This groundbreaking technical paper is informed by and supports the effort by Small Island Developing States (SIDS) to tackle the economic and commercial determinants of health—as set out in the 2023 Bridegtown Declaration . In particular, the paper addresses the challenges and opportunities for SIDS in addressing the economic and commercial determinants of noncommunicable diseases, mental health conditions, injuries and violence.
Titled " Economic and commercial determinants of health in Small Island Developing States: noncommunicable diseases, mental health conditions, injuries and violence ," the paper was unveiled during an official side event at the 78th World Health Assembly focusing on the upcoming UN High-Level Meeting on NCDs and Mental Health.
The technical paper is the first comprehensive analysis examining how commercial determinants specifically impact health outcomes in SIDS, identifying both challenges and opportunities for intervention.
Key findings
The paper reveals several critical common and shared vulnerabilities of SIDS which underpin their economic and commercial determinants of health.:
- Power imbalances: Due to small populations and limited human and financial resources, SIDS face disproportionate pressure from multinational commercial actors
- Less diversified economies: Many SIDS rely heavily on sectors centered on potentially health-harming products.
- Dependence on external supply: Import dependency leaves SIDS susceptible to market fluctuations and disadvantageous trade agreements
- Interconnected challenges: Climate change, food insecurity and harmful commercial practices compound leading to health harms.
Recommendations
The paper outlines five key opportunity areas for addressing economic and commercial determinants of health in SIDS:
- Creating policy environments that enable health through measures such as taxation of health-harming products as well as regulation of commercial practices such as harmful marketing
- Safeguarding against conflicts of interest through transparent and coordinated governance mechanisms
- Empowering community participation in governance for health
- Strengthening governance for commercial determinants in development approaches
- Investing in SIDS-SIDS and triangular cooperation
As Dr Etienne Krug, Director of WHO's Social Determinants of Health Department, notes in the paper's foreword: "Tackling the commercial determinants of health in SIDS includes action to support shifting businesses from health-harming to health-promoting practices, addressing power imbalances between public sectors and commercial actors, regulating harmful commercial practices, and improving underlying systems."
Building on momentum
The paper builds on the 2023 Bridgetown Declaration on NCDs and Mental Health, providing a technical foundation for implementing the roadmap established at the SIDS Ministerial Conference in Barbados.
This paper comes as the Bridgetown Declaration's importance moves beyond SIDS: it provides the momentum and path forward as the world approaches the Fourth High-Level Meeting. In the same way that the 2007 Declaration of Port-of-Spain on Uniting to Stop the Epidemic of Chronic NCDs is credited with building momentum for the first UN high-level meeting on NCDs in 2011 and its transformation of the NCD response, the 2023 Bridgetown Declaration promises to be a catalyst for the rebirth of the response to NCDs and mental health.
"The time for action is now," the technical paper concludes, calling for collaborative efforts between SIDS governments, communities, and international partners to develop integrated approaches that prioritize well-being, embrace Indigenous knowledge, and support health-aligned local businesses.
WHO will continue supporting SIDS and all countries through technical assistance, capacity-building and fostering a global community of practice on commercial determinants of health to protect health, promote wellbeing and save lives.
