Corporate practices and the health of populations: a research and translational agenda

Recognition is growing of the influence of corporate activity on the health of populations.1McKee M Stuckler D Revisiting the corporate and commercial determinants of health.Am J Public Health. 2018; 108: 1167-1170Crossref PubMed Scopus (128) Google Scholar Disciplines such as epidemiology,2Cuong P Casswell S Parker K et al.Cross-country comparison of proportion of alcohol consumed in harmful drinking occasions using the International Alcohol Control Study.Drug Alcohol Rev. 2018; 37: 45-52Crossref Scopus (22) Google Scholar anthropology,3Greenhalgh S Making China safe for Coke: how Coca-Cola shaped obesity science and policy in China.BMJ. 2019; 364k5050Crossref Scopus (29) Google Scholar ethics,4Marks JH The perils of partnership: industry influence, institutional integrity, and public health. Oxford University Press, Oxford2019Crossref Google Scholar and law5Gostin LO Monahan JT Kaldor J et al.The legal determinants of health: harnessing the power of law for global health and sustainable development.Lancet. 2019; 393: 1857-1910Summary Full Text Full Text PDF PubMed Scopus (119) Google Scholar are beginning to inform frameworks to study corporate power and influence.6Madureira Lima J Galea S Corporate practices and health: a framework and mechanisms.Global Health. 2018; 14: 21Crossref PubMed Scopus (71) Google Scholar This developing field of study has embraced a range of methods, some of which are new to public health, such as network7Fergie G Leifeld P Hawkins B Hilton S Mapping discourse coalitions in the minimum unit pricing for alcohol debate: a discourse network analysis of UK newspaper coverage.Addiction. 2019; 114: 741-753Crossref PubMed Scopus (14) Google Scholar and textual analyses,8Stuckler D Reeves A Loopstra R McKee M Textual analysis of sugar industry influence on the World Health Organization's 2015 sugars intake guideline.Bull World Health Organ. 2016; 94: 566-573Crossref PubMed Scopus (18) Google Scholar and some of which are more established approaches, such as modelling and policy impact assessments.9Penalvo JL Cudhea F Micha R et al.The potential impact of food taxes and subsidies on cardiovascular disease and diabetes burden and disparities in the United States.BMC Med. 2017; 15: 208Crossref PubMed Scopus (36) Google Scholar Encouragingly, research funders have begun to show interest in the effects of corporate practices on health. As the study of commercial determinants of health continues to expand, we highlight four conceptual and methodological challenges that hinder its development, and suggest productive areas for future research. First, conceptually, what is meant by commercial determinants of health is still unclear. Sometimes they are understood as harmful products that have direct effects on health, such as tobacco. At other times, these determinants include a much broader range of activities that promote the interests of corporations at the expense of the public, such as lobbying to reduce corporate taxation, erode labour rights, or dilute or delay measures that protect health at national, regional, and global levels. Corporations of substantial size and scope influence population health in myriad intersectional ways, across national borders. An agreement is therefore needed on a common, inclusive definition of the commercial determinants of health, within which different frameworks might sit. This agreement will require theoretical work that draws on multiple disciplines. Recent work building on insights from ethics4Marks JH The perils of partnership: industry influence, institutional integrity, and public health. Oxford University Press, Oxford2019Crossref Google Scholar or political science that are focused on the nature and distribution of power6Madureira Lima J Galea S Corporate practices and health: a framework and mechanisms.Global Health. 2018; 14: 21Crossref PubMed Scopus (71) Google Scholar points to a possible way forward. Second, much existing research happens in discrete, industry-specific silos, with researchers working in isolation to study particular product categories, such as tobacco, alcohol, or gambling. Notable exceptions exist, with some researchers studying corporations as entities operating in many different sectors.10Wiist WH The bottom line or public health: tactics corporations use to influence health and health policy, and what we can do to counter them. Oxford University Press, New York2010Google Scholar However, much more could be done to develop an understanding of how different corporations use the same methods. By working across sectors, researchers could develop new frameworks in which to situate existing research, effectively identify knowledge gaps, and aid in the development of solutions. These activities will be crucial to address the cumulative effects of corporate activity on areas such as social norms and public discourse. Third, much of the work on methodologies to study corporate practices and health has focused on analysis of documentary sources, such as internal documents, evidence submissions during policy development, stakeholder interviews, annual reports, or court filings. Little quantitative research has been done on the effects of different strategies, products, and networks of influence. This absence of empirical research is problematic in several ways. Without quantitative analysis based on sound theoretical frameworks and appropriate conceptual models, it is difficult to draw inference about the magnitude of the distal effects of individual or collective corporate actions on the health of populations, be they positive or negative. More research on corporate action and health that is grounded in the science of population health is therefore needed, using data sources such as social media that can illuminate associations between corporate actions and public conversations or health behaviours. Last, the focus of much of the existing research has been in high-income countries, which is problematic for two reasons. First, corporate practices are, by definition, embedded in political economies that are country—or at least regionally—specific, suggesting that lessons learnt from high-income countries might have limited tractability in other national contexts. Also, at a global level, many of the corporations affecting health are based in high-income countries, whereas their effects are seen in low-income and middle-income settings, something that is likely to increase as markets for some harmful products stagnate in high-income countries. Given these challenges, we propose three potential approaches that could advance the study of the commercial determinants of health. First, cross-disciplinary work is the highest priority. Beyond empirical research, such work will require the creation of research architecture (including journals and academic societies) that compiles what we know about commercial determinants. These can in turn provide the frameworks for building research capacity at a global level. Second, more purposeful and forward-looking research funding is needed. Commercial determinants of health have not been on the agenda of many funders, despite the clear importance for population health, both nationally and globally. This shortage of resources has led to a scarcity of scholars and networks to support them. Funding is needed for research that is not limited to individual empirical studies, but seeks to advance conceptual understanding of the effects of commercial determinants of health. Last, what evidence does exist often has little influence on policy choices. The evidence base points to a need to take account of the actions of corporations that affect health in many areas of policy. With this in mind, it is imperative that researchers participate in broader conversations with the public, policy makers, and the media about how existing evidence might better inform areas such as regulation, public–private partnerships, and trade. As the world grapples with challenges such as obesity, climate change, and environmental damage, it is becoming more important than ever that research helps redefine what responsible, sustainable corporate practice might look like in a future healthy society. The views presented here are those of the authors and not necessarily those of their funders or affiliations. We declare no competing interests.