Reflections on using systems approaches to support local action on commercial determinants of health

Abstract

There is increasing recognition of the importance of taking a whole systems approach to understanding and addressing the commercial determinants of health (CDoH) at local level but there is limited understanding of how to do this in practice, recognising the potential constraints to the scope of actions available to local government. In this paper, we reflect on the challenges and opportunities that emerged through our work implementing a systems approach to CDoH in a local government context in England. Our methodology centred around three workshops, which provided a framework for co-developing a systems map and action planning with eight local government sites in England. The first workshop involved mapping the local system around a central focus, defined by each site. The second workshop used this map to identify leverage points, using these to propose potential actions guided by the intervention level framework. The third workshop focused on the expected ease, and impact of action implementation to guide decision-making for implementation, supported by the LHGP team. Throughout the process, sites were encouraged to maintain a CDoH lens and consider wider system impacts of their decisions. This approach facilitated cross-sectoral collaborations across local government, leading to new insights on the breadth of action areas relevant to the CDoH and how they might act in their system to directly or indirectly address CDoH at a structural level, including who needs to be involved to develop and implement these actions. Key challenges included communicating CDoH to a cross-sectoral audience, creating initial buy-in from across the local government organisation to dedicate time and capacity to the systems approach, particularly for those teams not directly relate to public health. Another key challenge was to balance maintaining a systems approach throughout the work, while also remaining cognisant of the daily challenges faced by those working in local government.