Complex Public Health Problems Research Articles

The art and science of a strategic grantmaker: the experience of the Public Health Agency of Canada\u2019s Innovation Strategy

SettingThe Public Health Agency of Canada’s Innovation Strategy (PHAC-IS) was established amid calls for diverse structural funding mechanisms that could support research agendas to inform policy making across multiple levels and jurisdictions. Influenced by a shifting emphasis towards a population health approach and growing interest in social innovation and systems change, the PHAC-IS was created as a national grantmaking program that funded the testing and delivery of promising population health interventions between 2009 and 2020.InterventionDuring its decade-long tenure, the PHAC-IS supported the development of innovative, locally driven programs that emphasized health equity, encouraged iterative learning to respond reflexively to complex public health problems (the art), while at the same time promoting and integrating population health intervention research (the science) for improved health at the individual, community, and systems levels through four program components.OutcomesPHAC-IS projects reached priority audiences in over 1700 communities. Over 1400 partnerships were established by community-led organizations across multiple sectors with more than $30 million of leveraged funds. By the final phase of funding, 90% of the projects and partnership networks had a sustained impact on policy and public health practice. By the end of the program, 82% of the projects were able to continue their intervention beyond PHAC-IS funding. Through a phased approach, projects were able to adapt, reflect, and build partnership networks to impact policy and practice while increasing reach and scale towards sustainability.ImplicationsAnalysis and reflection throughout the course of this initiative showed that strong partnerships that contribute sufficient time to collaboration are critical to achieving meaningful outcomes. Building on evaluation cycles that strengthen project design can ensure both scale and sustainability of project achievements. Furthermore, a flexible, phased approach allows for iterative learning and adjustments across various phases to realize sustained population and systems change. The model and reflexive approach underlying the PHAC-IS has the potential to apply to a broad range of public programs.

Gut Microbiota Modulation In Diabetic Patients

Metabolic disorders and diabetes mellitus are one of the major complex public health problems in the world, and in fact are becoming a global epidemic. It is associated with an increased risk of a large number of complications, including dyslipidemia, cardiovascular disease. The microbiota modulates inflammation, metabolizes indigestible food components, affects intestinal permeability, glucose and lipid metabolism, insulin sensitivity, and overall energy homeostasis. The study investigated the effect of a multistrain probiotic on the intestinal microflora in diabetic patients. As a result of the work carried out, it was shown that the microbiome of patients with diabetes mellitus differs from normal and is depleted in bifidobacteria and some butyrate producers, such as Subdoligranulum, but enriched in Prevotella. The use of a multi-strain probiotic has led to an increase in the biodiversity of the intestinal microflora. Also, in the fecal samples, the content of acetate and butyrate increased, while the concentration of propionate decreased markedly.

Using graphic modelling to identify modifiable mediators of the association between area-based deprivation at birth and offspring unemployment.

BackgroundDeprivation can perpetuate across generations; however, the causative pathways are not well understood. Directed acyclic graphs (DAG) with mediation analysis can help elucidate and quantify complex pathways in order to identify modifiable factors at which to target interventions.Methods and findingsWe linked ten Scotland-wide databases (six health and four education) to produce a cohort of 217,226 pupils who attended Scottish schools between 2009 and 2013. The DAG comprised 23 potential mediators of the association between area deprivation at birth and subsequent offspring ‘not in education, employment or training’ status, covering maternal, antenatal, perinatal and child health, school engagement, and educational factors. Analyses were performed using modified g-computation. Deprivation at birth was associated with a 7.3% increase in offspring ‘not in education, employment or training’. The principal mediators of this association were smoking during pregnancy (natural indirect effect of 0·016, 95% CI 0·013, 0·019) and school absences (natural indirect effect of 0·021, 95% CI 0·018, 0·024), explaining 22% and 30% of the total effect respectively. The proportion of the association potentially eliminated by addressing these factors was 19% (controlled direct effect when set to non-smoker 0·058; 95% CI 0·053, 0·063) for smoking during pregnancy and 38% (controlled direct effect when set to no absences 0·043; 95% CI 0·037, 0·049) for school absences.ConclusionsCombining a DAG with mediation analysis helped disentangle a complex public health problem and quantified the modifiable factors of maternal smoking and school absence that could be targeted for intervention. This study also demonstrates the general utility of DAGs in understanding complex public health problems.

An Analytic Framework for Effective Public Health Program Design Using Correctional Facilities

We present a decision analytic framework that uses a mathematical model of Chlamydia trachomatis transmission dynamics in two interacting populations using ordinary differential equations. A public health survey informs model parametrization, and analytical findings guide the computational design of the decision-making process. The potential impact of jail-based screen-treat (S-T) programs on community health outcomes is presented. Numerical experiments are conducted for a case study population to quantify the effect and evaluate the cost-effectiveness of considered interventions. Numerical experiments show the effectiveness of increased jail S-T rates on community cases when resources for a community S-T program stays constant. Although this effect decreases when higher S-T rates are in place, jail-based S-T programs are cost-effective relative to community-based programs.Summary of Contribution: Public health programs have been developed to control community-wide infectious diseases and to reduce prevalence of sexually transmitted diseases (STD). These programs can consist of screening and treatment of diseases and behavioral interventions. Public correctional facilities play an important role in operational execution of these public health programs. However, because of lack of capacity and resources, public health programs using correctional facilities are questioned by policy-makers in terms of their costs and benefits. In this article, we present an analytical framework using a computational epidemiology model for supporting public health policy making. The system represents the dynamics of Chlamydia trachomatis transmission in two interacting populations, with an ordinary differential equations-based simulation model. The theoretical epidemic control conditions are derived and numerically tested, which guide the design of simulation experiments. Then cost-effectiveness of the potential policies is analyzed. We also present an extensive sensitivity analyses on model parameters. This study contributes to the computational epidemiology literature by presenting an analytical framework to guide effective simulation experimentation for policy decision making. The presented methodology can be applied to other complex policy and public health problems.

A pandemia de SARS-CoV-2: cenários epidemiológicos e medidas de correlações

The Coronavirus pandemic has been one of the most complex public health problems, in its magnitude, up to the present moment in human history. One possibility to guide public policies to combat this disease is the proposition of predictive models regarding the dissemination of SARS-CoV-2. This article aims to present some methods, non-linear fits and computational models used to estimate Coronavirus propagation in countries such as Italy and Brazil. We highlight the proposition of a Solid State Physics Model as a forecasting method. A sigmoid curve specifically used in solid materials transformation processes: the Avrami or Johnson-Mehl-Avrami-Kolmogorov (JMAK) equation. Also noteworthy are the SEIAHR model and the non-linear adjustments through Gaussians. Finally, we can infer that the methodologies used were able to propose a pattern for the process of dissemination of Coronavirus in the regions studied.

Transdisciplinary research outcomes based on the Transdisciplinary Research on Energetics and Cancer II initiative experience.

Intractable public health problems are influenced by interacting multi-level factors. Dynamic research approaches in which teams of scientists collaborate beyond traditional disciplinary, institutional, and geographic boundaries have emerged as promising strategies to address pressing public health priorities. However, little prior work has identified, defined, and characterized the outcomes of transdisciplinary (TD) research undertaken to address public health problems. Through a mixed methods approach, we identify, define, and characterize TD outcomes and their relevance to improving population health using the Transdisciplinary Research on Energetics and Cancer (TREC) II initiative as a case example. In Phase I, TREC II leadership (n = 10) identified nine initial TD outcomes. In Phase II (web-based survey; n = 23) and Phase III (interviews; n = 26; and focus groups, n = 23) TREC members defined and characterized each outcome. The resulting nine outcomes are described. The nine complementary TD outcomes can be used as a framework to evaluate progress toward impact on complex public health problems. Strategic investment in infrastructure that supports team development and collaboration, such as a coordination center, cross-center working groups, annual funded developmental projects, and face-to-face meetings, may foster achievement of these outcomes. This exploratory work provides a basis for the future investigation and development of quantitative measurement tools to assess the achievement of TD outcomes that are relevant to solving multifactorial public health problems.

Interplay Between Air Travel, Genome Integrity, and COVID-19 Risk vis-a-vis Flight Crew.

During air travel, flight crew (flight attendants, pilots) can be exposed to numerous flight-related environmental DNA damaging agents that may be at the root of an excess risk of cancer and other diseases. This already complex mix of exposures is now joined by SARS-CoV-2, the virus that causes COVID-19. The complex exposures experienced during air travel present a challenge to public health research, but also provide an opportunity to consider new strategies for understanding and countering their health effects. In this article, we focus on threats to genomic integrity that occur during air travel and discuss how these threats and our ability to respond to them may influence the risk of SARS-CoV-2 infection and the development of range of severity of the symptoms. We also discuss how the virus itself may lead to compromised genome integrity. We argue that dauntingly complex public health problems, such as the challenge of protecting flight crews from COVID-19, must be met with interdisciplinary research teams that include epidemiologists, engineers, and mechanistic biologists.

Climate Change and Public Health Challenges in the Horn of Africa: The Need for Sustainable Leadership and Institutions

Accumulated indigenous knowledge and scientific data prove that climate change is real. In the Horn of Africa, climate change is unmistakably visible. Instead of rain coming seasonally, it comes more sporadically. Frequently, the region experiences either severe flooding or drought. Lakes, rivers, and ponds are drying out, and forest fires are becoming more prevalent and intense. The highland regions of the Horn of Africa are fast losing their biodiversity. Climate change is aggravating food insecurity, water scarcity, and increasing the rate of water-food-borne diseases. It causes anthropogenic and zoonosis disease transmission to be more prevalent and aggravates heat-related disorders, such as respiratory and seasonal allergies. These conditions are fostering competition for resources and leading to conflicts. Climate change is becoming a major public health challenge of the century. Objectives: This paper's primary objective is raising awareness of the risks that climate change poses and advancing the need to develop sustainable leadership and institutions. The secondary aim is exploring the role of sustainable leadership and institutions in transforming society, mitigating and adapting to climate change and managing emerging public health problems. Methods: Using the “upstream” public health metaphor, I explore the relationships between climate change and public health problems and provide theoretical reasoning for developing sustainable leadership and institutions. Findings: For the Horn of Africa, climate change is the major public health challenge of the century. Climate change affects health in three major pathways: a) changing the severity or frequency of health problems; b) creating unprecedented or unanticipated health problems; c) multiplying health threats in places where they have not been known. Conclusions: Preventing those complex public health problems requires the development of sustainable leadership and institutions. Effective ways of adapting and mitigating climate change are fostering sustainable development and sustainable culture. The pursuits of public health goals are supported and supplemented by institutional and leadership development. Hence, public health needs to advance the development of sustainable leadership and institutions.

Integration as a tool for interprofessional work: A synthesis of the literature regarding how to use integrative strategies to address complex public health problems

There has been limited success addressing complex public health problems using "siloed" approaches. A next important step in addressing persistent public health problems is adopting an "integrative" approach-intentional collaboration across the domains of research, clinical practice, community, and policy. This synthesis of the literature aggregates and synthesizes the diffuse and multi-disciplinary integration literature base to describe key concepts, aspects of praxis, and challenges and successes to help guide interprofessional practice. A three-step approach was used: 1) a wide-ranging search for articles on integration theory/praxis; 2) a more focused search in the health literature bases; 3) a snowball strategy to identify additional studies. Identified themes included elements of successful integration; characteristics of an effective integrator; and dynamics between stakeholders in integration praxis. Results of this synthesis of the integration literature provide a deeper understanding of integration and points to clear and exciting next steps for integration praxis and inquiry.

Practice-Based Teaching Model for Undergraduate Public Health Students: Partnership for Exercise Is Medicine on Campus Initiative

The practice-based teaching (PBT) pedagogical approach is vital to prepare students to learn collaboratively how to solve real-world complex public health problems. Despite evidence of the new PBT approach in graduate public health courses, little is known about the development of PBT in undergraduate public health courses. The purpose of this article is to describe an undergraduate course design using PBT, offer suggestions for using the effective PBT STEPS (Securing Partnerships, Technology and Training, Engagement and Implementation, Presenting Deliverables, Sizing Up Results) framework, and explain lessons learned. The experiences are based on 4 years of successful implementation of the PBT course project, Exercise Is Medicine on Campus (EIM-OC) initiative. The college campus is a promising setting to promote EIM-OC and physical activity awareness. Undergraduate public health students in the Health Administration of Programs course partnered with the campus Wellness, Alcohol and Violence Education Program for the fall initiative. We used the comprehensive PBT STEPS framework in planning the EIM-OC. The evaluation included the number of participants at the Chancellor Walk and activity stations and student reflective writing papers. The findings suggest the effectiveness of PBT pedagogy for faculty to redesign an existing course. Students gain a deeper understanding of campus health and health topics. Faculty can guide students and empower them for working with partners to think, act, and practice like professionals during academic preparation.

Evaluation outcomes of a knowledge translation platform: a structure for support and exchange in prevention

Obesity prevention is an urgent public health priority that requires action at multiple levels. Collaboration between academics, policy and practice is necessary to ensure best-practice implementation. A national knowledge translation and exchange (KT) platform, the Collaboration of Community-based Obesity Prevention Sites (CO-OPS), was delivered and evaluated over three years (2013–15). A mixed-methods evaluation used communications and website data, knowledge-brokering data, event evaluations, interviews and tracer searches to assess process (reach, delivery, quality, cost, uptake) and impact (use of tools/resources, networking, improvements in practice). Results included: 1) average 27% yearly membership growth (330 new members per year) in response to KT activities including tailored communications, stakeholder engagement, knowledge brokering and networking opportunities; 2) sustained website use with approximately 1200 visits/month and 73% unique visitors; and high access to networking and professional development information (120 hits/month), and best practice guidelines (60 hits/month); 3) higher uptake of face-to-face interactive strategies (for example, workshops) than online interactive strategies (for example, knowledge broker service) and higher uptake of passive KT (for example, website resources) than interactive KT strategies (for example, workshops); 4) the KT function of CO-OPS was clearly valued, and appeared to address a gap in implementation. A central coordinating KT platform provided support for best practice and exchange opportunities to a broad network of practice, policy and academic professionals. Simple KT strategies such as tailored, targeted online resources were useful for practice, whilst more intensive KT strategies were important for network engagement. Findings are applicable to other information-sharing networks where professionals address complex public health problems.

A partnership between a local public health unit and schools to end female genital mutilation

Abstract Female genital mutilation (FGM) is a violation of human rights and has immediate and long-term health impacts. Our public health unit is in Amadora, one of the regions in Portugal with the highest prevalence of FGM in immigrant communities. Recognising the importance of education and of early-life interventions in changing beliefs, we partnered with local schools, a non-governmental organisation and child protection services. We developed a book with information and resources for teachers and created a training package for school professionals. This comprehensive school intervention focused on two aspects. First, it focused on prevention, as we trained school professionals, provided risk score indicators and defined actions to take. Second, in health promotion as we compiled ideas and resources on how to approach this subject in classes while debating sexual health, gender inequality, human rights and cultural heritages. From November 2018 to February 2019 we collected inputs by all partners and tested the instruments in a pilot school with a mixed-methods approach through questionnaires and a focus group. The book was distributed to all schools in Amadora, to other public health units and institutions. The preliminary evaluation was done by a questionnaire where 72.7% of the respondents found it useful and addressing the key topics and 54.5% found it detailed enough. These results are preliminary, with further evaluation planned for September 2019 and June 2020 to understand both the experience and needs of teachers after implementing the project. This project has led to schools showing interest in developing closer cooperation in this and in other health topics. To our knowledge, this is the first school intervention by a public health team focusing on FGM in Portugal. Other countries have materials on FGM for teachers, however we believe our intervention was the first tailored to a local community and in close collaboration with local schools and institutions. Key messages There is potential for a closer collaboration with schools to try to end female genital mutilation and to address other health topics. Local public health units should establish and mobilise local networks of institutions and community partners to tackle complex public health problems.

Systems approaches to population health in Canada: how have they been applied, and what are the insights and future implications for practice?

Systems approaches are promising yet under-utilized methods for tackling complex public health problems. This paper explores how systems approaches are understood in the public health literature, how they have been applied in Canada, the insights, and implications for future practice. A rapid review of the literature, including a content analysis and cross-case comparison, was conducted. It was used to distinguish concepts of systems approaches and identify case examples of the application of systems approaches in Canada. Seven cases with a population health perspective (non-health care related) were prioritized for analysis. Systems approaches are a variety of qualitative and quantitative methods that aim to understand a system of interest. Most case examples demonstrated systems thinking methods. Systems science methods were applied predominantly in health care. Only one case of systems science for the social determinants of health was found. Findings indicate that systems approaches were utilized because traditional methods were proving ineffective. These approaches can introduce new ways of thinking, enable collaboration across diverse stakeholders, identify where best to focus action and with what intensity, and provide more robust evidence for decision-making. There is a need to build capacity among practitioners for more widespread adoption and use of systems approaches. Population health professionals need to move beyond reductionist approaches, generate more case examples, and use an iterative evaluation approach that prioritizes the application of processes. This will provide further insight into the usefulness of systems approaches as effective methods to address complex health problems.

Turning conceptual systems maps into dynamic simulation models: An Australian case study for diabetes in pregnancy.

BackgroundSystem science approaches are increasingly used to explore complex public health problems. Quantitative methods, such as participatory dynamic simulation modelling, can mobilise knowledge to inform health policy decisions. However, the analytic and practical steps required to turn collaboratively developed, qualitative system maps into rigorous and policy-relevant quantified dynamic simulation models are not well described. This paper reports on the processes, interactions and decisions that occurred at the interface between modellers and end-user participants in an applied health sector case study focusing on diabetes in pregnancy.MethodsAn analysis was conducted using qualitative data from a participatory dynamic simulation modelling case study in an Australian health policy setting. Recordings of participatory model development workshops and subsequent meetings were analysed and triangulated with field notes and other written records of discussions and decisions. Case study vignettes were collated to illustrate the deliberations and decisions made throughout the model development process.ResultsThe key analytic objectives and decision-making processes included: defining the model scope; analysing and refining the model structure to maximise local relevance and utility; reviewing and incorporating evidence to inform model parameters and assumptions; focusing the model on priority policy questions; communicating results and applying the models to policy processes. These stages did not occur sequentially; the model development was cyclical and iterative with decisions being re-visited and refined throughout the process. Storytelling was an effective strategy to both communicate and resolve concerns about the model logic and structure, and to communicate the outputs of the model to a broader audience.ConclusionThe in-depth analysis reported here examined the application of participatory modelling methods to move beyond qualitative conceptual mapping to the development of a rigorously quantified and policy relevant, complex dynamic simulation model. The analytic objectives and decision-making themes identified provide guidance for interpreting, understanding and reporting future participatory modelling projects and methods.

Enhancing Graduate Practicum Project Development and Selection at Schools of Public Health: A Case Study

Experiential learning is a core competency of curricula across accredited U.S. schools of public health, helping students to hone diverse skill sets that will enable them to readily join the workforce and contribute to solving complex public health problems. At the City University of New York (CUNY) Graduate School of Public Health and Health Policy (SPH), all master’s and doctoral students are required to complete a practicum during their degree programs; yet practicum development and selection processes are often overlooked. To enhance the experiential learning program and Human Research Protection Program processes surrounding student practica at the CUNY SPH, researchers mined an administrative database and analyzed characteristics of practicum projects undertaken by graduate students. Findings from this novel study will facilitate policy and procedural changes within the SPH Office of Experiential Learning, which oversees the practicum program, and across SPH offices, including the Human Research Protection Program, to promote an optimal, student-centered practicum experience. Additionally, these analyses will serve as a model for other schools of public health seeking to develop, refine, and strengthen their practicum programs.

Improving Health Promotion Through the Integration of Technology, Crowdsourcing, and Social Media.

As Internet accessibility and technological innovations continue to increase communication, new opportunities have emerged to leverage these tools to improve health promotion practice. Advances and utilization of collaborative Internet communication, or social media, have provided global connectivity on an unprecedented scale. Using these innovations to leverage the collective intellect of online communities for specific goals, crowdsourcing is an approach that has the potential to solve complex public health problems. Due to the novelty of crowdsourcing implementations and the relative infancy of its application within public health, it is necessary to examine examples to facilitate practitioner conceptualization and application. This article details the development and application of a crowdsourced effort leveraging social media and technology to assist in relief efforts during Hurricane Harvey. Furthermore, the article presents examples corresponding to a typology of crowdsourcing for public health, including Knowledge Discovery and Management, Distributed Human Intelligence Tasking, Broadcast Search, and Peer-Vetted Creative Production problems. Leveraging these innovative applications has positive implications for health promotion practice, including improved intervention development and evaluation, increased multidisciplinary collaboration, and enhanced facilitation of communication, information exchange, and support.

Systems thinking and ethics in public health: a necessary and mutually beneficial partnership

Systems thinking has emerged as a means of conceptualizing and addressing complex public health problems, thereby challenging more commonplace understanding of problems and corresponding solutions as straightforward explanations of cause and effect. Systems thinking tries to address the complexity of problems through qualitative and quantitative modeling based on a variety of systems theories, each with their own assumptions and, more importantly, implicit and unexamined values. To date, however, there has been little engagement between systems scientists and those working in bioethics and public health ethics. The goal of this paper is to begin to consider what it might mean to combine systems thinking with public health ethics to solve public health challenges. We argue that there is a role for ethics in systems thinking in public health as a means of elucidating implicit assumptions and facilitating ethics debate and dialogue with key stakeholders.

Enhancing Local Air Quality Management to maximise public health integration, collaboration and impact in Wales, UK: A Delphi study

BackgroundOutdoor air pollution is a significant public health problem. The UK Local Air Quality Management (LAQM) regime is intended to protect public health through a prescribed process of assessment and collaborative action. Despite its intention and underpinning principles, public health bodies and specialists do not interact with or support LAQM as much as they could or should. This study aimed to explore and understand this disconnect, to inform action that can resolve problems and maximise public health integration, collaboration and impact in this important public health work. MethodsThe Delphi technique was used to elicit multiple viewpoints from a range of experts on this complex problem in Wales, UK. Over three iterative feedback-interspersed survey rounds, 86 expert panellists generated opinions and formed consensus on the role of public health bodies and specialists in LAQM and the added value that might be achieved as a result of increased integration and collaboration. Linked opportunities, barriers and solutions were also described. Qualitative data were subject to thematic analysis; quantitative data were analysed using descriptive statistics to assess consensus, and the Wilcoxon matched-pairs signed-ranks test to assess response stability. ResultsConsensus opinion confirmed the public health role in LAQM should support both broader mainstream risk assessment and management, and also enabling functions such as communications, research and evidence appraisal, advocacy and leadership. Linked opportunities, barriers and solutions were described so as to facilitate change. Panellists suggested that the added value of increasing integration and collaboration would be more efficient, creative and productive collaboration, meaningful risk assessments and effective action. ConclusionsThe significant role of public health in LAQM is rarely recognised or realised. The findings of this study present a convincing evidence-based case for directing and supporting much-needed change to LAQM so as to increase public health integration, collaboration and impact.Not only has this study generated new evidence to enhance LAQM policy and practice, it has also confirmed the applicability of the Delphi method in investigating complex environmental public health problems. While some opinions generated relat to Wales’ unique circumstances, most were general in context and will have relevance and importance across the UK and in countries beyond where air quality management and public health policy and practice are disconnected.

Identifying research priorities for public health research to address health inequalities: use of Delphi-like survey methods

BackgroundIn the funding of health research and public health research it is vital that research questions posed are important and that funded research meets a research need or a gap in evidence. Many methods are used in the identification of research priorities, however, these can be resource intensive, costly and logistically challenging. Identifying such research priorities can be particularly challenging for complex public health problems as there is a need to consult a number of experts across disciplines and with a range of expertise. This study investigated the use of Delphi-like survey methods in identifying important research priorities relating to health inequalities and framing tractable research questions for topic areas identified.MethodsThe study was conducted in two phases, both using Delphi-like survey methods. Firstly, public health professionals with an interest in health inequalities were asked to identify research priorities. Secondly academic researchers were asked to frame tractable research questions relating to the priorities identified. These research priorities identified using Delphi-like survey methods were subsequently compared to those identified using different methods.ResultsA total of 52 public health professionals and 21 academics across the United Kingdom agreed to take part. The response rates were high, from public health professionals across three survey rounds (69%, 50% and 40%) and from academics across one round (52%), indicating that participants were receptive to the method and motivated to respond. The themes identified as encompassing the most important research priorities were mental health, healthy environment and health behaviours. Within these themes, the topic areas that emerged most strongly included community interventions for prevention of mental health problems and the food and alcohol environment. Some responses received from academic researchers were (as requested) in the form of tractable research questions, whereas others contributed further potential topic areas instead.ConclusionsDelphi-like survey methods are practical and productive as a means of obtaining opinions from a wide number of relevant experts identifying potential priority topic areas for research; however, this method is less appropriate for framing tractable research questions.

‘Nothing can be done until everything is done’: the use of complexity arguments by food, beverage, alcohol and gambling industries

BackgroundCorporations use a range of strategies to dispute their role in causing public health harms and to limit the scope of effective public health interventions. This is well documented in...