Situating commercial determinants of health in their historical context: a qualitative study of sugar-sweetened beverages in Jamaica

Globalization and Health

Research

Ruth H. Thurstan¹  Karyn Morrissey²  Henrice Altink³  Matthew J. Smith⁴  Sheray Warmington⁵  Ishtar Govia⁶  Olivia Barnett-Naghshineh⁷  Cornelia Guell⁷  Nigel Unwin⁸ 

[1]Centre for Ecology and Conservation, University of Exeter, TR10 9FE, Penryn, UK

[2]Climate and Energy Policy, Department of Technology, Management and Economics, Technical University Denmark, 2800, Kgs. Lyngby, Denmark

[3]Department of History and Interdisciplinary Global Development Centre, University of York, YO10 5DD, Heslington, York, UK

[4]Department of History, University College London, WC1E 6BT, London, UK

[5]Epidemiology Research Unit, Caribbean Institute for Health Research (CAIHR), The University of the West Indies, 7, Mona, Kingston, Jamaica

[6]Epidemiology Research Unit, Caribbean Institute for Health Research (CAIHR), The University of the West Indies, 7, Mona, Kingston, Jamaica

[7]Institute for Global Health, University College London, WC1N 1EH, London, UK

[8]European Centre for Environment and Human Health, University of Exeter, TR10 9FE, Penryn, UK

[9]European Centre for Environment and Human Health, University of Exeter, TR10 9FE, Penryn, UK

[10]Medical Research Council Epidemiology Unit, University of Cambridge, CB2 0SL, Cambridge, UK

关键词: Commercial Determinants of Health;    Sugar Sweetened Beverages;    Jamaica;    Nutritional Colonialism;    History;    Qualitative Research;   

DOI  :  10.1186/s12992-023-00962-5

 received in 2023-01-17, accepted in 2023-08-07,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundNon-communicable diseases (NCDs) are the leading cause of mortality across the Caribbean and similar regions. Structural determinants include a marked increase in the dependency on food imports, and the proliferation of processed foods, including sugar-sweetened beverages (SSBs). We focused on Jamaica as a case study and the health challenge of SSBs, and situated contemporary actions, experiences and policies within their historical context to investigate underlying drivers of commercial determinants of health and attempts to counter them. We asked: how can a historical perspective of the drivers of high level SSB consumption in Jamaica contribute to an enhanced understanding of the context of public health policies aimed at reducing their intake?MethodsAn ethnographic approach with remote data collection included online semi-structured interviews and workshops with 22 local experts and practitioners of health, agriculture and nutrition in Jamaica and attending relevant regional public webinars on SSBs and NCD action in the Caribbean. Our analysis was situated within a review of historical studies of Caribbean food economies with focus on the twentieth century. Jamaican and UK-based researchers collected and ethnographically analysed the data, and discussed findings with the wider transdisciplinary team.ResultsWe emphasise three key areas in which historical events have shaped contextual factors of SSB consumption. Trade privileged sugar as a cash crop over food production during Jamaica’s long colonial history, and trade deregulation since the 1980s through structural adjustment opened markets to transnational companies. These changes increased Jamaican receptiveness to the mass advertisement and marketing of these companies, whilst long-standing power imbalances hampered taxation and regulation in contemporary public health actions. Civil society efforts were important for promoting structural changes to curb overconsumption of SSBs and decentring such entrenched power relations.ConclusionThe contemporary challenge of SSBs in Jamaica is a poignant case study of commercial determinants of health and the important context of global market-driven economies and the involvement of private sector interests in public health policies and governance. Historically contextualising these determinants is paramount to making sense of the sugar ecology in Jamaica today and can help elucidate entrenched power dynamics and their key actors.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023