Conceptualising the Commercial Determinants of Health Using a Power Lens: A Review and Synthesis of Existing Frameworks

Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.

The Science for Profit Model—How and why corporations influence science and the use of science in policy and practice

“…In short, influence on science does not occur in a vacuum; rather it is key part of the system through which corporate influence and power more generally are mediated. Amalgamating our typology with other models, overviews and conceptualisations of CPA and the commercial determinants of health (CDoH) [10,11,[16][17][18][19][20]69] could therefore provide a more holistic overview of how interactions with science serve corporate interests well beyond scientific and academic environments. This also indicates that addressing corporate influence on science is key to addressing CPA and CDoH more broadly.…”

“…Researchers have begun to develop such frameworks, but some earlier works did not explicitly identify science as a key tenet [16,17]. Emerging models of the commercial determinants of health [18][19][20] identify science as an important route of influence, but none of these, nor the sector-specific taxonomies of corporate political activity [9][10][11], examine or categorise science in detail.…”

Children’s, parents’ and professional stakeholders’ views on power concerning the regulation of online advertising of unhealthy food to young people in the UK: A qualitative study

“…Over the past decade, public health advocates have emphasised the role unhealthy commodity industries (UCIs) play in driving the increased rates of non-communicable diseases (NCDs), with NCDs contributing to two thirds of deaths and disability worldwide [ 1 ]. This has resulted in an increased examination of the role of politics and power in shaping health, and has contributed to the emergence of the field commercial determinants of health (CDoH) [ 2 ].…”

Recognising the elephant in the room: the commercial determinants of health

“…Many describe CDoH as originating from unchecked and unseen corporate power, including setting social narratives, influencing legal and political processes, framing rights and taking ownership of knowledge and ideas 6 12–15. Contemporary systems of trade, employment, public policy, political, legal, economic, civil society, media and others create environments that encourage and support the unbridled growth and power of corporate and commercial actors, with carefully constructed discourses supporting and shaping such systems.…”