Global Health Blogs with Professor Swahn

Noncommunicable diseases (NCDs) are known to cause “premature deaths” and increase the disease (cardiovascular disease, diabetes, cancers, and respiratory diseases etc.) burden globally. Each year, 41 billion lives are lost to NCDs which accounts for about 71% of all deaths globally. About 85% of these deaths occur in low- and middle- income countries, amongst individuals (30-69 years of age) that indulge in high risk behaviors such as tobacco use, physical inactivity, harmful use of alcohol and consumption of unhealthy diets. All the high-risk behaviors are preventable and therefore, prevention of NCDs calls for action (globally). The prevention strategies should be developed considering social determinants and commercial determinants of health.

Definition of Commercial Determinants of Health

The World Health Organization defines Social Determinants of Health as “the conditions in which people are born, grow, live, work and age as well as the complex, interrelated social structures and economic systems that shape these conditions” and Commercial Determinants of Health (CDoH), as “factors that influence health which stem from the profit motive.” However, in 2016, Kickbusch and her colleagues came up with a more precise definition for CDoH and defined it as “strategies and approaches used by the private sector to promote products and choices that are detrimental to health.”

List of Commercial Determinants of Health

As we know, Health is not only influenced by biologic and genetic factors but is also determined by the socioeconomic factors including income levels and educational status. Moreover, it is not only the social environment but the political agendas, corporate activities that shape our environment and determine the availability, promotion, and pricing of consumables. Corporate activities such as promotion and marketing of harmful goods such as sugar sweetened beverages, tobacco, alcohol use, and unhealthy foods and drinks (containing salts, trans fats, added sugars and chemicals/preservatives) affects the health of the consumers. Additionally, other commodities such as use of chemicals, pesticides, motor vehicles, drugs, guns etc. also add to the list of harmful/unhealthy commodities. These unhealthy commodities tend to create an unhealthy environment (increased air and noise pollution, lack of access to essential medications, clean water, and healthy foods, increased injuries due to motor vehicle crashes and gun violence) and pose a threat to individuals health.

Drivers and Tactics used to Promote Commercial Determinants of Health

Corporates or Transnational companies’ major motto is to make profit out of their commodities. Several factors aid in this process such as:

1)Business Practices (Internationalization of trade and capital) – through corporate citizenships and supply chains in lower- and middle-income countries

2)Market Practices (Supply and Demand market) – Increasing supply chain and marketing tactics

3)Political Practices (Expanding Outreach of Corporations) – Lobbying and Funding Government and Federal agencies

 

Globalization has indeed contributed in economic development but has lead us into Industrial epidemic where Multinational and Transnational Corporations act as Global Drivers to promote the production, sell and consumption of unhealthy commodities through business, market and political strategies and create an environment that causes nothing but ill-health.

One of the most common marketing strategies include advertising and commercials to vulnerable target populations through catchy tag lines and slogans that portray the unhealthy commodity as the most essential and required goods for living and for being healthy. Some examples include:

“It’s Game Day” – Heineken

“I’m lovin it” – Mc Donald’s

“It’s finger lickin` good” – KFC

“Open Happiness” – Coca Cola

“Betcha can’t eat just once” – Lays

“Take a Break, Eat a Kit-Kat” – Kit-Kat

        

                                        

 

Why is it Necessary to Understand Commercial Determinants of Health?

Even though we do not realize; we are surrounded by the products and unhealthy commodities at every single moment. We are currently living in an environment that is created and dominated by the corporations that market and produce these unhealthy commodities. Most public health prevention strategies and interventions aim for behavior change to combat the burden of NCDs. However, epidemiologic research suggest that behavior change interventions have short term effects and does not contribute towards the long-term goals. But research also suggest that interventions aimed at policy change and taxation have long lasting impact on high-risk behaviors and disease reductions as seen with tobacco products. Under the World Health Organization’s  “Tobacco Free Initiative (TFI),” a significant increase on taxes and prices for tobacco products were imposed along with other tobacco control measures such as advertising bans and public smoking bans to ensure the effectiveness of tobacco control measures and reduce tobacco use. As a result of this initiative, by 2015, the rates of current users of any form of tobacco has declined from a third of the global population (33.3% in year 2000) to a quarter (24.9%) of the global population (both sexes combined, aged 15 years and older).

 

Thus, as consumers, we should understand the corporate tactics used to promote the unhealthy commodities and try to make informed and responsible decisions.

Transnationals: A Boon or Curse?

The term “Commercial Determinants of Health (CDoH)” is a relatively new term and a comparatively less explored research area.  However, we should not forget to recognize the positive attributes that these commercial determinants and transnational companies have contributed towards strengthening economies. But, looking at the recent activities, amidst COVID-19 pandemic, it is debatable whether the positive outcomes outweigh the negative impacts of CDoH and the transnationals on health and health outcomes. The transnationals did not miss the opportunity and came out as the “pandemic heroes” serving millions of needy individuals with the unhealthy commodities during unprecedented times. Ms. Prachi Kathuria, Co-Ordinator, Healthy India Alliance- India NCD Alliance, said:

“The COVID-19 pandemic has exposed the vulnerability of people living with NCDs to COVID-19 related complications. The unhealthy commodities industries have even managed to plot misleading marketing strategies during a global public health emergency, challenging healthy behaviors and health promoting policies. It is the collective responsibility of all stakeholders to shield vulnerable citizens from these misleading tactics and work smartly to Build Back Better.”

It will be a lie if I said I did not agree with Ms. Kathuria. The global pandemic (COVID-19) has only grown the relationship between communicable and non-communicable diseases stronger. And the Commercial Determinants of Health and its advocates (corporations and transnationals) have managed to mislead the vulnerable population and made the sufferers more suffer.