Systems Thinking as a Framework for Analyzing Commercial Determinants of Health

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.

Oral diseases: a global public health challenge

“…139 Knai and colleagues have proposed a systems approach for analysing the commercial determinants of health. 140 Such an approach has the potential to promote a better understanding of the broader political, institutional, and cultural contexts in which health outcomes, risk factors and behaviours are embedded. They argue that taking a systems approach to understanding commercial determinants of NCDs helps identify more clearly how unhealthy commodity industries market their products, gain agency over policy and politics, and legitimise their increasing presence in public health decision-making.…”

“…The adverse influence of corporate players in governmental public health policy is well documented, with coherence of approaches often apparent across industries 140 Efforts employed include criticising health-promotion policies as overbearing governmental interference (nanny state) and insisting on the importance of consumer choice and individual responsibility. Knai and colleagues argue that corporations have an impact through being able to create systems that are resilient to public health interventions, having the capacity to adapt and diversify.…”

“…Knai and colleagues argue that corporations have an impact through being able to create systems that are resilient to public health interventions, having the capacity to adapt and diversify. 140 Buse and colleagues have expanded on the role of industry in influencing decision-making and describe a conceptual framework for governing the commercial drivers of NCD risk. 128 They emphasise the need for the development of new and more robust processes for governance and accountability of NCD prevention at the global level.…”

Tackling gambling related harms as a public health issue

“…9 The complex nature of the gambling environment and factors that influence both individual gambling behaviour and risk of harm means that policy change could lead to both the industry and individuals changing their behaviour in unpredictable ways. 10 When access is restricted or stakes reduced for a specific form of gambling, unintended consequences are likely to include an increase in other forms of gambling. This consideration serves as a strong rationale for a policy approach that, as well as targeting specific forms of gambling, includes systemwide interventions and for ensuring that all policies are evaluated for both the intended and unintended consequences.…”

A Systems Thinking Approach to Inform Coherent Policy Action for NCD Prevention Comment on "How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention"

“…3 The utility of this approach for understanding the etiology of NCDs is increasingly recognized. 4 In considering the dynamic complexity of complex systems, Sterman usefully describes a set of characteristics that would apply well to various NCD policy challenges that have emerged out of a dominant neoliberal paradigm. 2 For Sterman, complex systems display: • Constant change at different time scales.…”