Systems Thinking as a Framework for Analyzing Commercial Determinants of Health

被引：99

作者：

Knai, Cecile ^{[1
]}

Petticrew, Mark ^{[2
,3
,4
]}

Mays, Nicholas ^{[5
]}

Capewell, Simon ^{[11
]}

Cassidy, Rebecca ^{[12
]}

Cummins, Steven ^{[6
,7
,8
]}

Eastmure, Elizabeth ^{[9
]}

Fafard, Patrick ^{[13
]}

Hawkins, Benjamin ^{[10
]}

Jensen, Jorgen Dejgard ^{[14
]}

Katikireddi, Srinivasa Vittal ^{[15
]}

Mwatsama, Modi ^{[16
]}

Orford, Jim ^{[17
]}

Weishaar, Heide ^{[18
]}

机构：

[1] London Sch Hyg & Trop Med, Fac Publ Hlth & Policy, Publ Hlth Policy, London, England

[2] London Sch Hyg & Trop Med, Publ Hlth Evaluat, London, England

[3] London Sch Hyg & Trop Med, Publ Hlth Res Consortium, London, England

[4] London Sch Hyg & Trop Med, NIHR Sch Publ Hlth Res, London, England

[5] London Sch Hyg & Trop Med, Dept Hlth Serv Res & Policy, Hlth Policy, London, England

[6] London Sch Hyg & Trop Med, Populat Hlth, London, England

[7] London Sch Hyg & Trop Med, Epidemiol & Publ Hlth, London, England

[8] London Sch Hyg & Trop Med, Hlth Environm Res Programme, London, England

[9] London Sch Hyg & Trop Med, London, England

[10] London Sch Hyg & Trop Med, Dept Global Hlth & Dev, London, England

[11] Univ Liverpool, Clin Epidemiol, Liverpool, Merseyside, England

[12] Goldsmiths Univ London, Anthropol, London, England

[13] Univ Ottawa, Grad Sch Publ & Int Affairs, Ottawa, ON, Canada

[14] Univ Copenhagen, Dept Food & Resource Econ, Copenhagen, Denmark

[15] Univ Glasgow, Glasgow, Lanark, Scotland

[16] UK Hlth Forum, Policy & Global Hlth, London, England

[17] Univ Birmingham, Clin & Community Psychol, Birmingham, W Midlands, England

[18] Hertie Sch Governance, Berlin, Germany

来源：

MILBANK QUARTERLY | 2018年 / 96卷 / 03期

基金：

英国医学研究理事会;

关键词：

systems thinking; noncommunicable diseases; unhealthy commodity industries; PUBLIC-PRIVATE PARTNERSHIP; CORPORATE POLITICAL ACTIVITY; INDUSTRY SELF-REGULATION; RESPONSIBILITY DEAL; MULTILEVEL GOVERNANCE; NATURAL EXPERIMENTS; COMPLEX-SYSTEMS; FOOD-INDUSTRY; ALCOHOL; POLICY;

D O I：

10.1111/1468-0009.12339

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

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. ContextThe 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. MethodsDrawing 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. FindingsUnhealthy 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. ConclusionsIt 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.

引用

页码：472 / 498

页数：27

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