Why commercial determinants of health matter for us all

In public health, we’re well-versed in discussing social and environmental factors that shape our health, but one critical dimension that often remains underexplored are the Commercial Determinants of Health (CDoH).

A new think piece for the upcoming conference organized by the Public Health Association of BC in November 2024 discusses how commercial activities influence public health in profound ways—both directly and indirectly.

For public health professionals, reflecting on these commercial determinants isn’t just an academic exercise; it’s deeply personal.

From the products marketed to us daily, to the types of healthcare available, to the way urban spaces are developed, commercial forces are woven into the very fabric of our lives. CDoH encompasses practices and policies of companies and industries that impact health outcomes, for better or for worse. While certain sectors, like tobacco or fast food, may pose clear health risks, other industries and commercial actors may contribute positively—consider companies that prioritize sustainable practices, offer fair wages, or support health-focused research and development.

Why is it important for public health professionals to reflect on CDoH?

First, recognizing the influence of CDoH can help practitioners understand the invisible factors that shape health trends and disparities in their communities. For example, while many of us focus on addressing lifestyle diseases, we might overlook the role of aggressive marketing by processed food companies that drives unhealthy food consumption patterns. This reflection isn’t just about seeing what’s harmful but understanding how to harness positive commercial practices to improve health outcomes.

Secondly, CDoH are not confined to our workplaces—they permeate our personal lives. The products we consume, the media we engage with, and even the neighborhoods we live in are shaped by commercial forces. Reflecting on these influences helps us recognize the complexity of our role as public health advocates. It encourages us to advocate for policies that protect vulnerable populations, create healthier environments, and foster transparency around commercial influences on health.

The Path Forward

This think piece invites us all to reconsider how we view public health and our role within it. When we reflect on CDoH influences, we can better advocate for structural changes that promote equitable health outcomes.

As you explore this think piece, consider the ways commercial forces impact your own life and your work in public health.

How can we, as a community, drive the change from harmful practices to those that support health and well-being?

Reflecting on CDoH isn’t just an exercise; it’s a step toward shaping a healthier future for everyone.

Guided self-reflection

Consider the following as a starting point:

1. Which commercial determinants of health across the sectors discussed are of particular concern or interest to you?
2. How do these topics interact with CDoH in your community or area of work?
3. Specifically, how do these issues impact healthcare providers, public health professionals, health advocates, and public health researchers?
4. How do these areas interact with commercial actors at the local, provincial, or national level?
5. What competing motivations and objectives do different commercial actors have in this space?
6. Are there any examples of successful action taken in your community or workplace regarding CDoH?
7. Who would you consult to better understand this topic and how it relates to CDoH?

Consider these across different sectors:

Trade

• Health-harming Impact: Trade agreements that prioritize corporate interests over public health, such as allowing the import of unhealthy processed foods and tobacco products into low- and middle-income countries, can contribute to rising rates of noncommunicable diseases.
• Health-promoting Impact: Fair trade initiatives that ensure ethical labor practices and promote sustainable agriculture can improve the livelihoods and health of workers and communities involved in the production process.

Social Sector

• Health-harming Impact: When private companies take over essential social services, such as housing or elder care, profit-driven models can lead to reduced quality of care, affordability issues, and unequal access to services, disproportionately affecting populations experiencing inequities.
• Health-promoting Impact: Social enterprises that focus on providing access to clean water or affordable healthcare in underserved areas help reduce health inequities.

Economy

• Health-harming Impact: Economic policies that prioritize corporate profits over public health, such as deregulating industries that pollute the environment, can lead to poor health outcomes, especially in disadvantaged communities.
• Health-promoting Impact: Economic policies that promote living wages, paid parental leave, and access to healthcare can improve both mental and physical health for workers and their families.

Education

• Health-harming Impact: Corporations marketing unhealthy foods in schools, such as sugary drinks and snacks, contribute to childhood obesity and poor nutrition.
• Health-promoting Impact: Partnerships between businesses and educational institutions that promote health literacy and wellness programs can help children and adults make healthier choices and improve overall health outcomes.

Competition

• Health-harming Impact: Monopolies or dominant market players in industries like pharmaceuticals can lead to inflated drug prices, limiting access to essential medicines for many people.
• Health-promoting Impact: Policies that foster competition in the healthcare market, such as encouraging generic drug production, can lower costs and increase access to necessary treatments.

Transport

• Health-harming Impact: Car-centric transport policies that prioritize the automobile industry lead to increased air pollution and sedentary lifestyles, which contribute to respiratory diseases and obesity.
• Health-promoting Impact: Investments in public transport systems and bike-friendly infrastructure promote physical activity and reduce pollution, leading to better overall health outcomes.

Energy

• Health-harming Impact: The fossil fuel industry contributes to air and water pollution, leading to respiratory diseases and other health issues, particularly in communities near extraction sites.
• Health-promoting Impact: The renewable energy sector reduces reliance on polluting energy sources and helps mitigate climate change, which is beneficial for both public health and environmental sustainability.

Health

• Health-harming Impact: Pharmaceutical companies that aggressively market opioids without adequate warnings about addiction risks contributed to the opioid crisis, which has had devastating health consequences.
• Health-promoting Impact: Pharmaceutical companies that work with governments and nonprofits to make essential medicines affordable and accessible improve public health, particularly in low-income regions.

Environment

• Health-harming Impact: Deforestation driven by commercial agriculture or logging leads to the spread of vector-borne diseases, such as malaria, due to the destruction of natural habitats and breeding grounds for disease-carrying insects.
• Health-promoting Impact: Corporate environmental sustainability initiatives, like reducing plastic waste or supporting reforestation efforts, help protect ecosystems and improve community health by maintaining cleaner air and water.

Labor

• Health-harming Impact: Labor exploitation in industries like garment manufacturing can lead to poor working conditions, mental health issues, and occupational injuries, particularly in low-income countries.
• Health-promoting Impact: Companies that offer safe working conditions, fair wages, and access to health benefits promote the well-being of their workers and create healthier work environments.

Agriculture

• Health-harming Impact: Industrial farming practices that rely on pesticides and antibiotics contribute to antimicrobial resistance and environmental degradation, both of which have negative health impacts on communities.
• Health-promoting Impact: Organic farming and sustainable agriculture practices improve food safety and reduce exposure to harmful chemicals, leading to better long-term health outcomes for consumers and agricultural workers.

Science

• Health-harming Impact: Corporations that suppress or manipulate scientific research to protect their profits, such as tobacco companies or industries that deny climate change, hinder public health efforts to address critical health and environmental challenges.
• Health-promoting Impact: Investments in health innovation by the private sector, such as research and development for vaccines or new medical technologies, lead to major advancements in disease prevention and treatment.

Security

• Health-harming Impact: Arms manufacturing and trade can destabilize regions, leading to violence and conflict, which has severe impacts on mental health and increases the risk of injury and death.
• Health-promoting Impact: Companies that invest in cybersecurity or develop products to protect critical health infrastructure help ensure that health services can operate without disruption, improving overall community safety and health.

Media

• Health-harming Impact: Media companies that prioritize sensationalism and clickbait over responsible health reporting contribute to the spread of misinformation and public confusion about health issues, such as during the COVID-19 pandemic.
• Health-promoting Impact: Media campaigns that promote public health initiatives, such as those focused on smoking cessation or promoting vaccination, play a vital role in encouraging healthier behaviors and improving health literacy.

Local governments

Health-harming Impact:

• Unhealthy zoning decisions: Allowing fast food chains and liquor stores to dominate low-income areas contributes to food deserts and increases rates of obesity, diabetes, and heart disease.
• Weak environmental enforcement: Poor regulation of industrial pollution leads to higher rates of respiratory diseases and cancers, especially in communities near industrial zones.
• Car-centric infrastructure: Prioritizing cars over active transport options like biking or walking fosters sedentary lifestyles and worsens air pollution, contributing to obesity and respiratory conditions.
• Partnerships with health-harming industries: Collaborating with industries promoting sugary drinks, fast food, or alcohol undermines public health efforts and reinforces unhealthy behaviors.
• Urban design and lack of green spaces: Focusing on commercial development over green space limits opportunities for physical activity, increasing rates of lifestyle-related diseases like obesity and mental health issues.
• Inadequate regulation of alcohol and tobacco: Failing to regulate sales of alcohol and tobacco makes these products more accessible, especially to youth, raising addiction rates and long-term health consequences like liver disease and cancer.

Positive Impact:

• Zoning and land use: Encouraging grocery stores, farmers markets, and urban farms in underserved areas improves access to fresh food, helping reduce diet-related diseases like obesity and diabetes.
• Environmental protections: Enforcing environmental regulations on pollution helps lower rates of respiratory illnesses and cancers caused by industrial emissions.
• Public infrastructure and transportation: Investments in public transit, bike lanes, and walkable spaces promote physical activity and reduce pollution, addressing conditions like obesity and cardiovascular disease.
• Health-promoting partnerships: Collaborating with businesses to promote healthy and well-being initiatives, such as immunization campaigns or smoking cessation programs, aligns commercial incentives with public health.
• Green Spaces: Developing parks and recreational areas encourages physical activity and social interaction, reducing the risk of lifestyle-related diseases and improving mental health.
• Regulation of alcohol and tobacco: Strict regulation of alcohol and tobacco sales reduces consumption, particularly among young people, lowering addiction rates and related diseases.