The Commercial Determinants of Health

An accessible multidisciplinary overview for anyone seeking to understand the commercial determinants of health

Our health is largely shaped by the world around us—by the conditions in which we grow, work, and live. These conditions include the commercial determinants of health, the private sector activities which influence our physical and social environments, our available evidence and solutions, and even our discourse and understanding around key health and social issues.

Until recently, commercial determinants have remained largely absent from our conceptual understanding of the drivers of health. The scale of their potential impact necessitates a multidisciplinary and intersectional approach, but no book has yet explored the commercial impacts on health in their totality.

This pioneering volume sheds light on how commercial determinants shape health directly and indirectly through influencing policy, evidence, and discourse. Featuring original cross-sector research, The Commercial Determinants of Health draws on insights from a wide-ranging group of experts who introduce the commercial determinants of health and describe the proximal and distal pathways through which they affect population health. Each chapter further illustrates the health impact of commercial actors, including through multidisciplinary case studies ranging from tobacco to fossil fuels. Together, these essays seek to integrate new and emerging research across public health, economics, and policy to enrich our understanding and responses to the commercial determinants of health.

Nason Maani holds a Lectureship in Inequalities and Global Health Policy in the School of Social and Political Sciences at the University of Edinburgh. His research focuses on the structural and commercial drivers of health inequalities. He is a Fellow of the Royal Society of the Arts, and an Adjunct Assistant Professor at Boston University School of Public Health. He previously was Assistant Professor at the London School of Hygiene and Tropical Medicine as a member of the UK PRP SPECTRUM Consortium and co-founded the Commercial Determinants Research Group at LSHTM. He was a 2019-2020 Commonwealth Fund Harkness Fellow in Healthcare Policy and Practice.

Mark Petticrew is Professor of Public Health at the London School of Hygiene and Tropical Medicine and Director of the NIHR Public Health Policy Research Unit. His research has a focus on the commercial determinants of health and in particular, the influence of unhealthy commodity industries on health. He is a member of the UK PRP SPECTRUM Consortium which conducts research on the commercial determinants of health and other topics. His other research has examined alcohol advertising and marketing from a systems perspective and includes analyses of misinformation disseminated by alcohol industry corporate social responsibility bodies. He is a co-founder and member of the Commercial Determinants Research Group at LSHTM.

Sandro Galea is Dean and Robert A. Knox Professor at the Boston University School of Public Health. He has been named an epidemiology innovator by Time, a top voice in healthcare by LinkedIn, and is one of the most cited social scientists in the world. His writing and work are featured regularly in national and global public media. A native of Malta, he has served as a field physician for Doctors Without Borders and has held academic positions at Columbia University, University of Michigan, and the New York Academy of Medicine.

Section 1: Why Commercial Determinants?

Chapter 1: Commercial Determinants of Health: An Introduction
Nason Maani, Mark Petticrew, and Sandro Galea

Chapter 2: A Systems Perspective on the Pathways of Influence between CDOH and Health
Cécile Knai and Natalie Savona

Chapter 3: Global Health and Equity Burden of Commercial Determinants of Health
Julia Anaf, Fran Baum, and Matt Fisher


Section 2: How Do Commercial Determinants Shape Upstream Drivers of Health?

Chapter 4: The Role of Policy in Studying the Commercial Determinants of Health
Benjamin Hawkins

Chapter 5: Understanding the Politics of the Commercial Determinants of Health
Eduardo J. Gómez

Chapter 6: The Role of Commercial Influences in Public Understanding of Harms, Causes and Solutions
Mark Petticrew, Nason Maani, and May van Schalkwyk

Chapter 7: The Role of Corporations in Influencing Culture
Nancy Tomes

Chapter 8: Industry Influence on Science: What Is Happening and What Can Be Done
Alice Fabbri and Anna Gilmore

Chapter 9: Role in Trade Deals and Investment
Pepita Barlow and Eric Crosbie


Section 3: Case Studies by Industry

Chapter 10: Hidden from View: Alcohol Industry Efforts to Keep the Epidemic of Alcohol-Related Harm from Public Awareness
Tim Stockwell and Erin Hobin

Chapter 11: Learning from 70 Years of Tobacco Control: Winning the War and Not Just the Battles
Anna B. Gilmore and Sarah Dance

Chapter 12: The Fossil Fuel Industry: Fuelling Doubt and Navigating Contradiction
May van Schalkwyk, Nason Maani, and Mark Petticrew

Chapter 13: The Gambling Industry: Harmful Products, Predatory Practices and the Politics of Knowledge
May van Schalkwyk and Rebecca Cassidy

Chapter 14: Sugar-Sweetened Beverages
Eric Crosbie, Laura Schmidt, Jim Krieger, and Marion Nestle


Section 4: Cross-Industry Mechanisms

Chapter 15: Marketing
Simone Pettigrew and Alexandra Jones

Chapter 16: Corporate Social Responsibility: Past, Present, and Future
Nino Paichadze, Vinu Ilakkuvan, Muluken Gizaw, and Adnan A. Hyder

Chapter 17: The Institutionalization of Corporate Power within Policy
Gary Fooks

Chapter 18: Corporations as Irresponsible Artificial People: Human Rights, Profits, and Public Health
George J. Annas

Chapter 19: Industry Influence on Research: A Cycle of Bias
Lisa Bero

Chapter 20: The Global Technology Sector as a Commercial Determinant of Health
Nora Kenworthy, Katerini Tagmatarchi Storeng, and Marco Zenone


Section 5: Advancing Science and Scholarship

Chapter 21: Defining the Commercial Determinants of Health
Jennifer Lacy-Nichols, Cassandra de Lacy-Vawdon, and Rob Moodie

Chapter 22: Assessing Power Structures
Joana Madureira Lima

Chapter 23: Rethinking Conflict of Interest: From Individual to Structural Understandings
Jeff Collin, Rob Ralston, and Sarah Hill

Chapter 24: Assessing the Health Impacts of the Commercial Determinants of Health
Luke N. Allen

Chapter 25: Assessing the Economic Impacts of Corporations
Martin McKee

Chapter 26: Prioritizing Research on the Foundational Drivers of Corporate Policy Influence
William H. Wiist

Chapter 27: The Influence of Commercial Industries on Public Discourse
Shona Hilton

Chapter 28: Commercial Determinants of Health in Low- and Middle-Income Countries
Salma M. Abdalla, Leona Ofei, Nason Maani, and Sandro Galea


Section 6: A Way Forward

Chapter 29: The Question of Industry Partnerships
Peter J. Adams

Chapter 30: Understanding and Managing Corporate Conflicts of Interest
Katherine Cullerton and Martin White

Chapter 31: Teaching the Commercial Determinants of Health
Nicholas Freudenberg and Eric Crosbie

Chapter 32: Learning from Experience: Identifying Key Intervention Points around Corporate Practices to Improve Health
Mélissa Mialon, Julia Anaf, and Fran Baum

Chapter 33: A Policy Agenda for the Commercial Determinants of Health
Sally Casswell

Chapter 34: Commercial Determinants of Health: A Research and Translational Agenda
Nason Maani, Mark Petticrew, and Sandro Galea

Index