commercial determinants of health (2). The influence of the neoliberal framework

 

the neoliberal framework in which the thinking around Commercial Determinants of Health sits

 

this is the second blog in a series on CDOH.

There are important limitations of the socio / ecological model (it hopefully goes without saying there are mission critical limitations of orientating public health around individualistic thinking).

Taking a line from Rose, the socio-ecological model tends to obscure the locus of power and influence under the general rubric of ‘policy’, and suggests that the actual core of good public health is the intra- and interpersonal factors.

 

The commercial determinants of health model has the virtue of focusing attention on the most critical structural impediments to optimal public health in a very immediate way. This isnt to demean or cheapen the impact of social and deeper environmental or economic factors.

Lenchucha sets out the ‘core tenets’ of the neoliberal paradigm as constituted by a policy agenda of trade liberalisation, privatisation of state-owned utility companies and other public assets, progressive dismantling of welfare state and workers’ rights protections; and the reorientation of government regulatory powers to safeguard corporate interests, valorise the market, and protect private property rights. This can be extended further - noting how neoliberalism itself had proceeded through various iterations in the past forty years, from structural adjustment and privatisation (1980s) to financialization (1990s and 2000s), and then to austerity in the wake of the Global Financial Crisis (2010s).

The commercialisation of education and the ‘neoliberal turn’ is another concern. There has been a long term trend of partnering with corporations in the provision of educational programmes, the harms are are well documented. This article on distilling the curriculum sets out the dangers (using alcohol education as an example). They are unlikely to be effective , can serve as covert marketing, and are unlikely to be critical of their funders. The materials produced and funded tend to propose solutions that focus on individual ‘choices’ and decision-making, and peer pressure.

Such industry practices constitute part of broader developments that have been unfolding in the context of global neoliberal reforms where a view that market mechanisms and market forces can solve complex societal problems. Industries  will often invoke market econimc narrative to support a policy of low or no regulation, it is anti competitive. More often than not it seems about maintenance of a monopoly industry and its ability to sell products that lead to externalities costs to different sectors of the economy. The public health implications of such major structural changes have received far too little attention but are hugely important.

It can be seen how approaches to regulation can be exploited and captured by corporate interests. For example there are some who argue that the very govt agency that was established “better regulation executive” by govt Better Regulation Executive (BRE) - GOV.UK (www.gov.uk) has been exploited by industry to avoid regulation.  The description on the webpage “to ensure that the regulation which remains is smarter, better targeted and less costly to business.”.

The third blog in the series will focus on the tactics commonly deployed. There seems a fairly common playbook