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SEA‐HE‐217
EconomicandCommercialDeterminantsofHealthinSouth‐EastAsia:RegionalconsultationReport
17‐19October2023,Bangkok,Thailand
TableofContents
BACKGROUND
5
AIMSANDOBJECTIVESOFTHECONSULTATIONS
7
SUMMARYOFTHEPRESENTATIONSANDDISCUSSIONS
7
SUMMARYOFPROCEEDINGS
9
PARTI.INTRODUCTIONOFTHECDHCONCEPTANDIMPACTSONHEALTH
9
SESSIONI:INAUGURATIONSESSION
9
1.MEETINGOBJECTIVES
9
2.REGIONALDIRECTOR’SMESSAGE
9
3.MEETINGPROTOCOL
11
SESSIONII:INTRODUCTIONOFWHO’SAPPROACHTOWARDTHECOMMERCIALDETERMINANTSOFHEALTH(CDH)
11
SESSIONIII:REGIONALOVERVIEWOFBRIEFSCOPINGOFCDH
14
1.OVERALLFINDINGOFCDHINSEARBYDR.MONIKAARORA
14
2.REGIONALCONCERNSONFREETRADEAGREEMENT,PATENTS,REGULATIONAFFECTINGHEALTHSYSTEM,BYDRMANISHA
SHRIDHAR,REGIONALADVISORINTELLECTUALPROPERTYANDTECHOLOGYREGULATION(IPT),WHOSEARO
17
3.REGIONALPERSPECTIVESONUNHEALTHYFOODANDBEVERAGE,DRANGELADESILVA,REGIONALADVISORNUTRITIONAND
HEALTHRESEARCH,WHOSEARO
19
4.ILOAPPROACHTOWORKERS’HEALTHANDRESPONSIBLEBUSINESS,DRYUKAUJITA(OSH‐ILO)
22
SESSIONIV:COUNTRYEXPERIENCESONMAINCOMMERCIALDETERMINANTSOFHEALTHONPEOPLE’SHEALTH(FOCUSONNCD
RISKFACTORSE.G.TOBACCOCONTROL,SUBSTANCEABUSEANDALCOHOLCONSUMPTION,UNHEALTHYFOODANDBEVERAGES,OR
AIRPOLLUTIONETC.)
23
1.THAILANDEXPERIENCECDHAFFECTINGNCDRISKFACTORSBYDRPAIROJSAONAUM,THAIHEALTHPROMOTIONFOUNDATION23
2.INDONESIAEXPERIENCE:DRPRIHANDRIYOSRIHIJRANTIM.EPID.,PROJECTMANAGEROFFICER(PMO)DIRECTORATEGERAL
OFDISEASEPREVENTIONANDCONTROL,MINISTRYOFHEALTH
24
3.NEPALEXPERIENCE:MS.HIRAKUMARINIRAULA,DIRECTOR,NURSINGANDSOCIALSECURITYDIVISION,DEPARTMENTOF
HEALTHSERVICES,MOHP
26
4.PANELDISCUSSION:BANGLADESH,BHUTAN,TIMORLESTE
28
SESSIONV:COUNTRYEXPERIENCESONKEYCDHONHEALTHCARESERVICESANDHEALTHSERVICEDELIVERIES(E.G.INFANT
FORMULAS,MEDICALDEVICES,VACCINES,PHARMACEUTICALPRODUCTS,TELECOMMUNICATION&DIGITALHEALTH,
TRANSPORTATIONSYSTEM,ETC.)
30
1.THAILANDEXPERIENCE’SONCDHINHEALTHCARESERVICESANDSERVICEDELIVERIES,MS.SULADDAPONGUTTA,IHPP,
THAILAND
30
2.PANELDISCUSSION:BANGLADESH,INDONESIA,SRILANKA,MALDIVES
33
Page2of97
SESSIONVI:COUNTRYEXPERIENCESONECONOMICGAINS/LOSTFROMCOMMERCIALPRODUCTSANDACTIVITIES
35
SESSIONVII:SOUTH‐EASTASIACOUNTRIESPERSPECTIVEON“ECONOMYOFWELL‐BEINGANDWELLNESSPRODUCTS”
39
1.MR.ODDHANSSEN,TECHNICALSPECIALISTONHEALTH,TAXATIONANDFINANCING,UNDP
39
2.DR.SARAWUTBOONSUK,DEPUTYDIRECTORGENERAL,DEPARTMENTOFHEALTH,THAILAND
41
3.DR.IFTIKHAR,TRADEANDDEPARTMENT,GOVERNMENTOFMALDIVES
43
PARTIIECONOMYOFWELLBEINGANDEQUITY
44
SESSIONI:GLOBALREPORTONCOMMERCIALDETERMINANTSOFHEALTH–PRESENTATIONBYMS.JULIETTEMCHARDY,
CONSULTANT,ECONOMICANDCOMMERCIALDETERMINANTS,DEPARTMENTOFSOCIALDETERMINANTSOFHEALTH(WHOHQ)
44
SESSIONII:EQUITYLENSONCOMMERCIALDETERMINANTSOFHEALTH:3PRESENTATIONS
48
1.CONSUMERPROTECTIONOFPEOPLE’SVOICESBYDRVINYAARIYARATNE,SAVODAYA,SRILANKA
48
2.COMMUNITY’SVOICESBYPROFESSORSHARADONTA,NEPALPUBLICHEALTHFOUNDATION
50
3.COLLABORATIVEAPPROACHFORBETTERHEALTHBYDRTHANSIEN,PEOPLE’SHEALTHASSOCIATIONOFMYANMAR
51
SESSIONIII:BRAINSTORMSESSIONS:PEOPLEEXPERIENCEOFCDHTHROUGHOUTTHELIFE‐COURSEANDEQUITYLENSONCDH
ACROSSLIFE‐COURSE
52
Q1:
53
Q2:WHATARETHECRITICALCONCERNS?
55
Q3:WHATACTIONSCANINDIVIDUALSTAKE?
57
Q4:WHOISRESPONSIBLEFORCURBINGNEGATIVESANDENHANCINGPOSITIVES?
59
Q5:WHATDOESTHEPUBLICSECTORNEEDTODO?
61
Q6:WHATARETHEACTIONSTOADDRESSEQUITYGAPSFORVULNERABLEPOPULATION?
63
PARTIII:REGIONALPOSITIONONCOMMERCIALDETERMINANTSOFHEALTH
65
SESSIONSI,II,III:COUNTRYPRESENTATIONSONUNDERSTANDINGOFBURDEN,SECTORS,ACTIVITIES,ANDSYSTEMSFORTHECDH
ANDACTIONPOINTS:BANGLADESH,BHUTAN,NEPAL,INDONESIA,MALDIVES,TIMORLESTE,SRILANKA,THAILAND,MYANMAR
65
1.TOP3‐5CDHTOBECRITICALLYCONCERNSINTHENEXT5YEARS
65
2.COMMERCIALDRIVERS/ACTORSTHATHAVEDIRECTIMPACTSONPEOPLEHEALTH
66
3.EXISTINGECONOMICMODELS/SYSTEMSTHATMAYREDUCEORUNDERMININGHEALTHFORALL
68
4.EXISTINGPUBLICPRIVATEPARTNERSHIPSANDGOVERNANCETHATCANMANAGECDH
70
5.PUBLICHEALTHAPPROACHTOCDH
72
6.COUNTRYACTIONPOINTSIN2024‐2025
75
7.RECOMMENDATIONSFORWHO
76
SESSIONIV:REGIONALMECHANISMSRESPONDINGTOCOMMERCIALDETERMINANTSOFHEALTH
77
1.DRSHAMIMHAYDERTALUKDER,SEARNCDALLIANCE
77
2.DRYUKAUJITA,ILO
78
3.THAKSAPHON(MEK)THAMARANGSI,WHOSEARO
80
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SESSIONV:REGIONALPERSPECTIVESONCOMMERCIALDETERMINANTSOFHEALTH:COMPILATIONANDSYNTHESISOFCOUNTRY
PRESENTATIONS
81
COMPILATIONANDSYNTHESISOFCOUNTRYPRESENTATIONS
81
SESSIONVI:RECOMMENDATIONSFORWHO
85
ANNEX1:LISTOFATTENDINGPARTICIPANTS
87
ANNEX2:PROGRAMME
92
ANNEX3:REGIONALDIRECTOR’SMESSAGE
96
Page4of97
Background
Increasingly,publichealthandmedicalprofessionalshavewitnessedcommercialsystemandproductinfluencesoverpopulationhealthbehavioursandconditionsthatchangepeople’swaysoflife.Forexample,NCDsweredescribedas‘lifestylediseases’duetotheirassociationwithbehavioursincludingtobaccouse,alcoholuse,unhealthydiet,andphysicalinactivity.Behavioursandconsumptionpatternsareincreasinglyrecognizedassociallyconstructedactions,orcommerciallydriven,heavilyinfluencedbylarge-scaleproduction,marketing,anddistributingofservicesandproductsmakingthemreadilyavailableandappealingtodifferentgroupsofthepopulation.
Productstargetedtowardschildrenandadolescentswithlonglastingimpactsontheirhealthincludetobacco,alcohol,andunhealthydietsleadingtoillhealthconditionsamongchildrenandadolescents.Advertisementsoftobaccotargetingadolescentscauseharmtotheyounggeneration.AlcoholconsumptionamongadolescentsreportedinGSHSovertheyearsreveals,thatearlyinitiationofalcoholisat12-13yearsoldinmanycountries.Childhoodoverweightandobesityisestimatedtoaffectapproximately41millionin2016andalmosthalfofalloverweightchildrenunder5livedinAsia.Childhoodobesityresultsinanincreasedriskofcardiovasculardisease,diabetes,andlungdiseases.
Recently,WHOattemptedtodefinethecommercialdeterminantsofhealth(CDH)astheconditions,actionsandomissionsbycorporateactorsthataffecthealth,arisinginthecontextoftheprovisionofgoods,orservices,forpayment,whichincludecommercialactivities,aswellastheenvironmentinwhichcommercetakesplace,withbeneficialordetrimentalimpactsonhealth.
Thecommercialsystemimpactsmuchofsocietallivingandactionssuchassocialdeterminantsofhealth(incomedisparities,education,housingconditions,stigmaonpopulationexploitedinillicittrades)whicharethenon-medicalfactorsthatinfluencehealthoutcomesandinequities.Thesedeterminantsholdthekeytoturningthetideofrisingglobalhealthchallengesandhealthinequities.CDHexertsdramaticimpactsonhealthfromthelocaltogloballevel,acrosssectors,settingsandpopulations.
TheburdenofCDHimpactsfallsinequitablybetweenregionsandcountries.InSouth-EastAsia,commercialdeterminantsofchildandadolescenthealth,women’shealth,andworkers’health,liesinnotonlytheunhealthyproducts,butalsothewholesystemofsupplychainsofproductswithinacountry,orthroughtransnationalestablishments,causinglabourexploitationofchildren,women,workers,includinghumantraffickingforlabourexploitation.Impactsofcommercialproducts,services,andactivitiesonhealthrequirepublichealthinterventiontochangecorporatepracticesandprotectpeople’shealth.
Businessstructures,regulatoryregimes,andtaxsystemsthatallowprofitstoflowtoothercountries,awayfromthecountryorregionwheredamaginghealthimpactsandcostsareincurred,compoundstheproblem,particularlywheretheseprofitsaredriventhroughtheexploitationofpopulation,thenaturalenvironment,inadequatelabourlawsandsocialprotectionssystems.ConsumerprotectionsandrightsofconsumersareinvariablyeffectiveinmostcountriesinSouth-EastAsia.Whilevoicesofresearchandacademicstoprotectpeople’shealththroughhealthimpactstudiesarediminishing,asinfluenceofinternationaltradeandeconomicdevelopmentsareintertwined.BuildingonexperiencesofFCTCimplementationandcooperateinterferenceontobaccoprevention,WTOplayscriticalrolesinseveraltradeagreementsinfluencingLMICs,whileTrade-relatedAspectsofintellectualproperty
(TRIPS)isinfluencingdisclosureofcontentofproductsaswellaslabellingdisclosurepolicies.
Page5of97
TheWHOExecutiveBoard152ndSessionAgendaitem16,December2022onSocialDeterminantsofHealthreportedbytheDirector-General,mentionedinparagraph22thatWHOSecretariat’ssupportforcountriestostrengthenunderstandingofthecommercialdeterminantsofhealth.Althoughmuchhasbeendonetolookathowspecificprivatesectorproductsandpractices,notablythetobaccoindustry,haveimpactedonpublichealthoutcomesbyWHOandotheractors,thereareincreasingcallsforWHOtotakeamoresystematicapproachtodeterminingthecontributionofharmfulproductsandcommercialpracticestotheglobalburdenofdiseaseandtodevelopapproachesthatallowforleveragingtheco-benefitsofworkingwiththeprivatesector,whilesafeguardingagainstconflictsofinterest.
Thisconceptofcommercialdeterminantsofhealthneedstobecomprehendedanddeliberatewithmultisectoralauthoritiesandstakeholders.Criticalareasoffocuscouldbeconsideredaroundtobacco,alcohol,ultra-processfood,fossilfuelsthatimpactlargescalemortalities.ItisimportanttohavecrosssectoraldialoguesonpositiveandnegativeimpactsofCDH,powerrelations,systematicpathways,publichealthinterventions/solutionsincludingupstreampoliciesandopportunitiestopromotehealthinallpublicpolicies.
Commercialandeconomicdeterminantsofhealthneedtobediscussedtogetherbetweenpublichealthcommunities,professionalassociationsandeconomicsector,finance,nationalandlocalgovernmentsresponsibleforgovernanceandregulationofinternationalanddomestictrades.ThismeetingistimelytoraiseawarenessandunderstandingofCDHintheregion.
ThemeetingaimedatraisingawarenessofMemberStatesonthisimportantareaoffocusanddiscussinghealthcarecostandhealthimpactsofspecificcommercialdeterminantsofhealth.WHO’sconveningroleswithmultisectoralpartnerswillsupportmemberstatestoidentifyfurtherworkoncommercialdeterminantsincludingitsgapsandstrategicdirectionstoexerttheimportanceofpopulation’shealthasnationalcapitaltobevaluedequallytoeconomicgains.
ThismeetingwasanimportantplatformforMemberStatestoreviewtheDraftOutlineofthefirstWHOGlobalReportonCommercialDeterminantsofHealth,whichwillbepublishedin2024.MemberStatesprovidedcriticalinputsviathisconsultationonhowcountrylevelinterventionsandapproachescanbeaccelerated(fromregulatoryinterventionsorintegratedHiAP);orfacilitatedthroughpolicycoherencetools(HIA,ConflictofInterests,Transparencyregisters),orenabledthroughlocalgovernmentsaddressingCDHandengagementwithlocaleconomicoperatorsandworkingwithcivilsociety.
Page6of97
AimsandObjectivesoftheConsultations
Generalobjectives
TofindcommonunderstandingandawarenessoftheeconomicandcommercialdeterminantsofhealthinSouth-EastAsia
Specificobjectives
1.Toinformmemberstatesontheconceptandpotentialimpactsofeconomicandcommercialdeterminantsofhealth(CDH)
2.Tosharecountryexperiencesoneconomicandcommercialdeterminantsofhealthandcommonchallengesfacedbycountries.
3.TosolicitinputsfortheGlobalReportonCDHfrommemberstates
4.ToconsultonpriorityactionsandwaysforwardtostrengthenunderstandingofthecommercialdeterminantsofhealthinSouth-EastAsia
TargetParticipants
1.MemberStates:highlevelofficialsfromMOH(DGlevel),NationalProgrammemanagers(onchildoradolescentnutritionFoodsafety,TobaccoControl,Chemicalsafety,etc.)and/ornationalhealthplanningorcommission;representativefromMinistryofFinance/Commerceheadingtheworkoncommercialregulations,tradeinvestments,ortaxationofproducts,ormarketsystemsaffectingthehealthofthepopulation.
2.Representativesfromacademiaorcivilsocietyorganizations(CSOs)workingonconsumerprotections,andcivicandcommunity’srightstohealth.
3.NCDAlliance,ASEAN,SARRC,ADB,WorldBank,WorldTradeOrganization(WTO),FAO,UNTAD,UNESCAP,UNHumanRights,UNDP,ILO.
4.InternationalFoundationforHealthPromotioninThailand,InternationalSocietyforHealthPromotionand
EducationIndonesia,andVHAIIndia.
AlistofattendingparticipantsisattachedasAnnex1.
SummaryofthePresentationsandDiscussions
Theregionalconsultationtookplacefrom17Octoberto19October2023,withatotalof62participantsattending.Participantsincludedgovernmentrepresentativesfromministriesofhealth,finance/commercefrom9countries.OtherparticipantswererepresentativesfromacademiaorCSOsworkingonconsumerprotection,theNCDAlliance,UNagenciesincludingILO,2participantsfromWHOheadquarters,8participantsfromWHOcountryoffices,and5participantsfromWHOSEAregionaloffice.
Thethemesguidingthe3daysofmeetingswereasfollows:
.Day1:IntroductionoftheCDHConceptandImpactonHealth
.Day2:EconomyofWellbeingandEquity
.Day3:RegionalPositiononCommercialDeterminantsofHealth
Page7of97
OnDay1,governmentrepresentativesreflectedonthecountryexperienceswithCDHonpeople’shealth,healthcareservicesandhealthservicedeliveries,andeconomicgains/lossesfromcommercialproductsandactivities.Representativesalsoreflectedoneconomicwellbeingandwellnessproducts.OnDay2,participantsweredividedintofivegroupsforbrainstormingsessionsonpeople'sexperiencesonCDHthroughoutthelife-courseandequitylensonCDHacrossthelife-course.OnDay3,governmentrepresentativespresentedanunderstandingofburden,sectors,activities,andsystemsforCDHandcountryactionpoints.UNagencyrepresentativesreflectedontheregionalmechanismsrespondingtoCDH.Day3concludedwithrecommendationsforWHOincludingreflectionsondraftoutlineoftheWHO’sGlobalReportonCDH.
Page8of97
SummaryofProceedings
PartI.IntroductionoftheCDHConceptandImpactsonHealth
SessionI:Inaugurationsession
1.MeetingObjectives
RegionalconsultationoneconomicandcommercialdeterminantsofhealthinSouth-EastAsiastartedwithawarmwelcometoalldistinguishedparticipantsfromtheSouth-EastAsiaRegion(SEAR)countries.Dr.SuvajeeGood,RegionalAdvisorforSocialDeterminantsofHealthandHealthPromotion(RA-SDH),WorldHealthOrganizationforSouth-EastAsiaRegion(WHO-SEARO),introducedthecommercialdeterminantsofhealth(CDH)astheconditions,actionsandomissionsbycorporateactorsthataffecthealth.DrGoodelaboratedthatCDHcouldbebothpositiveornegativeinthecontextoftheprovisionofgoodsorservicesforpayment,includingcommercialactivitiesandtheenvironmentinwhichcommercetakesplacewithbeneficialordetrimentalimpactsonhealth.ShehighlightedthattheWHO'sattempttodefinecommercialdeterminantsmaynotbethemostcomprehensivebutis
stilldevelopingbasedontheevidence.
DrGoodhighlightedparticipants'geographiesacrossSEAR
countries,includingBangladesh,Bhutan,Indonesia,Maldives,
Myanmar,Nepal,SriLanka,Thailand,andTimorLeste.Participants
fromDPRKoreaandIndiacouldnotjoin.
Theprimaryobjectiveoftheconsultationsistofindacommon
understandingandawarenessofhealth'seconomicandcommercial
determinantsinSEAR.TheCDHandeconomicdeterminantsare
derivativesofthesocialdeterminantsofhealth.Thespecific
objectivesofthemeetingwerelaidout.
2.RegionalDirector’sMessage
DrJosVandelaer,WHORepresentativetoThailand,deliveredthemessagefromDrPoonamKhetrapalSingh,RegionalDirector,WHOSouth-EastAsia.HequotedDr.Khetrapal’sspeech(inAnnex3)andhighlightedthatglobalizationandcommercialactivitieshaveincreasedthescopeofeconomicopportunities,employment,accesstoessentialanddiscretionarygoodsandservicestonationalandlocalcommunities.Marketingstrategies,promotionofchoices,lobbying,donating,andfundingresearchactivities
areincreasinglyinfluencingthedecisionmakingofindividuals,families,communities,andpublicauthoritiestoadopttheproductsandpracticesthatcouldhavebeneficialordetrimentalimpactsonpeople’shealth.
Page9of97
Dr.KhetrapalmentionedthatWHOrecognizestheimportanceofeconomicandcommercialdeterminantsofhealththatgeneratepositiveandnegativeimpactsonpublichealthwhileenablingpoliticaleconomicsystemsandnormsforworkingconditionsandotherrelatedactivities.Theterm“commercialdeterminantsofhealth”isusedtounderstandhowindustrialdrivencommercialactivitiesincludingalltheproductsandservicesimpactingpublichealth(healthcaredeliverysystemsandcost),influencelifestylechoices(healthyorunhealthy),andglobalhealthinequities(includingoccupationalhealthofworkersindifferentcommercialsystems).Theproductionandconsumptionof‘unhealthy’products,forexample,tobacco,alcohol,ultra-processedfoods,andsugarbeverages,impactstheearth(planetaryhealth),degradestheenvironment,communities,families,people’shealthandaddstopollution.
Furthermore,theburdenofnon-communicablediseases(NCDs)washighlightedinSEARwhichaccountsfor9milliondeathsin2019accounting22%ofglobalNCDdeaths.NCDmortalityisattributedtolifestylerelatedriskfactors,includingincreasingemissionofpollutants,andburningofbiomassforindustrialdevelopment.
Thenutritiontransition(fromhome-grownorganicfoodtomassindustrialprocessedfoodproducts)hasbeenevidentinSEARcountries,whichhasledtoanincreaseinconsumptionofhighsugar,salt,andtrans-fatandhascontributedtoobesityandmetabolicdisorders.Thesalesofsugar-sweetenedbeverage(SSBs)haveincreasedeverywhereintheregion,withaparticularincreaseinIndonesiaandThailand.AlcoholuseisincreasingincountriessuchasDPRKorea,India,andThailand.Availabilityofcheapunhealthyitemsintheregione.g.,tobacco,loosecigarettes,cheapliquor,uncertifiedcontaminatedfoodandvegetables,cheapunhealthyimitatedfoodproducts,etc.isdrivingupnoncommunicablediseasesamongthepoor,rural,andlessinformativepopulation.
Herquotestressedthatthecommercialsystemofpharmaceuticalproducts,medicaltechnologies,vaccination,andhealthsupplementscandividehealthcareservicesbenefitingtherichandthepoordifferently.Commercialdeterminantsofhealthposeacomplexjuxtapositiontohealthequities.Itcanincreasehealthcarecostsincludingout-of-pocketexpendituresandwideningthegapsofhealthinequities.
Addressingdeterminantsofhealthrequirespublicpolicies(beyondthehealthsector)withattentiontotheroleofpower,equity,andgovernance.Anincreaseingovernance,sectoralaccountability,regulation,licensing,andtaxationaresomeexamplesofactionsthatcancurbtheproliferationofcommercialactivitiesthathavenegativeimpactsonhealth.Anincreaseinhealthliteracyamongconsumersandpromotionofhealthasahumanrightwouldraiseconsumerdemandforimprovedbusinessoperationandreformtocreatebetterproductsforhealthandwellbeing.
Calltoaction:Ministryofhealthandpartneragenciesshouldencourageothersectorstoadvancetheeconomyforhealthandwellbeing,promotionofwellnessandequitableaccesstohealthproducts,andincreasetheenablingenvironmentforhealthforallpopulations.DrKhetrapalstressedtheneedtofollow-uponthecommitmentstheworldleadershavemadeduringrecentG20,astheyarethedriversofsomeofthesecommercialdeterminantsofhealth,toreachoneearth,onehealthmakingtheworldahealthierplace.Herquotehighlightedthattakingthisasanopportunitytoalsounderstandtheeconomyofwell-being.Facilitatingequitableaccesstosafe,effective,quality-assured,andaffordablevaccines,therapeutics,diagnostics,andothercountermeasures,especiallyinlow-andmiddle-incomecountriesandsmallislanddevelopmentstatesisalsoaneedofthehour.
Page10of97
3.Meetingprotocol
AdministrativeinstructionswereprovidedbyDrSuvajeeGoodtotheparticipants.DrGoodalsoinsistedonfollowingtheWHOcodeofconducttopreventallkindsofharassment.
SessionII:IntroductionofWHO’sapproachtowardtheCommercialDeterminantsofHealth(CDH)
MsMonikaKosinska,globalcross-cuttingleadforeconomicandcommercialdeterminantsofhealth,WHOHeadquarters,introducedtheWHO’sapproachtoCDH.MsKosinskamentionedthatthebiggestpublichealthchallengesthattheworldisfacingincludeNCDsandcommunicablediseases,climatechange,relatedemergencies,occupationalillnessesandinjuries,mentalhealthconditionsandothers.
Shefurtherstressedthatmanyleadingscholarsareincreasinglyidentifyingcommercialproductsandpracticesastheleadingcauseoftheglobalburdenofdiseaseandthreatstoplanetaryhealth.ReferringtoastudypublishedintheLancet,inMarch2023,sheemphasizedthatone-thirdofthedeathsgloballyareattributedtoonlyfourindustrieswhichincludetobacco,alcohol,unhealthyfoodandfossilfuels.Shehighlightedtheimportantrolethatthecommercialsectorandtheprivatesectoractorsplayinwealth,economicdevelopment,andpartnershipaspartofthemulti-sectoralapproachandthatWHOissensitivetoensuringitsworkoneconomicandcommercialdeterminantsisreflectiveofboththepositiveandnegativeexternalitiestocommercialpractices.
MsKosinskamentionedthatCDHisbecominganincreasinglyimportantareaofinquiryforpublichealthbecauseoftherolethatcommercialactorsplaythroughoutthesocialdeterminantsthatinfluenceourhealth.Ahigh-levelstrategicmeetingonthesocialdeterminantsofhealthheldinGenevain2019identifiedtheriseofCDHanditsdirectimpactonhealthparticularlynegativelyandWHOwasaskedtoscopethisfurther.Thepurposeoftheregionalconsultationistocontributetothisscoping,buildingontheexistingworkofWHOtocoverthespectrumofcorporatebehaviourfromsupplychainsthroughregulatoryinfluenceandembeddingcommercialdynamicswithinsocialdeterminants.Thelensthatneedstobeappliedonthisemergingfieldofenquiryisofpower,ofequityinhealth,andofgovernance.
MsKosinskahighlightedfourkeychallenges:
.Commercialpracticesareembeddedwithinbroadereconomicandfinancialenvironmentsandtheseeconomicdriversactastheeconomicdeterminantsandenablersthatcreatetheconditionsinwhichcommercialactorsoperateandimpactpublichealth
Page11of97
.Thereisaneedtoquantifyandqualifyintermsoftheharmarisingfromcommercialpractices,andwhobearsthecostsoftheseharms–toooftenthosewhocan’taffordthem.
.Thehealthsectorneedsstrengtheningtounderstandandaddresstheimpactandtheoutcomesofnegativeexternalitiesfromthecommercialdeterminantsofhealth.
.Ensurethatthefocusisonbothconflictsofinterestandmanagementofrisksandmaintainsanequitylensonhealthoutcomesarisingfromcommercialpractices.
Therefore,itisimperativetothinkaboutthepathwaysavailabletogovernmenttoshiftcommercialpracticesfromhealth-harmingtobecominghealth-enablingandhealth-promoting.ThefirstbookpublishedonCDHdefinescommercialdeterminantsverybroadlyasanyactivityoftheprivatesector.However,recentlyintheLancetseries,aninternationalgroupofscholarsdefinedCDHassystems,practices,andpathwaysinwhichcommercialactorsdrivehealthandhealthequity.Itisessentialtostartlookingattheseimpactpathwaysandoutcomesalittlebitmoreclosely.Itisequallyimportanttomakeameaningfuldistinctionbetweenthecommercialactorsbasedonthenatureoftheirhealthimpacts.InCDH,thetermcommercialreflectsthecomplexityandtheheterogeneitythatexistswithinthebroaderprivatesector.Commercialactorscanbeprivatelyowned,buttheycanalsobeownedbythepublicsector,orindeedbynot-for-profitentities–theirclassificationasacommercialactorisnotaccordingtotheirownership,butratherwhethertheyengageincommercialpractices.
WHOisusingaworkingimpactframeworkwhichconsistsoffourdomains:twoimpactdomainsandtwoactivitydomains.Thetwomaingroupsofactivitiesthatdrivecommercialimpactsonhealthinclude:
Page12of97
.Thefirstiscorecommercialbusinessoperationsthroughthesupplychaininthedesignandsaleofproductsandservice,andparticipationwithinthemarket.Thisalsoincludesmarketingactivitiesandtheirimpactonsupplychainsorontheiremployees.
.Thesecondiscommercialcitizenshiporpersonhood.Thatiswhencommercialactorsactasinstitutions,throughCSRactivities,publicrelations,politicalactivities,lobbying,butalsothroughtheircontributionstonationaltaxbudgets;nationaltaxcontributions,budgetsandthroughthird-partyactivity,suchasfundingbusinessassociationsand‘Astroturf’ornot-for-profitactors.
Theimpactscanalsobegroupedintotwodomains.First,theimpactsonphysicalorsocialenvironmentsandultimately
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