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The role of causal ideas in the governance of commercial determinants of health. A qualitative study of tobacco control in the pacific

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  • Patay, Dori
  • Schram, Ashley
  • Friel, Sharon

Abstract

The consumption of tobacco, alcohol and ultra-processed foods and beverages drives the global noncommunicable disease (NCD) crisis in Pacific small island developing states (PSIDS). Addressing the commercial determinants of health (CDoH) requires policy coherence across government sectors; however, entrenched neoliberal ideologies that exhort self-regulation of markets and market actors impede such efforts. This paper aims to explore the roles ideas play in governing CDoH, through the analysis of causal ideas in multisectoral tobacco governance in Fiji and Vanuatu. An explorative, qualitative case study design was applied. Data collection relied primarily on in-depth interviews, of which 70 were conducted between 2018 and 2019. Data analysis was guided by a theory-informed analytical framework. Two causal ideas influence multisectoral tobacco governance in Fiji and Vanuatu. According to the idea of individual responsibility, high smoking prevalence is the consequence of individuals’ unhealthy lifestyle choices; it nominates the Ministry of Health as the responsible actor to solve this issue by providing health education. In contrast, the idea of CDoH argues that harmful commodity industries drive the NCD epidemic, and the sectors that regulate these private actors should be kept in closer check to ensure that their policies are aligned with the objectives of public health. In Fiji and Vanuatu, the non-health government agencies are effectively excused from implementing multisectoral tobacco policies because the dominant idea of individual responsibility relieves them of any responsibility. The wider adoption of the idea of CDoH is needed in PSIDS to tackle the NCD crisis.

Suggested Citation

  • Patay, Dori & Schram, Ashley & Friel, Sharon, 2022. "The role of causal ideas in the governance of commercial determinants of health. A qualitative study of tobacco control in the pacific," Social Science & Medicine, Elsevier, vol. 314(C).
  • Handle: RePEc:eee:socmed:v:314:y:2022:i:c:s0277953622007870
    DOI: 10.1016/j.socscimed.2022.115481
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    References listed on IDEAS

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    1. Sharon Friel1 & Patrick Harris & Sarah Simpson & Anjana Bhushan & Britta Baer, 2015. "Health in All Policies Approaches: Pearls from the Western Pacific Region," Asia and the Pacific Policy Studies 201526, Crawford School of Public Policy, The Australian National University.
    2. Barlow, P. & Thow, A.M., 2021. "Neoliberal discourse, actor power, and the politics of nutrition policy: A qualitative analysis of informal challenges to nutrition labelling regulations at the World Trade Organization, 2007–2019," Social Science & Medicine, Elsevier, vol. 273(C).
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    4. MacKenzie, Ross & Mathers, Annalise & Hawkins, Benjamin & Eckhardt, Jappe & Smith, Julia, 2018. "The tobacco industry’s challenges to standardised packaging: A comparative analysis of issue framing in public relations campaigns in four countries," Health Policy, Elsevier, vol. 122(9), pages 1001-1011.
    5. Lencucha, Raphael & Drope, Jeffrey & Labonte, Ronald, 2016. "Rhetoric and the law, or the law of rhetoric: How countries oppose novel tobacco control measures at the World Trade Organization," Social Science & Medicine, Elsevier, vol. 164(C), pages 100-107.
    6. Sharon Friel & Patrick Harris & Sarah Simpson & Anjana Bhushan & Britta Baer, 2015. "Health in All Policies Approaches: Pearls from the Western Pacific Region," Asia and the Pacific Policy Studies, Wiley Blackwell, vol. 2(2), pages 324-337, May.
    7. Emily Savell & Anna B Gilmore & Gary Fooks, 2014. "How Does the Tobacco Industry Attempt to Influence Marketing Regulations? A Systematic Review," PLOS ONE, Public Library of Science, vol. 9(2), pages 1-10, February.
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