How commercial actors influence and impact health and society

Commercial actors can contribute positively to health and society, and many do, providing essential products and services. However, some of these actors are escalating avoidable levels of ill health, damage to the planet, and inequity within and between countries.

In an increasingly market-driven world, an unsustainable push for sales and expansion has tipped the balance of power in favor of commercial profits over people and planet. Indeed, estimates suggest industries that produce just four harmful products—tobacco, alcohol, unhealthy food, and fossil fuels—cause at least a third of preventable deaths per year globally.

A Lancet Series on the commercial determinants of health (CDOH) is a ground-breaking exposé of the products and practices of the CDOH and provides recommendations and frameworks to foster a better understanding of the diversity of the commercial world, potential pathways to health harms or benefits, and the need for regulatory action and investment in enterprises that advance health, well-being, equity, and society.

Dr. Mélissa Mialon, Research Assistant Professor at the Trinity Business School and food engineer is a co-author on two out of the three publications that comprise the Series. Mélissa is a leading expert on the commercial determinants of health.

She said, “The Lancet Series provides in-depth evidence and knowledge on the commercial determinants of health. We call for a drastic change where profits are not anymore put before people’s health. ”

Dr. Mialon continued, “Often, we’re hearing that individuals just need to make healthier choices for themselves. But that’s ignoring that our choices are shaped by external factors, such as how much marketing we’re exposed to, or the lack of protection against pollution because fossil fuel companies orchestrated a disinformation campaign on that topic. My work exposes those practices of commercial actors. It helps inform the public, who can then ask for change.”

Most public health research on the CDOH to date has focused on a narrow segment of commercial actors, producing the unhealthy commodities that most of us are familiar with. Furthermore, public health researchers often discuss the CDOH using sweeping terms such as private sector, industry, or business that lump together diverse entities whose only shared characteristic is their engagement in commerce. The absence of clear frameworks for differentiating among commercial entities, and for understanding how they might promote or harm health, hinders the governance of commercial interests in public health.

In the second publication in the Series, Dr. Mialon and her co-authors developed a framework that enables meaningful distinctions among diverse commercial entities through consideration of their practices, portfolios, resources, organization, and transparency. The framework developed permits fuller consideration of whether, how, and to what extent a commercial actor might influence health outcomes.

The third publication looks at the future role of the commercial sector in global health and health equity. The authors tell us that progressive economic models, international frameworks, government regulation, compliance mechanisms for commercial entities, regenerative business types and models that incorporate health, social, and environmental goals, and strategic civil society mobilization together offer possibilities of systemic, transformative change, reduce those harms arising from commercial forces, and foster human and planetary well-being.

The Lancet Series on commercial determinants of health highlights the need to better understand the diversity of the commercial world and pathways to health harms or benefits. Differentiating between commercial actors—based on differences in their practices, portfolios, resources, organization, and transparency—helps clarify where and how interventions can be applied.

The authors issue recommendations to a range of audiences—including business leaders, policymakers, public health practitioners, and the public—underscoring the importance of whole-of-society engagement with the CDOH.

Dr. Mialon and her co-authors’ final statement leaves us to ponder, “The most basic public health question is not whether the world has the resources or will to take such actions, but whether humanity can survive if society fails to make this effort.”