Did you ever get scolded by your doctor for unhealthy habits like smoking or drinking? Did you ever feel ashamed of skipping kitchen work in favor of a quick and cheap hamburger? This guilt, self-inflicted or not, is mostly due to our conflicting notions of what is good for us and what we want at any given moment. But, are our desires really ours?
There is this notion that our poor personal choices cause all the bad things we are subjected to in life, and that these consequences are solely our responsibility. Well, that’s what most of us are led to believe, but that is not the full picture. In this article we are going to explore some of the socioeconomic structure that drives these choices and, hopefully, improve people’s health, mental and physical, through some new awareness.
In his 1979 book “Distinction: A Social Critique of the Judgement of Taste”, Pierre Bourdieu, a french sociologist, talks about how taste is socially constructed, mainly by lower-income classes following the lead of high income class. That sets the base for the argument that our tastes are not as individual as we might want to believe. They are mostly the confluence of an incredibly complex network of factors, and most of them can be heavily influenced by external sources.1
Ok now, but what are these influences and external sources? Most of these influences are determined by certain industries, namely ultra-processed food, alcohol and tobacco, which create demand for their products through advertising and secure distribution through political lobbying. In recent scientific literature, they are being called the commercial determinants of health and they shoulder part of that responsibility (and, therefore, the guilt) for some of our less than healthy habits.2
Those three, plus the fossil fuel industry, are estimated to have caused over one third of the deaths by non-communicable diseases according to the Global Burden of Disease study of 2019.3
So, how come they are still allowed to do that if we know the effects already? Well, the situation is even more complex than that. First of all, the health and economic sectors are inextricably connected, with the aforementioned industries accounting for a large part of the global economy, which not only moves money but creates jobs, and financial stability is a known factor to improving health. What that means is that just stopping the industry does not solve the problem, as it would impact a network of other factors like stagnating the economy, unemployment and disruption of supply chains, as most big players in the commercial world rarely focus on one type of product.
Another factor that should not be overlooked is the power shift that has been occurring since the 1970s, with the rise of neoliberalism decreasing state power and, in turn, enabling corporations to take over the lead in several sectors. A good example is how most States are somewhat powerless to regulate transnational corporations on many levels, as they share jurisdiction, along with a real threat of moving out of a country that needs their income.2
The public relations factor is also an important one, as most transnational corporations engage in both political and media campaigns. The political aspect, among many others, include offering financial gifts, that would otherwise be paid as taxes without the incentives, to incur influence within government, allowing for indirect impact on State regulations, including labor rules, health standards, environmental safety, waste disposal and taxes, to name a few.2
Although much can be said about the political influences of corporations, the aim of this article is how they influence us, individuals. That is the aforementioned media campaigns, which give rise to their most frightening power, the shaping of social norms.
“The media, ownership of which has become concentrated among a wealthy elite, has been shown to increasingly serve that elite, including global corporate interests.148 Herman and Chomsky describe how ‘money and power are able to filter out the news fit to print, marginalize dissent and allow the government and dominant private interests to get their messages across to the public’.38Consequently, the role of commercial actors in norm shaping is often overlooked. Few realise the term litter bug was coined by the plastics industry149 and carbon footprint by British Petroleum,150 both to detract from corporate harm by pointing the finger of blame at individuals via well-funded public relations campaigns.” (Direct citation from Gilmore et al,Defining and conceptualising the commercial determinants of health. The Lancet. 2023.)
This overwhelming influence and control of public opinion allows for the wealthy corporations to frame public health issues, like food-related cardiovascular mortality and smoking-related respiratory diseases, as a result of poor personal choices instead of their own designs aiming for short term profit and the benefit of shareholders. The shifted blame also impacts how science is currently made, investing heavily on individually-based solutions, like health literacy, which are important, but not nearly as effective to solve the root of the problem. In this scenario, even though people would know the right choices, they lack the resources to make them, whether it is money, time or energy.2
As mentioned before, the contradiction of knowing the right choice and the incapacity to make it gives rise to a feeling of shame. In turn, shame, as an umbrella term for several types of negative feelings, works short and long term to erode our self-worth and creates unhealthy defense mechanisms, like avoidance.4
Does this mean that shame will make us avoid all bad choices? Not really. The social and economical infrastructure makes sure that the most convenient choices, either financially or physically, are the ones that lead to corporate profits. Have you ever found yourself leaving work or school extremely tired and thinking about all the cooking you still have to do today just to find yourself in front of a big and convenient fast food chain restaurant? Or, if you ever felt lonely and seen heavy advertisements on TV framing alcohol as a way to make friends or associated with sports and healthy living, even though it actually worsens depression symptoms?5
So, what does avoidance mean in this case? It is a mechanism that helps an individual avoid this acute feeling of shame that comes from exposure to judgment from others due to perceived inadequate behaviors. It can manifest in simple but harmful ways, such as hiding smoking habits or under-reporting alcohol use, in the perspective of being scolded by a physician (disclaimer: doctors should not shame their patients in any way whatsoever). Another way would be to avoid some types of social situations due to non conformity with the impossible standards set by the media, namely body shaming, giving rise to silent epidemics like anorexia and bulimia.
The stigma created by this is also a source of chronic stress, and that can give rise to other psychological conditions, like depression and anxiety, as well as behavioral issues like aggression and antisocial behavior. Aside from the psychological injury, chronic stress due to perceived social threat and low self esteem have been linked to more biological issues, further deteriorating individual health, namely worst cardiovascular and immunological outcomes through a series of endocrine and immune responses.4
Therefore, the artificial shame induced by the shifting of blame from corporations towards individuals, along with taking away our full agency to make choices, compounds on the already declining health patterns of the last decades through many paths. And how do we work on that? Well, just as individual-driven policies have little effect, just the awareness of manipulations might not be enough for us to make healthier choices by the sheer limitations imposed by the big players. That said, individuals can make differences by a number of ways, even by pressuring representative, critical thought and increasing awareness of the issue until it reaches decision-makers. Although it may take some time, profound changes are needed in many areas, like sustainable business models, correcting the power imbalance between States and Corporations, and shifting the focus of policies back from profit towards public interest, and that can only be achieved through persistence.6
Following up on The Lancet series on Commercial Determinants of Health, this is a quick summary of actions that can be taken to work towards a healthier tomorrow.
References
1 - Bourdieu P. Distinction: A Social Critique of the Judgement of Taste. London: Routledge; 1984.
2 - Gilmore AB, Fabbri A, Baum F, Bertscher A, Bondy K, Chang HJ, et al. Defining and conceptualising the commercial determinants of health. The Lancet [Internet]. 2023 Apr 8;401(10383):1194–213. Available from:https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00013-2/fulltext
3 - Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Reference Life Table. Seattle, United States of America: Institute for Health Metrics and Evaluation (IHME), 2021.
4 - Dolezal L, Lyons B. Health-related shame: an affective determinant of health? Medical Humanities [Internet]. 2017 Jun 8;43(4):257–63. Available from: https://mh.bmj.com/content/43/4/257
5 - Nunes EV. Alcohol and the Etiology of Depression. American Journal of Psychiatry. 2023 Mar 1;180(3):179–81.
6 - Friel S, Collin J, Daube M, Depoux A, Freudenberg N, Gilmore AB, et al. Commercial determinants of health: future directions. The Lancet. 2023 Apr;401(10383):1229–40.
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