Understanding Commercial Determinants of Health: Moving Beyond Social Factors

In public health circles, we often discuss social determinants of health–the conditions where people are born, live, learn, work, play, worship, and age. However, a crucial missing piece in this framework is the commercial determinants of health. These are defined as the systems, practices, and pathways through which commercial actors drive health inequity [1]. This concept represents a paradigm shift in how we think about health outcomes in our modern capitalistic society.

Beyond Traditional Frameworks

While social determinants help us understand how circumstances affect health, commercial determinants reveal the deliberate corporate practices that shape these circumstances for profit. This isn’t just about business as usual–it’s about understanding how increasingly powerful transnational corporations dominate unhealthy commodity industries, notably:

• Tobacco industry
• Alcohol industry
• Ultra-processed food industry
• Fossil fuel industry
• Gambling industry
• Social media industry

These industries are responsible for at least one-third of deaths globally [1]. 

The Vicious Cycle of Commercial Influence

The system operates through a self-reinforcing cycle:

1. Companies create harmful products
2. They generate enormous profits
3. These profits are used to gain more influence through:
   • Lobbying
   • Campaign contributions
   • Academic funding
   • Media control
4. This influence helps them avoid regulation
5. The cycle continues while public health deteriorates

The Cost to Society

While companies privatize the profits, they socialize the costs through:

• Skyrocketing healthcare expenses
• Environmental degradation
• Increasing mental health issues
• Widening health inequalities
• Reduced life expectancy

The Power Imbalance

The scale of corporate power is staggering. Consider that:

• Walmart has higher revenues than Australia or Spain
• Exxon Mobil has more revenue than Belgium or Mexico

This creates a situation where commercial actors often have more economic power than national governments, making regulation increasingly difficult.

The Intersection with Social Determinants

Commercial determinants don’t operate in isolation–they interact with and often exacerbate social determinants. For example:

• Food swamps in low-income areas [2]
• Targeted marketing to vulnerable populations
• Limited access to healthy alternatives in disadvantaged communities
• Higher concentration of harmful products in marginalized neighborhoods

Solutions Require Systemic Change

Addressing commercial determinants requires:

1. Policy Reform
   • Stronger regulation of harmful industries
   • Limits on corporate political influence
   • Transparency in corporate funding
2. Research Independence
   • Reducing industry influence on academic research
   • Independent funding sources
   • Better conflict of interest policies
3. Public Awareness
   • Education about corporate tactics
   • Understanding of systemic influences
   • Recognition of corporate responsibility
4. Collective Action
   • Civil society mobilization
   • Professional organization reform
   • Community empowerment

The Path Forward

Understanding commercial determinants is crucial for:

• Healthcare professionals developing interventions
• Policymakers crafting regulations
• Researchers studying health outcomes
• Advocates fighting for change
• Communities seeking better health

We need to move beyond individual-focused interventions to address the systemic forces shaping our health environment. This means:

• Challenging corporate power
• Demanding transparency
• Supporting regulatory reform
• Building coalitions for change

The Role of Health Professionals

As health professionals, we must:

1. Recognize commercial influences in our field
2. Advocate for systemic change
3. Support policies that prioritize public health
4. Help patients understand broader influences
5. Join collective efforts for reform

Conclusion

The commercial determinants of health represent a crucial framework for understanding modern health challenges [3,4]. By recognizing and addressing these forces, we can work toward more effective solutions to tackling health inequities’ root causes. This requires moving beyond traditional public health approaches to challenge the systemic forces prioritizing profit over public health.

References

1. Gilmore, A. B., Fabbri, A., Baum, F., Bertscher, A., Bondy, K., Chang, H.-J., Demaio, S.,
   Erzse, A., Freudenberg, N., Friel, S., Hofman, K. J., Johns, P., Karim, S. A., Lacy-Nichols, J.,
   Carvalho, C. M. P. de, Marten, R., McKee, M., Petticrew, M., Robertson, L., … Thow, A. M.
   (2023). Defining and conceptualising the commercial determinants of health. The Lancet,
   401(Milbank Q 98 2020), 1194–1213. https://doi.org/10.1016/s0140-6736(23)00013-2
2. Cooksey-Stowers, K., Schwartz, M. B., & Brownell, K. D. (2017). Food Swamps Predict
   Obesity Rates Better Than Food Deserts in the United States. International Journal of
   Environmental Research and Public Health, 14(11), 1366.
   https://doi.org/10.3390/ijerph14111366
3. Friel, S., Collin, J., Daube, M., Depoux, A., Freudenberg, N., Gilmore, A. B., Johns, P., Laar,
   A., Marten, R., McKee, M., & Mialon, M. (2023). Commercial determinants of health: future
   directions. The Lancet, 401(10383), 1229–1240. https://doi.org/10.1016/s0140-
   6736(23)00011-9
4. Lacy-Nichols, J., Nandi, S., Mialon, M., McCambridge, J., Lee, K., Jones, A., Gilmore, A. B.,
   Galea, S., Lacy-Vawdon, C. de, Carvalho, C. M. P. de, Baum, F., & Moodie, R. (2023).
   Conceptualising commercial entities in public health: beyond unhealthy commodities and
   transnational corporations. The Lancet, 401(10383), 1214–1228.
   https://doi.org/10.1016/s0140-6736(23)00012-0