Countering the commercial determinants of health: strategic challenges for public health

Abstract

Private enterprise is widely seen as making a positive contribution to societal wellbeing. In 2018, more than 80% of Australians were employed in the private sector. 1 Commerce and industry-from small business to large corporations-generate wealth, drive technological innovation, and provide products and services that the community values. However, when the regulation of commercial practices is weak-particularly in the case of large corporations-chasing profits can trump public welfare. The findings of the Royal Commission into Misconduct in the Banking, Superannuation and Financial Services Industry aptly illustrate this conflict, concluding that "much if not all of the conduct identified in the first round of hearings can be traced to entities preferring pursuit of profit to pursuit of any other purpose." 2 The focus of this special issue on the 'commercial determinants of health' is on the corporations which produce and market unhealthy commodities such as tobacco, alcohol, soft drinks and processed food. The limited regulatory control of these industries has contributed to their role in driving the growing global epidemic of noncommunicable disease. The papers commissioned for this issue help to further illuminate how the behaviour of these companies serves to undermine advances in chronic disease prevention. In this, we have been guided by Kickbusch et al's widely cited definition of the commercial determinants of health as "strategies and approaches used by the private sector to promote products and choices that are detrimental to health". 3 This terminology reflects the increasing global understanding of how unhealthy commodity industries affect health, and is the term favoured by the World Health Organization (WHO) and other United Nations agencies. In using the commercial determinants of health framework, we also acknowledge the discussion in the literature of the 'corporate determinants of health' and the recent body of research on transnational corporations. 4-9 This work recognises the wider impact of major corporations on health and wellbeing, beyond the manufacture and marketing of commodities. This framing considers both the direct and indirect effects of corporate operations, including through the production process, environmental footprint, employment and remuneration practices, financial practices (such as meeting tax obligations) and political behaviour. 10 Kickbusch et al proposed that there would be value in using the commercial determinants of health banner as a multidisciplinary field to

Recognising the elephant in the room: the commercial determinants of health

“…Private enterprise makes positive social contributions through systems providing employment, wealth generation, technological innovation and the provision of products and services valued by the community and beneficial to health. 35 However, notwithstanding commercial businesses’ health promoting potential, this is often offset by cascading harms attributable to corporate and commercial actors, including exploitative work conditions, environmental and climate degradation and the entrenchment of inequality and inequities. Such harms typically arise when commercial profit motives conflict with public welfare and social well-being, 35 36 where social and political systems fail to protect workers and the environment, and where social revenues (eg, taxation) are not well guarded.…”

“… 35 However, notwithstanding commercial businesses’ health promoting potential, this is often offset by cascading harms attributable to corporate and commercial actors, including exploitative work conditions, environmental and climate degradation and the entrenchment of inequality and inequities. Such harms typically arise when commercial profit motives conflict with public welfare and social well-being, 35 36 where social and political systems fail to protect workers and the environment, and where social revenues (eg, taxation) are not well guarded. That said, in systems where such protections are upheld, real opportunities to promote population health may be available.…”

“…1 12 22 34 Private enterprise makes positive social contributions through systems providing employment, wealth generation, technological innovation and the provision of products and services valued by the community and beneficial to health. 35…”

“…Private enterprise makes positive social contributions through systems providing employment, wealth generation, technological innovation and the provision of products and services valued by the community and beneficial to health 35. However, notwithstanding commercial businesses’ health promoting potential, this is often offset by cascading harms attributable to corporate and commercial actors, including exploitative work conditions, environmental and climate degradation and the entrenchment of inequality and inequities.…”

Promoting health, preventing disease – making it happen

“…Governments are increasingly shy of regulating the commercial activities of big global enterprises such as those engaged in promoting unhealthy consumption of food, alcohol and sugar-sweetened beverages. 4 We need to learn from experience and be vigilant about implementation…”