Commercial determinants of health
Commercial determinants of health (CDoH) are the private sector activities impacting public health, either positively or negatively, and the enabling political economic systems and norms.
CDoH includes all products and services provided by private entities to gain a financial profit, as well as market strategies, working conditions, production externalities and political activities, such as misinformation, lobbying and donations. Some parts of the private sector also use instrumental, structural and discursive power to undermine public health policies that threaten profits.
Commercial activities, especially by transnational corporations, affect non-communicable disease, infectious diseases and pandemics, injuries and climate change. These impacts also worsen inequities between and within countries. Profit shifting and the aggressive use of trade agreements by the unhealthy commodity industries are particularly detrimental to the global south.
Simultaneously, the private sector is an indispensable partner for development by, for example, creating vaccines, medicines and assistive products, financing, building infrastructure and delivering health services towards Universal Health Coverage, or by ensuring food security. Member States should work to leverage these opportunities while protecting populations from harm.
Communities, civil society organizations, governments at all levels, philanthropists and, where aligned, the private sector, must work together to achieve health for all. This requires addressing CDoH through conflict of interest, regulative, legal, economic, whole-of-government and geopolitical reforms.
The commercial determinants of health (CDoH) can negatively impact health, wellbeing, equity and health-systems. For example, half of all tobacco consumers will die from health issues related to these products, with annual deaths hitting 8 million. Many others are harmed by the actions of the alcohol, fast-food and sugar-sweetened beverage industries. Additionally, 20% of suicides are related to pesticide product self-poisoning. These especially affect disadvantaged population groups and low- and middle- income countries.
CDoH also have health promoting and protective effects. Nearly 2 billion people will need assistive devices by 2050, greatly improving wellbeing. Installing and mandating the use of safety devices such as seatbelts, child restraints or helmets significantly reduces serious and fatal injuries. Pharmaceuticals and vaccines have significant effects, with the measles vaccines alone preventing 25.5 million deaths since 2000.
There are also broader existential and societal impacts. Industry action drives climate change while also preventing meaningful action. Around 66% of all antimicrobials are used in agricultural practices, worsening antimicrobial resistance and creating further pandemic risks.
Other evidence has shown exposure to long working hours was the key occupational risk, attributable to approximately 750 000 out of 1.9 million work-related deaths in 2016. Finally, privatization, deregulation and tax avoidance can worsen public services and increase inequities.
WHO urges Member States to address the commercial determinants of health (CDoH) to improve health and health equity, thereby leveraging the benefits while protecting populations from harm.
On a microlevel, this includes taxation, fiscal policies and meaningful government regulations on advertising, promotion and sponsorship of harmful products. Millions of lives have been saved thanks to the control policies under the WHO Framework Convention on Tobacco Control and MPOWER.
Member States should collaborate to address structural elements of CDoH, including the national and global political, economic, legal, financial and trade systems that enable and promote detrimental corporate practice. This broader agenda means repositioning social outcomes ahead of profit through alternative economic models and metrics, and reforming governance, including lobbying, donations and conflict of interest management.
The private sector can promote health and well-being. During the COVID-19 pandemic, several entertainment companies joined WHO in partnerships to prevent the spread of the virus.
Governments are also encouraged to ensure the equitable availability of those commercial products and services that promote or improve health and well-being.
Civil society organizations can lead this action, enhancing transparency, accountability and harnessing citizen power to set progressive agendas. This can motivate government regulation and directly on the private sector to eliminate the harmful and enhance favourable impacts of their activities.
