Abstract
There is increasing recognition that power imbalances that favour corporations, especially those active in unhealthy commodity industries, over other actors are central to the ways in which corporations influence population health. However, existing frameworks for analysing corporate strategies and practices that impact on health do not incorporate concepts of power in consistent ways. This paper aimed to review the ways in which corporate power has been incorporated into such frameworks, and to propose a revised framing of the commercial determinants of health (CDoH) that makes concepts of power explicit. We conducted a narrative review of frameworks that identify corporate strategies and practices and explain how these influence population health. Content analysis was conducted to identify explicit references to different qualities of power - its origins, nature, and manifestations. Twenty-two frameworks were identified, five of which used theories of power. A wide range of contexts that shape, and are shaped by corporate power were discussed, as were a diversity of corporate, social and ecological outcomes. A variety of material and ideational sources of power was also covered. We proposed an integrated 'Corporate Power and Health' framework to inform analysis of the CDoH, organised around key questions on power set out by Foucault. The proposed framework draws from a number of well-established corporate power theories and synthesises key features of existing CDoH frameworks. Public health advocates, researchers and policy-makers would likely be better placed to understand and address the CDoH by engaging with theories of power to a greater extent, and by explicitly incorporating concepts of corporate power in analyses of how the deployment of corporate strategies and practices influence population health.
Highlights
Many in the public health community have argued that key structural changes within the global political economy – including the promotion of neoliberal thinking across different social spheres, the internationalisation and liberalisation of trade and capital, and the deregulation of markets – have led to shifts in power that favour corporations over public health interests.[6,13,16,17]
We aimed to review existing frameworks for analysing the influence of strategies and practices used by corporations active in health-harming industries on population health to examine whether theories of power have been explicitly integrated, and to determine if and how they have discussed the different qualities of corporate power
Review Findings We identified 22 documents with frameworks or models designed to explain how the strategies and approaches used by private actors influence population health outcomes[4,5,6,7,8,9,13,16,17,48,49,50,51,52]
Summary
For decades, the public health community has recognised the need to understand and address the ways in which corporate actors influence population health,[1,2,3,4,5,6,7] particularly those active in health-harming industries such as the tobacco, processed food, alcohol, firearm, motor vehicle, gambling, and pharmaceutical industries.[4,7,8] In particular, within the past decade there has been a large emphasis on the role of corporations in driving the rising incidence of non-communicable diseases (NCDs).[5,7,9] This focus is unsurprising considering that NCDs result in more than twothirds of deaths and disability worldwide.[10,11] Importantly, the increased attention to the ways in which the for-profit private sector can shape social circumstances to the detriment of population health has represented a paradigm shift within the field of public health, with focus moving away from a framework of social determinism that emphasises weakness and disadvantage towards one that instead scrutinises the role of power and politics in shaping health.[5,7,12,13] Stemming from this recent shift in thinking, the field of corporate and commercial determinants of health (CDoH) emerged.[7,14,15]There is increasing awareness that at the heart of the CDoH lies the subject of corporate power.[13,16,17,18] It has been argued that, in contexts in which there is limited constraint on corporate power, dominant corporations have managed to influence many different aspects of society, from the macrostructural components (ie, policy and regulatory spaces) to the moulding of individual behaviours and consumption patterns, in order to protect and pursue their interests.[8,17,19] Furthermore, many in the public health community have argued that key structural changes within the global political economy – including the promotion of neoliberal thinking across different social spheres, the internationalisation and liberalisation of trade and capital, and the deregulation of markets – have led to shifts in power that favour corporations over public health interests.[6,13,16,17] To date, however, corporate power has not been a mainstream focus of the public health community, and the role that corporate actors play in
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