Experts call for action on commercial determinants of health and health equity

The private sector has a major impact on health through its products and practices. Commercial actors affect health in diverse and complex ways. They have been essential in the development and provision of essential health goods and services, but some of their products and practices are responsible for the escalation of ill health and health inequality around the world. Frameworks for understanding and an agenda for responding to these health impacts are set out in of Lancet Series on Trade Determinants of Health released today. His three documents point the way to a world where health comes before profit and all people live free from the harm caused by commercial forces.

“As the Lancet Series on Business Determinants of Health highlights, many of the most important risk factors for disease and injury – tobacco, alcohol and unhealthy diet – are major industries and profit drivers for some of the world’s largest companies. ” WHO Director-General Dr Tedros Adhanom Ghebreyesus wrote in a commentary within the series. “It is time for a paradigm shift. Public health cannot and will not improve without action on the commercial determinants of health, from the local to the global level. New forms of public health governance are needed.”

Dr Tedros also highlighted WHO’s work in this area in his commentary, highlighting WHO’s support to national governments in addressing specific aspects of trade determinants in areas such as tobacco control, marketing of milk substitutes breast and non-communicable diseases. Based on this work, in 2021, a new initiative on economic and trade determinants of health was established and, next year, the first Global Report on Trade Determinants of Health will be published.

Fixing the bad and enabling the good

The first paper in the series defines commercial determinants of health as “the systems, practices, and pathways through which commercial actors drive human health and health inequality.” In doing so, the authors of the series recognize the potential for trade actors to have positive and negative impacts on health and health equity, and lay a foundation for understanding how trade determinants can help guide governments in creating new policies and systems for adjusting damages and enabling benefits.

Importantly, these impacts on health, in the second and third papers, are contextualized by a framework for understanding commercial actors and a vision for the policies, governance systems and business models needed to ensure health, well-being and equality. This agenda requires, among other things, formations in the political and economic systems to promote pro-health trade practices and to empower governments to deal with harmful trade practices.

The authors describe the full range of sectors and commercial practices that have negative impacts on health, products including not only the alcohol, tobacco and unhealthy food industries, but also others such as fossil fuels, mining, gambling, as well as the range of wide range of practices that affect regulatory systems, laws and policies. Also included in the discussion are the impacts of industries such as automobiles, pharmaceuticals, new technologies, and social media, which can have both positive and negative impacts on health and health equity.

The authors conclude by emphasizing that now is the time to “…advance bold conceptualizations of social progress in ways that put public interests and human well-being above profit.

Next steps

The Lancet Series on Commercial Determinants of Health represents an important step forward in understanding the complex and multifaceted ways in which commercial actors affect health and health equity around the world. WHO is committed to ensuring that the private sector is able to fulfill its potential to become a partner for health and will closely follow and engage in the discussions and dialogues that the series generates. This will help inform WHO’s existing and developing efforts on the economic and trade determinants of health. Together, we can develop new metrics and governance, expand the evidence base, and reorient harmful commercial practices toward health and health equity.