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Zwierczyk U, Kobryn M, Duplaga M. The Awareness of the Role of Commercial Determinants of Health and the Readiness to Accept Restrictions on Unhealthy Food Advertising in Polish Society. Nutrients 2023; 15:4743. [PMID: 38004137 PMCID: PMC10674888 DOI: 10.3390/nu15224743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/17/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
The negative consequences of commercial determinants of health (CDoH) have become a major challenge for public health systems, especially in terms of non-communicable diseases (NCDs). CDoH are defined as profit-driven factors that influence health. In this study, we assessed the awareness of CDoH and the attitudes toward potential restrictions on advertising, as well as fiscal interventions targeting food products with harmful effects on health in Polish society. Our analysis is based on data from a computer-based web interviewing (CAWI) survey performed in May 2022 among 2008 adult internet users from Poland. Multivariable logistic regression models were developed for variables derived from three items exploring the respondents' understanding of the relationship between CDoH and NCDs, as well as three items asking about their acceptance of a prohibition of advertising unhealthy products during sports events, a general ban on unhealthy food advertising, and their attitudes toward sugar-sweetened beverages (SSBs). Food (FL) and e-health literacy (eHL) levels were consistently positive predictors of both awareness of CDoH and acceptance of the proposed actions. Both higher FL and eHL were significantly associated with the opinion that advertising unhealthy food is associated with the prevalence of NCDs (OR, 95% CI: 1.03, 1.02-1.05, and 1.04, 1.02-1.06, respectively). Health literacy was less frequently a significant predictor of the dependent variables. Among sociodemographic factors, a respondent's level of education and age showed a significant relationship with their awareness and acceptance of countermeasures against CDoH. Respondents with a university master's level of education were more likely to agree with the statement on the relationship between big industry profits and harm to society's health (OR, 95% CI: 1.96, 1.42-2.69) and to support a ban on advertising unhealthy food similar to that for tobacco products (OR, 95% CI: 1.66, 1.21-2.27). Respondents suffering from chronic diseases were also consistently more likely to show a greater understanding of the harmful impact of CDoH and support proposed restrictions. For example, they were more likely to agree with restrictions on advertising harmful products during sports events (OR, 95% CI: 1.23, 1.02-1.50) and the introduction of a sugar tax (OR, 95% CI: 1.26, 1.03-1.54). Our study revealed that more than 50% of the Polish population is conscious of the problem of the harmful effects of big industries producing and selling processed food, sugar-sweetened beverages, and alcoholic beverages. Interestingly, slightly more than half of the respondents supported the introduction of restrictions on advertising such products. Still, only approximately 30% of them accepted a sugar tax to counter the obesity epidemic. The results of our study indicate that Polish society is open to the introduction of regulations aimed at limiting the impact of commercial determinants of health. To our knowledge, this is one of the first studies to assess the awareness of CDoH and the acceptance of restrictions to limit their impact.
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Affiliation(s)
| | | | - Mariusz Duplaga
- Department of Health Promotion and e-Health, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Skawińska Str. 8, 31-066 Krakow, Poland; (U.Z.); (M.K.)
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Barrett J. Commercial Determinants of Health and Nursing Research: Opportunities for Advancement. Clin Nurs Res 2023; 32:995-999. [PMID: 37395541 DOI: 10.1177/10547738231185243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
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Logan AC, D'Adamo CR, Prescott SL. The Founder: Dispositional Greed, Showbiz, and the Commercial Determinants of Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095616. [PMID: 37174136 PMCID: PMC10178243 DOI: 10.3390/ijerph20095616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
Marketing unhealthy products by multinational corporations has caused considerable harm to individual health, collective wellbeing, and environmental sustainability. This is a growing threat to all societies and a significant contributor to the rising global burden of non-communicable diseases and early mortality. While there is growing consideration of the commercial determinants of health, this is largely focused on the methods by which unhealthy products are marketed and disseminated, including efforts to manipulate policy. Little attention has been paid to the underlying psychological traits and worldviews that are driving corporate greed. Here, we consider the role of "dispositional greed" in the commercial determinants of health with a focus on the historical attitudes and culture in the ultra-processed food industry-exemplified by "The Founder" of the McDonald's franchise. We argue that greed and associated psychological constructs, such as social dominance orientation and collective narcissism, permeate the commercial determinants of health at a collective level. This includes how a culture of greed within organizations, and individual dispositional greed, can magnify and cluster at scale, perpetuated by social dominance orientation. We also consider the ways in which "showbiz" marketing specifically targets marginalized populations and vulnerable groups, including children-in ways that are justified, or even celebrated despite clear links to non-communicable diseases and increased mortality. Finally, we consider how greed and exploitative mindsets mirror cultural values and priorities, with trends for increasing collective narcissism at scale, recognizing that many of these attitudes are cultivated in early life. A healthier future will depend on navigating a path that balances material prosperity with physical and spiritual wellbeing. This will require cultural change that places higher value on kindness, reciprocity, and mutualistic values especially in early life, for more equitable flourishing.
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Affiliation(s)
- Alan C Logan
- Nova Institute for Health, Baltimore, MD 21231, USA
| | - Christopher R D'Adamo
- Nova Institute for Health, Baltimore, MD 21231, USA
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Susan L Prescott
- Nova Institute for Health, Baltimore, MD 21231, USA
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Medical School, University of Western Australia, Nedlands, WA 6009, Australia
- The ORIGINS Project, Telethon Kids Institute, Nedlands, WA 6009, Australia
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Nykiforuk CIJ, Belon AP, de Leeuw E, Harris P, Allen-Scott L, Atkey K, Glenn NM, Hyshka E, Jaques K, Kongats K, Montesanti S, Nieuwendyk LM, Pabayo R, Springett J, Yashadhana A. An action-oriented public health framework to reduce financial strain and promote financial wellbeing in high-income countries. Int J Equity Health 2023; 22:66. [PMID: 37055742 PMCID: PMC10099014 DOI: 10.1186/s12939-023-01877-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 03/28/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Perceived financial security impacts physical, mental, and social health and overall wellbeing at community and population levels. Public health action on this dynamic is even more critical now that the COVID-19 pandemic has exacerbated financial strain and reduced financial wellbeing. Yet, public health literature on this topic is limited. Initiatives targeting financial strain and financial wellbeing and their deterministic effects on equity in health and living conditions are missing. Our research-practice collaborative project addresses this gap in knowledge and intervention through an action-oriented public health framework for initiatives targeting financial strain and wellbeing. METHODS The Framework was developed using a multi-step methodology that involved review of theoretical and empirical evidence alongside input from a panel of experts from Australia and Canada. In an integrated knowledge translation approach, academics (n = 14) and a diverse group of experts from government and non-profit sectors (n = 22) were engaged throughout the project via workshops, one-on-one dialogues, and questionnaires. RESULTS The validated Framework provides organizations and governments with guidance for the design, implementation, and assessment of diverse financial wellbeing- and financial strain-related initiatives. It presents 17 priority actionable areas (i.e., entry points for action) likely to have long-lasting, positive effects on people's financial circumstances, contributing to improved financial wellbeing and health. The 17 entry points relate to five domains: Government (All Levels), Organizational & Political Culture, Socioeconomic & Political Context, Social & Cultural Circumstances, and Life Circumstances. CONCLUSIONS The Framework reveals the intersectionality of root causes and consequences of financial strain and poor financial wellbeing, while also reinforcing the need for tailored actions to promote socioeconomic and health equity for all people. The dynamic, systemic interplay of the entry points illustrated in the Framework suggest opportunities for multi-sectoral, collaborative action across government and organizations towards systems change and the prevention of unintended negative impacts of initiatives.
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Affiliation(s)
- Candace I. J. Nykiforuk
- Centre for Healthy Communities, School of Public Health, University of Alberta, ECHA 3-300, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Ana Paula Belon
- Centre for Healthy Communities, School of Public Health, University of Alberta, ECHA 3-300, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Evelyne de Leeuw
- Centre for Primary Health Care & Equity, University of New South Wales, Level 3, AGSM, UNSW, Sydney, NSW 2052 Australia
| | - Patrick Harris
- Centre for Health Equity, Training, Research & Evaluation (CHETRE), Part of the UNSW Sydney Research Centre for Primary Health Care & Equity, A Unit of Population Health, South Western Sydney Local Health District, NSW Health, Ingham Institute, Liverpool Hospital Locked Bag 7103, NSW, Liverpool, BC 1871 Australia
| | - Lisa Allen-Scott
- Provincial Population and Public Health, Alberta Health Services, 2210, 2nd Street SW, Calgary, AB T2S 3C3 Canada
| | - Kayla Atkey
- Centre for Healthy Communities, School of Public Health, University of Alberta, ECHA 3-300, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Nicole M. Glenn
- Centre for Healthy Communities, School of Public Health, University of Alberta, ECHA 3-300, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Elaine Hyshka
- Centre for Healthy Communities, School of Public Health, University of Alberta, ECHA 3-300, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Karla Jaques
- Centre for Health Equity, Training, Research & Evaluation (CHETRE), Part of the UNSW Sydney Research Centre for Primary Health Care & Equity, A Unit of Population Health, South Western Sydney Local Health District, NSW Health, Ingham Institute, Liverpool Hospital Locked Bag 7103, NSW, Liverpool, BC 1871 Australia
| | - Krystyna Kongats
- Centre for Healthy Communities, School of Public Health, University of Alberta, ECHA 3-300, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Stephanie Montesanti
- Centre for Healthy Communities, School of Public Health, University of Alberta, ECHA 3-300, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Laura M. Nieuwendyk
- Centre for Healthy Communities, School of Public Health, University of Alberta, ECHA 3-300, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Roman Pabayo
- Centre for Healthy Communities, School of Public Health, University of Alberta, ECHA 3-300, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Jane Springett
- Centre for Healthy Communities, School of Public Health, University of Alberta, ECHA 3-300, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Aryati Yashadhana
- Centre for Primary Health Care & Equity, University of New South Wales, Level 3, AGSM, UNSW, Sydney, NSW 2052 Australia
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Borges LC, Zeferino de Menezes H, Crosbie E. More Pain, More Gain! The Delivery of COVID-19 Vaccines and the Pharmaceutical Industry's Role in Widening the Access Gap. Int J Health Policy Manag 2022; 11:3101-3113. [PMID: 36028975 PMCID: PMC10105197 DOI: 10.34172/ijhpm.2022.6942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 08/01/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND An effective response to the coronavirus disease 2019 (COVID-19) pandemic entails a comprehensive strategy that ensures equitable access to all COVID-19-fighting technologies. To achieve this goal, the international community has acknowledged immunization as a public good. However, a trend of grossly unequal dose distribution emerged, owing, among other factors, to pharmaceutical companies' profit-driven actions, jeopardizing the mechanisms built to increase vaccine access. The contradiction between public health interests and corporate discretion in determining vaccine dose distribution poses critical concerns about the health risks associated with lengthening the duration of the pandemic and the eventual liability of companies for violations of human rights. METHODS To evaluate the risks posed to the COVID-19 immunization program, data on vaccine allocation and delivery, vaccine dose application, immunized populations, and the volume of Advanced Purchase Agreements (APAs) between countries and pharmaceutical companies were compiled and assessed. A descriptive analysis was then conducted to analyze the role of pharmaceutical companies in providing equitable access to COVID-19 vaccines. RESULTS When the data is broken down by income (as of June 2021), it shows that high-income countries (HICs) have already crossed the COVID-19 Vaccine Global Access (COVAX) 20% immunization threshold. However, countries of all other income levels have yet to achieve this mark for fully vaccinated people. Upper-middle-income countries (UMICs) have approximately 3%, low- and middle-income countries (LMICs) have approximately 2% and low-income countries (LICs) have less than 0.1% of fully vaccinated people per hundred. The supply shortage is expected to last until the second half of 2021. CONCLUSION As a result of the COVAX failure, a health gap emerged with countries living in a pre-immunization period for an extended time. The existing conflict between the international response to tackle COVID-19 and corporate profit-driven behavior contributed to prolonging pandemic, especially in Africa. Accordingly, there is a need to approve an international treaty that targets the activities of all actors, including the pharmaceutical companies, in protecting human rights and the right to health realms.
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Affiliation(s)
| | | | - Eric Crosbie
- School of Public Health, University of Nevada Reno, Reno, NV, USA
- Ozmen Institute for Global Studies, University of Nevada Reno, Reno, NV, USA
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Abstract
Policy Points The commercial determinants of health (CDoH) concept, which currently focuses on markets that harm health, should be expanded to refer to the interface between commerce and health, which can sometimes have positive public health consequences. The regulatory stances framework helps us classify public health preferences for regulating specific markets related to CDoH, based on the intended effects of regulations on market size. The regulatory stances a jurisdiction can adopt can be classified as ranging from prohibitionist through contractionist, permissive, and expansionist, to universalist. The regulatory stances framework increases the usefulness of the CDoH concept by expanding the conversation beyond negative determinants of health and providing a fuller view of the tools at the disposal of society to alter markets and improve health. CONTEXT The effects of commerce on the public health are omnipresent. The commercial determinants of health (CDoH) represent a burgeoning area of scholarly debate and activist policymaking to redress markets that adversely affect public health. The CDoH debate is a logical extension of the tobacco control movement, but, to its detriment, the CDoH conversation remains primarily focused policies and proposals that are analogous to historical tobacco control strategies. METHODS This paper argues that for the CDoH to develop further and broaden its appeal, it should expand to cover markets with conditional and positive impacts on health. To explain and order this conversation, a comparative framework for regulatory policy is introduced: the regulatory stances. The regulatory stances classify a regulatory policy based on the intended effect of policy on the size of a market in the future relative to the present. FINDINGS Some markets that interface between commerce and health do not inherently harm health. Regulatory policy toward these markets should be different in intent than regulatory policy for markets with negative health effects. CONCLUSIONS By using the regulatory stances framework to encompass markets that have positive or conditional effects on health as well as those that have adverse health effects, the CDoH conversation can shift away from the exclusive focus on strategies to shrink markets with adverse health impacts to consider a wider array of policy options.
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Affiliation(s)
- ALEX C. LIBER
- Georgetown University Lombardi Comprehensive Cancer Center
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Wood B, Baker P, Sacks G. Conceptualising the Commercial Determinants of Health Using a Power Lens: A Review and Synthesis of Existing Frameworks. Int J Health Policy Manag 2022; 11:1251-1261. [PMID: 33619932 PMCID: PMC9808328 DOI: 10.34172/ijhpm.2021.05] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 01/16/2021] [Indexed: 01/12/2023] Open
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.
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Affiliation(s)
- Benjamin Wood
- Global Obesity Centre, Deakin University, Geelong, VIC, Australia
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Gary Sacks
- Global Obesity Centre, Deakin University, Geelong, VIC, Australia
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Profiling household double and triple burden of malnutrition in sub-Saharan Africa: prevalence and influencing household factors. Public Health Nutr 2022; 25:1563-1576. [PMID: 33896443 PMCID: PMC9991556 DOI: 10.1017/s1368980021001750] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Undernutrition and anaemia (the commonest micronutrient deficiency), continue to remain prevalent and persistent in sub-Saharan Africa (SSA) alongside a rising prevalence of overweight and obesity. However, there has been little research on the co-existence of all three conditions in the same household in recent years. The current study examines the co-existence and correlates of the different conditions of household burden of malnutrition in the same household across SSA. SETTING The study involved twenty-three countries across SSA who conducted Demographic and Health Surveys between 2008 and 2017. PARTICIPANTS The analytical sample includes 145 020 households with valid data on the nutritional status of women and children pairs (i.e. women of reproductive age; 15-49 years and children under 5 years). DESIGN Logistic regression analyses were used to determine household correlates of household burden of malnutrition. RESULTS Anaemia was the most common form of household burden of malnutrition, affecting about seven out of ten households. Double and triple burden of malnutrition, though less common, was also found to be present in 8 and 5 % of the households, respectively. The age of the household head, location of the household, access to improved toilet facilities and household wealth status were found to be associated with various conditions of household burden of malnutrition. CONCLUSIONS The findings of the current study reveal that both double and triple burden of malnutrition is of public health concern in SSA, thus nutrition and health interventions in SSA must not be skewed towards addressing undernutrition only but also address overweight/obesity and anaemia.
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Krokstad S, Weiss DA, Krokstad MA, Rangul V, Kvaløy K, Ingul JM, Bjerkeset O, Twenge J, Sund ER. Divergent decennial trends in mental health according to age reveal poorer mental health for young people: repeated cross-sectional population-based surveys from the HUNT Study, Norway. BMJ Open 2022; 12:e057654. [PMID: 35584877 PMCID: PMC9119156 DOI: 10.1136/bmjopen-2021-057654] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Public health trends are formed by political, economic, historical and cultural factors in society. The aim of this paper was to describe overall changes in mental health among adolescents and adults in a Norwegian population over the three last decades and discuss some potential explanations for these changes. DESIGN Repeated population-based health surveys to monitor decennial changes. SETTING Data from three cross-sectional surveys in 1995-1997, 2006-2008 and 2017-2019 in the population-based HUNT Study in Norway were used. PARTICIPANTS The general population in a Norwegian county covering participants aged 13-79 years, ranging from 48 000 to 62 000 000 in each survey. MAIN OUTCOME MEASURES Prevalence estimates of subjective anxiety and depression symptoms stratified by age and gender were assessed using the Hopkins Symptom Checklist-5 for adolescents and the Hospital Anxiety and Depression Scale for adults. RESULTS Adolescents' and young adults' mental distress increased sharply, especially between 2006-2008 and 2017-2019. However, depressive symptoms instead declined among adults aged 60 and over and anxiety symptoms remained largely unchanged in these groups. CONCLUSIONS Our trend data from the HUNT Study in Norway indicate poorer mental health among adolescents and young adults that we suggest are related to relevant changes in young people's living conditions and behaviour, including the increased influence of screen-based media.
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Affiliation(s)
- Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | | | - Morten Austheim Krokstad
- Faculty of Health Sciences and Nursing, Nord Universitet - Levanger Campus, Levanger, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Vegar Rangul
- HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway
- Faculty of Health Sciences and Nursing, Nord Universitet - Levanger Campus, Levanger, Norway
| | - Kirsti Kvaløy
- HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jo Magne Ingul
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ottar Bjerkeset
- Faculty of Health Sciences and Nursing, Nord Universitet - Levanger Campus, Levanger, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jean Twenge
- Department of Psychology, College of Sciences, San Diego State University, San Diego, California, USA
| | - Erik R Sund
- HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway
- Faculty of Health Sciences and Nursing, Nord Universitet - Levanger Campus, Levanger, Norway
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Nampewo Z, Mike JH, Wolff J. Respecting, protecting and fulfilling the human right to health. Int J Equity Health 2022; 21:36. [PMID: 35292027 PMCID: PMC8922072 DOI: 10.1186/s12939-022-01634-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Human rights are best protected, promoted and guaranteed when they can compel binding and enforceability duty. One prominent criticism of category of human rights which includes the human right to health is that it is difficult, to assign the duties that correspond to these rights, because of stark disparity in how the main duty bearers approach their duties. Methods This paper adopts a doctrinal approach to examine and evaluate the duties to the right to health. The method in this study entails a detailed literature search to systematically evaluate the legal implications, regulations, arguments and policy regarding the nature of the obligation to the right to health. This study also engages with normative and philosophical aspects of human rights. Results This paper posits that human rights protect against common, serious, and remediable threats and risks, and ensure that there are remedies from governments and third parties. However, it is difficult to compel duties especially in regard to the right to health. First it is not easy to achieve a uniform standard for duty bearers implied by the words ‘highest attainable physical and mental health.’ Theorists discussed in the paper outline views of what this could mean, from serious to common health concerns. Second, the right to health is not a legally established right in many jurisdictions, making it difficult to enforce. This paper outlines different layers of state and non-state legal duty bearers to enforce the right to health. Conclusion The duty to respect, protect, fulfil and even remedy the right to health, will often be meaningless in practice without a clear identification of the necessary duty bearers to enforce them. The law is the starting point for this to not only enshrine this right as a legally enforceable one but also to clearly identify duty bearers. Without this, the human right to health as outlined under international and regional human rights law generates an implausible, or even impossible, profusion of duties. There remains much work still to be done especially on the moral and legal fronts in order to fully guarantee this right. Trial Registration Not applicable Our work does not report results of a health care intervention on human participants. Registration is therefore not applicable.
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Affiliation(s)
- Zahara Nampewo
- Makerere University Faculty of Law: Makerere University School of Law, Kampala, Uganda.
| | - Jennifer Heaven Mike
- Makerere University Faculty of Law: Makerere University School of Law, Kampala, Uganda
| | - Jonathan Wolff
- Makerere University Faculty of Law: Makerere University School of Law, Kampala, Uganda
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Lee K, Freudenberg N. Public Health Roles in Addressing Commercial Determinants of Health. Annu Rev Public Health 2022; 43:375-395. [DOI: 10.1146/annurev-publhealth-052220-020447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The shared challenges posed by the production and distribution of health-harming products have led to growing recognition of the need for policy learning and transfer across problems, populations, and social contexts. The commercial determinants of health (CDoH) can serve as a unifying concept to describe the population health consequences arising from for-profit actors and activities, along with the social structures that sustain them. Strategies to mitigate harms from CDoH have focused on behavioral change, regulation, fiscal policies, consumer and citizen activism, and litigation. While there is evidence of effective measures for each strategy, approaches that combine strategies are generally more impactful. Filling gaps in evidence can inform ways of adapting these strategies to specific populations and social contexts. Overall, CDoH are addressed most effectively not through siloed efforts to reduce consumption of health-harming products, but instead as a set of integrated strategies to reduce exposures to health-harming commercial actors and activities. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Kelley Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Nicholas Freudenberg
- School of Public Health and Health Policy, City University of New York, New York, NY, USA
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Montez JK, Hayward MD, Zajacova A. Trends in U.S. Population Health: The Central Role of Policies, Politics, and Profits. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2021; 62:286-301. [PMID: 34528482 PMCID: PMC8454055 DOI: 10.1177/00221465211015411] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Recent trends in U.S. health have been mixed, with improvements among some groups and geographic areas alongside declines among others. Medical sociologists have contributed to the understanding of those disparate trends, although important questions remain. In this article, we review trends since the 1980s in key indicators of U.S. health and weigh evidence from the last decade on their causes. To better understand contemporary trends in health, we propose that commonly used conceptual frameworks, such as social determinants of health, should be strengthened by prominently incorporating commercial, political-economic, and legal determinants. We illustrate how these structural determinants can provide new insights into health trends, using disparate health trajectories across U.S. states as an example. We conclude with suggestions for future research: focusing on structural causes of health trends and inequalities, expanding interdisciplinary perspectives, and integrating methods better equipped to handle the complexity of causal processes driving health trends and inequalities.
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Abstract
BACKGROUND The growing concern of low health literacy in populations combined with the interest of companies to develop cultures of health and the emerging interest in the workplace as an arena for improving health literacy is increasingly acknowledged. This study aimed to explore how companies currently apply the concept of health literacy as part of their health efforts in the work sphere. METHODS A systematic literature review was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. The search was performed in the databases PubMed, Science Direct, and Directory of Open Access Journals from July 2019 to August 2019 and included the search terms "health literacy," "health literate," and "health competence" combined with the search terms "company/companies," "corporation/corporates," "workplace," "business," and "organization." Studies were eligible for inclusion if they (1) were written in English or German, (2) were concerned with employers/employees, companies, corporations, or organizations, (3) dealt with health literacy in particular, and (4) were formatted as journal articles, systematic literature reviews, or book chapters. KEY RESULTS The search identified 20 articles. A thematic analysis resulted in 5 clusters with 2 to 3 sub-themes illustrating the characteristics of how corporations apply health literacy. The clusters entailed the conceptualization of health literacy, its measurement, and the application of health literacy in strategies, interventions, and training. DISCUSSION The literature review reveals that the application of health literacy by companies is in its infancy. More research and practical experience are warranted on how companies can mobilize and facilitate a health literate workforce. [HLRP: Health Literacy Research and Practice. 2021;5(3):e218-e225.] Plain Language Summary: This literature study explored the role of advancing health literacy in companies. Five aspects were identified as important, including the understanding of the concept, its measurement, and its integration into strategies, interventions, and training. The involvement of management and the staff was crucial for success.
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Affiliation(s)
| | - Kristine Sørensen
- Address correspondence to Kristine Sørensen, PhD, Global Health Literacy Academy, Viengevej 100, 8240 Risskov, Denmark;
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14
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Howse E, Hankey C, Bauman A, Freeman B. Are young adults' discussions of public health nutrition policies associated with common food industry discourses? A qualitative pilot study. Aust N Z J Public Health 2021; 45:171-180. [PMID: 33617122 DOI: 10.1111/1753-6405.13074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/01/2020] [Accepted: 12/01/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Unhealthy diets are a key risk factor for chronic disease, with young adults (18-30 years old) in high-income countries like Australia and the UK particularly at risk. Improved public health nutrition policies can help address unhealthy diets in the population, but many of the more regulatory policies are opposed by food industry groups. This research explores how young adults in Australia and the UK discuss a range of topical public health nutrition policies and analyses whether and how their views may be associated with food industry discourses. METHODS Eight focus groups were held in Sydney, Australia, and Glasgow, UK, with a total of thirty young adults participating. A deliberative-style method was used in the focus groups to generate discussion about six public health nutrition policies, such as taxation of sugar-sweetened beverages and restrictions on advertising of less-healthy foods. Discourse analysis was used to examine participants' discussions. RESULTS Twenty discourse codes were developed iteratively from the focus group data. These were thematically linked with nine food industry discourses found in the peer-reviewed literature, including industry self-regulation, personal responsibility, corporate social responsibility and challenging nutrition science. CONCLUSIONS These results demonstrate there is an association between common food industry discourses and some young adults' views about public health nutrition policies. Implications for public health: Identifying, engaging with and responding to common industry discourses is a priority in order to build greater public support and acceptability of policies that will improve diet and prevent chronic disease.
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Affiliation(s)
- Eloise Howse
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Prevention Research Collaboration, New South Wales.,The Australian Prevention Partnership Centre, The Sax Institute, New South Wales
| | - Catherine Hankey
- University of Glasgow, School of Medicine, Dentistry and Nursing, United Kingdom
| | - Adrian Bauman
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Prevention Research Collaboration, New South Wales.,The Australian Prevention Partnership Centre, The Sax Institute, New South Wales
| | - Becky Freeman
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Prevention Research Collaboration, New South Wales
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15
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Abstract
Policy Points Explanations for the troubling trend in US life expectancy since the 1980s should be grounded in the dynamic changes in policies and political landscapes. Efforts to reverse this trend and put US life expectancy on par with other high-income countries must address those factors. Of prime importance are the shifts in the balance of policymaking power in the United States, the polarization of state policy contexts, and the forces behind those changes.
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16
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Movsisyan A, Rehfuess E, Norris SL. When complexity matters: a step-by-step guide to incorporating a complexity perspective in guideline development for public health and health system interventions. BMC Med Res Methodol 2020; 20:245. [PMID: 33008285 PMCID: PMC7532611 DOI: 10.1186/s12874-020-01132-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/23/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Guidelines on public health and health system interventions often involve considerations beyond effectiveness and safety to account for the impact that these interventions have on the wider systems in which they are implemented. This paper describes how a complexity perspective may be adopted in guideline development to facilitate a more nuanced consideration of a range of factors pertinent to decisions regarding public health and health system interventions. These factors include acceptability and feasibility, and societal, economic, and equity and equality implications of interventions. MAIN MESSAGE A 5-step process describes how to incorporate a complexity perspective in guideline development with examples to illustrate each step. The steps include: (i) guideline scoping, (ii) formulating questions, (iii) retrieving and synthesising evidence, (iv) assessing the evidence, and (v) developing recommendations. Guideline scoping using stakeholder consultations, complexity features, evidence mapping, logic modelling, and explicit decision criteria is emphasised as a key step that informs all subsequent steps. CONCLUSIONS Through explicit consideration of a range of factors and enhanced understanding of the specific circumstances in which interventions work, a complexity perspective can yield guidelines with better informed recommendations and facilitate local adaptation and implementation. Further work will need to look into the methods of collecting and assessing different types of evidence beyond effectiveness and develop procedural guidance for prioritising across a range of decision criteria.
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Affiliation(s)
- A Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Marchioninistrasse 17, 81377, Munich, Germany. .,Pettenkofer School of Public Health, LMU Munich, Marchioninistrasse 17, 81377, Munich, Germany.
| | - E Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Marchioninistrasse 17, 81377, Munich, Germany.,Pettenkofer School of Public Health, LMU Munich, Marchioninistrasse 17, 81377, Munich, Germany
| | - S L Norris
- Science Division, Department of Quality Assurance of Norms and Standards, World Health Organization, 20 Avenue Appia, 1211, 27, Geneva, Switzerland
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17
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Maani N, Collin J, Friel S, Gilmore AB, McCambridge J, Robertson L, Petticrew MP. Bringing the commercial determinants of health out of the shadows: a review of how the commercial determinants are represented in conceptual frameworks. Eur J Public Health 2020; 30:660-664. [PMID: 31953933 PMCID: PMC7445044 DOI: 10.1093/eurpub/ckz197] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The term 'commercial determinants of health' (CDOH) is increasingly focussing attention upon the role of tobacco, alcohol and food and beverage companies and others-as important drivers of non-communicable diseases (NCDs). However, the CDOH do not seem to be clearly represented in the most common social determinants of health (SDOH) frameworks. We review a wide range of existing frameworks of the determinants of health to determine whether and how commercial determinants are incorporated into current SDOH thinking. METHODS We searched for papers and non-academic reports published in English since 2000 describing influences on population health outcomes. We included documents with a formal conceptual framework or diagram, showing the integration of the different determinants. RESULTS Forty-eight framework documents were identified. Only one explicitly included the CDOH in a conceptual diagram. Ten papers discussed the commercial determinants in some form in the text only and fourteen described negative impacts of commercial determinants in the text. Twelve discussed positive roles for the private sector in producing harmful commodities. Overall, descriptions of commercial determinants are frequently understated, not made explicit, or simply missing. The role of commercial actors as vectors of NCDs is largely absent or invisible in many of the most influential conceptual diagrams. CONCLUSIONS Our current public health models may risk framing public health problems and solutions in ways that obscure the role that the private sector, in particular large transnational companies, play in shaping the broader environment and individual behaviours, and thus population health outcomes.
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Affiliation(s)
- Nason Maani
- London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health, Boston University, Boston, MA, USA
| | - Jeff Collin
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
- SPECTRUM Consortium, UK
| | - Sharon Friel
- SPECTRUM Consortium, UK
- School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, The Australian National University, Canberra, ACT, Australia
| | - Anna B Gilmore
- SPECTRUM Consortium, UK
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Jim McCambridge
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Lindsay Robertson
- SPECTRUM Consortium, UK
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Mark P Petticrew
- London School of Hygiene and Tropical Medicine, London, UK
- SPECTRUM Consortium, UK
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18
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de Lacy-Vawdon C, Livingstone C. Defining the commercial determinants of health: a systematic review. BMC Public Health 2020; 20:1022. [PMID: 32600398 PMCID: PMC7325018 DOI: 10.1186/s12889-020-09126-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 06/16/2020] [Indexed: 12/14/2022] Open
Abstract
Background Despite increasing attention to the social determinants of health in recent decades, globally there is an unprecedented burden from non-communicable diseases (NCDs). Recently, the corporate and commercial conditions associated with these, commercial determinants of health (CDoH), have also begun to receive attention. This research aims to articulate the CDoH as described in the literature, summarize substantive findings, and assess strengths and limitations of current literature. Methods Systematic review of formal (Medline, EMBASE, Scopus, Global Health) and grey literature (database, Google Advanced, targeted website, citation searching). Searching identified 125 texts for full-text review, with 33 included for final review. Data extracted were analyzed thematically. Results The dynamics constituting CDoH include broad facilitators such as globalization of trade, corporate structures, and regulatory systems, articulation of social and economic power, neoliberal and capitalist ideologies; additional elements include corporate activities such as marketing, corporate political activities, corporate social responsibility, extensive supply chains, harmful products and production, and issues of accessibility. These contribute significantly to worsened global health outcomes. Conclusions Literature describing effects of macro conditions and corporate activities on health could usefully utilize CDoH terminology. Facilitation via revised, consistent and operational definition of CDoH would assist. Social, political, commercial and economic structures and relations of CDoH are under-theorized. Systematic approaches to identifying, describing, and disrupting these are required to improve global health.
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Affiliation(s)
| | - Charles Livingstone
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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19
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Clark H, Coll-Seck AM, Banerjee A, Peterson S, Dalglish SL, Ameratunga S, Balabanova D, Bhan MK, Bhutta ZA, Borrazzo J, Claeson M, Doherty T, El-Jardali F, George AS, Gichaga A, Gram L, Hipgrave DB, Kwamie A, Meng Q, Mercer R, Narain S, Nsungwa-Sabiiti J, Olumide AO, Osrin D, Powell-Jackson T, Rasanathan K, Rasul I, Reid P, Requejo J, Rohde SS, Rollins N, Romedenne M, Singh Sachdev H, Saleh R, Shawar YR, Shiffman J, Simon J, Sly PD, Stenberg K, Tomlinson M, Ved RR, Costello A. A future for the world's children? A WHO-UNICEF-Lancet Commission. Lancet 2020; 395:605-658. [PMID: 32085821 DOI: 10.1016/s0140-6736(19)32540-1] [Citation(s) in RCA: 377] [Impact Index Per Article: 94.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/10/2019] [Accepted: 09/19/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Helen Clark
- The Helen Clark Foundation, Auckland, New Zealand; Partnership for Maternal Newborn & Child Health, Geneva, Switzerland
| | | | - Anshu Banerjee
- Department of Maternal Newborn Child and Adolescent Health, Geneva, Switzerland
| | - Stefan Peterson
- UNICEF Headquarters, Programme Division, Health Section, New York, USA
| | - Sarah L Dalglish
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Shanthi Ameratunga
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, OT, Canada; Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - John Borrazzo
- Global Financing Facility, World Bank, Washington, DC, USA
| | - Mariam Claeson
- Global Financing Facility, World Bank, Washington, DC, USA
| | - Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Fadi El-Jardali
- Department of Health Management and Policy, Beirut, Lebanon; Knowledge to Policy Center American University of Beirut, Beirut, Lebanon
| | - Asha S George
- School of Public Health, University of Western Cape, Bellville, South Africa
| | | | - Lu Gram
- Institute for Global Health, London, UK
| | - David B Hipgrave
- UNICEF Headquarters, Programme Division, Health Section, New York, USA
| | - Aku Kwamie
- Health Policy and Systems Research Consultant, Accra, Ghana
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Raúl Mercer
- Program of Social Sciences and Health, Latin American School of Social Sciences, Buenos Aires, Argentina
| | - Sunita Narain
- Centre for Science and Environment, New Delhi, India
| | | | | | | | - Timothy Powell-Jackson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Papaarangi Reid
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jennifer Requejo
- Division of Data, Analysis, Planning and Monitoring, Data and Analytics Section, New York, USA
| | - Sarah S Rohde
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Nigel Rollins
- Department of Maternal Newborn Child and Adolescent Health, Geneva, Switzerland
| | | | - Harshpal Singh Sachdev
- Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Rana Saleh
- Knowledge to Policy Center American University of Beirut, Beirut, Lebanon
| | - Yusra R Shawar
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Jeremy Shiffman
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Jonathon Simon
- Department of Maternal Newborn Child and Adolescent Health, Geneva, Switzerland
| | - Peter D Sly
- Children's Health and Environment Program, The University of Queensland, Brisbane, QLD, Australia
| | - Karin Stenberg
- Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Rajani R Ved
- National Health Systems Resource Centre, New Delhi, India
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20
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An exposé of the realpolitik of trade negotiations: implications for population nutrition. Public Health Nutr 2019; 22:3083-3091. [PMID: 31439059 DOI: 10.1017/s1368980019001642] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To explore the formal and informal ways in which different actors involved in shaping trade agreements pursue their interests and understand the interactions with nutrition, in order to improve coherence between trade and nutrition policy goals. DESIGN The paper draws on empirical evidence from Australian key informant interviews that explore the underlying political dimensions of trade agreements that act as barriers or facilitators to getting nutrition objectives on trade agendas. SETTING Countries experiencing greater availability and access to diets full of energy-dense and nutrient-poor foods through increased imports, greater foreign direct investment and increasing constraints on national health policy space as a result of trade agreements. PARTICIPANTS Interviews took place with Australian government officials, industry, public-interest non-government organizations and academics. RESULTS The analysis reveals the formal and informal mechanisms and structures that different policy actors use both inside and outside trade negotiations to pursue their interests. The analysis also identifies the discourses used by the different actors, as they attempt to influence trade agreements in ways that support or undermine nutrition-related goals. CONCLUSIONS Moving forward requires policy makers, researchers and health advocates to use various strategies including: reframing the role of trade agreements to include health outcomes; reforming the process to allow greater access and voice to health arguments and stakeholders; establishing cross-government partners through accountable committees; and building circles of consensus and coalitions of sympathetic public-interest actors.
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Rochford C, Tenneti N, Moodie R. Reframing the impact of business on health: the interface of corporate, commercial, political and social determinants of health. BMJ Glob Health 2019; 4:e001510. [PMID: 31478013 PMCID: PMC6703283 DOI: 10.1136/bmjgh-2019-001510] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/30/2019] [Accepted: 05/04/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Connor Rochford
- Blavatnik School of Government, University of Oxford, Oxford, UK
| | - Naveen Tenneti
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rob Moodie
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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22
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Current opportunities to catalyze research in nutrition and cancer prevention - an interdisciplinary perspective. BMC Med 2019; 17:148. [PMID: 31357989 PMCID: PMC6664739 DOI: 10.1186/s12916-019-1383-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/02/2019] [Indexed: 02/02/2023] Open
Abstract
Cancer Research UK and Ludwig Cancer Research convened an inaugural international Cancer Prevention and Nutrition Conference in London on December 3-4, 2018. Much of the discussion focused on the need for systematic, interdisciplinary approaches to better understand the relationships of nutrition, exercise, obesity and metabolic dysfunction with cancer development. Scientists at the meeting underscored the importance of studying the temporal natural history of exposures that may cumulatively impact cancer risk later in life.A robust dialogue identified obesity as a major risk for cancer, and the food environment, especially high energy and low nutrient processed foods, as strong and prevalent risk factors for obesity. Further engagement highlighted challenges in the post-diagnostic setting, where similar opportunities to understand the complex interplay of nutrition, physical activity, and weight will inform better health outcomes.Going forward, holistic research approaches, encompassing insights from multiple disciplines and perspectives, will catalyze progress urgently needed to prevent cancer and improve public health.
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Exploring the relationship between Big Food corporations and professional sports clubs: a scoping review. Public Health Nutr 2019; 22:1888-1897. [PMID: 30935432 DOI: 10.1017/s1368980019000545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Professional sport occupies a prominent cultural position in societies across the globe and commercial organisations make use of this to promote their products. The present scoping review explores existing academic literature on the relationship between professional sports clubs and food and drink marketing and considers how this relationship may impact upon the public's health. DESIGN The scoping review searched six databases. Experts were also consulted. Records written in languages other than English were excluded. We also excluded records relating to mega events (e.g. Olympics, Football World Cup) and alcohol marketing, because of the attention already given to these. SETTING Professional sports clubs. RESULTS We identified 18 166 titles, reviewed 163 abstracts and read twenty-six full texts. We included six papers in the review. Four were from Australia and New Zealand. The Australasian literature focused largely on the marketing of foods and beverages to children and the potential impact on consumption. Single papers from researchers in Turkey and the USA were identified. The Turkish paper analysed shirt sponsorship in football leagues internationally and showed food and beverage (including alcohol) companies were the most common sponsors. The US paper examined a mixed reaction to a football team named after an energy drink. CONCLUSIONS Commercial relationships between professional sports clubs and Big Food corporations have largely eluded scrutiny in much of the world. The current review highlights the lack of public health research on these relationships. Research exploring the interdependent commercial practices of food and drink companies and professional sports clubs is urgently needed.
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Ireland R, Bunn C, Reith G, Philpott M, Capewell S, Boyland E, Chambers S. Commercial determinants of health: advertising of alcohol and unhealthy foods during sporting events. Bull World Health Organ 2019; 97:290-295. [PMID: 30940986 PMCID: PMC6438257 DOI: 10.2471/blt.18.220087] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/08/2019] [Accepted: 01/24/2019] [Indexed: 11/27/2022] Open
Abstract
Tobacco, alcohol and foods that are high in fat, salt and sugar generate much of the global burden of noncommunicable diseases. We therefore need a better understanding of how these products are promoted.The promotion of tobacco products through sporting events has largely disappeared over the last two decades, but advertising and sponsorship continues bycompanies selling alcohol, unhealthy food and sugar-sweetened beverage. The sponsorship of sporting events such as the Olympic Games, the men’s FIFA World Cup and the men’s European Football Championships in 2016, has received some attention in recent years in the public health literature. Meanwhile, British football and the English Premier League have become global events with which transnational companies are keen to be associated, to promote their brands to international markets. Despite its reach, the English Premier League marketing and sponsorship portfolio has received very little scrutiny from public health advocates. We call for policy-makers and the public health community to formulate an approach to the sponsorship of sporting events, one that accounts for public health concerns.
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Affiliation(s)
- Robin Ireland
- College of Social Sciences,School of Social and Political Sciences, University of Glasgow, 25-29 Bute Gardens, Glasgow G12 8RS Scotland
| | - Christopher Bunn
- College of Social Sciences,School of Social and Political Sciences, University of Glasgow, 25-29 Bute Gardens, Glasgow G12 8RS Scotland
| | - Gerda Reith
- School of Social and Political Sciences, University of Glasgow, Glasgow, Scotland
| | | | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, England
| | - Emma Boyland
- Department of Psychological Sciences, University of Liverpool, Liverpool, England
| | - Stephanie Chambers
- MRC/CSOSocial and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
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Affiliation(s)
- Samuel J Moysés
- School of Life Sciences at Pontifícia Universidade Católica do Paraná (PPGO/PUCPR), Curitiba, PR, Brazil
| | - Renata C Soares
- School of Life Sciences at Pontifícia Universidade Católica do Paraná (PPGO/PUCPR), Curitiba, PR, Brazil
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McKee M, Stuckler D. Revisiting the Corporate and Commercial Determinants of Health. Am J Public Health 2018; 108:1167-1170. [PMID: 30024808 DOI: 10.2105/ajph.2018.304510] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We trace the development of the concept of the corporate determinants of health. We argue that these determinants are predicated on the unchecked power of corporations and that the means by which corporations exert power is increasingly unseen. We identify four of the ways corporations influence health: defining the dominant narrative; setting the rules by which society, especially trade, operates; commodifying knowledge; and undermining political, social, and economic rights. We identify how public health professionals can respond to these manifestations of power.
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Affiliation(s)
- Martin McKee
- Martin McKee is with the London School of Hygiene & Tropical Medicine, London, UK. David Stuckler is with the Department of Policy Analysis and Public Management and Dondena Research Centre, University of Bocconi, Milan, Italy
| | - David Stuckler
- Martin McKee is with the London School of Hygiene & Tropical Medicine, London, UK. David Stuckler is with the Department of Policy Analysis and Public Management and Dondena Research Centre, University of Bocconi, Milan, Italy
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27
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Baum F, Friel S. Politics, policies and processes: a multidisciplinary and multimethods research programme on policies on the social determinants of health inequity in Australia. BMJ Open 2017; 7:e017772. [PMID: 29273655 PMCID: PMC5778301 DOI: 10.1136/bmjopen-2017-017772] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The development and implementation of multisectoral policy to improve health and reduce health inequities has been slow and uneven. Evidence is largely focused on the facts of health inequities rather than understanding the political and policy processes. This 5-year funded programme of research investigates how these processes could function more effectively to improve equitable population health. METHODS AND ANALYSIS The programme of work is organised in four work packages using four themes (macroeconomics and infrastructure, land use and urban environments, health systems and racism) related to the structural drivers shaping the distribution of power, money and resources and daily living conditions. Policy case studies will use publicly available documents (policy documents, published evaluations, media coverage) and interviews with informants (policy-makers, former politicians, civil society, private sector) (~25 per case). NVIVO software will be used to analyse the documents to see how 'social and health equity' is included and conceptualised. The interview data will include qualitative descriptive and theory-driven critical discourse analysis. Our quantitative methodological work assessing the impact of public policy on health equity is experimental that is in its infancy but promises to provide the type of evidence demanded by policy-makers. ETHICS AND DISSEMINATION Our programme is recognising the inherently political nature of the uptake, formulation and implementation of policy. The early stages of our work indicate its feasibility. Our work is aided by a Critical Policy Reference Group. Multiple ethics approvals have been obtained with the foundation approval from the Social and Behavioural Ethics Committee, Flinders University (Project No: 6786).The theoretical, methodological and policy engagement processes established will provide improved evidence for policy-makers who wish to reduce health inequities and inform a new generation of policy savvy knowledge on social determinants.
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Affiliation(s)
- Fran Baum
- Southgate Institute for Health, Society and Equity, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Sharon Friel
- School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, The Australian National University, Canberra, Australia
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28
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Greer SL, Vasev N, Wismar M. Fences and ambulances: Governance for intersectoral action on health. Health Policy 2017; 121:1101-1104. [DOI: 10.1016/j.healthpol.2017.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Buse K, Tanaka S, Hawkes S. 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. Global Health 2017; 13:34. [PMID: 28619031 PMCID: PMC5472958 DOI: 10.1186/s12992-017-0255-3] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/02/2017] [Indexed: 11/10/2022] Open
Abstract
Background Non-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. Materials We 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. Conclusion While 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.
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Affiliation(s)
| | | | - Sarah Hawkes
- Institute for Global Health, University College London, London, UK.
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McKee M, Stuckler D. Current Models of Investor State Dispute Settlement Are Bad for Health: The European Union Could Offer an Alternative Comment on "The Trans-Pacific Partnership: Is It Everything We Feared for Health?". Int J Health Policy Manag 2017; 6:177-179. [PMID: 28812799 PMCID: PMC5337257 DOI: 10.15171/ijhpm.2016.116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/13/2016] [Indexed: 11/18/2022] Open
Abstract
In this commentary, we endorse concerns about the health impact of the trans-pacific partnership (TPP), paying particular attention to its mechanisms for investor state dispute settlement. We then describe the different, judge-led approach being advocated by the European Commission team negotiating the Trans-Atlantic Trade and Investment Partnership, arguing that, while not perfect, it offers significant advantages.
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Affiliation(s)
- Martin McKee
- ECOHOST, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - David Stuckler
- Department of Sociology, University of Oxford, Oxford, UK
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Abstract
Sub-Saharan Africa (SSA) lagged furthest behind in achieving targets for the millennium development goals (MDG). We investigate the hypothesis that its slow progress is influenced by political factors. Longitudinal data on three health MDG indicators: under-five mortality, maternal mortality and HIV prevalence rates were collated from 1990 to 2012 in 48 countries. Countries were grouped into geo-political and eco-political groups. Groupings were based on conflict trends in geographical regions and the International Monetary Fund's classification of SSA countries based on gross national income and development assistance respectively. Cumulative progress in each group was derived and main effects tested using ANOVA. Correlation analysis was conducted between political variables - POLITY 2, fragile state index (FSI), voter turnout rates, civil liberty scores (CLS) and the health variables. Our results suggest a significant main effect of eco-political and geo-political groups on some of the health variables. Political conflict as measured by FSI and political participation as measured by CLS were stronger predictors of slow progress in reducing under-five mortality rates and maternal mortality ratios. Our findings highlight the need for further research on political determinants of mortality in SSA. Cohesive effort should focus on strengthening countries' political, economic and social capacities in order to achieve sustainable goals beyond 2015.
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Affiliation(s)
- Emma Atti
- a Unit for Health Promotion Research , University of Southern Denmark , Esbjerg , Denmark
| | - Gabriel Gulis
- a Unit for Health Promotion Research , University of Southern Denmark , Esbjerg , Denmark
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Gill S, Benatar S. Global Health Governance and Global Power: A Critical Commentary on the Lancet-University of Oslo Commission Report. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2016; 46:346-65. [PMID: 26883181 DOI: 10.1177/0020731416631734] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Lancet-University of Oslo Commission Report on Global Governance for Health provides an insightful analysis of the global health inequalities that result from transnational activities consequent on what the authors call contemporary "global social norms." Our critique is that the analysis and suggested reforms to prevailing institutions and practices are confined within the perspective of the dominant-although unsustainable and inequitable-market-oriented, neoliberal development model of global capitalism. Consequently, the report both elides critical discussion of many key forms of material and political power under conditions of neoliberal development and governance that shape the nature and priorities of the global governance for health, and fails to point to the extent of changes required to sustainably improve global health. We propose that an alternative concept of progress-one grounded in history, political economy, and ecologically responsible health ethics-is sorely needed to better address challenges of global health governance in the new millennium. This might be premised on global solidarity and the "development of sustainability." We argue that the prevailing market civilization model that lies at the heart of global capitalism is being, and will further need to be, contested to avoid contradictions and dislocations associated with the commodification and privatization of health.
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Affiliation(s)
- Stephen Gill
- Department of Political Science, York University, Toronto, Canada
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Piot P, Abdool Karim SS, Hecht R, Legido-Quigley H, Buse K, Stover J, Resch S, Ryckman T, Møgedal S, Dybul M, Goosby E, Watts C, Kilonzo N, McManus J, Sidibé M. Defeating AIDS--advancing global health. Lancet 2015; 386:171-218. [PMID: 26117719 DOI: 10.1016/s0140-6736(15)60658-4] [Citation(s) in RCA: 187] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Peter Piot
- London School of Hygiene & Tropical Medicine, London, UK.
| | | | - Robert Hecht
- Results for Development Institute, Washington, DC, USA
| | - Helena Legido-Quigley
- London School of Hygiene & Tropical Medicine, London, UK; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | | | - Stephen Resch
- Harvard T H Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA
| | | | - Sigrun Møgedal
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Mark Dybul
- Global Fund to Fight Aids, Tuberculosis and Malaria, Geneva, Switzerland
| | - Eric Goosby
- Global Health Sciences, University of California, San Francisco, CA, USA
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Affiliation(s)
- Martin McKee
- European Centre on Health of Societies in Transition, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK.
| | - David Stuckler
- Department of Sociology, University of Oxford, Oxford, UK
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McKee M, Haines A, Ebrahim S, Lamptey P, Barreto ML, Matheson D, Walls HL, Foliaki S, Miranda JJ, Chimeddamba O, Garcia-Marcos L, Vineis P, Pearce N. Towards a comprehensive global approach to prevention and control of NCDs. Global Health 2014; 10:74. [PMID: 25348262 PMCID: PMC4215019 DOI: 10.1186/s12992-014-0074-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 10/15/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The "25×25" strategy to tackle the global challenge of non-communicable diseases takes a traditional approach, concentrating on a few diseases and their immediate risk factors. DISCUSSION We propose elements of a comprehensive strategy to address NCDs that takes account of the evolving social, economic, environmental and health care contexts, while developing mechanisms to respond effectively to local patterns of disease. Principles that underpin the comprehensive strategy include: (a) a balance between measures that address health at the individual and population level; (b) the need to identify evidence-based feasible and effective approaches tailored to low and middle income countries rather than exporting questionable strategies developed in high income countries; (c) developing primary health care as a universal framework to support prevention and treatment; (d) ensuring the ability to respond in real time to the complex adaptive behaviours of the global food, tobacco, alcohol and transport industries; (e) integrating evidence-based, cost-effective, and affordable approaches within the post-2015 sustainable development agenda; (f) determination of a set of priorities based on the NCD burden within each country, taking account of what it can afford, including the level of available development assistance; and (g) change from a universal "one-size fits all" approach of relatively simple prevention oriented approaches to more comprehensive multi-sectoral and development-oriented approaches which address both health systems and the determinants of NCD risk factors. SUMMARY The 25×25 is approach is absolutely necessary but insufficient to tackle the the NCD disease burden of mortality and morbidity. A more comprehensive approach is recommended.
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Affiliation(s)
- Martin McKee
- />European Centre on Health of Societies in Transition (ECOHOST), London School of Hygiene and Tropical Medicine, London, WC1H 9SH UK
| | - Andy Haines
- />Departments of Social and Environmental Health Research and of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Shah Ebrahim
- />Centre for Global NCDs, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Lamptey
- />Centre for Global NCDs, London School of Hygiene and Tropical Medicine, London, UK
| | - Mauricio L Barreto
- />Instituto de Saude Coletiva, Federal University of Bahia, Bahia, Brazil
| | - Don Matheson
- />Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Helen L Walls
- />Centre for Global NCDs, London School of Hygiene and Tropical Medicine, London, UK
- />Leverhulme Centre for Integrative Research on Agriculture and Health, London, UK
- />National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Sunia Foliaki
- />Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - J Jaime Miranda
- />CRONICAS Centre of Excellence in Chronic Diseases, and School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Oyun Chimeddamba
- />Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (SPHPM), Monash University, Melbourne, Australia
| | - Luis Garcia-Marcos
- />Respiratory and Allergy Units, Arrixaca University Children’s Hospital, University of Murcia and IMIB-Arrixaca Research Institute, Murcia, Spain
| | - Paolo Vineis
- />MRC-PHE Center for Environment and Health, School of Public Health, Imperial College, London, UK
| | - Neil Pearce
- />Centre for Global NCDs, London School of Hygiene and Tropical Medicine, London, UK
- />Leverhulme Centre for Integrative Research on Agriculture and Health, London, UK
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Ottersen OP, Dasgupta J, Blouin C, Buss P, Chongsuvivatwong V, Frenk J, Fukuda-Parr S, Gawanas BP, Giacaman R, Gyapong J, Leaning J, Marmot M, McNeill D, Mongella GI, Moyo N, Møgedal S, Ntsaluba A, Ooms G, Bjertness E, Lie AL, Moon S, Roalkvam S, Sandberg KI, Scheel IB. The political origins of health inequity: prospects for change. Lancet 2014; 383:630-67. [PMID: 24524782 DOI: 10.1016/s0140-6736(13)62407-1] [Citation(s) in RCA: 297] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Chantal Blouin
- Institut National de Santé Publique du Québec, QC, Canada
| | - Paulo Buss
- Centre for Global Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Julio Frenk
- Harvard School of Public Health, Harvard University, Boston, MA, USA
| | - Sakiko Fukuda-Parr
- Graduate Program in International Affairs, The New School, New York, NY, USA
| | | | - Rita Giacaman
- Institute of Community and Public Health, Birzeit University, West Bank, occupied Palestinian territory
| | | | - Jennifer Leaning
- FXB Center for Health and Human Rights, Harvard University, Boston, MA, USA
| | - Michael Marmot
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Desmond McNeill
- Centre for Development and the Environment, University of Oslo, Oslo Norway
| | | | - Nkosana Moyo
- Mandela Institute for Development Studies, Johannesburg, South Africa
| | - Sigrun Møgedal
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | | | - Gorik Ooms
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Espen Bjertness
- Institute of Health and Society, University of Oslo, Oslo Norway
| | - Ann Louise Lie
- Institute of Health and Society, University of Oslo, Oslo Norway
| | - Suerie Moon
- Harvard Global Health Institute, Harvard University, Cambridge, MA, USA
| | - Sidsel Roalkvam
- Centre for Development and the Environment, University of Oslo, Oslo Norway
| | - Kristin I Sandberg
- Centre for Development and the Environment, University of Oslo, Oslo Norway
| | - Inger B Scheel
- Institute of Health and Society, University of Oslo, Oslo Norway
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