[Download Full Document (PDF)]
Deep Dive Audio Overview
Video Explainer
Executive Summary
Non-communicable diseases such as diabetes, heart disease, cancer, and depression have become widespread across the world. These conditions are often attributed to personal behavior, but the environments in which people live tell a different story. The food supply, marketing systems, urban design, labor conditions, digital platforms, and global trade agreements shaping daily life are the result of commercial decisions and policy choices — not individual preferences alone.
This paper examines the Commercial Determinants of Health: the systems and strategies through which commercial actors influence wellbeing. Products that drive disease — including ultra-processed foods, sugary beverages, alcohol, tobacco, and fossil fuels — are among the most profitable industries globally. Their influence extends into advertising, policymaking, scientific research, and international trade law, making it difficult for governments to enact strong health protections. This dynamic creates regulatory chill, where the threat of legal or economic retaliation discourages governments from acting in the public interest.
The alternative is health sovereignty: the capacity of societies to prioritize and protect health without interference from commercial interests. Achieving health sovereignty requires insulating public policy from undue influence, protecting children from targeted marketing, reshaping food and living environments to make healthy choices accessible, strengthening regional cooperation to counterbalance corporate power, and shifting public understanding away from blame and toward shared responsibility.
The solutions presented in this paper are practical and achievable. They include front-of-pack warning labels, restrictions on marketing to children, taxes on harmful products with revenues reinvested into community health, reform of school nutrition environments, plain packaging, and coordinated regional legal defense for public health policies. Countries that have adopted these measures — including Uruguay, Mexico, Chile, Scotland, and Barbados — have demonstrated meaningful improvements in health outcomes and public support.
We are not facing a crisis of knowledge — we are facing a crisis of structure.
Once we recognize that health is shaped by the environments we create, we gain the ability to change them.
This is the work of building societies that protect life, dignity, and the conditions for people to flourish.
