Measuring the Commercial Determinants of Health and Disease: A Proposed Framework

Abstract

The commercial determinants of health (CDoH) describe the adverse health effects associated with for-profit actors and their actions. Despite efforts to advance the definition, conceptualization, and empirical analyses of CDoH, the term's practical application to mitigate these effects requires the capacity to measure the influences of specific components of CDoH and the cumulative impacts of CDoH on the health and well-being of specific populations. Building on the Global Burden of Disease Study, we begin by conceptualizing CDoH as risk factor exposures that span agency and structural influences. We identify 6 components of these influences and propose an initial set of indicators and datasets to rank exposures as high, medium, or low. These are combined into a commercial determinants of health index (CDoHi) and illustrated by 3 countries. Although now a proof of concept, comparative analysis of CDoH exposures by population, over time and space, and their associated health outcomes will become possible with further development of indicators and datasets. Expansion of the CDoHi and application to varied populations groups will enable finer targeting of interventions to reduce health harms. The measurement of improvements to health and wellness from such interventions will, in turn, inform overall efforts to address the CDoH.

A proposal for systematic monitoring of the commercial determinants of health: a pilot study assessing the feasibility of monitoring lobbying and political donations in Australia

“…One of the earlier CDoH models refers to corporations as “vectors of disease,” an analogy that, if we follow its epidemiological logic, leads us to ask why we don’t monitor corporations and other commercial entities with the same vigilance that we attend to other disease vectors [ 6 ]. Several researchers and organisations, including WHO, have called for systematic monitoring of the CDoH [ 7 , 8 ]. There are many potential elements of a CDoH monitoring program.…”

“…Powerful corporations engage in a range of political practices to influence the political environment in their favour. Researchers of the CDoH analyse these practices, providing insights on how businesses engage in lobbying, political contributions, litigation, the revolving door, issue framing, manufacturing doubt and more [ 7 , 9 – 13 ]. Collectively, these political practices delay, block and undermine the development and implementation of the most effective and equitable policies to protect and improve public health [ 14 ].…”

Integrating Social, Political and Commercial Determinants of Health Frameworks to Advance Public Health in the twenty-first Century

“… Develop and test reliable and consistent ways to measure changes in underlying determinants and their outcomes. To inform practice, regulation, and scientific advances, a framework must define specific reliable and generalizable metrics that can be used to measure variables of interest. While investigators have proposed various approaches for measuring social, 34 political, 35 and commercial 36 determinants and their outcomes, none of these approaches are yet widely tested, accepted across disciplines and geographies, or used by official health agencies. Moreover, few investigators have attempted to define common measures across the three frameworks.…”

From silos to policy coherence: tobacco control, unhealthy commodity industries and the commercial determinants of health

“…They have targeted marketing at less advantaged groups, including the poor, ethnic minorities and women, 18 26 27 and promoted voluntary measures 28 such as health information campaigns (less effective for disadvantaged groups 29 ) over stronger forms of tobacco control. 26 30 At a macro level, transnational cigarette manufacturers aggressively pursue market access and resist regulation, [31][32][33] thus increasing their structural power 12 and exacerbating economic and social inequities. 27 34 While evidence is strongest for tobacco, similar inequities are evident in other industrial epidemics.…”

“…Here we highlight the potential for strengthening tobacco control’s links with broader health and development agendas in order to support coherent approaches to advancing global health. We argue that such efforts are facilitated by understanding and addressing tobacco from a commercial determinants of health (CDoH) perspective 7 11 12. This means regulating the tobacco industry as part of an intersectoral strategy to mitigate the impacts of corporate actors whose profit-driven policies, practices and products damage health via their influence on wider social, economic and political determinants.…”