Introduction by Croakey: As the Prime Minister and NSW Premier stress the importance of “self-regulation” and “personal responsibility” in managing COVID at such a critical time in the pandemic, the refrain is all too familiar for many public health advocates.
For decades, various corporate interests – from tobacco companies, to the fossil fuels, alcohol and gambling industries – have strategically promoted such framing in order to avoid regulation and other interventions to benefit public health.
The commercial determinants of health (CDoH) are also shaping responses to the pandemic – locally, nationally and globally – in ways that are not always transparent and often not in the public interest.
Participants in the World Health Organization’s first public event on the CDoH recently heard about their far-reaching impacts, with one speaker saying that failing to address these determinants of health amounts to “public health malpractice”.
Professor Fran Baum, Co-Chair of the People’s Health Movement Global Steering Council, moderated the discussions, and reports below.
Fran Baum writes:
7th December 2021 marked a significant day for the World Health Organization (WHO) as it held its first public event on the commercial determinants of health; I was very honoured to accept an invitation to moderate the session.
The phrase – the commercial determinants of health (CDoH) – is relatively new to the lexicon of health promotion. It was first used by the queen of health promotion Professor Ilona Kickbusch and colleagues in 2016, and since that time its meaning and relevance to health has been extensively conceptualised and applied in public health research.
While the phrase CDoH is new, the related health impacts are not. Health and economic wellbeing are always in a delicate balance as we have seen during the pandemic. A lockdown threatens many industries including tourism, hospitality, personal services and retail.
In the 19th century Engels produced his book, The Condition of the Working Class in England, and made the case that the industrial revolution had been bad for workers’ health as death rates were much higher in Manchester and Liverpool (both rapidly industrialising towns) than the national average. He put this down to working and living conditions – and was documenting CDoH.
Wide-ranging
When people first think about the CDoH, they tend to look to harmful products such as tobacco, sugar-laden drinks and alcohol. But the negative impacts are much wider.
They include tax evasion, which robs public coffers of resources to spend on public goods like public hospitals, education, disability and aged care and environmental restoration.
Commercial forces are also heavily implicated in the climate crisis for their use of and marketing and sale of carbon products.
Increasingly means of communication are controlled by private companies and there are few regulations to govern their behaviour. The digital platforms we use for so many daily functions – including socialising, activism and consumerism – are controlled by hugely powerful corporations.
The CEOs of these companies have become our new feudal overloads. For example, Jeff Bezos, the founder of Amazon is the second wealthiest man in the world and worth US$200 billion as of December 2021. Bill Gates, the founder of Microsoft, is the fourth richest man and uses his fortune to influence and shape global health initiatives through the Gates Foundation.
The fortunes amassed by such entrepreneurs give them considerable power in a world where regulation of their activities is minimal.
The most worrying aspect of CDoH is the growth of transnational corporations. Some 25 years ago David Korten wrote of a future time “When Corporations Rule the World” ( ) and warned of the threat to democracy and well-being.
His comments were prophetic and alerted me to the risks, and I included his work in the first edition of my book, The New Public Health.
In the 21st century commercial activity is again threatening health profoundly, which is why WHO has launched a series of webinars on CDoH with the first entitled “Commercial determinants of health: what are they? Why do they matter? What can we do?”
Forces at work
Dr Etienne Krug, Director of the Department for Social Determinants of Health at the WHO in Geneva, introduced the webinar, stressing how importance CDoH are to multiple health issues including non-communicable diseases like diabetes, cardiovascular disease and to injury prevention and air pollution.
The keynote speaker was Professor Nicholas Freudenberg from City University of New York, who has recently been daring enough to use the ‘C’ word in the title of his book, At What Cost Modern Capitalism and the Future of Health.
Freudenberg (who has also featured in recent Croakey articles from the Global Food Governance conference) started by documenting what has changed regarding commercial forces in recent years.
He identified the rise of corporations, the financialisation of the world economy, the wave of deregulation and privatisations, business control of science and technology and the promotion of ideology of individualism. He also suggested practical measures that could be taken to tackle CDoH which include regulation, taxation and activism.
Such is the impact of CDoH that Freudenberg said failing to address them amounted to “public health malpractice”. (He presented the two slides below).
Global perspectives
A panel discussion followed Freudenberg’s presentation, which provided perspectives from different standpoints.
Dr Vesna-Kerstin Petric, Slovenia’s Director-General, Public Health Directorate, Ministry of Health and a Member of the WHO Executive Board, spoke of how her country had to stand firm against pressures from the tobacco industry but by keeping the importance of health uppermost they had managed to dramatically reduce the use of tobacco.
Plain packaging was introduced, which she explained has been shown to have reduced the attractiveness of tobacco products; eliminated the effect of tobacco packaging as a form of advertising and promotion; eliminated package design techniques that may suggest that some products are less harmful than others; and increased the noticeability and effectiveness of health warnings.
A representative of the Governor of Jakarta in Indonesia also stressed the importance of city-wide action to control tobacco.
Dr James Hospedales, Special Advisor for the Health Caribbean Coalition, Founder and Director of EarthMedic/EarthNurse and past Director of the Caribbean Public Health Agency, stressed that small island nations felt powerless in the face of very powerful commercial forces, which adversely affected health.
Hospedales emphasised the importance of receiving strong support from WHO to tackle the adverse impacts of commercial forces.
Jayati Ghosh, Professor of Economics at the University of Massachusetts in the USA, a member of the WHO Council on the Economics of Health For All, and member of the UN High-Level Advisory Board on Economic and Social Affairs, spoke powerfully about the ways in which our current global economic system left the cards in the hands of the commercial sector to a large degree.
This has resulted in a very unequal world in which wealth disparity is growing between countries and within countries. In her view a new economic order is required that is both healthier and more equal.
Dr Douglas Webb, Manager, Health and Innovating Financing HIV, Health and Development Group, United Nations Development Fund (UNDP), works on pandemics health emergencies and health governance. He reflected on how from his development perspective, commercial determinants are very visible influences.
Low- and middle-income countries are often at the mercy of transnational corporations that extract goods from their country but also extract profits which then cannot be used for development, he said.
Ways forward
The webinar’s last comment went to Monika Kosinska, Head, Economic and Commercial Determinants of Health, Department of Social Determinants at the WHO, who will lead the WHO focus on CDoH in to the future. She spoke WHO’s plans for action on CDoH.
These can also be seen here, with the WHO saying its new program, the Economic and Commercial Determinants of Health, has four goals: to strengthen the evidence base; develop tools and capacity to address the commercial determinants; convene partnerships and dialogue; and raise awareness and advocacy.
The WHO says that partnering with civil society, adopting so-called best buy strategies and conflict of interest policies, and supporting safe spaces for discussions with industry are all examples of how countries can address the commercial determinants of health.
It says more research is needed on the health equity dimensions of commercial determinants of health as well as governance considerations, including transparency and accountability, in addition to state capabilities to avoid corruption and steer private sector engagements.
The WHO gives as examples of actions governments are taking to address CDoH:
- Twenty-nine countries with 832 million people (12 percent of the world’s population) have passed a comprehensive ban on tobacco advertising.
- Around 50 countries, including France, Brunei Darussalam, Chile, Hungary, India and Ireland, among others, have charged a tax on sugary soft drinks.
- In Bulgaria, companies give women over 58 weeks of maternity leave on average, which is one of the highest in the world.
WHO is to be roundly congratulated for expanding their work on the CDoH, in making commercial activity healthier and more supportive of well-being.
This work is going to be vital for the future health of our planet and all creatures who call it home.
See Croakey’s archive of stories about the commercial determinants of health.
