Defining the commercial determinants of health: a systematic review

Abstract

Background: Despite increasing attention to the social determinants of health in recent decades, globally there is an unprecedented burden from non-communicable diseases (NCDs). Recently, the corporate and commercial conditions associated with these, commercial determinants of health (CDoH), have also begun to receive attention. This research aims to articulate the CDoH as described in the literature, summarize substantive findings, and assess strengths and limitations of current literature. Methods: Systematic review of formal (Medline, EMBASE, Scopus, Global Health) and grey literature (database, Google Advanced, targeted website, citation searching). Searching identified 125 texts for full-text review, with 33 included for final review. Data extracted were analyzed thematically. Results: The dynamics constituting CDoH include broad facilitators such as globalization of trade, corporate structures, and regulatory systems, articulation of social and economic power, neoliberal and capitalist ideologies; additional elements include corporate activities such as marketing, corporate political activities, corporate social responsibility, extensive supply chains, harmful products and production, and issues of accessibility. These contribute significantly to worsened global health outcomes. Conclusions: Literature describing effects of macro conditions and corporate activities on health could usefully utilize CDoH terminology. Facilitation via revised, consistent and operational definition of CDoH would assist. Social, political, commercial and economic structures and relations of CDoH are under-theorized. Systematic approaches to identifying, describing, and disrupting these are required to improve global health.

The case for developing a cohesive systems approach to research across unhealthy commodity industries

“…Our study echoes others in calling for a unified approach to research on UCIs 25 36 102 and argues for a complex systems approach to analyse the linkages between UCIs and the way in which they collectively influence policy. 103 Complex systems thinking has long been recommended as a powerful tool for the analysis of UCIs, but has been underused to date.…”

“…4 This study sits within the overarching domain of, and contributes to research on, the 'commercial determinants of health', variously defined as adverse health impacts attributable to commercial activities and strategies employed by UCIs to promote products which can damage health. [23][24][25] There is growing evidence of convergence of strategic approaches between UCIs themselves, 26 27 and the need for a systems approach to conducting research on UCIs' influence of public health policy. Doing so would conceptualise poor health as the result of many factors-such as UCIs' shaping of policy-as interconnected elements working together to bring about change throughout the system.…”

“…30 31 A systems approach to research on UCIs offers an analytical framework within which to explore not only the conditions and factors shaping the commercial determinants of health, but also, importantly, the way in which these factors relate to each other and how they generate environments which negatively affect health. 25 This paper explores the links between UCIs, analyses the extent of alignment across their corporate political strategies and proposes a cohesive systems approach to research across UCIs.…”

“… 30 31 A systems approach to research on UCIs offers an analytical framework within which to explore not only the conditions and factors shaping the commercial determinants of health, but also, importantly, the way in which these factors relate to each other and how they generate environments which negatively affect health. 25 …”

The COVID-19 pandemic and its implications for the food information environment in Brazil

“…Also, there are no regulations currently in place to protect consumers from the social responsibility actions of the food industry associated with self-promotion or sponsorship. When companies do not take responsibility for the health consequences of consuming their products and divert the attention from questionable practices through corporate social responsibility actions, they end up increasing their credibility before consumers, especially in vulnerable contexts such as the COVID-19 pandemic (33) . The health crisis cannot justify the promotion of the unhealthy food industry since it has a crucial impact on the epidemic of obesity and chronic non-communicable diseases, which in turn increases the population's vulnerability to COVID-19 and emerging infectious diseases (34,18).…”