Addressing business interest in curbing Non-Communicable Disease (NCD) in Indonesia

#GHM104 Target audience: Ministry of Health Aim: elaborate on Indonesia’s approach to curbing NCDs – this could include legislation, strategies, action plans. # Policy Brief: Assessed Assignment GHM104 # Executive Summary # Introduction While the pandemic delivered an intense health shock, Non-Communicable Diseases (NCDs) have quietly become the leading cause of death worldwide, contributing to 75% of global deaths, surpassing infectious diseases in both high-income and low-income countries. ([WHO](https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases#:~:text=Noncommunicable%20diseases%20(NCDs)%20killed%20at,%2Dpandemic%2Drelated%20deaths%20globally.)) These conditions, including heart disease, diabetes, cancer, and respiratory diseases, represent a global health crisis that affects every region and income level. Unlike the sudden shock of infectious disease outbreaks, NCDs represent a slow-burning epidemic that quietly claims millions of lives each year. Despite their devastating toll, NCDs often lack the urgency associated with infectious disease outbreaks. However, fueled by rapid urbanization, unhealthy diets, smoking, and sedentary lifestyles, NCDs are now not only a leading health concern but also a significant economic burden, projected to cost $47 trillion globally by 2030. Once thought to be diseases from developed nation, with [[Trade liberalisation]] and increasingly available high-calorie, nutrition-depleted food, the burden of NCDs are soaring in LMICs, even contributed 73% of all NCD deaths. ([WHO](https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases#:~:text=Noncommunicable%20diseases%20(NCDs)%20killed%20at,%2Dpandemic%2Drelated%20deaths%20globally.)) Cardiovascular diseases account for most NCD deaths, or at least 19 million deaths in 2021, followed by cancers (10 million), chronic respiratory diseases (4 million), and diabetes (over 2 million including kidney disease deaths caused by diabetes). These four groups of diseases account for 80% of all premature NCD deaths. Tobacco use, physical inactivity, the harmful use of alcohol, unhealthy diets and air pollution all increase the risk of dying from an NCD. This global crisis mirrors the trends in countries like Indonesia, where NCDs have overtaken infectious diseases as the dominant health challenge. Indonesia suffers from increasing NCD while CDs are decreasing, termed double burden of diseases, with four diseases who have the highest financial burden to the country's national health insurance being cardiovascular disease, cancer, kidney diseases, and stroke. While the Ministry of Health transforms its health system to address NCD from detection to treatment to palliative care, safeguarding people's health from social determinants of health will be imperative for Indonesia in the years to come. For example, # Methods and results ## Policy focus Indonesia has a high number of smokers, which resulted from the absence of political will in tobacco control, such as ratifying FCTC (despite being one of its founding members) and the cheap prices. [[@knaiCaseDevelopingCohesive2021]] noted that other [[unhealthy commodity industries]] such as alcohol, food/beverages, and online gambling deployed similar strategies with tobacco industries. [[@knaiCaseDevelopingCohesive2021]] The influence of corporate interest and power beyond the health sector is as one of the underlying factors in Indonesia's health policymaking cycle that has not been properly taken into account as a major policy focus of the Ministry of Health. [Find CSR landscape in Indonesia on health issues, as a tool of influence.] In this policy brief, I will focus on identifying corporate influence on policy-making and regulation that fuel and exacerbate NCDs, what are the government strategies and actions to push back the influence to protect its people, what are the available evidence and effectiveness of those interventions, e.g., sugar taxes, and the role of [[public private partnership]] to regulate the private sector involvement. ## Search strategies The search strategy was developed based on the policy focus. A search keywords to narrow down on corporate influence through CSR, policy areas, government interventions, and case studies. In February 2025, I searched the following databases: PubMed and Globalization and Health using the following search string: | Theme | | | ----------- | --------------------------------------------------------------------------------------------------------------------------------- | | Corporation | ("corporate social responsibility" OR "CSR" OR "corporate influence" OR "commercial determinants of health" OR "corporate power") | | NCD policy | AND ("non-communicable disease policy" OR "NCD policy") | ### Screening and selection criteria After duplicates and erratums were removed, a total of 47 articles were identified and manually screened for its title and abstract. A total of 33 articles were assessed at the full text stage against the following inclusion and exclusion criteria: 1. Inclusion criteria - focusing on NCD and business influence. - in English - published between January 2014 and December 2024 - studies with policy recommendations relevant to developing countries 2. Exclusion criteria - Articles focusing only on clinical aspects of NCDs without policy discussions. - Studies on business influence unrelated to health policy (e.g., environmental policies). 19 articles met our criteria for further analysis and synthesis. | Database | Boolean String | Result | Filters | | ------------------------ | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------ | -------------------------------- | | Pubmed | ("corporate social responsibility" OR "CSR" OR "corporate influence" OR "commercial determinants of health" OR "corporate power") AND ("non-communicable disease policy" OR "NCD policy") | 10 results - exclude 2 as they were erratum to the other articles in the list. 1 article is added due to add a context of the commentary. | - Publication date: 10 years | | Globalization and Health | | 41 results - exclude 1 duplication. | | ### Results of Pubmed | No. | Detail | | ------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | 1. | [**Corporate** **power** and the international trade regime preventing progressive policy action on non-communicable diseases: a realist review.](https://pubmed.ncbi.nlm.nih.gov/33276385/) Milsom P, Smith R, Baker P, Walls H.Health Policy Plan. 2021 May 17;36(4):493-508. doi: 10.1093/heapol/czaa148.PMID: 33276385 Free PMC article. Review. | | 2. | [ Using System Dynamics to Understand Transnational **Corporate** **Power** in Diet-Related Non-communicable Disease Prevention Policy-Making: A Case Study of South Africa.](https://pubmed.ncbi.nlm.nih.gov/38618803/) Milsom P, Tomoaia-Cotisel A, Smith R, Modisenyane SM, Walls H.Int J Health Policy Manag. 2023;12:7641. doi: 10.34172/ijhpm.2023.7641. Epub 2023 Sep 17.PMID: 38618803 | | 3. | Duplicate to 4 | | 4. | [**Non**-**communicable** **disease** **policy** implementation from 2014 to 2021: a repeated cross-sectional analysis of global policy data for 194 countries.](https://pubmed.ncbi.nlm.nih.gov/36925173/) Allen LN, Wigley S, Holmer H, Barlow P.Lancet Glob Health. 2023 Apr;11(4):e525-e533. doi: 10.1016/S2214-109X(23)00042-6.PMID: 36925173 | | 5. | [Systems Thinking as a Framework for Analyzing **Commercial** **Determinants** **of** **Health**.](https://pubmed.ncbi.nlm.nih.gov/30277610/) Knai C, Petticrew M, Mays N, Capewell S, Cassidy R, Cummins S, Eastmure E, Fafard P, Hawkins B, Jensen JD, Katikireddi SV, Mwatsama M, Orford J, Weishaar H.Milbank Q. 2018 Sep;96(3):472-498. doi: 10.1111/1468-0009.12339.PMID: 30277610 | | 6. | [Non-communicable disease governance in the era of the sustainable development goals: a qualitative analysis of food industry framing in WHO consultations.](https://pubmed.ncbi.nlm.nih.gov/32847604/) Lauber K, Ralston R, Mialon M, Carriedo A, Gilmore AB.Global Health. 2020 Aug 26;16(1):76. doi: 10.1186/s12992-020-00611-1.PMID: 32847604 | | 7. | [Barriers and Opportunities for WHO "Best Buys" **Non**-**communicable** **Disease** **Policy** Adoption and Implementation From a Political Economy Perspective: A Complexity Systematic Review.](https://pubmed.ncbi.nlm.nih.gov/38618832/) Loffreda G, Arakelyan S, Bou-Orm I, Holmer H, Allen LN, Witter S, Ager A, Diaconu K.Int J Health Policy Manag. 2024;13:7989. doi: 10.34172/ijhpm.2023.7989. Epub 2024 Feb 4.PMID: 38618832 | | 8. | [Does international trade and investment liberalization facilitate **corporate** **power** in nutrition and alcohol policymaking? Applying an integrated political economy and power analysis approach to a case study of South Africa.](https://pubmed.ncbi.nlm.nih.gov/35279184/) Milsom P, Smith R, Modisenyane SM, Walls H.Global Health. 2022 Mar 12;18(1):32. doi: 10.1186/s12992-022-00814-8.PMID: 35279184 | | 9. | [A Systems Thinking Approach to Inform Coherent Policy Action for NCD Prevention Comment on "How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention".](https://pubmed.ncbi.nlm.nih.gov/32563223/) Milsom P, Smith R, Walls H.Int J Health Policy Manag. 2020 May 1;9(5):212-214. doi: 10.15171/ijhpm.2019.113.PMID: 32563223 | | 10.Additional | [How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention.](https://pubmed.ncbi.nlm.nih.gov/31657174/) Lencucha R, Thow AM.Int J Health Policy Manag. 2019 Sep 1;8(9):514-520. doi: 10.15171/ijhpm.2019.56.PMID: 31657174 | | | | ### Result from Globalization and Health | No. | Title/Detail | | -------------------------------------------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | 1. | [Healthy people and healthy profits? Elaborating a conceptual framework for governing the commercial determinants of non-communicable diseases and identifying options for reducing risk exposure](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-017-0255-3) Non-communicable diseases (NCDs) represent a significant threat to human health and well-being, and carry significant implications for economic development and health care and other costs for governments and b... Authors:Kent Buse, Sonja Tanaka and Sarah Hawkes Citation:_Globalization and Health_ 2017 13:34 Content type:ReviewPublished on: 15 June 2017 | | 2. | [India’s NCD strategy in the SDG era: are there early signs of a paradigm shift?](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-018-0357-6) The Sustainable Development Goals (SDGs) are seen in most corners as the embodiment of a more inclusive and holistic development approach, key to addressing the numerous and urgent challenges the world faces. ... Authors:Shinjini Mondal and Sara Van Belle Citation:_Globalization and Health_ 2018 14:39 Content type:DebatePublished on: 25 April 2018 | | 3. | [Situating commercial determinants of health in their historical context: a qualitative study of sugar-sweetened beverages in Jamaica](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-023-00962-5) Non-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 prolif... Authors:Olivia Barnett-Naghshineh, Sheray Warmington, Henrice Altink, Ishtar Govia, Karyn Morrissey, Matthew J. Smith, Ruth H. Thurstan, Nigel Unwin and Cornelia Guell Citation:_Globalization and Health_ 2023 19:69 Content type:ResearchPublished on: 12 September 2023 | | 4. | [International investment liberalization, transnational corporations and NCD prevention policy non-decisions: a realist review on the political economy of tobacco, alcohol and ultra-processed food](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-021-00784-3) Public health concerns relating to international investment liberalization have centred on the potential for investor-state dispute settlement (ISDS)-related regulatory chill. However, the broader political an... Authors:Penelope Milsom, Richard Smith, Phillip Baker and Helen Walls Citation:_Globalization and Health_ 2021 17:134 Content type:ReviewPublished on: 24 November 2021 | | 5.(Duplicate from PubMed) | Non-communicable disease governance in the era of the sustainable development goals: a qualitative analysis of food industry framing in WHO consultations | | 6. | [Trade and investment liberalization and Asia’s noncommunicable disease epidemic: a synthesis of data and existing literature](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-014-0066-8) Trade and investment liberalization (trade liberalization) can promote or harm health. Undoubtedly it has contributed, although unevenly, to Asia’s social and economic development over recent decades with resu... Authors:Phillip Baker, Adrian Kay and Helen Walls Citation:_Globalization and Health_ 2014 10:66 Content type:ResearchPublished on: 12 September 2014 | | 7.Exclude -> no proposed policy solution | ### [Risk, lifestyle and non-communicable diseases of poverty](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-023-00914-z) Common discourse in public health and preventive medicine frames non-communicable diseases, including cardiovascular and metabolic diseases, as diseases of ‘lifestyle’; the choice of terminology implies that t... Authors:Lenore Manderson and Sara Jewett Citation:_Globalization and Health_ 2023 19:13 Content type:CommentaryPublished on: 2 March 2023 | | 8. | [A framework of NGO inside and outside strategies in the commercial determinants of health: findings from a narrative review](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-023-00978-x) Public health scholarship has uncovered a wide range of strategies used by industry actors to promote their products and influence government regulation. Less is known about the strategies used by non-governme... Authors:Belinda Townsend, Timothy D. Johnson, Rob Ralston, Katherine Cullerton, Jane Martin, Jeff Collin, Fran Baum, Liz Arnanz, Rodney Holmes and Sharon Friel Citation:_Globalization and Health_ 2023 19:74 Content type:ReviewPublished on: 10 October 2023 | | 9.Exclude no policy solutions | [Incorporating a structural approach to reducing the burden of non-communicable diseases](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-018-0380-7) Non-communicable diseases (NCDs) account for over two-thirds of deaths worldwide, and global efforts to address NCDs have accelerated. Current prevention and control efforts rely primarily on individual behavi... Authors:Joshua S. Yang, Hadii M. Mamudu and Rijo John Citation:_Globalization and Health_ 2018 14:66 Content type:DebatePublished on: 6 July 2018 | | 10. | [Global Health diplomacy for noncommunicable diseases prevention and control: a systematic review](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00572-5) The prevention and control of noncommunicable diseases (NCDs) are one of the main challenges of healthcare systems around the world. In addition to the technical level, it requires political negotiations and s... Authors:Mahnaz Afshari, Ahmad Ahmadi Teymourlouy, Mohsen Asadi-Lari and Mohammadreza Maleki Citation:_Globalization and Health_ 2020 16:41 Content type:ResearchPublished on: 6 May 2020 | | 11. | [Global Health diplomacy for noncommunicable diseases prevention and control: a systematic review](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00572-5) The prevention and control of noncommunicable diseases (NCDs) are one of the main challenges of healthcare systems around the world. In addition to the technical level, it requires political negotiations and s... Authors:Mahnaz Afshari, Ahmad Ahmadi Teymourlouy, Mohsen Asadi-Lari and Mohammadreza Maleki Citation:_Globalization and Health_ 2020 16:41 Content type:ResearchPublished on: 6 May 2020 | | 12. | [The challenges in protecting public health interests in multisectoral governance in the context of small island developing states: the case of tobacco control in Fiji and Vanuatu](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-023-00931-y) The commercial determinants of health (CDoH) drive the rise of NCDs globally, and their regulation requires multisectoral governance. Despite existing recommendations to strengthen institutional structures, pr... Authors:Dori Patay, Ashley Schram and Sharon Friel Citation:_Globalization and Health_ 2023 19:31 Content type:ResearchPublished on: 28 April 2023 | | 13. | [[@mckeeComprehensiveGlobalApproach2014]] | | 14. | [_‘Choice should be made through… educated decisions not regressive dictates’_: discursive framings of a proposed ‘sugar tax’ in Bermuda: analysis of submissions to a government consultation](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-022-00877-7) Several governments have introduced taxes on products with high sugar content as part of their obesity prevention strategies. Bermuda is the first jurisdiction to apply such measures in the Caribbean – a regio... Authors:Sarah Williams, Sarah E. Hill and Oyinlola Oyebode Citation:_Globalization and Health_ 2022 18:89 Content type:ResearchPublished on: 21 October 2022 | | 15. | [Public health advocacy strategies to influence policy agendas: lessons from a narrative review of success in trade policy](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-023-00960-7) Despite accumulating evidence of the implications of trade policy for public health, trade and health sectors continue to operate largely in silos. Numerous barriers to advancing health have been identified, i... Authors:Belinda Townsend, Brigitte Frances Tenni, Sharni Goldman and Deborah Gleeson Citation:_Globalization and Health_ 2023 19:60 Content type:ReviewPublished on: 23 August 2023 | | 16. | [Brexit, trade and the governance of non-communicable diseases: a research agenda](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-023-00956-3) The UK’s post-Brexit trade strategy has potentially important implications for population health and equity. In particular, it will impact on the structural risk factors for non-communicable diseases (NCDs), i... Authors:Benjamin Hawkins, Pepita Barlow, May CI van Schalkwyk and Chris Holden Citation:_Globalization and Health_ 2023 19:61 Content type:ReviewPublished on: 23 August 2023 | | 17.Excluded due to analysis did not identify policy strategies | [Trade, investment and public health: compiling the evidence, assembling the arguments](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-018-0425-y) Trade has long been an axiomatic characteristic of globalization, although international rules governing trade are of more recent vintage. Notably in the post-World War II period, an ever increasing number of ... Authors:Ronald Labonté Citation:_Globalization and Health_ 2019 15:1 Content type:EditorialPublished on: 3 January 2019 | | 18. | [Civil society: the catalyst for ensuring health in the age of sustainable development](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-016-0178-4) | | 19.No mention of corporate influence | [Reducing the global burden of type 2 diabetes by improving the quality of staple foods: The Global Nutrition and Epidemiologic Transition Initiative](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-015-0109-9) | | 20. | [A political economy analysis of the legislative response to unhealthy food and beverage marketing in Chile, Canada and the UK](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-024-01093-1) United Nations bodies call for legal responses to restrict children’s exposure to unhealthy food marketing; however, few governments have introduced legislative controls. This research studies the underlying p... Authors:Fiona Sing, Sally Mackay, Boyd Swinburn and Kelly Garton Citation:_Globalization and Health_ 2025 21:4 Content type:ResearchPublished on: 20 February 2025 | | 21.Exclude, no policy solution | [Framing international trade and chronic disease](https://globalizationandhealth.biomedcentral.com/articles/10.1186/1744-8603-7-21) | | 22.Exclude, no policy solution | [The future of human malnutrition: rebalancing agency for better nutritional health](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-021-00767-4) | | 23.No policy solution | [Tobacco smoking trends in Samoa over four decades: can continued globalization rectify that which it has wrought?](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-017-0256-2) | | 24. | [Enhancing global health diplomacy for non-communicable diseases: application of the global health network framework](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-023-00944-7) Understanding the characteristics of global policy actors and the political context in which they address diplomatic issues in the field of NCDs can play an important role in advancing NCD-related goals. The p... Authors:Mahnaz Afshari, Ahmad Ahmadi Teymourlouy, Mohammadreza Maleki and Mohsen Asadi-Lari Citation:_Globalization and Health_ 2023 19:41 Content type:ResearchPublished on: 21 June 2023 | | 25.Irrelevant | [The biomedical securitization of global health](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-023-00915-y) | | 26. | [Strategies to expand corporate autonomy by the tobacco, alcohol and sugar-sweetened beverage industry: a scoping review of reviews](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-022-00811-x) Noncommunicable diseases contribute to over 70% of global deaths each year. Efforts to address this epidemic are complicated by the presence of powerful corporate actors. Despite this, few attempts have been m... Authors:Connie Hoe, Caitlin Weiger, Marela Kay R. Minosa, Fernanda Alonso, Adam D. Koon and Joanna E. Cohen Citation:_Globalization and Health_ 2022 18:17 Content type:ResearchPublished on: 14 February 2022 | | 27. | [The structure of the Canadian packaged food and non-alcoholic beverage manufacturing and grocery retailing sectors through a public health lens](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-023-00917-w) Corporate power has been recognized as an important influence on food environments and population health more broadly. Understanding the structure of national food and beverage markets can provide important in... Authors:Alexa Gaucher-Holm, Benjamin Wood, Gary Sacks and Lana Vanderlee Citation:_Globalization and Health_ 2023 19:18 Content type:ResearchPublished on: 11 March 2023 | | 28. | [Analysis of the corporate political activity of major food industry actors in Fiji](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-016-0158-8) Non-communicable diseases (NCDs) are the leading cause of mortality in Fiji, a middle-income country in the Pacific. Some food products processed sold and marketed by the food industry are major contributors t... Authors:Melissa Mialon, Boyd Swinburn, Jillian Wate, Isimeli Tukana and Gary Sacks Citation:_Globalization and Health_ 2016 12:18 Content type:ResearchPublished on: 10 May 2016 | | 29. | [Towards reconciling population nutrition goals and investment policy in Thailand: understanding how investment policy actors defined, framed and prioritised nutrition](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-022-00888-4) Government’s investment policy is an important driver of food system activities, which in turn influence consumers practices, dietary consumption patterns and nutrition-related health of populations. While gov... Authors:Sirinya Phulkerd, Ashley Schram, Jeff Collin, Anne-Marie Thow, Yandisa Ngqangashe, Carmen Huckel Schneider and Sharon Friel Citation:_Globalization and Health_ 2022 18:94 Content type:ResearchPublished on: 12 November 2022 | | 30.No policy solution, only building coalition | [Who influences nutrition policy space using international trade and investment agreements? A global stakeholder analysis](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-021-00764-7) | | 31. | [Fifty shades of partnerships: a governance typology for public private engagement in the nutrition sector](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-023-00912-1) Multistakeholder collaboration has emerged as a dominant approach for engaging and mobilising non-state actors; notably embedded in the paradigm of the UN Sustainable Development Goals. Yet, considerable ambig... Authors:Dori Patay, Rob Ralston, Aliyah Palu, Alexandra Jones, Jacqui Webster and Kent Buse Citation:_Globalization and Health_ 2023 19:11 Content type:CommentaryPublished on: 21 February 2023 | | 32.Exclude | [Global Health – emergence, hegemonic trends and biomedical reductionism](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00573-4) | | 33.Exclude | [“We have to look deeper into why”: perspectives on problem identification and prioritization of women’s and girls’ health across United Nations agencies](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-024-01086-0) | | 34. | [The global fight against _trans_-fat: the potential role of international trade and law](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0488-4) Non-communicable diseases in general and cardiovascular diseases in particular are a leading cause of death globally. _Trans_-fat consumption is a significant risk factor for cardiovascular diseases. The World Heal... Authors:Andrea Parziale and Gorik Ooms Citation:_Globalization and Health_ 2019 15:46 Content type:DebatePublished on: 11 July 2019 | | 35.Exclude | [Reprising the _globalization_ dimensions of international health](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-018-0368-3) | | 36.Exclude | [The role of universal health coverage and global health security nexus and interplay on SARS-CoV-2 infection and case-fatality rates in Africa : a structural equation modeling approach](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-023-00949-2) | | 37.Exclude | [Public–private partnerships for universal health coverage? The future of “free health” in Sri Lanka](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0522-6) | | 38. | [Food systems transformations, ultra-processed food markets and the nutrition transition in Asia](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-016-0223-3) Attracted by their high economic growth rates, young and growing populations, and increasingly open markets, transnational food and beverage corporations (TFBCs) are targeting Asian markets with vigour. Simult... Authors:Phillip Baker and Sharon Friel Citation:_Globalization and Health_ 2016 12:80 Content type:ResearchPublished on: 3 December 2016 | | 39. | [Assessing the health impact of transnational corporations: a case study on McDonald’s Australia](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-016-0230-4) The practices of transnational corporations affect population health through production methods, shaping social determinants of health, or influencing the regulatory structures governing their activities. Ther... Authors:Julia Anaf, Frances E. Baum, Matt Fisher, Elizabeth Harris and Sharon Friel Citation:_Globalization and Health_ 2017 13:7 Content type:ResearchPublished on: 6 February 2017 | | 40.Exclude | [Barriers and facilitators to primary healthcare utilization among immigrants and refugees of low and middle-income countries: a scoping review](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-024-01079-z) | | 41.Exclude, focus on individual behavior not population | [Evaluation of the international standardized 24-h dietary recall methodology (GloboDiet) for potential application in research and surveillance within African settings](https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-017-0260-6) | ## Results Corporations employ a range of strategies to resist NCD actions by leveraging their instrumental, structural, and economic power to shape policies (Milsom et al., 2023) Tactis include lobbying, funding research, legal threats, market manipulation, and strategic framing around personal responsibility and economic importance. (Hoe et al., 2022; Milsom et al., 2022, 2019; Williams et al., 2022) These corporate strategis have stalled global implementation of WHO-recommended NCD policies, which sat at 47.8% in 2021, with corporate economic power, measured by Corporate Financial Influence Index (CFII), explained 23.7% of the variance in NCD policy implementation from 2014-2021 in 194 countries. (Allen et al., 2023; Loffreda et al., 2024). In response, governments and civil society organization have responded by implementing policy countermeasures, such as sugar taxes, even as high as 75% import duty on high-sugar products by the Bermudan government, marketing restrictions, improved labelling, stronger conflict-of-interest policies, and complementary measures such as subsidies on healthy foods. (Buse et al., 2017; Mialon et al., 2016; Williams et al., 2022) The success of these interventions depends on building coalitions, increasing transparency, and reframing of health issues beyond personal responsibility but structural drivers. (Hoe et al., 2022; Williams et al., 2022) However, challenges persist, such as ambiguity and contestation around public private engagement (PPE) with industry actors, particularly in countries where economic activities were supported by unhealthy commodity industries and where civil society activities were limited (Patay et al., 2023a; Sing et al., 2025) # Discussion Even though common themes and tactics were identified, tailored policy responses are needed to address rising burden of NCDs. A study by ((Suhrcke and Urban, 2010) found that cCVD mortality does not have a significant relationship with economic growth in the sub-sample of middle and low-income countries showed that. Apparently, CVD mortality only negatively impact economic growth, only if income levels are sufficiently high to be impacted. This fact should not ease GoI in seeking economic growth and ignore NCDs burden, but rather, serve as a precaution that a with a faster rate of CVD burden, Indonesia must prevent high CVD mortality rates and secure our accelerated economic growth. Other countries have shown strong political will to resist corporate influence in NCD actions. Australia implemented Corporate Health Impact Assessment (CHIA) and sugar taxes to reduce population consumption (Anaf et al., 2017; Williams et al., 2022) even though in the past Australia has dealt with tobacco industry legal litigation (Investor-State Dispute Settlement, ISDS), to block new regulation to introduce plain packaging of cigarette packs. The Australian government relied on FCTC as international health instrument and won the case, but it was not without cost. Such cases might resulted in ‘chilling effect’ and deter other countries, especially LMICs, to bring cases to the court. (Hawkins and Holden, 2016; Milsom et al., 2021) A similar ISDS vulnerabilities were observed in the case of tobacco control in Fiji and Vanuatu. (Patay et al., 2023b) # Recommendations 1. **Implement stronger governance and regulatory frameworks**, including a clear public private engagement (PPE), implement fiscal measures like sugar taxes, along with complementary measures such as making healthy foods more accessible With clear and transparent playbook with industries in different stages in the policy cycle, the Government of Indonesia (GoI) can limit the corporate influence. The GoI can employ several tactics to regulate commercial determinants of health, such as CHIA, marketing restrictions and food labeling. Further, the Government of Indonesia is poised to make healthy foods more accessible and affordable, such as through the newly launched Free Nutritious Meal (FNM) program. **2.** **Build coalitions with diverse stakeholders, including health actors and civil society** With ongoing health system transformation in Indonesia, the GoI can avoid what happened in Fiji and Vanuatu where health actors were not supported by institutional conditions to protect public health interests. **3.** **Framing battles: structural drivers, the perils of trade agreements, and international health instruments to shift policy norms** The GoI should frame the NCD battle not as personal responsibility of the citizens, and utilize international health instruments to shift policy norms, such as seen with Australia with the plain cigarette packaging and relying on FCTC. In addition, the health sectors should be more aware of the trade and health issues to avoid the perils of trade agreement issues such as ISDS. Indonesia can start with reconsidering its position towards FCTC, ratify FCTC, and limit the power of tobacco corporations in Indonesia # Conclusions NCDs are not only high-income countries problem, even more deadly in LMICs. Indonesia is no exception, with high number of smokers and rising burden of NCDs, the GoI must devise a strategic plan to limit corporate influence in curbing NCDs, and ensure the vision to become a developed country does not get hampered by NCD epidemic. The government can deploy several strategies to ensure corporate influence is limited in NCD policymaking and implementation. # References and suggested sources [[GHM104 Assessed Assignment - Policy Brief]] ![[@EnvironmentHealthDev2016 1#^7dd029]]