In their retrospective study, Dorfman et al.1 examined media, legislative, and industry documents reflecting tobacco control responsibility rhetoric (1952–1965). The investigators used a responsibility framework to analyze causality, culpability, and accountability. The causality frame found tobacco harm attributed to the product rather than the industry that produced it.
The culpability frame found blame without identifying responsible actors or remedial actions. The accountability frame found government was perceived as most accountable to address smoking hazards.
The investigators discussed the implications for unhealthy food environments by emphasizing the need to shift the discourse from unhealthy products to the food industry’s harmful corporate behavior. They recognized several challenges, including divisive party politics and public distrust of government, but did not mention how a prevailing neoliberal ideology drives governance gaps, a deregulatory agenda, and the “corporate capture of public health.”2
Public health challenges have been viewed through a collective responsibility lens3–5 to prevent an overemphasis on personal responsibility rooted in victim-blaming ideology.
Yet responsibility framing is unlikely to challenge government inaction or create optimal healthy default choices in food environments.3 We believe that responsibility and accountability are distinct concepts. Both were important core values for the global tobacco control epistemic community to confront a powerful tobacco industry.6 Responsibility involves using moral judgment to act in an ethically appropriate way.7 By contrast, accountability demands a relationship between an actor and a forum, the actor is required to explain and justify one’s performance or conduct, the forum has power to pass judgment, and the actor may face consequences.8
Viewing corporate performance through an accountability lens is essential to guide government and food industry engagement as part of a broader obesity prevention strategy.9 An empowered body has not yet been appointed in the United States or other countries to develop clear objectives, a transparent governance process, and performance standards for diverse food industry actors to address unhealthy food environments.10
We suggest that governments, researchers, and independent bodies use an institutional accountability framework to assess and benchmark progress and communicate evidence of progress; that government agencies hold actors to account by acknowledging and incentivizing achievements, disincentivizing noncompliance, and enforcing regulations; and that all stakeholders respond to the account through system-wide structural improvements (Figure 1).10 The systematic process of taking account (assessment), sharing the account (communication), holding to account (enforcement), and responding to the account (improvements) can bypass a narrow conception of responsibility and minimize neoliberal pseudoaccountability that appears to promote healthy food environments.10
FIGURE 1—
Accountability framework for healthy food environments.
Acknowledgments
Vivica Kraak received research support from Deakin University’s World Health Collaborating Centre for Obesity Prevention and the Population Health Strategic Research Centre to complete this letter.
References
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