The Commercial Determinants of Health

The Wider Determinants of Health

Not everyone has the same chances in life when it comes to maintaining good health and avoiding illness and by examining data across large populations researchers can identify these differences and they are known as the determinants of health. While many of these determinants are more focussed on the individual and how they interact with others (see this link for more on this), there are many which shape the environment in which the individual exists and these are termed the Social Determinants. There are a number of social determinants which can often interact in overlapping, interconnected complex ways. One such influence is known as the "Commercial Determinants of Health"

The Commercial Determinants of Health

Research highlights that the "commercial determinants of health" (CDoH) (how commercial actors, especially large transnational corporations, influence health), are increasingly recognised as major contributors to ill health, health inequalities, and environmental damage in the UK and globally (Gilmore et al., 2023; Mialon, 2020; Maani et al., 2020; De Lacy-Vawdon & Livingstone, 2020). Key industries implicated include tobacco, alcohol, ultra-processed foods, gambling, and fossil fuels, whose products and business practices drive non-communicable diseases, mental health issues, and planetary harm (Gilmore et al., 2023; Tompson et al., 2022). These corporations use sophisticated marketing, political lobbying, and strategies to shape science, policy, and public opinion, often deflecting responsibility onto individuals and weakening regulation (Gilmore et al., 2023; Tompson et al., 2022).

There is growing concern that public health frameworks have historically underrepresented or obscured the role of commercial actors, making it harder to address the root causes of health problems (Maani et al., 2020; Mialon, 2020). Newer models call for a broader, more nuanced understanding of commercial entities and their diverse tactics, moving beyond just unhealthy commodities to include the full spectrum of corporate influence on health (Lacy-Nichols et al., 2023; Mialon, 2020). Addressing CDoH is seen as essential for reducing health inequalities, improving mental and physical health, and empowering governments and civil society to counterbalance corporate power and protect public health (Gilmore et al., 2023; Tompson et al., 2022).

References

Mialon, M. (2020). An overview of the commercial determinants of health. Globalization and Health, 16. https://doi.org/10.1186/s12992-020-00607-x

Tompson, A., Mulrenan, C., Hartwell, G., Petticrew, M., Van Schalkwyk, M., & Maani, N. (2022). Commercial determinants of mental health. BMJ, 378. https://doi.org/10.1136/bmj.o2034

Gilmore, A., Fabbri, A., Baum, F., Bertscher, A., Bondy, K., Chang, H., Demaio, S., Erzse, A., Freudenberg, N., Friel, S., Hofman, K., Johns, P., Karim, A., Lacy-Nichols, J., De Carvalho, C., Marten, R., Mckee, M., Petticrew, M., Robertson, L., Tangcharoensathien, V., & Thow, A. (2023). Defining and conceptualising the commercial determinants of health. The Lancet, 401, 1194-1213. https://doi.org/10.1016/s0140-6736(23)00013-2

Lacy-Nichols, J., Nandi, S., Mialon, M., McCambridge, J., Lee, K., Jones, A., Gilmore, A., Galea, S., De Lacy-Vawdon, C., De Carvalho, C., Baum, F., & Moodie, R. (2023). Conceptualising commercial entities in public health: beyond unhealthy commodities and transnational corporations. The Lancet, 401, 1214-1228. https://doi.org/10.1016/s0140-6736(23)00012-0

Maani, N., Collin, J., Friel, S., Gilmore, A., McCambridge, J., Robertson, L., & Petticrew, M. (2020). Bringing the commercial determinants of health out of the shadows: a review of how the commercial determinants are represented in conceptual frameworks. The European Journal of Public Health, 30, 660 - 664. https://doi.org/10.1093/eurpub/ckz197

De Lacy-Vawdon, C., & Livingstone, C. (2020). Defining the commercial determinants of health: a systematic review. BMC Public Health, 20. https://doi.org/10.1186/s12889-020-09126-1

PBHM01 Commercial Determinants

Critical reflection questions

What are the key pathways through which commercial factors influence health?
How can commercial determinants impact the production and sharing of knowledge through research? (e.g. Bero et al, 2007; Lundh et al, 2017; Lesser et al, 2007; Barnes et al, 1998; Legg et al, 2021)
How do commercial determinants of health vary across different socioeconomic groups and communities?
What are the ethical implications of commercial marketing of unhealthy products, such as fast food, tobacco, and alcohol?
How can governments and public health organizations effectively regulate commercial activities that negatively impact health?
What role can individuals and communities play in mitigating the harmful effects of commercial determinants of health?
How can we ensure that commercial interests align with the promotion of public health?
What might potential frameworks for corporate social responsibility and ethical marketing practices look like?
What are the global dimensions of commercial determinants of health? How do transnational corporations and global trade agreements influence health policies and outcomes in different countries?
How does the digital age amplify the impact of commercial determinants of health?
What are the emerging trends in commercial determinants of health that we need to be aware of? What are the potential impact of new technologies, such as artificial intelligence, on health marketing and product development.
How can we effectively communicate the complex issues surrounding commercial determinants of health to diverse audiences? What are the strategies for engaging the public, policymakers, and industry stakeholders in meaningful discussions and action.

Key Recommended Reading

Allen, L. (2021) Commercial Determinants of Global Health. In Haring, R., Kickbusch, I., Ganten, D. and Moeti, M. The Handbook of Global Health. Springer https://link.springer.com/content/pdf/10.1007%2F978-3-030-05325-3_57-1.pdf

Kickbusch, I., Allen, L., & Franz, C. (2016). The commercial determinants of health. The Lancet Global Health, 4(12), e895-e896. https://doi.org/10.1016/S2214-109X(16)30217-0

McKee, M., & Stuckler, D. (2018). Revisiting the corporate and commercial determinants of health. American Journal of Public Health, 108(9), 1167-1170. https://doi.org/10.2105/AJPH.2018.304510

Mialon, M. (2020). An overview of the commercial determinants of health. Globalization and Health, 16(1), 1-7. https://doi.org/10.1186/s12992-020-00607-x

Naik et al. (2019) Going upstream – an umbrella review of the macroeconomic determinants of health and health inequalities. BMC Public Health 19:1678 https://doi.org/10.1186/s12889-019-7895-6

World Health Organisation (2021) Commercial determinants of health https://www.who.int/news-room/fact-sheets/detail/commercial-determinants-of-health

Image from: Kickbusch, I., Allen, L., & Franz, C. (2016). The commercial determinants of health. The Lancet Global Health, 4(12), e895-e896. https://doi.org/10.1016/S2214-109X(16)30217-0

Image from: Mialon, M. (2020). An overview of the commercial determinants of health. Globalization and Health, 16(1), 1-7. https://doi.org/10.1186/s12992-020-00607-x

Collin J, Ralston R, Hill SE, Westerman L (2020) Signalling Virtue, Promoting Harm: Unhealthy commodity industries and COVID-19. NCD Alliance, SPECTRUM https://ncdalliance.org/resources/signalling-virtue-promoting-harm

From The Lancet Series (March 2023): Commercial Determinants of Health https://www.thelancet.com/series/commercial-determinants-health

Allen, L.N., Wigley, S., Holmer, H. (2022) Assessing the association between Corporate Financial Influence and implementation of policies to tackle commercial determinants of non-communicable diseases: A cross-sectional analysis of 172 countries. Social Science & Medicine. 297, March 2022, 114825 https://doi.org/10.1016/j.socscimed.2022.114825

Barnes, D. E., & Bero, L. A. (1998). Why review articles on the health effects of passive smoking reach different conclusions. Jama, 279(19), 1566-1570. https://doi.org/10.1001/jama.279.19.1566

Bero, L., Oostvogel, F., Bacchetti, P., & Lee, K. (2007). Factors associated with findings of published trials of drug–drug comparisons: why some statins appear more efficacious than others. PLoS medicine, 4(6), e184. https://doi.org/10.1371/journal.pmed.0040184

Briggs, J., & Vallone, D. (2022). The Tobacco Industry’s Renewed Assault on Science: A Call for a United Public Health Response. American Journal of Public Health, 112(3), 388-390. https://doi.org/10.2105/AJPH.2021.306683

Brownell KD, Warner KE (2009) The perils of ignoring history: Big tobacco played dirty and millions died. how similar is big food. Milbank Q 87:259–294. doi: 10.1111/j.1468-0009.2009.00555.x

Buse, K., Tanaka, S., & Hawkes, S. (2017). Healthy people and healthy profits? Elaborating a conceptual framework for governing the commercial determinants of non-communicable diseases and identifying options for reducing risk exposure. Globalization and health, 13(1), 1-12. https://doi.org/10.1186/s12992-017-0255-3

David, J. L., Thomas, S. L., Randle, M., Daube, M., & Balandin, S. (2019). The role of public health advocacy in preventing and reducing gambling related harm: challenges, facilitators, and opportunities for change. Addiction research & theory, 27(3), 210-219. https://doi.org/10.1080/16066359.2018.1490410

Dorfman L, Cheyne A, Friedman LC, et al (2012) Soda and tobacco industry corporate social responsibility campaigns: How do they compare? PLoS Med 9:9. doi: 10.1371/journal.pmed.1001241

Even, D., Abdalla, S. M., Maani, N., & Galea, S. (2024). News media as a commercial determinant of health. The Lancet Global Health, 12(8), e1365-e1369. https://doi.org/10.1016/S2214-109X(24)00191-8

Fallin, A., Grana, R., & Glantz, S. A. (2014). ‘To quarterback behind the scenes, third-party efforts’: the tobacco industry and the Tea Party. Tobacco Control, 23(4), 322-331. http://dx.doi.org/10.1136/tobaccocontrol-2012-050815

Friel, S., Schram, A., Frank, N., Arthur, M., Townsend, B., & Gajurel, H. (2024). Financialisation: a 21st century commercial determinant of health equity. The Lancet Public Health, 9(9), e705-e708. https://doi.org/10.1016/S2468-2667(24)00187-7

Friel, S., Collin, J., Daube, M., Depoux, A., Freudenberg, N., Gilmore, A. B. et al. (2023) Commercial determinants of health: future directions. Lancet, 401, 1229–1240. https://doi.org/10.1016/S0140-6736(23)00011-9

Goldberg, R. F., & Vandenberg, L. N. (2021). The science of spin: targeted strategies to manufacture doubt with detrimental effects on environmental and public health. Environmental Health, 20(1), 33. https://doi.org/10.1186/s12940-021-00723-0

Gómez, E. J. (2022). Enhancing our understanding of the commercial determinants of health: Theories, methods, and insights from political science. Social Science & Medicine, 114931. https://doi.org/10.1016/j.socscimed.2022.114931

Gostin, L. O., Monahan, J. T., Kaldor, J., DeBartolo, M., Friedman, E. A., Gottschalk, K., ... & Cabal, L. (2019). The legal determinants of health: harnessing the power of law for global health and sustainable development. The Lancet, 393(10183), 1857-1910.

Greenhalgh, S. (2019). Making China safe for Coke: how Coca-Cola shaped obesity science and policy in China. BMJ, 364. https://doi.org/10.1136/bmj.k5050

Hernandez-Aguado I, Zaragoza GA (2016) Support of public–private partnerships in health promotion and conflicts of interest. BMJ Open 6:e009342. doi: 10.1136/bmjopen-2015-009342

Jahiel, R. I., & Babor, T. F. (2007). Industrial epidemics, public health advocacy and the alcohol industry: Lessons from other fields [Editorial]. Addiction, 102(9), 1335–1339. https://doi.org/10.1111/j.1360-0443.2007.01900.x

Jane, B., & Gibson, K. (2017). Corporate sponsorship of physical activity promotion programmes: part of the solution or part of the problem?. Journal of Public Health, 1-10. https://doi.org/10.1093/pubmed/fdx065

Kickbusch, I. (2012) Addressing The Interface of the Political and Commercial Determinants of Health. Health Promotion International, 27 (4), 427-428.

Kickbusch, I., Allen, L., & Franz, C. (2016). The commercial determinants of health. The Lancet Global Health, 4(12), e895-e896. https://doi.org/10.1016/S2214-109X(16)30217-0

Knai, C., Petticrew, M., Mays, N., Capewell, S., Cassidy, R., Cummins, S., ... & Katikireddi, S. V. (2018). Systems thinking as a framework for analyzing commercial determinants of health. The Milbank Quarterly, 96(3), 472-498. https://doi.org/10.1111/1468-0009.12339

Kriznik, N. M., Kinmonth, A. L., Ling, T., & Kelly, M. P. (2018). Moving beyond individual choice in policies to reduce health inequalities: the integration of dynamic with individual explanations. Journal of Public Health, 40(4), 764-775. https://doi.org/10.1093/pubmed/fdy045

Lacy-Nichols, J., Marten, R., Crosbie, E. and Moodie, R. (2022) The public health playbook: ideas for challenging the corporate playbook. The Lancet Global Health https://doi.org/10.1016/S2214-109X(22)00185-1

de Lacy-Vawdon, C., & Livingstone, C. (2020). Defining the commercial determinants of health: a systematic review. BMC public health, 20(1), 1-16. https://doi.org/10.1186/s12889-020-09126-1

Lee, K., Freudenberg, N., Zenone, M., Smith, J., Mialon, M., Marten, R., ... & Buse, K. (2022). Measuring the Commercial Determinants of Health and Disease: A Proposed Framework. International Journal of Health Services, 52(1), 115-128. https://doi.org/10.1177%2F00207314211044992

Lee, K., & Freudenberg, N. (2022). Public health roles in addressing commercial determinants of health. Annual review of public health, 43(1), 375-395. https://doi.org/10.1146/annurev-publhealth-052220-020447

Legg, T., Hatchard, J., & Gilmore, A. B. (2021). The science for profit model—how and why corporations influence science and the use of science in policy and practice. PloS one, 16(6), e0253272. https://doi.org/10.1371/journal.pone.0253272

Lesser, L. I., Ebbeling, C. B., Goozner, M., Wypij, D., & Ludwig, D. S. (2007). Relationship between funding source and conclusion among nutrition-related scientific articles. PLoS medicine, 4(1), e5. https://doi.org/10.1371/journal.pmed.0040005

Lundh, A., Lexchin, J., Mintzes, B., Schroll, J. B., & Bero, L. (2017). Industry sponsorship and research outcome. Cochrane database of systematic reviews, 2 (MR000033):1–140. https://doi.org/10.1002/14651858.MR000033.pub3

Maani, N., van Schalkwyk, M. C. I., Filippidis, F. T., Knai, C., & Petticrew, M. (2022). Manufacturing doubt: Assessing the effects of independent vs industry-sponsored messaging about the harms of fossil fuels, smoking, alcohol, and sugar sweetened beverages. SSM-population health, 17, 101009. https://doi.org/10.1016/j.ssmph.2021.101009

Maani, N., McKee, M., Petticrew, M., Galea, S. (2020) Corporate practices and the health of populations: a research and translational agenda. The Lancet Public Health DOI: https://doi.org/10.1016/S2468-2667(19)30270-1

Maani, N., Collin, J., Friel, S., Gilmore, A.B., McCambridge, J., Robertson, L., Petticrew, M.P. (2020) Bringing the commercial determinants of health out of the shadows: a review of how the commercial determinants are represented in conceptual frameworks, European Journal of Public Health, ckz197, https://doi.org/10.1093/eurpub/ckz197

Maani, N, Bertscher A, Critchlow N, Fitzgerald N, Knai C, Stead M, Petticrew M. Recruiting the “Heavy-Using Loyalists of Tomorrow”: An Analysis of the Aims, Effects and Mechanisms of Alcohol Advertising, Based on Advertising Industry Evaluations. International Journal of Environmental Research and Public Health. 2019; 16(21):4092. https://doi.org/10.3390/ijerph16214092

Maani, N., van Schalkwyk, M. C., Petticrew, M., & Buse, K. (2022). The pollution of health discourse and the need for effective counter-framing. bmj, 377. https://doi.org/10.1136/bmj.o1128

Maani, N., & McKee, M. (2022). The commercial determinants of health: The mini-budget is a consequence of foundational forces medicine must bear witness to. BMJ, 378. https://doi.org/10.1136/bmj.o2327

Marks, J. H. (2019). The perils of partnership: Industry influence, institutional integrity, and public health. Oxford University Press. [publisher]

McKee, M., & Stuckler, D. (2018). Revisiting the corporate and commercial determinants of health. American Journal of Public Health, 108(9), 1167-1170. https://doi.org/10.2105/AJPH.2018.304510

Mialon, M., Vandevijvere, S., Carriedo-Lutzenkirchen, A., Bero, L., Gomes, F., Petticrew, M., ... & Sacks, G. (2020). Mechanisms for addressing and managing the influence of corporations on public health policy, research and practice: a scoping review. BMJ open, 10(7), e034082. http://dx.doi.org/10.1136/bmjopen-2019-034082

Mialon, M. (2020). An overview of the commercial determinants of health. Globalization and Health, 16(1), 1-7. https://doi.org/10.1186/s12992-020-00607-x

Michaels, D., & Monforton, C. (2005). Manufacturing uncertainty: contested science and the protection of the public’s health and environment. American Journal of Public Health, 95(S1), S39-S48.

Newall, P. W. S., Walasek, L., Singmann, H., & Ludvig, E. A. (2019, August 3). Testing a gambling warning label’s effect on behavior. https://doi.org/10.31234/osf.io/dxfkj

Petticrew, M., Katikireddi, S. V., Knai, C., Cassidy, R., Hessari, N. M., Thomas, J., & Weishaar, H. (2017). ‘Nothing can be done until everything is done’: the use of complexity arguments by food, beverage, alcohol and gambling industries. J Epidemiol Community Health, 71(11), 1078-1083.

Petticrew, M., Maani, N., Pettigrew, L., Rutter, H. and Van Schalkwyk, M.C. (2020), Dark Nudges and Sludge in Big Alcohol: Behavioral Economics, Cognitive Biases, and Alcohol Industry Corporate Social Responsibility. The Milbank Quarterly. doi:10.1111/1468-0009.12475

Petticrew, M. P., Lee, K., & McKee, M. (2012). Type A behavior pattern and coronary heart disease: Philip Morris’s “crown jewel”. American journal of public health, 102(11), 2018-2025. https://doi.org/10.2105/AJPH.2012.300816

Ralston R, Godziewski C, Brooks E (2023) Reconceptualising the commercial determinants of health: bringing institutions in. BMJ Global Health 8:e013698 http://dx.doi.org/10.1136/bmjgh-2023-013698

Roy-Highley, E., Körner, K., Mulrenan, C., & Petticrew, M. (2024). Dark patterns, dark nudges, sludge and misinformation: alcohol industry apps and digital tools. Health Promotion International, 39(5), daae037. https://doi.org/10.1093/heapro/daae037

Serodio, P., Ruskin, G, McKee, M., Stuckler, D. (2020) Evaluating Coca-Cola’s attempts to influence public health ‘in their own words’: analysis of Coca-Cola emails with public health academics leading the Global Energy Balance Network Public Health Nutrition DOI: https://doi.org/10.1017/S1368980020002098

Sismondo, S., & Bernisson, M. (2024). How an opioid giant deployed a playbook for moulding doctors’ minds. bmj, 385. https://doi.org/10.1136/bmj.q1208

Sutherland, I. (1987). Health education-half a policy: the rise and fall of the Health Education Council. National Extension Trust Limited.

Ulucanlar, S., Lauber, K., Fabbri, A., Hawkins, B., Mialon, M., Hancock, L., ... & Gilmore, A. B. (2023). Corporate political activity: taxonomies and model of corporate influence on public policy. International Journal of Health Policy and Management, 12, 7292. https://doi.org/10.34172/ijhpm.2023.7292

van Schalkwyk, M. C., Petticrew, M., Maani, N., Hawkins, B., Bonell, C., Katikireddi, S. V., & Knai, C. (2022). Distilling the curriculum: An analysis of alcohol industry-funded school-based youth education programmes. Plos one, 17(1), e0259560. https://doi.org/10.1371/journal.pone.0259560

Van Schalkwyk, M. C., Maani, N., Hawkins, B., Petticrew, M., & Buse, K. (2024). Reclaiming the narrative: countering harmful commercial discourses. Health Promotion International, 39(6), daae182. https://doi.org/10.1093/heapro/daae182

WHO (2023) Commercial determinants of health. https://www.who.int/health-topics/commercial-determinants-of-health#tab=tab_1

Wiist, W. H. (2019). Mechanisms Underlying Corporations as Determinants of Health. American journal of public health, 109(2), e1-e1.

William H. Wiist (Ed.). (2010). The bottom line or public health: tactics corporations use to influence health and health policy, and what we can do to counter them. Oxford University Press. [google books]

Berkely Media Studies Group - Media Advocacy Resources and find them on twitter @BMSG

Corporate Consumption Complex And The Need For A New Public Health Agenda

Further Links on this website

Coke and Physical Activity Schemes

Determinants of Health

Weight Stigma

Further Links elsewhere

A twitter conversation about Cadbury's sponsoring a National Trust egg-hunt

Deep concerns over public health as The BMJ reveals MPs’ links to organisation backed by tobacco industry https://www.bmj.com/company/newsroom/deep-concerns-over-public-health-as-the-bmj-reveals-mps-links-to-organisation-backed-by-tobacco-industry/

Marion Nestle's blog articles on "Conflict of Interest" https://www.foodpolitics.com/tag/conflicts-of-interest/

Listen

A podcast linked to Greenhalgh, S. (2019). Making China safe for Coke: how Coca-Cola shaped obesity science and policy in China. BMJ, 364. https://doi.org/10.1136/bmj.k5050

Watch

When the PM "won" a vote of no confidence in Parliament in June 2022, the DCMS Secretary of State, Nadine Dorries came out to defend him saying that MPs should pay attention to the fact that the donors who collectively gave £80m to the Conservative party wanted the PM to stay in post.

A parody film from Last Week Tonight with John Oliver. There are some gems regarding CDOH within it. Enjoy.

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The Commercial Determinants of Health

The Wider Determinants of Health