Conceptualizing the Commercial Determinants of Health Using a Power Lens: A Review and Synthesis of Existing Frameworks
Abstract
Background
There is increasing recognition that power imbalances that favour corporations, especially those active in unhealthy commodity industries, over other actors are central to the ways in which corporations influence population health. However, existing frameworks for analyzing corporate strategies and practices that impact on health do not incorporate concepts of power in consistent ways. This paper aimed to review the ways in which corporate power has been incorporated into such frameworks, and to propose a revised framing of the commercial determinants of health
(CDoH) that makes concepts of power explicit.
Methods
The researchers conducted a narrative review of frameworks that identify corporate strategies and practices and explain how these influence population health. Content analysis was conducted to identify explicit references to different qualities of power – its origins, nature, and manifestations.
Results
Twenty-two frameworks were identified, five of which used theories of power. A wide range of contexts that shape, and are shaped by corporate power were discussed, as were a diversity of corporate, social and ecological outcomes. A variety of material and ideational sources of power was also covered. The authors proposed an integrated ‘Corporate Power and Health’ framework to inform analysis of the CDoH, organized around key questions on power set out by Foucault. The proposed framework draws from a number of well-established corporate power theories and synthesizes key features of existing CDoH frameworks.
Conclusion
Public health advocates, researchers and policy-makers would likely be better placed to understand and address the CDoH by engaging with theories of power to a greater extent, and by explicitly incorporating concepts of corporate power in analyses of how the deployment of corporate strategies and practices influence population health.