Global Obesity Centre, Deakin University, Geelong, VIC, Australia.
Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia.
Int J Health Policy Manag. 2022 Aug 1;11(8):1251-1261. doi: 10.34172/ijhpm.2021.05. Epub 2021 Jan 25.
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 analysing 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.
We 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.
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. We proposed an integrated 'Corporate Power and Health' framework to inform analysis of the CDoH, organised around key questions on power set out by Foucault. The proposed framework draws from a number of well-established corporate power theories and synthesises key features of existing CDoH frameworks.
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.
越来越多的人认识到，有利于公司（尤其是那些活跃于不健康商品行业的公司）的权力失衡，是公司影响人口健康的方式的核心。然而，现有的分析影响健康的公司战略和做法的框架并没有以一致的方式纳入权力概念。本文旨在审查将公司权力纳入这些框架的方式，并提出一个经修订的健康的商业决定因素（CDoH）框架，明确权力概念。
我们对确定公司战略和做法并解释这些战略和做法如何影响人口健康的框架进行了叙述性综述。采用内容分析法，明确提及权力的不同性质——权力的起源、性质和表现。
确定了 22 个框架，其中 5 个框架使用了权力理论。讨论了塑造和受公司权力影响的各种背景，以及公司、社会和生态的多样性结果。还涵盖了各种物质和意识形态的权力来源。我们提出了一个综合的“公司权力与健康”框架，为分析健康的商业决定因素提供信息，该框架围绕福柯提出的关于权力的关键问题组织。所提出的框架借鉴了一些成熟的公司权力理论，并综合了现有健康的商业决定因素框架的关键特征。
如果公共卫生倡导者、研究人员和政策制定者更多地参与权力理论，并在分析公司战略和做法的实施如何影响人口健康时明确纳入公司权力概念，他们可能更有能力理解和解决健康的商业决定因素。
