Policy Points:
Worldwide, more than 70% of all deaths are attributable to noncommunicable diseases (NCDs), nearly half of which are premature and apply to individuals of working age. Although such deaths are largely preventable, effective solutions continue to elude the public health community.
One reason is the considerable influence of the “commercial determinants of health”: NCDs are the product of a system that includes powerful corporate actors, who are often involved in public health policymaking.
This article shows how a complex systems perspective may be used to analyze the commercial determinants of NCDs, and it explains how this can help with (1) conceptualizing the problem of NCDs and (2) developing effective policy interventions.
Context
The high burden of noncommunicable diseases (NCDs) is politically salient and eminently preventable. However, effective solutions largely continue to elude the public health community. Two pressing issues heighten this challenge: the first is the public health community's narrow approach to addressing NCDs, and the second is the involvement of corporate actors in policymaking. While NCDs are often conceptualized in terms of individual‐level risk factors, we argue that they should be reframed as products of a complex system. This article explores the value of a systems approach to understanding NCDs as an emergent property of a complex system, with a focus on commercial actors.

Methods
Drawing on Donella Meadows's systems thinking framework, this article examines how a systems perspective may be used to analyze the commercial determinants of NCDs and, specifically, how unhealthy commodity industries influence public health policy.

Findings
Unhealthy commodity industries actively design and shape the NCD policy system, intervene at different levels of the system to gain agency over policy and politics, and legitimize their presence in public health policy decisions.

Conclusions
It should be possible to apply the principles of systems thinking to other complex public health issues, not just NCDs. Such an approach should be tested and refined for other complex public health challenges.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/1468-0009.12339

Systems Thinking as a Framework for Analyzing Commercial Determinants of Health

Water in crisis: paths to sustainable water use

Childhood diarrhoeal diseases in developing countries.

Is 2030 too soon for Africa to achieve the water and sanitation sustainable development goal

Waterborne pathogens have attracted a great deal of attention in the public health sector over the last several decades. However, little is known about the pathogenic microorganisms in urban water systems. In this study, the bacterial community structure of 16 typical surface waters in the city of Beijing were analyzed using Illumina MiSeq high-throughput sequencing based on 16S rRNA gene. The results showed that Bacteroidetes, Proteobacteria and Actinobacteria were the dominant groups in 16 surface water samples, and Betaproteobacteria, Alphaproteobacteria, Flavobacteriia, Sphingobacteriia and Actinobacteria were the most dominant classes. The dominant genus across all samples was Flavobacterium. In addition, fifteen genus level groups of potentialy pathogenic bacteria were detected within the 16 water samples, with Pseudomonas and Aeromonas the most frequently identified. Spearman correlation analysis demonstrated that richness estimators (OTUs and Chao1) were correlated with water temperature, nitrate and total nitrogen (p < 0.05), while ammonia-nitrogen and total nitrogen were significantly correlated with the percent of total potential pathogens (p ≤ 0.05). These results could provide insight into the ecological function and health risks of surface water bacterial communities during the process of urbanization.

/pdf/bacterial-communities-and-potential-waterborne-pathogens-2gd41qoapg.pdf

Bacterial communities and potential waterborne pathogens within the typical urban surface waters.

Background: As human populations become more and more urban, decision-makers at all levels face new challenges related to both the scale of service provision and the increasing complexity of cities and the networks that connect them. These challenges may take on unique aspects in cities with different cultures, political and institutional frameworks, and at different levels of development, but they frequently have in common an origin in the interaction of human and environmental systems and the feedback relationships that govern their dynamic evolution. Accordingly, systems approaches are becoming recognized as critical to understanding and addressing such complex problems, including those related to human health and wellbeing. Management of water resources in and for cities is one area where such approaches hold real promise. Results: This paper seeks to summarize links between water and health in cities and outline four main elements of systems approaches: analytic methods to deal with complexity, interdisciplinarity, transdisciplinarity, and multi-scale thinking. Using case studies from a range of urban socioeconomic and regional contexts (Maputo, Mozambique; Surat and Kolkata, India; and Vienna, Austria). Conclusion: We show how the inclusion of these elements can lead to better research design, more effective policy and better outcomes.

/pdf/improving-health-in-cities-through-systems-approaches-for-3e1umdqj9k.pdf

Improving health in cities through systems approaches for urban water management

Access to adequate water, sanitation and hygiene (WASH) is essential for the health, well-being and dignity of all people. The World Health Organization South-East Asia Region has made considerable progress in WASH provision during the past two decades. However, compared with increases in coverage of improved drinking water, in some parts of the region, access to adequate sanitation remains low, with continued prevalence of open defecation. The Sustainable Development Goals (SDGs) have set ambitious targets for WASH services to be achieved by 2030. Examples of major health outcomes that would benefit from meeting these targets are diarrhoea and nutrition status. Although the total number of deaths attributable to diarrhoea declined substantially between 1990 and 2012, inadequate WASH still accounts for more than 1000 child deaths each day worldwide. And, despite the reductions in mortality, diarrhoea morbidity attributable to diarrhoea remains unchanged at around 1.7 billion cases per year. It has been known for decades that repeated episodes of diarrhoea increase a child's risk of long-term undernutrition, reduced growth and impaired cognitive development. Nutritional effects of inadequate WASH also include environmental enteropathy, leading to chronic intestinal inflammation, malnutrition and developmental deficits in young children. Inadequate WASH also contributes to iron deficiency anaemia resulting from infestation with soil-transmitted helminths. The cross-sectoral emphasis of the SDGs should act as a stimulus for intersectoral collaboration on research and interventions to reduce all inequities that result from inadequate WASH.

Indira Chakravarty

Papers

Improving health in cities through systems approaches for urban water management

Water, sanitation and hygiene: The unfinished agenda in the World Health Organization South-East Asia Region

Sanitation and Health: A Movement Visualizing Gandhi's Dream`