Commercial Determinants of Health: Economic and Health Interests Can Be Aligned

Most public health research on the commercial determinants of health (CDOH) to date has focused on a narrow segment of commercial actors. These actors are generally the transnational corporations producing so-called unhealthy commodities such as tobacco, alcohol, and ultra-processed foods. Furthermore, as public health researchers, we often discuss the CDOH using sweeping terms such as private sector, industry, or business that lump together diverse entities whose only shared characteristic is their engagement in commerce. The absence of clear frameworks for differentiating among commercial entities, and for understanding how they might promote or harm health, hinders the governance of commercial interests in public health. Moving forward, it is necessary to develop a nuanced understanding of commercial entities that goes beyond this narrow focus, enabling the consideration of a fuller range of commercial entities and the features that characterise and distinguish them. In this paper, which is the second of three papers in a Series on commercial determinants of health, we develop a framework that enables meaningful distinctions among diverse commercial entities through consideration of their practices, portfolios, resources, organisation, and transparency. The framework that we develop permits fuller consideration of whether, how, and to what extent a commercial actor might influence health outcomes. We discuss possible applications for decision making about engagement; managing and mitigating conflicts of interest; investment and divestment; monitoring; and further research on the CDOH. Improved differentiation among commercial actors strengthens the capacity of practitioners, advocates, academics, regulators, and policy makers to make decisions about, to better understand, and to respond to the CDOH through research, engagement, disengagement, regulation, and strategic opposition.

The actors influencing the commercial determinants of health (CDOH) in sub-Saharan Africa (SSA) have different interests and lenses around the costs and benefits of market influences in health. We analysed...

BackgroundThe commercial determinants of health (CDoH) drive the rise of NCDs globally, and their regulation requires multisectoral governance. Despite existing recommendations to strengthen institutional structures, protecting public health interests can be challenging amidst industry interference and conflicting policy priorities, particularly in low and middle-income countries (LMICs) where the need for rapid economic development is pronounced. Small island developing states (SIDS) face even more challenges in regulating CDoH because their unique socioeconomic, political, and geographic vulnerabilities may weaken institutional conditions that could aid health sector actors in protecting health interests. This study aims to explore the institutional conditions that shape health sector actors’ capability to protect public health interests in tobacco governance in Fiji and Vanuatu.MethodsWe employed a qualitative, exploratory case study design. We applied the administrative process theory to inform data collection and analysis. Seventy interviews were completed in Fiji and Vanuatu from 2018 to 2019.ResultsThe findings show that the protection of health interests in tobacco governance were not supported by the institutional conditions in Fiji and Vanuatu. While the policy processes formally ensured a level playing field between actors, policies were often developed through informal mechanisms, and the safeguards to protect public interests from vested private interests were not implemented adequately. SIDS vulnerabilities and weak regulation of political parties contributed to the politicisation of government in both states, resulting in high-level government officials’ questionable commitment to protect public health interests. The system of checks and balances usually embedded into democratic governments appeared to be muted, and policymakers had limited bureaucratic autonomy to elevate health interests in multisectoral policymaking amidst high-level government officials’ frequent rotation. Finally, capacity constraints aggravated by SIDS vulnerabilities negatively impacted health sector actors' capability to analyse policy alternatives.ConclusionsHealth sector actors in Fiji and Vanuatu were not supported by institutional conditions that could help them protect public health interests in multisectoral governance to regulate CDoH originating from the tobacco industry. Institutional conditions in these states were shaped by SIDS vulnerabilities but could be improved by targeted capacity building, governance and political system strengthening.

Why action on the commercial determinants of health is vital.

The main causes of non-communicable diseases (NCDs), health inequalities and health inequity include consumption of unhealthy commodities such as tobacco, alcohol and/or foods high in fat, salt and/or sugar. These exposures are preventable, but the commodities involved are highly profitable. The economic interests of ‘Unhealthy Commodity Producers’ (UCPs) often conflict with health goals but their role in determining health has received insufficient attention. In order to address this gap, a new research consortium has been established. This open letter introduces the SPECTRUM (Shaping Public hEalth poliCies To Reduce ineqUalities and harM)Consortium: a multi-disciplinary group comprising researchers from 10 United Kingdom (UK) universities and overseas, and partner organisations including three national public health agencies in Great Britain (GB), five multi-agency alliances and two companies providing data and analytic support. Through eight integrated work packages, the Consortium seeks to provide an understanding of the nature of the complex systems underlying the consumption of unhealthy commodities, the role of UCPs in shaping these systems and influencing health and policy, the role of systems-level interventions, and the effectiveness of existing and emerging policies. Co-production is central to the Consortium’s approach to advance research and achieve meaningful impact and we will involve the public in the design and delivery of our research. We will also establish and sustain mutually beneficial relationships with policy makers, alongside our partners, to increase the visibility, credibility and impact of our evidence. The Consortium’s ultimate aim is to achieve meaningful health benefits for the UK population by reducing harm and inequalities from the consumption of unhealthy commodities over the next five years and beyond.

The main causes of non-communicable diseases (NCDs), health inequalities and health inequity include consumption of unhealthy commodities such as tobacco, alcohol and/or foods high in fat, salt and/or sugar. These exposures are preventable, but the commodities involved are highly profitable. The economic interests of 'Unhealthy Commodity Producers' (UCPs) often conflict with health goals but their role in determining health has received insufficient attention. In order to address this gap, a new research consortium has been established. This open letter introduces the SPECTRUM ( S haping Public h Ealth poli Cies To Reduce ineq Ualities and har M)Consortium: a multi-disciplinary group comprising researchers from 10 United Kingdom (UK) universities and overseas, and partner organisations including three national public health agencies in Great Britain (GB), five multi-agency alliances and two companies providing data and analytic support. Through eight integrated work packages, the Consortium seeks to provide an understanding of the nature of the complex systems underlying the consumption of unhealthy commodities, the role of UCPs in shaping these systems and influencing health and policy, the role of systems-level interventions, and the effectiveness of existing and emerging policies. Co-production is central to the Consortium's approach to advance research and achieve meaningful impact and we will involve the public in the design and delivery of our research. We will also establish and sustain mutually beneficial relationships with policy makers, alongside our partners, to increase the visibility, credibility and impact of our evidence. The Consortium's ultimate aim is to achieve meaningful health benefits for the UK population by reducing harm and inequalities from the consumption of unhealthy commodities over the next five years and beyond.

Socio-economic rights have been largely neglected in international human rights law. Misconceptions about the nature of these rights have resulted in their marginalisation and their relegation to second-class rights. Effective enforcement mechanisms in respect of socio-economic rights are still lacking in international human rights law. In the context of the ICESCR, an individual complaint mechanism for socio-economic rights was only introduced in 2009. In contrast, civil and political rights have long been recognised in international human rights law and have always been subjected to effective enforcement mechanisms, in particular, individual complaint mechanisms. The distinction between the two sets of rights - civil and political rights on the one hand, and socio-economic rights on the other hand - has begun to fade. The international human rights community has now recognised the interdependence, indivisibility and interrelatedness of all human rights. Supervisory organs tasked with the interpretation and enforcement of civil and political rights treaties, most notably the ECtHR and the HRC, have played a crucial role in this process. They have recognised in their jurisprudence the interrelatedness of both sets of rights and have allowed socio-economic interests to be enforced indirectly through the canon of traditional, civil and political rights. This article specifically considers the ECtHR’s and the HRC’s jurisprudence on the right to life which demonstrates the extent to which these organs have protected social and economic interests. By using a variety of techniques, which are examined in this article, both organs have permeated the right to life with significant socio-economic dimensions. The analysis of the jurisprudence of the ECtHR shows that the right to life applies to cases concerning health interests in the broad sense as well as environmental interests. For its part, the HRC has not only recognised health and environmental interests as coming within Article 6 of the ICCPR, but also subsistence interests. The article concludes that, despite the conceptual developments, it is difficult for victims of such violations to succeed before the ECtHR and the HRC. The high standards imposed make it difficult for victims to bring successful claims based on the right to life.

Three periods are distinguished and applied to describe the dynamics of changes in the system of supply of alcoholic beverages in Central and Eastern Europe since 1980. The distinction of these three periods is based on changes in the regulation of the supply. The period of the old regulation ended in most countries around the 1990s. A deregulation took place in the early 1990s. The first steps toward a reregulation were visible in attempts to create a new order in the alcohol market in the last years of the 1990s. The analysis builds mainly on developments in Poland and Russia, with more scattered information from other countries. In each period the role of different actors (the state, the enterprises, organized crime, civil organizations and individuals), different interests (economic development, state finances, political order, public order, public health and various symbolic interests) and different public measures to regulate the supply (licensing, taxation and preventive actions and treatment) are considered. The analysis shows how the state lost its dominant position to private firms and is slowly regaining it again, how interest in state finances, overall economic development and later in profit-making dominate all three periods, and how the old system of regulations was ruined, to become rebuilt in very small steps with many conflicts and complications. Public health interests and also civil society interests were weak in comparison with economic interests. From the public health perspective, changes in the supply system have had significant consequences, but a more comprehensive regulation of supply does not necessarily lead to diminished alcohol-related harm.

We develop a novel approach integrating epidemiological and economic models that allows data-based simulations during a pandemic. We examine the economically optimal opening strategy that can be reconciled with the containment of a pandemic. The empirical evidence is based on data from Germany during the SARS-CoV-2 pandemic. Our empirical findings reject the view that there is necessarily a conflict between health protection and economic interests and suggest a non-linear U-shape relationship: it is in the interest of public health and the economy to balance non-pharmaceutical interventions in a manner that further reduces the incidence of infections. Our simulations suggest that a prudent strategy that leads to a reproduction number of around 0.75 is economically optimal. Too restrictive policies cause massive economic costs. Conversely, policies that are too loose lead to higher death tolls and higher economic costs in the long run. We suggest this finding as a guide for policy-makers in balancing interests of public health and the economy during a pandemic.

Canada has been regarded as a model global citizen with firm commitments to multilateralism. It has also played important roles in several international health treaties and conventions in recent years. There are now concerns that its interests in health as a foreign policy goal may be diminishing. This article reports on a thematic analysis of key Canadian foreign policy statements issued over the past decade, and interviews with key informants knowledgeable of, or experienced in the interstices of Canadian health and foreign policy. It finds that health is primarily and increasingly framed in relation to national security and economic interests. Little attention has been given to human rights obligations relevant to health as a foreign policy issue, and global health is not seen as a priority of the present government. Global health is nonetheless regarded as something with which Canadian foreign policy must engage, if only because of Canada’s membership in many United Nations and other multilateral fora. Development of a single global health strategy or framework is seen as important to improve intersectoral cooperation on health issues, and foreign policy coherence. There remains a cautious optimism that health could become the base from which Canada reasserts its internationalist status.

This chapter proposes that companies are taking a new biopolitical interest in health which is leading to a convergence of work and health. When digital self-tracking (DST) devices are used in corporate wellness (CW) programmes, they form a socio-technical assemblage which enables companies to improve health through encouraging higher levels of activity while increasing productivity. Economic interests and an incitement to health are merged with an ethical concern for the population and a drive to ‘do good’ as part of social responsibility. This dual concern with commerce and health improvement, enabled by the development of DST, is causing healthiness (and virtuousness) to become increasingly associated with ‘activity’, which becomes a general arbiter of moral value.

Balancing health and the environment against economic interests – in terms of production but also employment – is a big conundrum for national, European and international courts and politics. It seems a ‘tragic choice’ to deal with. The Ilva case symbolises an environmental disaster that offers an opportunity to delve into several sensitive issues. Part I will address, firstly, the possible methods and limitations of balancing constitutional rights in the Italian legal system, drawing on the flexible and dynamic nature of the hierarchy of legal values. Secondly, it will address the role of effective judicial protection of the right to health and environment, taking into consideration access to justice and effective remedies, as the European Court of Human Rights (ECtHR) pointed out. Part II will focus on the role of civil liability in repairing damage where no effective prevention is feasible. While focusing on the unilateral prevention of accidents and the irrelevance of a regulatory compliance defence, the paper will contend that ‘reflected’ environmental damage should be awarded compensation through a strict rule of liability. Finally, the paper will articulate some policy remarks as to the most effective model to regulate environmental disasters.

Three periods are distinguished and applied to describe the dynamics of changes in the system of supply of alcoholic beverages in Central and Eastern Europe since 1980. The distinction of these three periods is based on changes in the regulation of the supply. The period of the old regulation ended in most countries around the 1990s. A deregulation took place in the early 1990s. The first steps toward a reregulation were visible in attempts to create a new order in the alcohol market in the last years of the 1990s. The analysis builds mainly on developments in Poland and Russia, with more scattered information from other countries. In each period the role of different actors (the state, the enterprises, organized crime, civil organizations and individuals), different interests (economic development, state finances, political order, public order, public health and various symbolic interests) and different public measures to regulate the supply (licensing, taxation and preventive actions and treatment) are considered. The analysis shows how the state lost its dominant position to private firms and is slowly regaining it again, how interest in state finances, overall economic development and later in profit‐making dominate all three periods, and how the old system of regulations was ruined, to become rebuilt in very small steps with many conflicts and complications. Public health interests and also civil society interests were weak in comparison with economic interests. From the public health perspective, changes in the supply system have had significant consequences, but a more comprehensive regulation of supply does not necessarily lead to diminished alcohol‐related harm.

The Covid-19 pandemic around the world has caused various problems, especially in the health and economic sectors. Various efforts have been made by the government to overcome the impact of Covid-19. One of the government's efforts is to carry out various public communication strategies to influence public discourse and behavior in order to avoid the virus. However, the government's efforts to construct public discourse must deal with other discourses that are sourced from information spread on the internet. This article seeks to understand the construction of government discourse and other discourses by using secondary data from internet. The conclusion that can be drawn is that the discourse constructed by the government in an effort to deal with the impact of the Covid-19 pandemic is that there is always a middle way between health interests and economic interests. People must remain productive at work while maintaining health. Meanwhile, another public discourse that has also developed is that Covid-19 is a form of global conspiracy that aims to destabilize the world economy.

The informal governance of public-private partnerships in UK obesity policy: Collaborating on calorie reduction or reducing effectiveness?