• The information environment

  • Access and opportunity

  • Economic factors

  • The legal and regulatory environment

  • Prevention and treatment programs

  • The social environment

The Information Environment

The environment in which people are informed about public health issues is of critical importance, but also fraught with controversy, particularly when dealing with the marketing of commercial products. As a rule, the public health community tends to favor restrictions on commercial speech, if felt necessary to insure the public health. On the other hand, commercial interests tend to view any restrictions on marketing as infringements of their constitutional right to freedom of speech. A thorough discussion on individual speech versus commercial speech is beyond the scope of this paper; however, this tenet was a central argument in the Food and Drug Administration’s (FDA’s) attempt to regulate tobacco products (Kessler, 2001), and it remains an argument whenever legislators or regulators attempt to restrict the advertising for commercial products such as tobacco, alcohol, and foods.

Although product advertising may result in a public health benefit when the advertising promotes healthy products (Ippolito and Mathios, 1995), the majority of the debate about product marketing focuses on those products that may have harmful effects, particularly among children. Despite the concerns of commercial interests, governments do have the right to alter the informational environment, particularly when the information being conveyed is considered to be false, misleading, or deceptive. In the United States, the regulatory authority in this area is shared by multiple federal agencies, but particularly by the FDA and the Federal Trade Commission (FTC). Gostin (2003) notes that government’s power to alter the informational environment is one of the major ways in which governments can “assure the conditions for people to be healthy.” The article goes on to describe that governments can alter the informational environment in a number of ways, including by sponsoring health education campaigns and other persuasive communications, requiring product labeling, and restricting harmful or misleading advertising.

Most of the effort in altering the information environment has been done in relation to children and adolescents, particularly when it is believed that the information being conveyed may be harmful or misleading to children (Strasburger and Donnerstein, 1999). Because of this, the quality of the evidence documenting the effect of informational efforts, particularly

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