Commercial determinants of health: an ethical exploration
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REVIEW
Commercial determinants of health: an ethical exploration Paul Ndebele1 • Hina Shaikh1 • Nino Paichadze1 • Imran Bari1 • David Michaels1 • Carlos Santos Burgoa1 Adnan A. Hyder1
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Received: 3 February 2020 / Revised: 27 June 2020 / Accepted: 6 July 2020 / Published online: 25 August 2020 Ó Swiss School of Public Health (SSPH+) 2020
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. Keywords Commercial determinants of health CDoH Ethics Public health Private sector Bioethics
Introduction With every region of the world facing the epidemic of noncommunicable diseases (NCDs), researchers are increasingly exploring the role of commercial determinants of health in the increasing chronic disease and disability burden (Maani et al. 2020; Buse et al. 2017; Knai et al.
This article is part of the special issue ‘‘Market-driven forces and Public Health.’’ & Paul Ndebele [email protected] 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
2018; Lima and Gale
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