Systems thinking as a framework for analyzing commercial determinants of health

Research output: Contribution to journalJournal articleResearchpeer-review


  • Cécile Knai
  • Mark Petticrew
  • Nicholas Mays
  • Simon Capewell
  • Rebecca Cassidy
  • Steven Cummins
  • Elizabeth Eastmure
  • Patrick Fafard
  • Benjamin Hawkins
  • Jensen, Jørgen Dejgård
  • Srinivasa Vittal Katikireddi
  • Modi Mwatsama
  • Jim Orford
  • Heide Weishaar

Policy Points: Worldwide, more than 70% of all deaths are attributable to noncommunicable diseases (NCDs), nearly half of which are premature and apply to individuals of working age. Although such deaths are largely preventable, effective solutions continue to elude the public health community. One reason is the considerable influence of the “commercial determinants of health”: NCDs are the product of a system that includes powerful corporate actors, who are often involved in public health policymaking. This article shows how a complex systems perspective may be used to analyze the commercial determinants of NCDs, and it explains how this can help with (1) conceptualizing the problem of NCDs and (2) developing effective policy interventions. Context: The high burden of noncommunicable diseases (NCDs) is politically salient and eminently preventable. However, effective solutions largely continue to elude the public health community. Two pressing issues heighten this challenge: the first is the public health community's narrow approach to addressing NCDs, and the second is the involvement of corporate actors in policymaking. While NCDs are often conceptualized in terms of individual-level risk factors, we argue that they should be reframed as products of a complex system. This article explores the value of a systems approach to understanding NCDs as an emergent property of a complex system, with a focus on commercial actors. Methods: Drawing on Donella Meadows's systems thinking framework, this article examines how a systems perspective may be used to analyze the commercial determinants of NCDs and, specifically, how unhealthy commodity industries influence public health policy. Findings: Unhealthy commodity industries actively design and shape the NCD policy system, intervene at different levels of the system to gain agency over policy and politics, and legitimize their presence in public health policy decisions. Conclusions: It should be possible to apply the principles of systems thinking to other complex public health issues, not just NCDs. Such an approach should be tested and refined for other complex public health challenges.

Original languageEnglish
JournalThe Milbank Quarterly
Issue number3
Pages (from-to)472-498
Number of pages27
Publication statusPublished - 2018

    Research areas

  • noncommunicable diseases, systems thinking, unhealthy commodity industries

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ID: 203086942