The double burden of neoliberalism? Noncommunicable disease policies and the global political economy of risk

Abstract

Publisher's copyright statement: NOTICE: this is the author's version of a work that was accepted for publication in Health place. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reected in this document. Changes may have been made to this work since it was submitted for publication. A denitive version was subsequently published in Health place, 34, July 2015, 10.1016/j.healthplace.2015.06.005Additional information: Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. AbstractThe growing prevalence of NCDs in low-and middle-income countries (LMICs) is now recognized as one of the major global health policy issues of the early 21 st century. Current official approaches reflect ambivalence about how health policy should approach the social determinants of health identified by the WHO Commission on the topic that released its report in 2008, and in particular the role of macro-scale economic and social processes. Authoritative framing of options for NCD prevention in advance of the September, 2011 UN high-level meeting on NCDs arguably relied on a selective reading of the scientific (including social scientific) evidence, and foregrounded a limited number of risk factors defined in terms of individual behaviour: tobacco use, unhealthy diet, alcohol (ab)use and physical inactivity. The effect was to reproduce at a transnational level the individualization of responsibility for health that characterizes most health promotion initiatives in high-income countries, ignoring both the limited control that many people have over their exposure to these risk factors and the contribution of macro-scale processes like trade liberalization and the marketing activities of transnational corporations to the global burden of NCDs. An alternative perspective focuses on "the inequitable distribution of power, money, and resources" described by the WHO Commission, and the ways in which policies that address those inequities can avoid unintentional incorporation of neoliberal constructions of risk and responsibility.2

Qualitative research in teen experiences living with food‐induced anaphylaxis: A meta‐aggregation

“…As media portrayals of allergy frame public conceptions of risk (Harrington, Elliott, & Clarke, 2012;Rachul & Caulfield, 2011) and a multitude of institutions and corporations exert their influence (Waggoner, 2013), FIA becomes a very public social issue. Teens with FIA are often assigned a limited amount of autonomy and responsibility for their individual health, socially policed in how they manage it and detrimentally constructed as risky beings (Glasgow & Schrecker, 2015;Spencer, 2013). However, teens with FIA live in a context where they are subject to rules of others and dependent on adult and peer supports, as the reviewed studies demonstrate.…”

Incorporating a structural approach to reducing the burden of non-communicable diseases

“…Critical review of the NCDs Declaration and subsequent documents suggests that the recommendations for action have been highly individualized, with limited emphasis on structural issues such as the social determinants of NCDs [18, 19]. Though the importance of social determinants of NCDs is acknowledged, these reviews indicate that specific recommendations for action provided by guiding documents tend to undergo a “lifestyle drift,” shifting attention from social determinants of health and other structural issues to changing individual behavior/lifestyle [19].…”

“…Though the importance of social determinants of NCDs is acknowledged, these reviews indicate that specific recommendations for action provided by guiding documents tend to undergo a “lifestyle drift,” shifting attention from social determinants of health and other structural issues to changing individual behavior/lifestyle [19]. …”

Causal narratives in public health: the difference between mechanisms of aetiology and mechanisms of prevention in non‐communicable diseases

“…On the other hand, it isn't the case that this way of thinkingthe simple narrativehas not been challenged. But the ideas and the implications of a vast body of work focusing on the social determinants of health have not been translated into preventive activity (Glasgow and Schrecker 2015) in spite of the fact that it is often acknowledged in many of the documents produced by the English Department of Health and more broadly (see for example Department of Health 2010, Commission on the Social Determinants of Health 2008). The very large amount of evidence pointing to structural determinants of health and disease and patterns of inequalities is largely absent from policy programmes other than in a rhetorical role (Bonnefoy et al 2007, Kelly andDoohan 2012).…”

“…The strong emphasis placed on simple accounts of individual behaviour and of its associated risks drives attention away from the broader factors at work (Glass et al 2013, Glasgow and Schrecker 2015, McMichael 1999. Policy makers default to simple heuristics of individual level behaviour change because it is apparently easier and more obvious than the complex thinking required to engage whole populations, or indeed to confront those anti-health forces whose profit margins depend on selling the population salty, fatty, sugary foods of low nutritional value, of flooding the market with cheap alcohol, or providing carbon greedy forms of private transport at the expense of walking or cycling.…”