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
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.
The researchers 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.
The researchers analyse the challenges inherent in each model, and review what is known (or not) about their impact on NCD outcomes.
While piecemeal efforts have been established, the researchers argue that mechanisms to control the commercial determinants of NCDs are inadequate and efforts at remedial action too limited. The paper sets out an agenda to strengthen each of the three governance models. The researchers 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.
The ability of the global public health sector acting alone to influence the commercial determinants of NCD risk, or deal with NCD outcomes, is limited. Reaching SDG target 3.4 will necessitate interaction with, rather than exclusion of, the private sector, but such interaction needs to take into account not only the heterogeneity inherent in the ‘private sector’ (in terms of scale, nature of risk, and willingness to ameliorate public health impacts of those risks) but also the varied and potentially complex range of interactions and engagements that need to be addressed.
While we, as public health professionals, believe that such interaction should be based on promoting evidence-informed interventions to meet globally agreed standards for public health goals, these are not the interests and objectives of all stakeholders involved in ‘engagement’ or ‘partnership’.
The asymmetrical distribution of power and authority in these public-private interactions, and, hence, the overarching goals adopted, will depend, to a large degree, on the governance and accountability mechanisms put in place (and by whom).
Our review of governance models for interaction between public and private sectors in relation to the commercial drivers of NCDs leads us to conclude that a sea-change in both governance and accountability is needed to prioritise and protect public health globally.”
The researchers summarise the criteria and conditions they deem are necessary to safeguard the health of the public in relation to the commercial drivers of NCD risk. While the public health community may have strong views about the need for one type of governance mechanism for NCD risk over and above any other, the reality of the prevailing and powerful private sector interests are clear. The researchers present an agenda with a set of measures that the public health community should promote if we are to achieve public health targets and goals for all.