Defining the Commercial Determinants of Health

Abstract

A critical component of scholarship is defining the commercial determinants of health (CDOH). This chapter develops a more nuanced approach to the CDOH by unpacking existing definitions and argues for the need to acknowledge that some commercial activity is (directly or indirectly) health promoting. It then explores the existing models that demonstrate the complex relationships that exist between upstream drivers, commercial actors, and health outcomes. It problematizes the public health understanding of the private sector by exploring the sheer diversity of commercial actors and activities that could be included within CDOH research. It concludes by theorizing what these new understandings mean for public health researchers and practitioners.

Fifty shades of partnerships: a governance typology for public private engagement in the nutrition sector

“…Regarding food industry types, as the size of a company is likely to correlate with its economic power, policy makers have a better chance to maintain a level playing field between stakeholders if transnational corporations are not involved [ 22 ]. Since MSMEs’ economic power is considerably more modest than transnational or large, local companies, involving them in a PPE would have potentially better chance to ensure more balanced power relations with potentially better health outcomes [ 4 ].…”

“…The products and practices of the food industry exert a significant influence on population health and health equity [ 2 ]. While the effectiveness of mandatory regulation (e.g., taxation of sugar sweetened beverages) is well established [ 3 , 4 ], non-binding ‘soft’ modes of regulation, particularly multi-stakeholder platforms and public-private partnerships, have emerged as widespread approaches at multiple levels of governance [ 5 ]. Within global governance, the United Nations Sustainable Development Goal 17 calls for the establishment of multistakeholder partnerships [ 6 ], with national-level governments launching multistakeholder platforms to tackle a range of climate and health challenges.…”

“…These include the draft World Health Organization approach on the prevention and management of conflicts of interest in the policy development and implementation of nutrition programmes at country level [ 20 ], complemented by a simplified triage tool [ 21 ]. While these resources suggest conducting a risk assessment for each individual actor, the public health community tends to discuss engagement with the food industry as if industry were a homogenous group of players, without differentiating the range of actors in this space [ 4 ]. Although the same groups of industry actors are often found across multistakeholder food platforms (e.g., trade associations, large transnational manufacturers), recognising the heterogeneity among industry actors is important in considering public health outcomes, as different types of actors (e.g.…”

“…Although the same groups of industry actors are often found across multistakeholder food platforms (e.g., trade associations, large transnational manufacturers), recognising the heterogeneity among industry actors is important in considering public health outcomes, as different types of actors (e.g. local fruit producers compared to industrial processors) are likely to have different products (and hence externalities), interests, resources, activities, sources and amount power, and thus might aim or able to influence population diet and food regulation differently [ 4 ]. This has led to a growing recognition among researchers that more analytical definitions of food industry actor types would help in conceptualising PPEs, which would be of use to policy makers and advocates [ 4 ].…”

“…local fruit producers compared to industrial processors) are likely to have different products (and hence externalities), interests, resources, activities, sources and amount power, and thus might aim or able to influence population diet and food regulation differently [ 4 ]. This has led to a growing recognition among researchers that more analytical definitions of food industry actor types would help in conceptualising PPEs, which would be of use to policy makers and advocates [ 4 ].…”