Profit Before People: The commercial determinants of health and lessons from the tobacco epidemic (2023)

There is no single answer to a complex problem like the tobacco epidemic. It is a wicked problem not amenable to short-term or simplistic/linear thinking. The complexity takes in multiple dimensions - the TI and their need for profit at any cost, the marketing that seeps into the public consciousness, the smokers (and non-smokers) that are affected, the health services treating conditions caused by smoking, the views of the media, the interest of the ruling politicians, and the list goes on.

Add to this the fact that all of these things apply at local, regional, national, and international levels and it is easy to think it is all too difficult. But through many years of working on tobacco we have proved that the TC model is an effective, appropriate and cost effective way to make significant progress. 

We have proved that a comprehensive, multi-component programme applied consistently and over the long-term produces results. It is both vital to continue to tackle smoking so that we can end the tobacco epidemic for good, but also to learn from that experience to help tackle other complex public health issues. 

The TC model provides a blueprint for planning how to reduce the harm caused by the other key commercial determinants of health.

Key lessons learned from the TC experience would suggest the need for the following steps/actions to be considered in relation to these other 'wicked' problems:

1. Recognise the problem to be addressed and agree on the need to work together to tackle it, including the resource required to do so
2. Develop and commit to a comprehensive, multi-strand and long-term collaborative approach
3. Agree evidence-based and jointly owned objectives which are monitored and flexible enough to adapt to real time learning
4. Work at scale and aim for consistency - some things only need doing once, but leave room for local flexibility
5. One key message communicated by many voices
6. Demonstrate visible and enthusiastic leadership at every opportunity
7. Develop a communication strategy in support of efforts and ensure ongoing media presence 
8. Identify local champions, including political leaders and those impacted by the commercial determinants
9. Develop awareness and support for change among the public and advocate on their behalf
10. Focus primarily on adults - changing the adult world will change the environment kids grow up in
11. Things don't happen quickly because culture change is complex - keep going, be tenacious and trust the approach