Articlehybrid2018

Systems Thinking as a Framework for Analyzing Commercial Determinants of Health

Cécile Knai · Mark Patrick Petticrew · Nicholas Mays · Simon Capewell · Rebecca Cassidy · Steven Cummins +8 more

199 citations0/0 files storedMilbank Quarterly

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Global Public Health Policies and Epidemiology Public Health Policies and Education Complex Systems and Decision Making

Abstract

Policy Points: Worldwide, more than 70% of all deaths are attributable to noncommunicable diseases (NCDs), nearly half of which are premature and apply to individuals of working age. Although such deaths are largely preventable, effective solutions continue to elude the public health community. One reason is the considerable influence of the "commercial determinants of health": NCDs are the product of a system that includes powerful corporate actors, who are often involved in public health policymaking. This article shows how a complex systems perspective may be used to analyze the commercial determinants of NCDs, and it explains how this can help with (1) conceptualizing the problem of NCDs and (2) developing effective policy interventions. CONTEXT: The high burden of noncommunicable diseases (NCDs) is politically salient and eminently preventable. However, effective solutions largely continue to elude the public health community. Two pressing issues heighten this challenge: the first is the public health community's narrow approach to addressing NCDs, and the second is the involvement of corporate actors in policymaking. While NCDs are often conceptualized in terms of individual-level risk factors, we argue that they should be reframed as products of a complex system. This article explores the value of a systems approach to understanding NCDs as an emergent property of a complex system, with a focus on commercial actors. METHODS: Drawing on Donella Meadows's systems thinking framework, this article examines how a systems perspective may be used to analyze the commercial determinants of NCDs and, specifically, how unhealthy commodity industries influence public health policy. FINDINGS: Unhealthy commodity industries actively design and shape the NCD policy system, intervene at different levels of the system to gain agency over policy and politics, and legitimize their presence in public health policy decisions. CONCLUSIONS: It should be possible to apply the principles of systems thinking to other complex public health issues, not just NCDs. Such an approach should be tested and refined for other complex public health challenges.

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References

2009Thinking in systems: a primer 2003Unraveling the Central State, but How? Types of Multi-level Governance 2013Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries 2011Priority actions for the non-communicable disease crisis 2010Alcohol: No Ordinary Commodity 2017The need for a complex systems model of evidence for public health 1995Integrated Strategy: Market and Nonmarket Components 2006Learning from Evidence in a Complex World

Cited by

2020Defining the commercial determinants of health: a systematic review 2021The Science for Profit Model—How and why corporations influence science and the use of science in policy and practice 2019How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention 2021Ultra-Processed Profits: The Political Economy of Countering the Global Spread of Ultra-Processed Foods – A Synthesis Review on the Market and Political Practices of Transnational Food Corporations and Strategic Public Health Responses 2023Conceptualising commercial entities in public health: beyond unhealthy commodities and transnational corporations

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