Systems thinking as a framework for analyzing commercial determinants of health

Knai, C. et al. (2018) Systems thinking as a framework for analyzing commercial determinants of health. Milbank Quarterly, 96(3), pp. 472-498. (doi: 10.1111/1468-0009.12339) (PMID:30277610) (PMCID:PMC6131339)

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Policy Points: • Worldwide, more than 70% of all deaths are attributable to noncommunicable diseases (NCDs), nearly half of which are premature and apply to individuals of working age. Although such deaths are largely preventable, effective solutions continue to elude the public health community. • One reason is the considerable influence of the “commercial determinants of health”: NCDs are the product of a system that includes powerful corporate actors, who are often involved in public health policymaking. • This article shows how a complex systems perspective may be used to analyze the commercial determinants of NCDs, and it explains how this can help with (1) conceptualizing the problem of NCDs and (2) developing effective policy interventions. Context: The high burden of noncommunicable diseases (NCDs) is politically salient and eminently preventable. However, effective solutions largely continue to elude the public health community. Two pressing issues heighten this challenge: the first is the public health community's narrow approach to addressing NCDs, and the second is the involvement of corporate actors in policymaking. While NCDs are often conceptualized in terms of individual‐level risk factors, we argue that they should be reframed as products of a complex system. This article explores the value of a systems approach to understanding NCDs as an emergent property of a complex system, with a focus on commercial actors. Methods: Drawing on Donella Meadows's systems thinking framework, this article examines how a systems perspective may be used to analyze the commercial determinants of NCDs and, specifically, how unhealthy commodity industries influence public health policy. Findings: Unhealthy commodity industries actively design and shape the NCD policy system, intervene at different levels of the system to gain agency over policy and politics, and legitimize their presence in public health policy decisions. Conclusions: It should be possible to apply the principles of systems thinking to other complex public health issues, not just NCDs. Such an approach should be tested and refined for other complex public health challenges.

Item Type:Articles
Additional Information:Also funded by the Scottish Government Chief Scientist Office (SPHSU13 and SPHSU 15).
Glasgow Author(s) Enlighten ID:Katikireddi, Dr Vittal and Weishaar, Dr Heide
Authors: Knai, C., Petticrew, M., Mays, N., Capewell, S., Cassidy, R., Cummins, S., Eastmure, E., Fafard, P., Hawkins, B., Jensen, J., Katikireddi, S.V., Mwatsama, M., Orford, J., and Weishaar, H.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
Journal Name:Milbank Quarterly
ISSN (Online):1468-0009
Published Online:11 September 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in Millbank Quarterly 96(3): 472-498
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
699162Understanding the impacts of welfare policy on health: A novel data linkage studySrinivasa KatikireddiChief Scientist office (CSO)SCAF/15/02IHW - MRC/CSO SPHU
727651SPHSU Core Renewal: Measuring and Analysing Socioeconomic Inequalities in Health Research ProgrammeAlastair LeylandMedical Research Council (MRC)MC_UU_12017/13IHW - MRC/CSO SPHU
727671SPHSU Core Renewal: Informing Healthy Public Policy Research ProgrammePeter CraigMedical Research Council (MRC)MC_UU_12017/15IHW - MRC/CSO SPHU