Elly Howse
Many of us working, teaching and researching in public health are aware of the impact of the commercial or corporate determinants of health – namely, how private sector companies and groups seek to influence decision making and promote the manufacturing, sale and consumption of unhealthy products and practices. These groups include the obvious characters and players – tobacco, alcohol, unhealthy food and drink industries – and include the gambling industry, guns and arms dealers, and fossil fuel companies.
Unhealthy commodity industries are a serious risk to both human and planetary health. These industries and their products are substantial drivers of poor health and inequity worldwide, yet for the most part, governments, research funding bodies and other groups focus on individual-level behaviour change strategies, particularly in regards to major problems like chronic disease.
The commercial determinants of health area is of significant and increasing interest to researchers and policymakers, with publication of a number of great reviews on the topic (see Mialon, 2020; de Lacy-Vawdon and Livingstone, 2020; and Maani et al 2020) and an excellent special edition of Public Health Research and Practice. We’ve also seen some concerning activities of unhealthy commodity industries during the COVID-19 pandemic. Even a very recent example of investigative journalism from the Australian Financial Review highlights just how much the tobacco industry has been behind the push to legalise vaping (e-cigarettes) in Australia – actions and engagement that are totally contrary to our international obligations under the Framework Convention on Tobacco Control.
The challenges for this research include: understanding and documenting the myriad ways in which these commercial determinants and entities impact on health; working out what the solutions are; and when, where and how we can apply these solutions to benefit health. Systems science approaches to health suggest there are multiple levers and interconnected parts where unhealthy commodity industries have influence. One area I’ve been researching as part of my PhD is public opinion and acceptability of chronic disease prevention. Acceptability is important as it can help influence governments and decision-makers to act and implement solutions.
A recent paper I led, published in the Australian and New Zealand Journal of Public Health, looks at an interesting and under-studied area of acceptability – the ways in which people’s views about preventive health may be associated with and possibly influenced by some common discourses or narratives used by unhealthy commodity industries.
We conducted some focus groups with young adults in Sydney and Glasgow (UK) and analysed how they responded to and deliberated over six public health nutrition policies. We found some evidence our participants used or referred to common industry discourses when justifying and discussing their views about preventive interventions like taxing unhealthy foods and restricting advertising (Figure 1). Many of these discourses would be familiar to us; indeed, some researchers and advocates have called this the ‘industry playbook’.
Figure 1. Common food industry discourses, from Howse et al 2021 ANZJPH.
Our research suggests these discourses and ideas are powerful at shaping views and attitudes about prevention, especially for young adults who are at the stage of their life where they want to feel empowered about their decisions as adults. It’s not a surprise that industry groups – who have marketing budgets that dwarf government health promotion campaigns and initiatives – can be so effective at influencing not just what we buy and consume but how we think.
Industry is probably also picking up on pre-existing community sentiment and social norms, such as views regarding personal responsibility for health, and then reinforcing these views to reject and lobby against public health interventions, particularly more regulatory ones.
So how should those of us in public health respond to these findings?
First of all, we should be looking at strategies that aim to shift cultural attitudes and social norms about harmful products, as what’s happened with tobacco in countries like Australia. Even then, it’s a persistent fight to protect these gains; harmful industries will do all they can to be one step ahead of regulatory and social change, like using TikTok and social influencers to promote new tobacco products.
Second, we need to refocus and reframe the debate about health to be about corporate and government responsibility, rather than individual responsibility; this is an approach that is increasingly being applied in other areas of public health such as gambling harm. One participant said to me about social media companies that they could write and employ an algorithm to ban certain types of harmful advertising on their platforms. But commercial entities won’t do that voluntarily, which is why government regulation and law is so vital. Governments have a clear role to play in creating the conditions that support and enable good health for all.
Third, critical engagement with industry discourses is important and it needs to be led by those who are most affected, such as young people. There are some great examples of this, such as BiteBack2030 in the UK and Tobacco Free Kids in the US.
One final point to note is that while there are significant harms occurring from the actions of commercial industries in high income countries like Australia, these harms are demonstrably far worse in emerging economies like Indonesia and other countries in our region. As public health professionals and researchers, we need to build strong partnerships with governments and civil society, nationally and internationally, to challenge these disturbing practices and proactively address the commercial determinants of health.
Elly Howse is a Research Fellow with The Australian Prevention Partnership Centre and a PhD candidate with the Prevention Research Collaboration at the University of Sydney. In addition to her work in public health, Elly has experience in federal and state politics and has worked with ministers and shadow ministers on a range of public policy issues.