Systems thinking as a framework for analysing commercial determinants of health

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Knai, C; Petticrew, M; Mays, N; Capewell, S; Cassidy, Rebecca; Cummins, S; Eastmure, E; Fafard, P; Hawkins, B and Jensen, J. 2018. Systems thinking as a framework for analysing commercial determinants of health. Milbank Quarterly, 96(3), pp. 472-498. ISSN 0887-378X, [Article]

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Official URL: https://onlinelibrary.wiley.com/doi/full/10.1111/1...

Abstract or Description

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.

Item Type:

Article

Identification Number (DOI):

https://doi.org/10.1111/1468-0009.12339

Additional Information:

Funders

NHS Research Scotland Senior Clinical Fellowship. Grant Number: SCAF/15/02
Medical Research Council. Grant Numbers: MC_UU_12017/13, MC_UU_12017/15
Scottish Government Chief Scientist Office. Grant Numbers: SPHSU13, SPHSU15