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Defining and conceptualising the commercial determinants of health

It has been long understood that corporate actors impact health and health equity outcomes. However, the field of public health, has only recently began to deepen its understanding of these determinants and explore their role in both research and policy to address these impacts. This includes an emergent focus on the Commercial Determinants of Health (CDOH). Despite the rising discussion, this concept has not been defined or fully conceptualized.

This article is the first in a series on the CDOH. The authors — public health academics from across the globe — define the CDOH as “the systems, practices, and pathways through which commercial actors drive health and equity.” They also develop and describe an elaborate model for the CDOH.  The model can be used to understand how health inequities are generated via commercial determinants. The authors discuss corporate power, seven key commercial sector practices that impact health and equity, and how commercial actors shape societal norms to advance their interests. The article also includes a case study in which the proposed model is applied, examining sugar-sweetened beverage consumption in South Africa. This paper makes clear that change is needed as health and equity are threatened.

As the authors note, this paper advances the field in three significant ways.

  1. Bring consensus around the scale, scope, and complexity of the issue.
  2. Explain why commercially driven harm to health is hard to address and continues to escalate, including corporate power and the ability of corporations to impact norms and regulations.
  3. Develop a model to provide a way to understand the CDOH and guide solutions from system changes to specific interventions (i.e. regulating harmful commercial practices).

“Reshaping the [CDOH] … will therefore require the political and economic changes that are increasingly being called for. Commercial entities will need to meet the true costs of the harm they cause; governments will need to exercise their power in holding commercial entities to account; and norms need to be reshaped in the public interest, drawing attention to the right to health and governmental obligation to protect health and not just corporate freedoms.

Use thise resource to:

  • deepen understanding of the commercial determinants of health and how they influence health and health equity;
  • facilitate discussion about the commercial determinants of health; and
  • identify action that can be taken to address the impacts of the commercial determinants of health.


Alignment with NCCDH Work:

The concept of the Social Determinants of Health has been around for many years and has been the focus of NCCDH’s work. Recently, the field of public health has been describing other determinants of health – structural, political, moral, and commercial for example.
Each of these deepens our understanding of one aspect of what impacts our health. NCCDH is starting to explore these determinants of health, incorporating resources like this into our knowledge translation work.

Limiting corporate power is one strategy explored in Let’s Talk: Redistributing power for health equity, as a way to advance health equity.

See other resources on the structural determinants of health.


Gilmore, A. B., Fabbri, A., Baum, F., Bertscher, A., Bondy, K., Chang, H.-J., Demaio, S., Erzse, A., Freudenberg, N., Friel, S., Hofman, K. J., Johns, P., Karim, S. A., Lacy-Nichols, J., Paes de Carvalho, M. P., Marten, R., McKee, M., Petticrew, M., Robertson, L., Tangcharoensathien, V., et al. (2023). Defining and Conceptualising the Commercial Determinants of Health. The Lancet, 401(10383), 1194-1213.

Tags: Structural determinants, Power, Academic Institution, Document, Journal Article