The first quarter of the 21st century has seen multiple public health crises like economic depression, conflicts, wars, earthquakes, and pandemics.1 Similar issues will persist unless effective actions are taken. To understand the situation, we must delve deeply into the root causes. Population growth, economic crises, inequality and inequity in resource allocation, humanitarian crises, infodemic burden, and the compelling effects of commercial determinants of health2 are just examples of challenges.
Is it so difficult to struggle with all these complex problems?
Some people will answer “yes” to this simple question, while others will answer “no.”
Let me share my point of view.
To me, we have the power of science. Science always produces evidence to understand the causes and all related dynamics and helps us to understand the solutions.
Why is success not achieved even if the solution is known?
Because the problem is too complicated. Remember that ill health is an outcome with multiple determinants including social, economic, digital, structural, individual, and commercial. All interact resulting in high morbidity and mortality. Poverty, for example, may increase communities’ vulnerability to the effects of commercial determinants of health, including Big Tobacco, Big Food, the arms industry4, the fossil fuel industry,5 and others.
Then, start with combatting the determinants of health. They may be avoided.
Consider the world without the tobacco industry for a moment. In this scenario, millions of lives could be saved6. Youth will not be familiar with “heated tobacco products,” electronic nicotine delivery system”, and other “new generation” tobacco alternatives7. Add the absence of the trans fatty acid industry to the scenario. Could you imagine how the noncommunicable disease burden would be significantly reduced? Fight poverty and overcome one of the main causes of poor health.
All of us can think about comparable settings that fit our imagination.
Where shall we start?
To make our imaginations real, my sole proposal is to create human-centered health models as components of sustainable ecosystems. In such systems, setting real goals and ambitions based on planetary ideals that prioritize solidarity may be critical notions. We’re aware of them because we’re familiar with the “one health” concept, which emphasizes the culture of coexistence with animals and plants in a sustainable ecosystem8. However, there is a need for the global integration of respect, dignity, and other core humanitarian and ethical values. They should all be integrated into equality/equity-based health systems.
If we can put all these values into practice, I believe we will be successful.
It is now time to unite around such unique values and take a step forward.
Dilek ASLAN, 11.10.2025
References
- 21st century health challenges: can the essential public health functions make a difference? Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO
- WHO, Commercial determinants of health https://www.who.int/health-topics/commercial-determinants-of-health#tab=tab_1
- Blanchet K, Ramesh A, Frison S, Warren E, Hossain M, Smith J, et al. Evidence on public health interventions in humanitarian crises. Lancet. 2017 Nov 18;390(10109):2287-2296. doi: 10.1016/S0140-6736(16)30768-1. Epub 2017 Jun 8. PMID: 28602563.
- Bellis MA, Jones L, Tucker J, Muggah R, Hughes K, Ford K, Smith E, Feder G. Weapons, wealth, and health: the arms industry as a commercial determinant of health. BMJ. 2025 Sep 1;390:e086166. doi: 10.1136/bmj-2025-086166. PMID: 40889973.
- Loffreda G, Osborne R, Arteaga-Cruz E, Baum F. The dangers of “health washing” the fossil fuel industry. BMJ. 2023 Apr 19;381:843. doi: 10.1136/bmj.p843. PMID: 37076173.
- Prevalence https://tobaccoatlas.org/challenges/prevalence/ Accessed on 21st of September, 2025.
- WHO, Tobacco https://www.who.int/health-topics/tobacco#tab=tab_1
- The Lancet. One Health: a call for ecological equity. Lancet. 2023 Jan 21;401(10372):169. doi: 10.1016/S0140-6736(23)00090-9. PMID: 36681403.