The political economy of non-communicable diseases

Non-communicable diseases are the major cause of death and disability globally, but are largely preventable. The five major modifiable risk factors are tobacco use, alcohol use, unhealthy diets, physical inactivity, and air pollution—all of which have a strong environmental component. Implementation of policy to address non-communicable diseases (NCDs), however, has focused on individual responsibility rather than creating supportive environments for health promotion and NCD prevention, in part because of industry influence. A political economy perspective is helpful in considering how economic interests intersect with political decisions to shape the environments in which individuals live. When ‘environments of risk’ are considered from a political economy perspective, it enables us to critically assess sociopolitical factors that generate product environments characterized by health-harming products, built environments that condition physical inactivity over physical activity, and marginalization of pollution reduction. The enormous size and reach of these ‘industries of risk’ translates into significant political power. Industry actively exerts power in formal decision-making forums (‘decision-making power’), shapes the agenda in political debates (‘non-decision-making power’), and exercises ideological power in ways that are contrary to NCD prevention. Despite the power wielded by industry interests in the policy process, there has been innovation and meaningful policy change for NCD prevention. Key strategies include: assembling strong, local evidence to underpin policy; developing strong coalitions of actors with public health interests; preparing for push-back from industry; and developing specific proposals for healthier economic policy.