Why does thinking about the commercial determinants of health matter within local government

 

Why does thinking about the commercial determinants of health matter within local government

 

1            Why does Non Communicable Disease matters to local government. Why should local government care

Non Communicable Disease, or NCD (for example cancer, diabetes, heart disease and stroke, muscle and joint problems) is, by far, the biggest contributor to overall ill health. Of course that matters to NHS demand. Often these illnesses occur concurrently (this is called multi morbidity) and this is more common in working age than old age in sheer numbers.

This also matters to social care (a huge amount of social care demand is secondary to and the downstream consequence of illness.

It also matters to economic productivity. The health / wealth / economic productivity line is under appreciated. People who develop cancer aged 55 most likely wont go back to work. This this becomes impact on family income, benefit system demand, availability of workforce. See the recent Bank of England analysis on long covid being a big worry for economic productivity. See this thread for an explanation   

Long covid is important but just tip of iceberg in terms of ill health burden

Thus lack of health is drag on economic productivity – which wont be solved by better or more health care ( tho that will help) but by better health

Of course with regard to the gap between the haves and the haven’t there remains an enormous social justice issue

 

2            Prevention outguns cure

We all know that prevention outguns treating and fixing (though that is necessary) in terms of impact.

The question of “how to go about prevention” matters a great deal. In health, both medicalisation, lifestyle drift, and personal responsibility is everywhere

This skews peoples mind and attention to what is measurable not what it most important.

That in itself does harm AND it ISNT the answer to the enormous gap in health outcomes. See Beyond 'Run, Knit and Relax' (Neoliberalism itself is the problem and reimagining social determinants of health (“lifestyle drift” vs CDOH and SDOH / structural influences) as examples

We simply cant “treat” (ie individual level behaviour change interventions) our way though this problem.

We all know in every context a focus on tackling something upstream outguns downstream in terms of both equity and impact.

 

3            the influence of commercial influence on health outcomes

This takes us into the space of the commercial determinants of health – companies that sell products that are harmful - as a way of thinking and acting.

The nature of products and tactics of industry is about as upstream as it gets in most of the areas of NCD prevention. Many industries selling us harmful products invest enormous sums in avoiding regulation and keeping us consuming those products.

Thus its sort of important to know the nature of the ground in terms of how to achieve positive change

 

4            We as a profession need to upskill in this space

Ignorance of CDOH IS in itself problem .. (As we then mis frame answers)

So obviously PH types need to (re) get knowledgeable about tactics of industry and counter tactics. I have written a bit of stuff on this in previous blogs:

If you were ever wondering why say policies on tobacco and gambling are as they are then read the literature on #CDOH Summarised here

Introduction & concepts -  what's it about / framing lessons of history / progress / why focus on policies alone not enough

Industry tactics - A fairly familiar playbook.  Distortion / Denial / Doubt / Distraction/ Lobbying discredit science or scientists/  influence science / presenting false balance or / sponsoring education

how to respond / counter tactics- Policies on products into a broader framework / Structurally excluding industry influence / Conflicts of interest / Raising awareness / Shape a different narrative / responding to nanny calling / Don’t allow industry funded education

Side (but imporant) note on the neoliberal framework in which CDOH sits 

 

There is more we can do for ourselves on getting skilled up in this space.

We can change the nature of what we mean “intervention”. See this (long, sorry) thread for thoughts.

“Should we as PH need to completely reframe our understanding of the word “intervention”. Shifting away from things that can be codified and counted at individual level and towards shifting whole systems and narrative and framing. The Harry Rutter mentality – the intervention should be shifting the system, not (only) the constituent part of the system”

 

5            Why does local matter in this

 of course the business end of this is national (and international) policy

but local DOES matter

what can we do. Here are some suggestions

Completely reframing “health” away from what the NHS does and refocus our narrative toward interventions that orient around individuals to “system” and structural

be clear why commercial influences matter. It is the policies and interventions per se AND the actions of industry that influence health

get our narrative right and be clear on why this matters for local govt

be clear that whilst of course national and international policy matters. Lots cant be done locally re lobbying and advocacy. Local policy innovation also matters - radical policy innovation often starts local.

Think through where to look in terms of local level actions: many aspects of LA function, and then beyond -  advertising etc, planning, licensing process, pensions and investments, what types of business growth we prioritise

Challenge the framing of and proposed solution to problems. When people say “health has nothing to do with me” point out the burning demand pressures and where they come from

Some will say but we cant. Maybe. Absolutism vs line in sand / clear statement and direction of travel. So I cant simply kick out oil investment in pension scheme but can set out a direction of travel  etc