The private sector has a major influence on health through its products and practices and is a key partner for health and development. Commercial actors influence health in varied and complex ways and have been fundamental in developing and delivering essential health goods and services, but some of their products and practices are responsible for escalating ill health and health inequity worldwide. The frameworks for understanding and an agenda for responding to these influences on health are set out in The Lancet Series on the Commercial Determinants of Health published today. Its three papers show the way to a world where health comes before profit and all people live free from harms caused by commercial forces.
"As the Lancet Series on the Commercial Determinants of Health underlines, many of the most significant risk factors for disease and injury – tobacco, alcohol and unhealthy diet – are major industries and profit-drivers for some of the world's biggest companies." Wrote WHO Director General Dr Tedros Adhanom Ghebreyesus 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 global level. New forms of public health governance are needed."
Dr Tedros also outlined WHO's work in this area in his commentary, highlighting WHO's support to national governments in tackling specific aspects of the commercial determinants in areas such as tobacco control, the marketing of breastmilk substitutes, and noncommunicable diseases. Building on this work, in 2021, a new initiative on the economic and commercial determinants of health was established and, next year, the first Global Report on the Commercial Determinants of Health will be published.
Regulating the bad and enabling the good
The first paper in the series defines the commercial determinants of health as the "systems, practices and pathways through which commercial actors drive human health and health inequity." In this way, these experts recognize the potential for commercial actors to have both positive and negative impacts on health and health equity and focuses on their wide range of influences – which go beyond selling products for profit. This model for understanding the commercial determinants will help guide governments in creating new policies and systems for regulating harms and enabling benefits.
Importantly, these impacts on health are, in the second and third paper, contextualized by a framework for understanding commercial actors and a vision for the policies, governance systems and business models needed for ensuring health, wellbeing and equity. This agenda calls for, among other things, formations in political and economic systems to incentivize pro-health commercial practice and empower governments in addressing harmful commercial practices.
The authors emphasize the critical need for action across the full range of commercial sectors and practices that have negative impacts – products including not just alcohol, tobacco, and unhealthy food industries but also others such as fossil fuels, mining, gambling, automobile, pharmaceuticals, technology and social media as well as the broad range of practices that influence regulatory systems, laws and policies. They conclude by emphasizing that now is the time to "… advance bold conceptualizations of social progress in ways that make public interests and human wellbeing higher priorities than profit."
Next Steps
The Lancet Series on the Commercial Determinants of Health represents a significant step forward in understanding the complex and multifaceted ways in which commercial actors influence health and health equity worldwide. WHO is committed to ensuring the private sector is able to fulfil 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 commercial determinants of health. Together, we can develop new metrics and governance, expand the evidence base, and reorient harmful commercial practices towards health and health equity.
