Noncommunicable diseases (NCD) epidemic constitute a major socioeconomic development challenge in the 21st century. NCD hampers health and well-being as well as economic at individual and macro levels. NCD are the leading causes of morbidity and mortality, and workload and financial burden to health system. Meanwhile morbidity and deaths from NCDs, particularly premature mortality, cripple human asset and economic growth collectively.
“Efforts to prevent noncommunicable diseases go against the business interests of powerful economic operators ”. Risks for NCDs are largely associated with the production, marketing and trade, and consumption of commercially produced health-harming commodities; mainly Tobacco products, alcoholic beverages, ultra-processed foods-especially sweetened beverages, and breast milk substitutes. All are massively profitable and heavily marketed. And so, NCD crisis can be characterized as profit-driven epidemic , as well as a manifestation of economic system that currently prioritizes wealth over health creation .
“Commercial determinants of health” (CDH) has been referred to as a driver for NCD crisis. Defined as strategies and approaches used by the private sector to promote products and choices that are detrimental to health, commercial determinants affect health at both individual and macro levels, through four pathways; 1) marketing, 2) supply chain, 3) influence on policy process (including lobbying) and 4) corporate social responsibility (CSR) (including corporate citizenship) programs .
Collective capacity to response to the four mechanisms of commercial determinants are uneven. Regulations on marketing and supply chain (physical availability) of harmful products are quite common. In comparison, awareness and ability to address industry undue influence on policy process and actors (including on social norm through CSR) are quite limited, despite a broad acknowledgement that industry interference is one of the five major challenges curbing global effort to tackle NCD epidemic . Inadequate availability of evidence and policy attention on commercial determinants of heath, particularly in low and middle income settings, are inadequate to found an appropriate policy response to protect public health.
In modern time, markets of these harmful products are increasingly influenced by transnational businesses. With diminishing control, domestic operators in LMICs gradually either collaborate and merge with, or behave like transnational counterparts, or both. Described as an upstream driver, market liberalization could facilitate investment, production capacity, distribution and marketing efficiency, hence drives up consumption, of harmful products. Not only as mechanism to promote access to emerging markets, mechanism for trade and investment liberalization mechanisms have been used to influence NCD prevention and control policy process, especially in low- and middle-income countries. For example, threating governments on WTO dispute is effective in halting NCD-related policy decision, crating so-called ‘regulatory chill’ phenomenon, even though without WTO decision .
Understanding on trade and investment, as well as on influence of these NCD-promoting businesses, is crucial for capacity to address commercial determinants to protect health and well-being of the population. And as most best buys interventions lie beyond health sector boundary, this capacity and awareness to address commercial determinants have to be installed in all relevant sectors.
WHO SEARO, in collaboration with Thai Health Promotion Foundation, is at the beginning to work on strengthening collective capacity and governance to address commercial determinants of health, focusing on tobacco, alcohol, sugary sweetened beverages (SSB) and Breastmilk substitute (BMS). This collaboration is expected to deliver case study of industry interference in the region, toolkit to safeguard public health and knowledge and experience sharing opportunities.
CDH is highly relevant to NCD and Prince Mahidol Award Conference (2019), political economy of NCD cannot be analyzed without a good understanding on CDH. This side event aims to promote awareness and policy attention on the need to boost preparedness and capacity to address commercial determinants of health of these four NCD-promoting products.