Public health challenge: taking on the commercial determinants of health

Next year the World Health Organization is expected to release its first Global Report on the Commercial Determinants of Health. In April this year, Lancet published a series of papers on the commercial determinants of health (CDoH), the most comprehensive assessment to date on this emerging field of public health scholarship. Defined by the WHO as “private sector activities that affect people’s health,” the Lancet reports describe commercial determinants as the “systems, practices, and pathways through which commercial actors drive health and equity.” A CDoH framework has the potential to inform powerful new approaches to reducing the world’s most serious public health problems. For public health professionals, scholars, and activists, the growing interest in CDoH provides a forum for re-thinking how to improve public health by changing established policies on regulation, marketing, conflicts of interest,  lobbying, and other business practices. 

How commercial actors threaten planetary and human health

Increasing evidence shows that the activities of commercial actors shape the adverse health and environmental consequences of climate change, the growing global burden of diet-related and other chronic diseases, firearms deaths and injuries, the failure of governments to respond adequately to infectious disease outbreaks, and inadequate access to health care for low income populations. Commercial actors include transnational corporations, small and medium sized businesses, trade associations, financial institutions, advertising, legal and public relations firms, as well as industry-funded Corporate Social Responsibility organizations, such as charities. Through business practices that are focused only on profit generation, these organizations promote, defend, and market unhealthy products, push people into debt, pollute the environment, and endanger their workers. Through political practices such as lobbying, campaign contributions, and “capture” of government agencies, they mislead policymakers and undermine, dilute, or delay policies designed to protect public health. 

Over the last 100 years or so, businesses have also made positive contributions to improving health but increasingly in the last 50 years, changes in the world’s political economy including globalization, financialization, and market concentration have amplified the negative consequences and moderated the positive ones. 

How can the public health community use the CDoH lens to better protect human and planetary health and reduce the stark health inequities that characterize the world today? We suggest four cross-cutting strategies.

1. Restoring the public sector

First, public health professionals can contribute to restoring the role of the public sector in defending health. As the wealth and power of the market economy has grown, the role of government in regulating business activities, providing quality public services, and shaping belief systems has diminished. Using their communications and message framing skills, health professionals can challenge commercial actors that mislead the public, counteract ideas that emphasize individual  rather than collective responsibility  for health, and defend regulations that protect public health against attacks from private interests. 

2. Identifying the pathways that harm health

To inform action to reduce commercial harms, researchers need to identify the specific pathways by which business practices lead to poor health outcomes. An impressive body of evidence documents how tobacco, alcohol, unhealthy food, gambling, fossil fuel, firearms, and other industries have harmed health, but more work is needed to identify emerging twenty-first-century threats. How do employers of precarious workers, payday and mortgage lenders, private equity firms that invest in nursing homes, or Big Tech companies that market to children shape patterns of health and disease? By elucidating the pathogenic routes of harm, investigators can suggest policies and regulatory approaches to prevent these adverse outcomes.  

3. Using practice-based evidence to inform strategies

While some are pessimistic about overcoming the power of business to shape the rules, around the world thousands of organizations are campaigning—and sometimes winning— battles to create healthier communities, challenge corporate pollution, provide healthier and more affordable food, make essential medicines more accessible, and find other ways to create healthier communities and worlds.

By analyzing these experiences and identifying what works and what does not—creating a body of practice-based evidence to reduce harmful commercial influences—researchers can speed the scaling up of best and promising practices. 

4. Joining the fight for democracy

Finally, the public health community can join the fight for democracy, promoting the societal benefits of fair taxation and protecting voting and other democratic rights, key foundations for healthier and more just societies. Providing a health rationale for reversing the growing voice of corporations in deciding voting, tax, climate, health care, and other policies creates a more level playing field where ordinary citizens can reclaim their rights to a livable world.

As we write in the Lancet series, in our view, the most basic public health question is not whether the world has the resources or will to take action but whether humanity can survive if society fails to make this effort.