Reproduced from: Commercial determinants of health (thelancet.com)
Table of Contents
Commercial determinants of health
Published: March 23, 2023
Executive Summary
Commercial actors can contribute positively to health and society, and many do, providing essential products and services. However, a substantial group of commercial actors are escalating avoidable levels of ill health, planetary damage, and inequity — the commercial determinants of health. While policy solutions are available, they are not currently being implemented, and the costs of harm caused by some products and practices are coming at a great cost to individuals and society.
A new Lancet Series on the commercial determinants of health provides recommendations and frameworks to foster a better understanding of the diversity of the commercial world, potential pathways to health harms or benefits, and the need for regulatory action and investment in enterprises that advance health, wellbeing, equity, and society.
Editorial
♦ Unravelling the commercial determinants of health
The Lancet
Published: March 23, 2023
Series
♦ Defining and conceptualising the commercial determinants of health
Anna B Gilmore, Alice Fabbri, Fran Baum, Adam Bertscher, Krista Bondy, Ha-Joon Chang, Sandro Demaio, Agnes Erzse, Nicholas Freudenberg, Sharon Friel, Karen J Hofman, Paula Johns, Safura Abdool Karim, Jennifer Lacy-Nichols, Camila Maranha Paes de Carvalho, Robert Marten, Martin McKee, Mark Petticrew, Lindsay Robertson, Viroj Tangcharoensathien, Anne Marie Thow
Summary
Although commercial entities can contribute positively to health and society there is growing evidence that the products and practices of some commercial actors — notably the largest transnational corporations — are responsible for escalating rates of avoidable ill health, planetary damage, and social and health inequity; these problems are increasingly referred to as the commercial determinants of health. The climate emergency, the non-communicable disease epidemic, and that just four industry sectors (ie, tobacco, ultra-processed food, fossil fuel, and alcohol) already account for at least a third of global deaths illustrate the scale and huge economic cost of the problem. This paper, the first in a Series on the commercial determinants of health, explains how the shift towards market fundamentalism and increasingly powerful transnational corporations has created a pathological system in which commercial actors are increasingly enabled to cause harm and externalise the costs of doing so. Consequently, as harms to human and planetary health increase, commercial sector wealth and power increase, whereas the countervailing forces having to meet these costs (notably individuals, governments, and civil society organisations) become correspondingly impoverished and disempowered or captured by commercial interests. This power imbalance leads to policy inertia; although many policy solutions are available, they are not being implemented. Health harms are escalating, leaving health-care systems increasingly unable to cope. Governments can and must act to improve, rather than continue to threaten, the wellbeing of future generations, development, and economic growth.
The Lancet
Published: March 23, 2023
♦ Supplementary appendix
♦ Conceptualising commercial entities in public health: beyond unhealthy commodities and transnational corporations
Jennifer Lacy-Nichols, Sulakshana Nandi, Melissa Mialon, Jim McCambridge, Kelley Lee, Alexandra Jones, Anna B Gilmore, Sandro Galea, Cassandra de Lacy-Vawdon, Camila Maranha Paes de Carvalho, Fran Baum, Rob Moodie
Summary
Most public health research on the commercial determinants of health (CDOH) to date has focused on a narrow segment of commercial actors. These actors are generally the transnational corporations producing so-called unhealthy commodities such as tobacco, alcohol, and ultra-processed foods. Furthermore, as public health researchers, we often discuss the CDOH using sweeping terms such as private sector, industry, or business that lump together diverse entities whose only shared characteristic is their engagement in commerce. The absence of clear frameworks for differentiating among commercial entities, and for understanding how they might promote or harm health, hinders the governance of commercial interests in public health. Moving forward, it is necessary to develop a nuanced understanding of commercial entities that goes beyond this narrow focus, enabling the consideration of a fuller range of commercial entities and the features that characterise and distinguish them. In this paper, which is the second of three papers in a Series on commercial determinants of health, we develop a framework that enables meaningful distinctions among diverse commercial entities through consideration of their practices, portfolios, resources, organisation, and transparency. The framework that we develop permits fuller consideration of whether, how, and to what extent a commercial actor might influence health outcomes. We discuss possible applications for decision making about engagement; managing and mitigating conflicts of interest; investment and divestment; monitoring; and further research on the CDOH. Improved differentiation among commercial actors strengthens the capacity of practitioners, advocates, academics, regulators, and policy makers to make decisions about, to better understand, and to respond to the CDOH through research, engagement, disengagement, regulation, and strategic opposition.
The Lancet
Published: March 23, 2023
♦ Commercial determinants of health: future directions
Sharon Friel, Jeff Collin, Mike Daube, Anneliese Depoux, Nicholas Freudenberg, Anna B Gilmore, Paula Johns, Amos Laar, Robert Marten, Martin McKee, Melissa Mialon
Summary
This paper is about the future role of the commercial sector in global health and health equity. The discussion is not about the overthrow of capitalism nor a full-throated embrace of corporate partnerships. No single solution can eradicate the harms from the commercial determinants of health — the business models, practices, and products of market actors that damage health equity and human and planetary health and wellbeing. But evidence shows that progressive economic models, international frameworks, government regulation, compliance mechanisms for commercial entities, regenerative business types and models that incorporate health, social, and environmental goals, and strategic civil society mobilisation together offer possibilities of systemic, transformative change, reduce those harms arising from commercial forces, and foster human and planetary wellbeing. In our view, the most basic public health question is not whether the world has the resources or will to take such actions, but whether humanity can survive if society fails to make this effort.
The Lancet
Published: March 23, 2023
Comment
♦ Achieving health for all requires action on the economic and commercial determinants of health
Tedros Adhanom Ghebreyesus
The Lancet
Published: March 23, 2023
Perspectives
♦ Anna Gilmore: confronting the commercial determinants of health
Udani Samarasekera
The Lancet
Published: March 23, 2023
♦ Rob Moodie: a radical voice in public health
Geoff Watts
The Lancet
Published: March 23, 2023
Reproduced from: Rebalancing global power asymmetries to substantially improve human and planetary health (thelancet.com)
INFOGRAPHICS
♦ Rebalancing global power asymmetries to substantially improve human and planetary health
March 23, 2023
Although commercial entities can contribute positively to health and society, the products and practices of some commercial actors are responsible for escalating rates of avoidable ill health, planetary damage, and social and health inequity. Addressing commercial determinants of health and health inequities requires a global rebalancing of power that prioritises public interests over commercial profit and challenges contemporary capitalism to increase its compatibility with health and health equity.
Reproduced from: The public health playbook: ideas for challenging the corporate playbook – The Lancet Global Health
VIEWPOINT
♦ The public health playbook: ideas for challenging the corporate playbook
May 24, 2022
The Lancet Global Health, Volume 10, Issue 7, e1067 – e1072
Jennifer Lacy-Nichols, PhD
Robert Marten, PhD
Eric Crosbie, PhD
Prof Rob Moodie, MPH
Summary
Many commercial actors use a range of coordinated and sophisticated strategies to protect business interests — their corporate playbook — but many of these strategies come at the expense of public health. To counter this corporate playbook and advance health and wellbeing, public health actors need to develop, refine, and modernise their own set of strategies, to create a public health playbook. In this Viewpoint, we seek to consolidate thinking around how public health can counter and proactively minimise powerful commercial influences. We propose an initial eight strategies for this public health playbook: expand public health training and coalitions, increase public sector resources, link with and learn from social movements to foster collective solidarity, protect public health advocates from industry threats, develop and implement rigorous conflict of interest safeguards, monitor and expose corporate activities, debunk corporate arguments, and leverage diverse commercial interests. This set of strategies seeks to amplify inherent assets of the public health community and create opportunities to explicitly counter the corporate playbook. These strategies are not exhaustive, and our aim is to provoke further discussion on and exploration of this topic.
Reproduced from: Lancet Series (vichealth.vic.gov.au)
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