Power

Trans-national corporations (TNCs) are recognised as having an adverse impact on public health through the marketing and sale of unhealthy products. In addition to this some of their practices affect health, including taxation avoidance, lobbying politicians to gain favourable legislative and regulatory environments for their operations, and failure to abide by occupational health and safety standards. We argue that while considering the individual practices of commercial actors is crucial the true public health harms are only evident when the synergistic impacts of the practices are considered. We also note that the practices are supported by a global economic and political system which operates in the favour of commercial actors rather than the health of people and the planet. Consequently there needs to be a norm change by which norms and power are shifted away from commercial interests and externalities of commercial practices are no longer outsourced to the public purse.

Walking is a complex activity that involves multiple parts of the body, including the lower limb, upper limb, trunk, head, and neck. Contrary to popular belief, walking is not solely related to the forward movement of the legs. Biomechanical analysis, especially in terms of mechanical power, is an essential aspect of gait studying. The study aims to explore how altering arm swing speed affects the 3D maximum mechanical power of the lower limb while walking.

In this study, 30 healthy women walked on a force plate path in front of cameras in three states of normal upper limb swing, fast upper limb swing, and slow upper limb swing. The calculation of muscle power in each lower limb joint and plane is based on the product of the joint moment and its angular velocity. The average mechanical power of the joints was compared using the repeated measurement test (P≤0.05).

The results showed that changing the swing speed of the arm has a significant effect on all absorption and production parameters related to the mechanical power of the lower limb joints.

In conclusion, any change in arm movement during walking can affect movement, balance, and gait biomechanics.

This article agrees with Lassa et al that biomedical paradigms and medical professionals are a dominating force within the policy dynamics of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and that there needs to be greater community involvement in how global health initiatives (GHIs) are adopted, designed, implemented and evaluated. However, we argue that many of the conditions identified are entrenched and perpetuated by how GHIs are financed and the financing modalities employed in Development Aid for Health (DAH), particularly in low resource settings. As a result, the dynamics of power not only flow from traditionally entrenched epistemic authorities but are disproportionally sustained by global health financing modalities that favour particular GHIs over others. As we argue, these DAH modalities can exert forms of power with problematic effects on policy-making.

Political economy analysis (PEA) has been advanced as critical to understanding the political dimensions of policy change processes. However, political economy (PE) is not a theory on its own but draws on several concepts. Nannini et al, in concert with other scholars, emphasise that politics is characterised by conflict, contestation and negotiation over interests, ideas and power as various agents attempt to influence their context. This commentary reflects how Nannini et al wrestled with these PEA concepts - summarised in their conceptual framework used for PEA of the Ugandan case study on financial risk protection reforms. The central premise is that a common understanding of the PEA concepts (mainly structure-agency interactions, ideas, interests, institutions and power) forms a basis for strategies to advance thinking and working politically. Consequently, I generate several insights into how we can promote politically informed approaches to designing, implementing and evaluating policy reforms and development efforts.

To study major system change (MSC) in healthcare, it is crucial to consider the influence of power. Despite this, dominant perspectives on MSC in healthcare present these as relatively neutral processes, where reconfigurations are logical solutions to clearly defined problems. Perry and colleagues’ paper adds to a growing body of research which challenges the presentation of MSC as neutral, managerial processes, instead identifying how power dynamics lie at the heart of why service change happens, how it unfolds, and its outcomes. However, the introduction of power considerations raises several overlapping methodological and ethical dilemmas for researchers, and questions regarding research design and dissemination. In this commentary, we use the insights generated by Perry et al to further explore these issues.

  Performance-based financing (PBF) was introduced to Kilifi county in Kenya in 2015. This study investigates how and why political and bureaucratic actors at the local level in Kilifi county influenced the extent to which PBF was politically prioritised at the sub-national level.

  The study employed a single-case study design. The Shiffman and Smith political priority setting framework with adaptations proposed by Walt and Gilson was applied. Data was collected through document review (n = 19) and in-depth interviews (n = 8). Framework analysis was used to analyse data and generate findings.

  In the period 2015-2018, the political prioritisation of PBF at the county level in Kilifi was influenced by contextual features including the devolution of power to sub-national actors and rigid public financial management (PFM) structures. It was further influenced by interpretations of the idea of ‘pay-for-performance,’ its framing as ‘additional funding,’ as well as contestation between actors at the sub national level about key PBF design features. Ultimately PBF ceased at the end of 2018 after donor funding stopped.

  Health reformers must be cognisant of the power and interests of national and sub national actors in all phases of the policy process, including both bureaucratic and political actors in health and non-health sectors. This is particularly important in devolved public governance contexts where reforms require sustained attention and budgetary commitment at the sub national level. There is also need for early involvement of critical actors to develop shared understandings of the ideas on which interventions are premised, as well as problems and solutions.

Lassa and colleagues’ study is a strong commentary on the biomedical hegemony and professional monopoly of medical doctors in the policy landscape of the Global Fund in Nigeria. Situating this critical dimension of professional power within wider scholarship of power and governance of global health initiatives (such as the Global Fund), in this comment, I put forth two core arguments. I call for a relational perspective of power in a dynamic policy space that the Fund characterises. I argue that a systems-view analysis of power requires a thorough examination of subsystems, how they interact, and the diverse forms of power — individual agentic, ideational, and structural — and the mechanisms through which power is wielded. The lens of governmentality allows linking individual (expertise and practices) with institutional regimes and social practices these enable; and in examining the interface of local/sub-national, national, and global within which policy formulation and implementation occurs.

The onset and impacts of COVID-19 have prompted attention to national health system preparedness for, and capacity to adapt in response to, public health emergencies and other shocks. This preparedness and adaptive capacity are often framed as ‘health system resilience’ a concept previously associated more with assessments of health systems in conflict-affected and fragile states. Yet health system resilience remains a slippery concept, defined and applied in multiple ways. Reflecting on the Hodgins and colleagues’ study “the COVID-19 system shock framework: capturing health system innovation during the COVID-19 pandemic,” this article restates the limitations of health systems resilience as a concept capable of anchoring evaluative assessments of health system performance but stresses its value in the context of explanatory research investigating how and why health systems adapt, with due attention to the power of actors’ whose choices inform the nature and direction of change.

Medical professionals exercised structural and productive power in the Global Fund’s Country Coordinating Mechanism (CCM) in Nigeria, directly impacting the selection of approaches to HIV/AIDS care, as described in a case study by Lassa and colleagues. This research contributes to a robust scholarship on how biomedical power inhibits a holistic understanding of health and prevents the adoption of solutions that are socially grounded, multidisciplinary, and co-created with communities. We highlight Lassa and colleagues’ findings demonstrating the ‘long arm’ of global health institutions in country-level health policy choices, and reflect on how medical dominance within global institutions serves as a tool of control in ways that pervert incentives and undermine equity and effectiveness. We call for increased research and advocacy to surface these conduits of power and begin to loosen their hold in the global health policy agenda.

Powell and Manion present an important review of reviews about health and policy research. They zero in on theories of the policy process as the most likely to unearth what is really going on in health policy. Here I contend that their analysis insufficiently attends to institutions. Powell and Manion situate ‘institutions’ (with ‘Ideas’ and ‘Interests’) as a ‘health policy process models’ that ‘tend to’ list factors rather than connect them. Rather, I show how there is a rich history of considering institutions in the political science literature that is under considered by Powell and Manion. By necessity for a Public Health audience I quickly pull back the covers on ‘rigour’ and ‘causation’ to demonstrate what is ‘fit for purpose’ in rigorous institution focussed policy analysis. I conclude by arguing how institutionally focussed public health policy analysis is vital for understanding and addressing heath inequities. That focus necessitates research that provides better, explicit, conceptualisations of power in health policy: especially drawing out the roles played by structure and agency. I offer some recent examples.

  Commercial determinants of health (CDoH) represent a critical frame for exploring undue corporate and commercial influence over health. Power lenses are integral to understanding CDoH. Impacts of food, alcohol, and gambling industries are observable CDoH outcomes. This study aims to inform understanding of the systems and institutions of commercial and/or corporate forces working within the Australian food, alcohol, and gambling industries that influence health and well-being, including broader discourses materialised via these systems and institutions.

  Twenty semi-structured interviews were conducted with key-informants on Australian public policy processes. Interviewees were current and former politicians, political staff members, regulators and other public servants, industry representatives, lobbyists, journalists, and researchers with expertise and experience of the Australian food, alcohol, and/or gambling industries. Interviews sought participants’ perceptions of Australian food, alcohol, and gambling industries’ similarities and differences, power and influence, relationships, and intervention opportunities and needs.

  Strategies and tactics used by Australian food, alcohol and gambling industries are similar, and similar to those of the tobacco industry. They wield considerable soft (eg, persuasive, preference-shaping) and hard (eg, coercive, political, and legal/economic) power. Perceptions of this power differed considerably according to participants’ backgrounds. Participants framed their understanding of necessary interventions using orthodox neoliberal discourses, including limiting the role of government, emphasising education, consumer freedom, and personal choice.

  Food, alcohol, and gambling industries exercise powerful influences in Australian public policy processes, affecting population health and well-being. Per Wood and colleagues’ framework, these manifest corporate, social, and ecological outcomes, and represent considerable instrumental, structural, and discursive power. We identify power as arising from discourse and material resources alike, along with relationships and complex industry networks. Addressing power is essential for reducing CDoH harms. Disrupting orthodox discourses and ideologies underpinning this should be a core focus of public health (PH) advocates and researchers alike.

This study presents sports performance based on food nutrition. The study aims to increase athletes' power and anaerobic fatigue by eating enough food nutrition to use sports exercise on a cycle ergometer by a scenario study.

The cycle ergometer model and simulation of energy-power is impacted by nutrition and movement as the study linked energy and power (the athlete scenario).

This study conducted a theoretical study using 21 scenario athlete weights and a cycle ergometer device. It focused on athlete strength and anaerobic fatigue using flywheel resistance. The study demonstrated reliability and mathematical modeling of scenario data. This study was based on SPSS 28.0 for data analysis and evaluation (one-way ANOVA, spectral analysis, autocorrelation function, and T-Test), assessing the reliability of scenario data using regression analysis.

The modeling showed that the scenario athletes with 21 different weights had an anaerobic fatigue efficiency greater than 80% and anaerobic power capacities between 10.2 [kW] and 16.7 [kW].

The athletes' anaerobic capacity and fatigue increased with weight, but their efficiency (capacity) remained the same. As a result, ATP (Adenosine Triphosphate) is produced and used by the body, which enhances performance. This study demonstrates how the athlete's social economic environment and movement patterns impact power-energy.