It’s a familiar concept that the commercial drivers in life, and consumerism in particular, have a largely unhealthy impact on our lives. But those striving to control tobacco, and those working against alcohol advertising, and those struggling against the monoliths of the food industry, haven’t always had a coherent framework in which to see how closely their interests align.
The commercial determinants of health framework, described beautifully here by Cassandra de Lacy-Vawdon, clarifies the commonalities between the various assaults on health and wellbeing, and gives public health people (and politicians and members of the public) a simple framework.
This essay was part of the Public Health Association of Australia’s National Public Health Student Think Tank Competition.
Cassandra de Lacy-Vawdon writes:
The social determinants of health (SDoH) are familiar to us all thanks to the formative work of Marmot and colleagues. For more than a decade, the SDoH have been embedded within the work and practice of public health professionals. However, this increased consciousness and effort has not yet led to broad-reaching, increased population welfare as initially hoped. In fact, there is now greater disease burden from non-communicable diseases than ever before.
For exceeding the good work of public health professionals the world over have been the efforts of corporate interests. The tobacco industry, the alcohol industry, mining and fossil fuel industries, processed food and beverage industries, the gambling industry, the pharmaceutical industry, the automotive industry, the firearms industry and many more, have been working to maximise profits often at the expense of public health.
When considering that 69 of the world’s top 100 economies are now corporations, their effect on health can be easily understood.
Taken their money
However, we have not been overly good at recognising the true extent of these influences on health. Instead, we have focused on individualisation and ‘unhealthy lifestyle’ factors, we have partnered with these harmful industries, and we have taken their money.
In recent years, this has led some to turn their attention to the commercial determinants of health. These are ‘strategies and approaches used by the private sector to promote products and choices detrimental to health’.
We can think about the commercial determinants as a separate set of determinants, operating parallel to the social determinants, which influence every facet of health.
Driven by factors such as internationalisation, and corporate growth and expansion, we see them reflected in trade relations, the outsourcing of labour to countries with lower wages and fewer worker protections, and multinational corporates that move profits offshore to avoid taxes.
Corporates have better protection than citizens
The commercial determinants are channelled through corporate citizenship that affords corporates greater rights and greater protections than governments and people, and marketing and advertising that on the one hand tell us to buy more, consume more, and on the other hand tell us to ‘drink responsibly’, ‘enjoy within a healthy, balanced lifestyle’, and ‘gamble responsibly’. All the while, these approaches promote industry as part of the solution without assuming any responsibility for harms caused (see Moodie et al).
They are also channelled through vertically integrated supply chains that control all facets of production, distribution and sales and through corporate political activities such as lobbying, political donations, revolving doors and grey gifts.
All of these result in environmental degradation, overconsumption and a general erosion of health and wellbeing. The actions of corporate and commercial interests are consistently at odds with public health and, for the most part, these behaviours go unchecked.
Public health leadership needed
To address the commercial determinants of health effectively, public health leadership is needed. Public health professionals are primed to protect and promote population health. Whilst the commercial determinants sound like a wild and possibly untameable beast, and whilst addressing them comprehensively would likely require significant political intervention (and possibly reorientation), there are small things that can be incorporated within everyday work and practice to minimise their influence over public health.
First and foremostthis means checking corporate behaviours. These are currently going unchecked and public health professionals are probably best placed to change that. This means being educated and alert, and as conscious of the commercial determinants of health as we are of the social determinants, but also researching, documenting and building an evidence base from which to examine corporate practices and health outcomes.
Practically, this translates to considerations for partnerships and funding (in particular) within consultations, programming and research, and being critical of the influences upon our own and others’ work.
Look to tobacco
The best example of where this has already been successful is probably tobacco. Once big funders of research and ‘corporate social responsibility’ activities in Australia, this is now almost unimaginable in the current environment. This was brought about by painstaking documentation and evidence building until the case against tobacco was too great.
Therefore, to check corporate power means to examine things like the food industry’s involvement in physical activity research, or the gambling or alcohol industries’ involvement in sports sponsorship and sporting programs. Whilst this requires more than managing vested interests, this is probably a good place to start.
Secondly,there is a need to reorient public health efforts towards addressing the commercial determinants at the centre of many public health challenges. This involves moving away from industry-favoured language emphasising personal responsibility, and calling out the underlying determinants. If not, we are only doing industry’s job for them. We need to dispel the doubt, as was done with tobacco, and to accurately capture and describe the harms.
Re-evaluate apparently benign relationships
This may also mean that industries traditionally considered benign need to be re-evaluated within a commercial determinants of health lens for previously unconsidered harms.
And finally, and perhaps above all, we need to be advocating for more ethical corporate practice for the betterment of public health. This also means advocating for better policies that require this and greater transparency to identify where unethical practice is occurring.
To do this effectively, we need to seek greater involvement in policy processes, to use the evidence of harms to advocate for greater population protections from corporate interests, and to learn from industry tactics to be proactive. This is something that can be done at all levels of public health, whether internally (e.g. within a single organisation, department, team or project) or externally (e.g. to a politician or the media).
Pressing health challenge
The commercial determinants of health present one of the most pressing health challenges of our time. A failure to check corporate influences on health is likely only to lead to ever-worsening public health outcomes. However, by checking corporate influence, acknowledging the commercial determinants at the centre of our work, and being advocates for ethical practice, we can begin to change this outlook.
Cassandra de Lacy-Vawdon is a first year PhD student in the Gambling and Social Determinants Unit in the School of Public Health and Preventive Medicine at Monash University. Cassandra has worked in gambling, and physical activity and obesity prevention research since then. Her current work focuses on the commercial determinants of health, with particular attention to the activities of the alcohol, food and gambling industries in Australia. Cassandra works within a public health framework and has particular interests in harm minimisation and prevention, equity in health, and policy and politics.
Declaration of interests: Cassandra is supported by an Australian Government Research Training Program Scholarship and a Monash Graduate Excellence Scholarship provided by Monash University. She has also received funding from the Susan McKinnon Foundation, the Victorian Responsible Gambling Foundation, the Victorian Department of Health and Human Services, municipal councils in Victoria, MOVE Muscle, Bone & Joint Health previously, and the Department of Social Services previously. She does not work for, consult to, own shares in, or receive funding from any company or organisation that would benefit from this study.
