Melanie Parker, Public Health Association of Australia
Commercial entities are now well known for being able to influence the health of people and populations.
But untangling the ways that commercial entities influence people’s lives and health is an emerging, but still somewhat opaque, area that is stimulating the interest of the public, journalists, and the field of public health.
The public health student and workforce community know well the so-called ‘social determinants’ of health, like housing, income, education, and racism. Their significant effects on health are generally well established and well defined.
But many will hear the phrase ‘commercial determinants of health’ and have trouble clearly conceptualising the many complex factors that this simple phrase encompasses.
“Health does not begin in clinics or hospitals… health starts with the conditions in which we are born and raised.”
— The Lancet (@TheLancet) March 27, 2023
What’s in a definition?
First, it’s important to understand how the definition of the commercial determinants of health has adapted over time, in this relatively new field of public health.
Many definitions of these determinants have been posited, including:
“Factors that influence health which stem from the profit motive” (West & Marteau, 2013)
A few years later in 2016, the above definition was built on by Kickbusch et al, who said that it didn’t highlight the complexities of the area. They instead suggested the following:
“Strategies and approaches used by the private sector to promote products and choices
that are detrimental to health”
When reading this definition, large unhealthy product industries like tobacco and alcohol spring to mind. But just last month in March 2023, experts from across the world provided consensus on a new definition, which they say covers the huge range of commercial entities (from large companies that cross borders, to small, locally-owned, independent businesses).
The new definition, published in The Lancet (with co-authors including Professor Anna Gilmore from the University of Bath, Australia’s own Professor Fran Baum, VicHealth CEO Dr Sandro Demaio, and Professor Martin McKee), provides an updated explanation of the commercial determinants of health:
“The systems, practices, and pathways through which
commercial actors drive health and equity.”
This definition nicely acknowledges the complexities and concerns of the relationship between commercial determinants and not just health but also equity. Addressing inequity is another key role of public health.
The authors highlighted how just a few industries account for a large portion of preventable deaths across the world, and noted how the new definition of the commercial determinants was neutral, which acknowledged that contributions from different actors could both improve or worsen health and equity in complex ways across the world.
While commercial actors can contribute positively to health and society, a significant proportion are not.
Just 4 industry sectors are responsible for at least 1/3 of global deaths every year:
🍔 Unhealthy foods
🏭 Fossil fuelshttps://t.co/5JHf7IVlbh
— The Lancet (@TheLancet) March 24, 2023
An Australian perspective on the commercial determinants of health
The National Preventive Health Strategy 2021-2030 (NPHS), launched in December 2021 by the former Liberal-National Government, referenced on page 19 both the 2013 West & Marteau definition, as well as the definition proposed by Kickbusch et al in 2016.
The NPHS, a document published by the Australian Government’s Department of Health, also acknowledged key aspects of how corporate influence is exerted, including through:
- Marketing (e.g., advertisements)
- Lobbying and political donations
- Supply chains
- Corporate social responsibility strategies
One of the March 2023 Lancet series articles expands on this list, providing a list of seven categories of the commercial sector’s practices which can affect health and equity across the world:
- Political practices, e.g., lobbying
- Scientific practices
- Marketing practices
- Supply chain and waste practices
- Labour and employment practices
- Financial practices
- Reputational management practices
Although the commercial determinants of health occupy only a small section of the Australian Government’s National Preventive Health Strategy, they acknowledged that considering these determinants is “critical to establishing effective approaches to preventive health, as individuals have limited control over their circumstances and what they are exposed to in their everyday life”.
Where to from here?
A spokesperson for the Australian Health Minister Mark Butler MP recently said that they were developing an implementation and evaluation plan for the Strategy. Experts including Associate Professor Jennifer Lacy-Nichols, a co-author of one of the new Lancet articles, have outlined several actions that they say could help address the commercial determinants of health. But, as yet, there are no details on what the Government’s ‘implementation and evaluation plan’ involves, and how the commercial determinants of health will be addressed.
PHAA continues to closely watch for updates on the NPHS, and how the Government considers the commercial determinants of health in its policies. It’s crucial that we don’t ignore how these determinants affect our health – otherwise we’ll lose the opportunity to provide better health and equity to people in Australia.
This is the second in a series on the National Preventive Health Strategy. Subscribe to Intouch for further instalments that explore the Strategy’s key sections.
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Want to learn more about the Australian Centre for Disease Control (ACDC)? Read the CDC Corner, where authors discuss its potential scope, structure and governance.
Article updated 13/4/23