Defining and conceptualising the commercial determinants of health.

Karen J Hofman, Anne Marie Thow, Viroj Tangcharoensathien, Lindsay Robertson, Mark Petticrew, Martin McKee, Robert Marten, Camila Maranha Paes de Carvalho, Jennifer Lacy-Nichols, Safura Abdool Karim, Paula Johns, Anna B Gilmore, Sharon Friel, Nicholas Freudenberg, Agnes Erzse, Sandro Demaio, Ha-Joon Chang, Krista Bondy, Adam Bertscher, Fran Baum, Alice Fabbri

Journal: Lancet (London, England) 2023;401(10383):1194-1213

PMID: 36966782

Full Text on Elsevier Science View on PubMed

Abstract

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.

Address: Department for Health, University of Bath, Bath, UK. Electronic address: [email protected].; Department for Health, University of Bath, Bath, UK.; Stretton Health Institute, University of Adelaide, Adelaide, SA, Australia.; Stirling Management School, University of Stirling, Stirling, UK.; Department of Economics, School of Oriental and African Studies University of London, London, UK.; Victorian Health Promotion Foundation, Melbourne, VIC, Australia.; South African Medical Research Council/Wits Centre for Health Economics and Decision Science, Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa.; Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.; Menzies Centre for Health Governance, School of Regulation and Global Governance, The Australian National University, Acton, ACT, Australia.; ACT Health Promotion, Rio de Janeiro, Brazil.; Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia.; Emília de Jesus Ferreiro Faculty of Nutrition, Fluminense Federal University, Niterói, Brazil.; Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland.; Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.; Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.; Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.; International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand.; Menzies Centre for Health Policy and Economics, University of Sydney, NSW, Australia.

DOI: 10.1016/S0140-6736(23)00013-2

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MeSH Terms: Humans, Industry, Commerce, Policy, Government, Health Policy