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Commercial determinants of health: an ethical exploration

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  • Published:
International Journal of Public Health

Abstract

Objectives

This paper seeks to contribute toward a better understanding of commercial determinants of health by proposing a set of ethical principles that can be used by researchers and other health actors in understanding and addressing Commercial Determinants of Health (CDoH).

Methods

The paper is mainly based on a systematic review and qualitative analysis of the existing literature on CDoH and public health ethics frameworks. We conducted searches using selected search engines (Google Scholar and Pubmed). For ethical challenges relating to CDOH, our searches in Google Scholar yielded 17 papers that discussed ethical challenges that affect CDoH. For ethical frameworks relevant for CDOH, our searches in Google Scholar and Pubmed yielded 15 papers that clearly described bioethical models including relevant ethical principles. Additionally, we consulted eight experts working on CDoH. Through these two methods, we were able to identify ethical challenges as well as norms and values related to CDoH that we offer as candidates to comprise a foundational ethics framework for CDoH.

Results

Discussing risk factors associated with CDH frequently brings public health into conflict with the interests of industry actors in the food, automobile, beverage, alcohol, ammunition, gaming and tobacco industries including conflict between profit-making and public health. We propose the following candidate ethical principles that can be used in addressing CDoH: moral responsibility, nonmaleficence, social justice and equity, consumer sovereignty, evidence-informed actions, responsiveness, accountability, appropriateness, transparency, beneficence and holism.

Conclusions

We hope that this set of guiding principles will generate wider global debate on CDoH and help inform ethical analyses of corporate actions that contribute to ill health and policies aimed at addressing CDoH. These candidate principles can guide researchers and health actors including corporations in addressing CDoH.

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References

  • Backman G, Hunt P, Khosla R, Jaramillo-Strouss C, Fikre BM, Rumble C, Tarco D (2008) Health systems and the right to health: an assessment of 194 countries. The Lancet 372(9655):2047–2085

    Article  Google Scholar 

  • Baum NM, Gollust SE, Goold SD, Jacobson PD (2007) Looking ahead: addressing ethical challenges in public health practice. J Law Med Ethics 35(4):657–667

    Article  PubMed  Google Scholar 

  • Beauchamp TL, Childress JF (2001) Principles of biomedical ethics. Oxford University Press, USA

    Google Scholar 

  • Bevan DJ, Wolfe RW, Werhane PH (2019) Systems thinking and moral imagination: rethinking business ethics with Patricia Werhane, vol 48. Springer, Berlin

    Book  Google Scholar 

  • Breslow L (2002) Encyclopedia of public health. Macmillan reference USA/gale group thomson learning, New York

    Google Scholar 

  • Buse K, Tanaka S, Hawkes S (2017) 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. Glob Health 13(1):34

    Article  Google Scholar 

  • Crosbie E, Sosa P, Glantz SA (2018) Defending strong tobacco packaging and labelling regulations in Uruguay: transnational tobacco control network versus Philip Morris International. Tobacco Control 27(2):185–194

    Article  PubMed  Google Scholar 

  • Daniels N (2000) Accountability for reasonableness: establishing a fair process for priority setting is easier than agreeing on principles. BMJ: Br Med J 321(7272):1300

    Article  CAS  Google Scholar 

  • Esser MB, Jernigan DH (2015) Multinational alcohol market development and public health: diageo in India. Am J Public Health 105(11):2220–2227

    Article  PubMed  PubMed Central  Google Scholar 

  • Freeman B, Sindall C (2019) Countering the commercial determinants of health: strategic challenges for public health. Public Health Res Pract 29(3):e2931917

    Google Scholar 

  • Ireland R, Bunn C, Reith G, Philpott M, Capewell S, Boyland E, Chambers S (2019) Commercial determinants of health: advertising of alcohol and unhealthy foods during sporting events. Bull World Health Organ 97(4):290

    Article  PubMed  PubMed Central  Google Scholar 

  • Jaffe HW, Hope T (2010) Treating for the common good: a proposed ethical framework. Public Health Ethics 3(3):193–198

    Article  Google Scholar 

  • Kass NE (2001) An ethics framework for public health. Am J Public Health 91(11):1776–1782

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kenny NP, Sherwin SB, Baylis FE (2010) Re-visioning public health ethics: a relational perspective. Can J Public Health 101(1):9–11

    Article  PubMed  PubMed Central  Google Scholar 

  • Kickbusch I, Allen L, Franz C (2016) The commercial determinants of health. Lancet Glob Health 4(12):e895–e896

    Article  PubMed  Google Scholar 

  • Knai C, Petticrew M, Mays N, Capewell S, Cassidy R, Cummins S, Katikireddi SV (2018) Systems thinking as a framework for analyzing commercial determinants of health. Milbank Q 96(3):472–498

    Article  PubMed  PubMed Central  Google Scholar 

  • Krubiner CB, Hyder AA (2014) A bioethical framework for health systems activity: a conceptual exploration applying ‘systems thinking’. Health Syst 3(2):124–135

    Article  Google Scholar 

  • Lenk H (2019) Is individual responsibility enough? Int J Arts Human 1(1):3–12

    Article  Google Scholar 

  • Lima JM, Galea S (2018) Corporate practices and health: a framework and mechanisms. Glob Health 14(1):21

    Article  Google Scholar 

  • Louise J, Eliott J, Olver I, Braunack-Mayer A (2015) Mandatory cancer risk warnings on alcoholic beverages: what are the ethical issues? Am J Bioethics 15(3):3–11

    Article  Google Scholar 

  • Maani N, Collin J, Friel S, Gilmore AB, McCambridge J, Robertson L, Petticrew MP (2020) Bringing the commercial determinants of health out of the shadows: a review of how the commercial determinants are represented in conceptual frameworks. Eur J Public Health. https://doi.org/10.1093/eurpub/ckz197

    Article  PubMed  PubMed Central  Google Scholar 

  • McKee M, Stuckler D (2018) Revisiting the corporate and commercial determinants of health. Am J Public Health 108(9):1167–1170

    Article  PubMed  PubMed Central  Google Scholar 

  • Meislik A (2004) Weighing in on the scales of justice: the obesity epidemic and litigation against the food industry. Ariz L Rev 46:781

    Google Scholar 

  • Millar JS (2013) The corporate determinants of health: how big business affects our health, and the need for government action! Can J Public Health 104(4):e327–e329

    Article  PubMed  PubMed Central  Google Scholar 

  • Nuffield Council on Bioethics (Great Britain) (2007) Public health: ethical issues. Nuffield Council on Bioethics, London

    Google Scholar 

  • Paull J (2019) Contamination of farms by genetically modified organisms (GMOs): options for compensation. J Organ 6(1):31–46

    Google Scholar 

  • Petrini C (2007) Ethical issues in public health and prevention. J Med Person 5:117–122

    Google Scholar 

  • Petrini C, Gainotti S (2008) A personalist approach to public-health ethics. Bull World Health Organ 86:624–629

    Article  PubMed  PubMed Central  Google Scholar 

  • Powers M, Faden RR, Faden RR (2006) Social justice: the moral foundations of public health and health policy. Oxford University Press, Oxford

    Google Scholar 

  • Reuter E, Ueberbacher F (2019) Corporate strategies to defend social irresponsibility: a typology of symbolic and substantive tactics. In: Sales A (ed) Corporate social responsibility and corporate change. Springer, Cham, pp 221–239

    Chapter  Google Scholar 

  • Ruger JP (2004) Ethics of the social determinants of health. Lancet 364(9439):1092–1097

    Article  PubMed  PubMed Central  Google Scholar 

  • Scharding T (2019) Individual actions and corporate moral responsibility: a (reconstituted) kantian approach. J Bus Ethics 154(4):929–942

    Article  Google Scholar 

  • Shiva V (2019) The fight against Monsanto’s roundup: the politics of pesticides. Simon and Schuster, New York

    Google Scholar 

  • Sirgy MJ, Lee DJ (2008) Well-being marketing: an ethical business philosophy for consumer goods firms. J Bus Ethics 77(4):377–403

    Article  Google Scholar 

  • Stuckler D, Ruskin G, McKee M (2018) 2018) Complexity and conflicts of interest statements: a case-study of emails exchanged between Coca-Cola and the principal investigators of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE. J Public Health Policy 39(1):49–56

    Article  PubMed  Google Scholar 

  • Swain GR, Burns KA, Etkind P (2008) Preparedness: medical ethics versus public health ethics. J Public Health Manag Pract 14(4):354–357

    Article  PubMed  Google Scholar 

  • Thompson AK, Faith K, Gibson JL, Upshur RE (2006) Pandemic influenza preparedness: an ethical framework to guide decision-making. BMC Med Ethics 7(1):12

    Article  PubMed Central  Google Scholar 

  • Upshur RE (2002) Principles for the justification of public health intervention. Can J Public Health 93(2):101–103

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Center for Commercial Determinants of Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, Suite 722, Washington, DC, 20037, USA

    Paul Ndebele, Hina Shaikh, Nino Paichadze, Imran Bari, David Michaels, Carlos Santos Burgoa & Adnan A. Hyder

Authors
  1. Paul Ndebele
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  2. Hina Shaikh
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  3. Nino Paichadze
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  4. Imran Bari
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  5. David Michaels
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  6. Carlos Santos Burgoa
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  7. Adnan A. Hyder
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Corresponding author

Correspondence to Paul Ndebele.

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The authors declare that they have no conflict interest.

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This article is part of the special issue “Market-driven forces and Public Health.”

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Ndebele, P., Shaikh, H., Paichadze, N. et al. Commercial determinants of health: an ethical exploration. Int J Public Health 65, 1123–1132 (2020). https://doi.org/10.1007/s00038-020-01427-x

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  • DOI: https://doi.org/10.1007/s00038-020-01427-x

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