Healthy people and healthy profits? Elaborating a conceptual framework for governing the commercial determinants of non-communicable diseases and identifying options for reducing risk exposure

Abstract

BackgroundNon-communicable diseases (NCDs) represent a significant threat to human health and well-being, and carry significant implications for economic development and health care and other costs for governments and business, families and individuals. Risks for many of the major NCDs are associated with the production, marketing and consumption of commercially produced food and drink, particularly those containing sugar, salt and transfats (in ultra-processed products), alcohol and tobacco. The problems inherent in primary prevention of NCDs have received relatively little attention from international organizations, national governments and civil society, especially when compared to the attention paid to secondary and tertiary prevention regimes (i.e. those focused on provision of medical treatment and long-term clinical management). This may in part reflect that until recently the NCDs have not been deemed a priority on the overall global health agenda. Low political priority may also be due in part to the complexity inherent in implementing feasible and acceptable interventions, such as increased taxation or regulation of access, particularly given the need to coordinate action beyond the health sector. More fundamentally, governing determinants of risk frequently brings public health into conflict with the interests of profit-driven food, beverage, alcohol and tobacco industries.MaterialsWe use a conceptual framework to review three models of governance of NCD risk: self-regulation by industry; hybrid models of public-private engagement; and public sector regulation. We analyse the challenges inherent in each model, and review what is known (or not) about their impact on NCD outcomes.ConclusionWhile piecemeal efforts have been established, we argue that mechanisms to control the commercial determinants of NCDs are inadequate and efforts at remedial action too limited. Our paper sets out an agenda to strengthen each of the three governance models. We identify reforms that will be needed to the global health architecture to govern NCD risks, including to strengthen its ability to consolidate the collective power of diverse stakeholders, its authority to develop and enforce clear measures to address risks, as well as establish monitoring and rights-based accountability systems across all actors to drive measurable, equitable and sustainable progress in reducing the global burden of NCDs.

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

“…Reconfiguring relationships between powerful and entrenched commercial interests and populations at risk for or suffering from NCDs requires first a reconsideration of assumptions that governmental engagement and “co-regulation” with the private sector is the preferred model of governance for NCDs [14]. The question of private sector engagement in NCDs governance has been taken up by Working Group 3 of the WHO GCM, the international body charged with advancing implementation of the WHO GAP [32].…”

Understanding motivations for large US cannabis firms' participation in the cannabis space: Qualitative study exploring views of key decision‐makers

“…For‐profits' characterisation of cannabis as a medicine may lead to for‐profits defining standards for medical cannabis, similar to previous cases in the tobacco and agri‐food industries . Increased regulation around the characterisation of cannabis as medicine may be necessary to prevent adverse public health outcomes . Previous research regarding industries centred on addictive products suggests that such firms have an incentive to engineer and perpetuate dependence .…”

Identifying a human rights–based approach to obesity for States and civil society

“…We propose a conceptual framework for a human rights–based response to the leading obesity risk factors based on the twin pillars of State obligations and civil society engagement, and we offer recommendations for both States and civil society organizations. Our focus is the role of States and civil society; a discussion of private sector responsibilities to respect human rights in the context of obesity is beyond the scope of this paper . Nonetheless, we recognize that action by the private sector is critical, in addition to action by civil society and States.…”

“…Our focus is the role of States and civil society; a discussion of private sector responsibilities to respect human rights in the context of obesity is beyond the scope of this paper. [21][22][23][24] Nonetheless, we recognize that action by the private sector is critical, in addition to action by civil society and States. Corporations are major contributors to the global obesity pandemic, including through the formulation and promotion of unhealthy foods and beverages, including alcohol.…”