on b

ehal

f of t

he in

dus

try)

and

jour

nalis

ts,

edito

rs, m

edia

org

anis

atio

ns a

nd jo

urna

lism

org

anis

atio

ns

(incl

udin

g p

rofe

ssio

nal a

nd e

duc

atio

nal b

odie

s)88

Whe

re c

ount

ries

regu

late

jour

nalis

m, t

he a

bov

e st

rate

gies

cou

ld

be

man

dat

ed b

y la

w, w

ith s

ubst

antia

l fine

s fo

r th

ose

who

fail

to

com

ply

X

X

Oth

erP

ublic

dat

abas

e of

con

flict

s of

inte

rest

s fo

r in

div

idua

ls a

nd

inst

itutio

ns in

pub

lic h

ealth

40 6

8 83

X

X

►

The

Cen

tre

for

Sci

ence

in t

he P

ublic

Inte

rest

(CS

PI)

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associated risks for public health were recently discussed in the literature.43 Public institutions sometimes lack resources, particularly financial resources, to address urgent public health issues.43 Academic institutions might want to contribute to the economic development in their country, thus partnering with corporations.43 The current situation is perhaps challenging, but there is scope (and need) for change. Many of the examples we identified in our review related to the implementation of the WHO FCTC, the only global treaty that explicitly addresses the interference of an industry with public health policy. The proposed FCFS and FCAC are therefore potential solu-tions to address and manage the influence that vested interests could have on public health policy, research and practice. If adopted and evaluated more widely, many of the mechanisms described in this manuscript could contribute to efforts to prevent and control non- communicable diseases.

More research on each of these mechanisms is needed, including on their effectiveness in addressing and/or managing the influence of corporations on public health policy, research and practice. There is a need to under-stand if these mechanisms are effective in addressing the influence of all industries, or of only some industries, and then study the political, social and other factors respon-sible for these differences. Collectively, public health professionals might also develop, in the future, new mech-anisms not described in our manuscript. Some countries have already adopted some of the mechanisms proposed in this manuscript; others have done little, including countries facing strong resistance to developing and implementing them. An evaluation of the implementa-tion of these mechanisms, which could include a bench-marking exercise, is therefore needed and will inform governments, universities and other actors in public health. In addition to these mechanisms, a module on ‘corporations and health’ could be part of the curriculum for professionals being trained in public health policy, research or practice. Conferences and other meetings of public health professionals should also be used as a platform where to discuss the influence of the industry on public health policy, research and practice. This may be particularly important in the case of academic confer-ences which involve extensive resources and input from and partnerships with corporations, such as nutrition and gambling conferences.

In conclusion, corporations have significant economic and political power, which may, in some circumstances, be detrimental to public health. We identified several mechanisms that could help address and/or manage that influence. The development, implementation and moni-toring of these mechanisms seem crucial to protect public health from the commercial interests of industry actors.

Author affiliations1School of Public Health, University of Sao Paulo, Sao Paulo, Brazil2School of Nutrition and Dietetics, University of Antioquia, Medellin, Colombia3Sciensano, Brussels, Brussels, Belgium

4World Public Health Nutrition Association, London, UK5Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia6Pan American Health Organization, Washington, District of Columbia, USA7Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK8Dondena Research Centre and Department of Policy Analysis and Public Management, Bocconi University, Milano, Lombardia, Italy9Global Obesity Centre, Deakin University, Burwood, Victoria, Australia

twitter Martin McKee @martinmckee

Acknowledgements The authors would like to acknowledge Jaramillo Ferney, a librarian at the University of Antioquia, for his support during the development of the search strategy for this scoping review.

Contributors MM and GS contributed to the conception of the work, with support from SV and LB. MM led data collection and analysis, with support from SV, AC- L, LB, FG, MP, MMcK and GS. MM led the writing of the manuscript and all authors have substantively revised it. All authors have approved the submitted version. All authors have agreed both to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved and the resolution documented in the literature.

Funding MM received a Fellowship from the São Paulo Research Foundation (FAPESP), Brazil (grant number 2017/24744–0). MM obtained seed funding from the Faculty of Health Sciences (FHS) at the American University of Beirut (AUB), as part of a grant funded by the International Development Research Centre (IDRC). This funding supported her fieldwork in Colombia and Chile in 2019. DS is funded by a Wellcome award.

Competing interests None declared.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; externally peer reviewed.

Data availability statement Data are available upon reasonable request. The data sets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Open access This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non- commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non- commercial. See: http:// creativecommons. org/ licenses/ by- nc/ 4. 0/.

OrCiD iDsMelissa Mialon http:// orcid. org/ 0000- 0002- 9883- 6441Martin McKee http:// orcid. org/ 0000- 0002- 0121- 9683

reFerenCes 1 Moodie R, Stuckler D, Monteiro C, et al. Profits and pandemics:

prevention of harmful effects of tobacco, alcohol, and ultra- processed food and drink industries. Lancet 2013;381:670–9.

2 World Health Organization. Opening address - Dr Margaret Chan Director- General of the World Health Organization. 8th global conference on health promotion Helsinki, Finland, 2013.

3 Swinburn BA, Kraak VI, Allender S, et al. The global syndemic of obesity, undernutrition, and climate change: the lancet commission report. Lancet 2019;393:791–846.

4 State of California - Department of Justice - Office of the Attorney General. Master settlment agreement, 2017. Available: http:// oag. ca. gov/ tobacco/ msa

5 University of California San Francisco. Truth tobacco industry documents, 2017. Available: https://www. indu stry docu ment slibrary. ucsf. edu/ tobacco/

6 Gilmore AB, Fooks G, Drope J, et al. Exposing and addressing tobacco industry conduct in low- income and middle- income countries. Lancet 2015;385:1029–43.

7 Savell E, Gilmore AB, Fooks G. How does the tobacco industry attempt to influence marketing regulations? A systematic review. PLoS One 2014;9:e87389.

8 Ulucanlar S, Fooks GJ, Gilmore AB. The policy dystopia model: an interpretive analysis of tobacco industry political activity. PLoS Med 2016;13:e1002125.

on October 7, 2020 by guest. P

rotected by copyright.http://bm

jopen.bmj.com

/B

MJ O

pen: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. D

ownloaded from

19Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082

Open access

9 Costa H, Gilmore AB, Peeters S, et al. Quantifying the influence of the tobacco industry on EU governance: automated content analysis of the EU tobacco products Directive. Tob Control 2014;23:473–8.

10 Peto R, Lopez AD, Boreham J, et al. Mortality from smoking in developed countries 1950-2000. 2 edn, 2006.

11 Mialon M, Swinburn B, Sacks G. A proposed approach to systematically identify and monitor the corporate political activity of the food industry with respect to public health using publicly available information. Obes Rev 2015;16:519–30.

12 McCambridge J, Mialon M, Hawkins B. Alcohol industry involvement in policymaking: a systematic review. Addiction 201810.1111/add.14216. [Epub ahead of print: 15 Mar 2018].

13 Savell E, Fooks G, Gilmore AB. How does the alcohol industry attempt to influence marketing regulations? A systematic review. Addiction 2016;111:18–32.

14 Oreskes N, Conway E. Merchants of doubt: how a handful of scientists obscured the truth on issues from tobacco smoke to global warming, 2011.

15 Hancock L, Ralph N, Martino FP. Applying corporate political activity (CPA) analysis to Australian gambling industry submissions against regulation of television sports betting advertising. PLoS One 2018;13:e0205654.

16 Kickbusch I, Allen L, Franz C. The commercial determinants of health. Lancet Glob Health 2016;4:e895–6.

17 Madureira Lima J, Galea S. The corporate permeation index - a tool to study the macrosocial determinants of non- communicable disease. SSM Popul Health 2019;7:100361.

18 World Health Organization. Technical resource on the protection of public health policies with respect to tobacco control from commercial and other vested interests of the tobacco industry for country implementation of who framework convention on tobacco control article 5.3. Geneva, 2012.

19 Southeast Asia Tobacco Control Alliance (SEATCA). Surveillance of tobacco industry activities toolkit. Thailand, 2009.

20 Tobacco Control Research Group. Tobaccotactics, 2013. Available: http://www. tobaccotactics. org/ index. php/ Main_ Page

21 Mialon M, Swinburn B, Allender S, et al. Systematic examination of publicly- available information reveals the diverse and extensive corporate political activity of the food industry in Australia. BMC Public Health 2016;16:283.

22 Mialon M, Swinburn B, Wate J, et al. Analysis of the corporate political activity of major food industry actors in Fiji. Global Health 2016;12:18.

23 Mialon M, Mialon J. Analysis of corporate political activity strategies of the food industry: evidence from France. Public Health Nutr 2018;21:3407–21.

24 Mialon M, Mialon J. Corporate political activity of the dairy industry in France: an analysis of publicly available information. Public Health Nutr 2017;20:2432–9.

25 Mialon M, Gomes FdaS. Public health and the ultra- processed food and drink products industry: corporate political activity of major transnationals in Latin America and the Caribbean. Public Health Nutr 2019;22:1898–908.

26 Jaichuen N, Phulkerd S, Certthkrikul N, et al. Corporate political activity of major food companies in Thailand: an assessment and policy recommendations. Global Health 2018;14:115.

27 Tselengidis A, Östergren P- O. Lobbying against sugar taxation in the European Union: analysing the lobbying arguments and tactics of stakeholders in the food and drink industries. Scand J Public Health 2019;47:565–75.

28 Friends of the UN HLM on NCDs. The how: a message for the un high- level meeting on NCDS. Lancet 2018;392:e4–5.

29 Moynihan R, Macdonald H, Heneghan C, et al. Commercial interests, transparency, and independence: a call for submissions. BMJ 2019;365:l1706.

30 Baum FE, Margaret Anaf J. Transnational corporations and health: a research agenda. Int J Health Serv 2015;45:353–62.

31 Baum FE, Sanders DM, Fisher M, et al. Assessing the health impact of transnational corporations: its importance and a framework. Global Health 2016;12:27.

32 World Health Organization. WHO framework convention on tobacco control. Geneva, 2003.

33 The Lancet . A framework convention on alcohol control. Lancet 2007;370:1102.

34 World Health Organization.. Parties to the WHO framework convention on tobacco control. Available: https://www. who. int/ fctc/ cop/ en/ [Accessed 6 Feb 2019].

35 Gravely S, Giovino GA, Craig L, et al. Implementation of key demand- reduction measures of the who framework convention on tobacco control and change in smoking prevalence in 126 countries: an association study. Lancet Public Health 2017;2:e166–74.

36 McCambridge J, Daube M, McKee M. Brussels declaration: a vehicle for the advancement of tobacco and alcohol industry interests at the science/policy interface? Tob Control 2019;28:7–12.

37 World Health Organization. Sixty- fifth World health assembly WHA65.6 agenda item 13.3. Geneva: World Health Organization, 2012.

38 Torjesen I. Exclusive: partnering with alcohol industry on public health is not okay, who says. BMJ 2019;365:l1666.

39 McCambridge J, Mialon M. Alcohol industry involvement in science: a systematic review of the perspectives of the alcohol research community. Drug Alcohol Rev 2018;37:565–79.

40 Cullerton K, Adams J, Forouhi N, et al. What principles should guide interactions between population health researchers and the food industry? systematic scoping review of peer- reviewed and grey literature. Obes Rev 2019;20:1073–84.

41 Cochrane Training. Scoping reviews: what they are and how you can do them. Available: https:// training. cochrane. org/ resource/ scoping- reviews- what- they- are- and- how- you- can- do- them [Accessed 9 Aug 2019].

42 Fabbri A, Santos Ala, Mezinska S, et al. Sunshine policies and murky shadows in Europe: disclosure of pharmaceutical industry payments to health professionals in nine European countries. Int J Health Policy Manag 2018;7:504–9.

43 Marks JH. The' ' perils of partnership: Industry influence, institutional integrity, and public health. New York: Oxford University Press.

44 Goldberg DS. The shadows of sunlight: why disclosure should not be a priority in addressing conflicts of interest. Public Health Ethics 2018.

45 World Health Organization. About WHO: WHO’s engagement with non- state actors, 2016. Available: http://www. who. int/ about/ collaborations/ non- state- actors/ en/

46 Khayatzadeh- Mahani A, Ruckert A, Labonté R. Could the WHO’s framework on engagement with Non- State actors (FENSA) be a threat to tackling childhood obesity? Glob Public Health 2018;13:1337–40.

47 Bank AD. Organisation for economic co- operation and development. managing conflict of interest: frameworks, tools, and instruments for preventing, detecting, and managing conflict of interest. Mandaluyong City, Metro Manila, Philippines: Asian Development Bank, 2008.

48 Organization For Economic Co- operation and Development. Managing conflict of interest in the public sector: a toolkit, 2005.

49 Organization For Economic Co- operation and Development. Preventing policy capture: integrity in public decision making. Available: https:// doi. org/ 10. 1787/ 9789264065239- en [Accessed 9 Apr 2019].

50 Organization For Economic Co- operation and Development. Transparency and integrity in lobbying, 2013.

51 Organization For Economic Co- operation and Development. Financing democracy: funding of political parties and election campaigns and the risk of policy capture, 2016.

52 Bank W. Public sector governance - public accountability, echanisms, 2013. Available: http:// web. worldbank. org/ WBSITE/ EXTERNAL/ TOPICS/ EXTP UBLI CSEC TORA NDGO VERNANCE/ 0,, contentMDK: 23352107~ pagePK: 148956~ piPK: 216618~ theSitePK: 286305, 00. html [Accessed 5 Feb 2019].

53 Adams PJ. Assessing whether to receive funding support from tobacco, alcohol, gambling and other dangerous consumption industries. Addiction 2007;102:1027–33.

54 World Health Organization. Draft approach for the prevention and management of conflicts of interest in the policy development and implementation of nutrition programmes at country level: decision- making process and tool, 2017.

55 Hennessy M, Cullerton K, Baker P, et al. Time for complete transparency about conflicts of interest in public health nutrition research. HRB Open Res 2019;2:1.

56 Mart S, Giesbrecht N. Red flags on pinkwashed drinks: contradictions and dangers in marketing alcohol to prevent cancer. Addiction 2015;110:1541–8.

57 Freedhoff Y, Hébert PC. Partnerships between health organizations and the food industry risk derailing public health nutrition. CMAJ 2011;183:291–2.

58 Jacobson MF. Lifting the veil of secrecy from industry funding of nonprofit health organizations. Int J Occup Environ Health 2005;11:349–55.

59 Arie S. Nestle and PepsiCo will give nutritional advice to women in anti- hunger campaign in Mexico. BMJ 2013;346:f2458.

60 Simon M. Clowning around with charity: how McDonald’s exploits philanthropy and targets children. USA: Eat Drink Politics, 2013.

61 Brooks EC. Does truthful advertising ever pass "the smell test" in a peer- reviewed journal? J Hum Lact 2019;35:649–53.

on October 7, 2020 by guest. P

rotected by copyright.http://bm

jopen.bmj.com

/B

MJ O

pen: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. D

ownloaded from

20 Mialon M, et al. BMJ Open 2020;10:e034082. doi:10.1136/bmjopen-2019-034082

Open access

62 Fooks GJ, Smith J, Lee K, et al. Controlling corporate influence in health policy making? an assessment of the implementation of article 5.3 of the world Health organization framework convention on tobacco control. Global Health 2017;13:12.

63 World Health Organization. Guidelines for implementation of Article 5.3 of theWHO Framework Convention on Tobacco Control' ' on the protection of public health policies with respect to tobacco control from commercial and other vested interests of the tobacco industry, 2008.

64 Swinburn B, Vandevijvere S, Kraak V, et al. Monitoring and benchmarking government policies and actions to improve the healthiness of food environments: a proposed government healthy food environment policy index. Obes Rev 2013;14 Suppl 1:24–37.

65 Balwicki Łukasz, Stokłosa M, Balwicka- Szczyrba M, et al. Tobacco industry interference with tobacco control policies in Poland: legal aspects and industry practices. Tob Control 2016;25:521–6.

66 Dhalla I, Laupacis A. Moving from opacity to transparency in pharmaceutical policy. CMAJ 2008;178:428–31.

67 Nestle M. Unsavory truth: how food companies skew the science of what we eat. 1 edn. New York: Basic Books, 2018.

68 Stenius K, Babor TF. The alcohol industry and public interest science. Addiction 2010;105:191–8.

69 Adams PJ, Rossen F. Reducing the moral jeopardy associated with receiving funds from the proceeds of gambling. J Gambl Issues 2006;11.

70 Reeve B, Gostin LO. "Big" food, tobacco, and alcohol: reducing industry influence on noncommunicable disease prevention laws and policies comment on ”addressing ncds: challenges from industry market promotion and interferences". Int J Health Policy Manag 2019;8:450–4.

71 Galea S, Saitz R, Funding SR. Funding, institutional conflicts of interest, and schools of public health: realities and solutions. JAMA 2017;317:1735–6.

72 Miller P, Babor TF, McGovern T, et al. Relationships with the Alcoholic- Beverage Industry, Pharmaceutical Companies, and Other Funding Agencies: Holy Grail or Poisoned Chalice? In: Babor TF, Stenius K, Pates R, et al, eds. Publishing addiction science: a guide for the Perplexe. London: Ubiquity Press, 2017: 323–52.

73 Bero LA, Glantz S, Hong M- K. The limits of competing interest disclosures. Tob Control 2005;14:118–26.

74 Mozaffarian D. Conflict of interest and the role of the food industry in nutrition research. JAMA 2017;317:1755–6.

75 Livingstone C, Adams PJ. Clear principles are needed for integrity in gambling research. Addiction 2016;111:5–10.

76 Gmel G. The good, the bad and the ugly. Addiction 2010;105:203–5. 77 Laine C, Mulrow CD. Exorcising ghosts and unwelcome guests. Ann

Intern Med 2005;143:611. 78 Wall GC, Smith HL, Craig SR, et al. Structured pharmaceutical

representative interactions and counterdetailing sessions as components of medical resident education. J Pharm Pract 2013;26:151–6.

79 Rodwin MA. Conflicts of interest, institutional corruption, and pharma: an agenda for reform. J Law Med Ethics 2012;40:511–22.

80 Spelsberg A, Martiny A, Schoenhoefer PS, et al. Is disclosure of potential conflicts of interest in medicine and public health sufficient to increase transparency and decrease corruption? J Epidemiol Community Health 2009;63:603–5.

81 Poli A, Marangoni F, Agostoni CV, et al. Research interactions between academia and food companies: how to improve transparency and credibility of an inevitable liaison. Eur J Nutr 2018;57:1269–73.

82 Babor TF. How should we define, document, and prevent conflicts of interest in alcohol research? Int J Alcohol Drug Res 2016;5:5.

83 Lesser LI. Reducing potential bias in industry- funded nutrition research. Am J Clin Nutr 2009;90:699–700.

84 American College of Clinical Pharmacy, Hatton RC, Chavez ML, et al. Pharmacists and industry: guidelines for ethical interactions. Pharmacotherapy 2008;28:410–20.

85 Portugal C, Cruz TB, Espinoza L, et al. Countering tobacco industry sponsorship of Hispanic/Latino organizations through policy adoption: a case study. Health Promot Pract 2004;5:143S–56.

86 Studdert DM, Mello MM, Brennan TA. Financial conflicts of interest in physicians' relationships with the pharmaceutical industry--self- regulation in the shadow of federal prosecution. N Engl J Med 2004;351:1891–900.

87 Shnier A, Lexchin J. Continuing medical education and pharmaceutical industry involvement: an evaluation of policies adopted by Canadian professional medical associations. Int J Risk Saf Med 2017;29:1–16.

88 Lipworth W, Kerridge I, Sweet M, et al. Widening the debate about conflict of interest: addressing relationships between journalists and the pharmaceutical industry. J Med Ethics 2012;38:492–5.

89 Ramsay S. Online database reveals researchers' industry ties. Lancet 2001;357:1677.

on October 7, 2020 by guest. P

rotected by copyright.http://bm

jopen.bmj.com

/B

MJ O

pen: first published as 10.1136/bmjopen-2019-034082 on 19 July 2020. D

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