Recently, the World Health Organization (WHO) released a new fact sheet on commercial determinants of health. Simultaneously, The Lancet published a special series on the Commercial Determinants of Health.
The social determinants of health are the conditions in which people are born, grow, work, live, and age, the systems put in place to deal with illness, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems. Social determinants of health matter because addressing them not only helps prevents illness, but also promotes healthy lives and societal equity.
Commercial determinants of health refer to the conditions, actions and omissions by commercial actors that affect health. Commercial determinants arise in the context of the provision of goods or services for payment and include commercial activities, as well as the environment in which commerce takes place. They can have beneficial or detrimental impacts on health.
Companies shape our social and physical environments
Commercial activities shape the physical and social environments in which people are born, grow, work, live and age – both positively and negatively.
- Company choices in the production, price-setting and targeted marketing of products, such as breast-milk substitutes, ultra-processed foods, tobacco, sugar-sweetened beverages and alcohol lead to diseases such as cardiovascular disease, type 2 diabetes and certain cancers, as well as hypertension and obesity.
- Young people are especially at risk of being influenced by advertisements and celebrity promotion of material. For example, fast-food advertising to youth activates highly sensitive and still-developing pathways in teens’ brains.
- Mass removal of trees creates mosquito breeding sites, causing vector-borne disease outbreaks like malaria and chikungunya, with up to 20% of malaria risk in deforestation hotspots attributable to international trade of deforestation-implicated export commodities such as timber, tobacco, cocoa, coffee and cotton.
- Factories, which are disproportionately located in disadvantaged communities, pollute the air, causing and exacerbating respiratory diseases.
- Unsafe or toxic work environments can impact employee mental health, for example for women working in the ready-made garment industry.
- Intensive animal agriculture is a leading cause of climate change, deforestation, antimicrobial resistance, and air, soil and water pollution. The consumption of animal-derived food products is linked to higher rates of noncommunicable diseases, including some cancers and diabetes.
- Harmful use of intellectual property law can prevent some communities to access affordable medicines.
However, there are positive contributions by companies to public health, for example when companies implement the following health interventions:
- increasing the availability of essential medicines and health technologies, and supporting improved access to essential, high-quality, safe, effective and affordable medicines and medical products;
- reformulation of goods and products to reduce harm and injury, including the industry introduction of seat belts, efforts to reduce salt content in food production, and to eliminate trans fats from the global food supply;
- ensuring living wages, paid parental leave to improve child health outcomes, sick leave and access to health insurance; and
- financial decisions to divest from products and services harmful to health.
The workplace also functions as a setting of health promotion and protection against harm, allowing:
- principles to guard against modern slavery, exploitation or indentured servitude;
- occupational health and safety standards and hygiene practices that reduce the risk of disease or work-related disability;
- health promotion activities aimed at the workforce, including use of stairs, healthy canteens, walkathons or sports events; and
- health literacy events, including awareness building about deadly ailments, blood donation or vaccination.
Commercial determinants often disproportionately affect countries and populations that are not profiting from the product or service that causes harm to health or planet, but instead are faced with the burdens of these harms. As a result, they shape health equities, both within and between countries.
Private sector influence on health policy
Companies commonly influence public health through lobbying and party donations. This incentivizes politicians and political parties to align decisions with commercial agendas. Further, some commercial actors work to capture branches of government in order to prevent or weaken regulation of their products and services, leading to unregulated activity, limiting their liability and bypassing the threat of litigation and pre-emption. More subtly, the private sector has been known to influence the direction and volume of research through funding medical education and research, where data may be skewed in favour of commercial interests.
To further shape preferences, some companies capture civil society by founding or funding front groups, consumer groups and think tanks, allowing them to manufacture doubt and promote their framings.
WHO has initiated a new programme of action, the Economic and Commercial Determinants of Health, which has four goals:
- to strengthen the evidence base;
- develop tools and capacity to address the commercial determinants;
- convene partnerships and dialogue; and
- raise awareness and advocacy.
Link to the WHO fact sheet:
Link to the Lancet series on Commercial Determinants of health: