Reframing the impact of business on health: the interface of corporate, commercial, political and social determinants of health

• Published in: BMJ global health 2019-08, Vol.4 (4), p.e001510-e001510
• Main Authors: Rochford, Connor, Tenneti, Naveen, Moodie, Rob
• Format: Article
• Language: English
• Subjects: business; Commentary; commercial determinants; corporate determinants; Employees; Global health; Health care; Health care policy; Health insurance; Health promotion; Influence; Medical personnel; political economy; Power; Private sector; Profits; Public health; Social responsibility; Tax rates
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2019-001510

If successful, the innovations could diffuse through to the 150 million other Americans currently receiving health insurance through their employers.1 This move occurs on the background of decreasing public financing for healthcare and increasing service competition with the private sector, ostensibly to improve efficiency.2 The design of ABC is also shaped by its need to interact with the US healthcare system—one of the least effective examples in the OECD—which former UN boss Ban Ki-moon has diagnosed as ‘morally wrong’.3 Considering the impact of business on health more broadly requires reconciling such an initiative with the other practises—both health promoting and detracting—of these corporations. [...]in August 2018, Amazon released figures from its UK corporation tax bill, which recorded tax payments of 4.5 million pounds on profits of 72 million pounds.4 While the various loopholes available in domestic and international law ensure that this is not technically a crime, this figure is significantly less than the nominated corporate tax rate of 21% for companies with annual profits exceeding 300 000 pounds, and is certainly not a victimless practice.5 The case raises several questions and opportunities for academic inquiry, which are as follows: Existing frameworks assessing the role of business in health do not empower health professionals to answer such questions.6 7 This is in part because the predominant focus of current analytical efforts is on the external services or products delivered by private entities, without an appreciation for the way that the internal processes (ie, employee relations, workplace design and physical infrastructure) and external processes (eg, sales, marketing and lobbying) affect the operation of power between different stakeholders and influence health. The need to carefully navigate public–private relationships was formally recognised in 1993, when the World Health Assembly called on the WHO to ‘mobilise and encourage the support of all partners in health development, including non-governmental organisations and institutions in the private sector’.14 The latest iteration of the WHO’s thinking is embodied in the Framework of Engagement with Non-State Actors (FENSA), which describes the different forms of potential interaction between the WHO and business (eg, technical collaboration, financial support, and so on) and discusses their risks and benefits.15 However, FENSA provides no such guidance on how other health sys