New three-paper series from The Lancet shines light on the commercial determinants of health, calling for a radical rethink on what role business plays in public health. 24 March 2023Researchers from SPECTRUM have contributed to a new Lancet series, ‘People, profits, and health’, focused on the commercial determinants of health.These relate to the ways in which businesses and business interests influence human and planetary health and equity.Impact on health and inequitiesMany commercial entities contribute positively to health and society, for example through the creation of jobs or products essential to health.However, the products and practices of some companies – particularly the largest transnational corporations – are responsible for escalating rates of avoidable ill health, planetary damage, and social and health inequity.For example, the products of just four industries – tobacco, fossil fuels, ultra-processed foods and alcohol – are responsible for at least a third of global deaths.The Lancet series authors also identify a broader range of commercial practices beyond the production and promotion of harmful products that harm the health of people and the planet, and contribute to inequities across society.Cycle of harmThe series authors describe the cycle of harm that can evolve from commercial activities.Influential companies use their wealth and power to shape regulations and policies in their favour.These favourable policies allow them to promote products that damage health, weaken standards that protect health, and restrict access to products and services essential to health by charging inflated prices. All this can damage human and planetary health, creating a cost burden.Favourable policies also protect companies from this cost burden. Instead, these costs – for example, treating non-communicable diseases or clearing corporate waste – are largely met by the states and individuals affected. This reduces the resources available to pay for medicines, health care, food, and housing.The result is that states become increasingly impoverished and health systems are increasingly unable to cope.Significant change neededThe authors argue that significant, systemic change is needed, and offer policymakers and practitioners a toolbox to help them respond.Some of these changes might include:Governments to legislate higher standards for marketing of harmful products, including via social media.Governments moving to ensure the corporations that are damaging our health and planet start to meet their true costs, including by ‘polluter pays’ approaches.Businesses to commit to stopping lobbying against pro-health policies, including using third parties such as fake grassroots (astroturf) organisations and think tanks to push political agendas.Improved rules on transparency and ways to address conflicts of interest in policy making. Businesses are of course vital to society and most contribute positively to health. However, over recent decades there has been a creeping trend towards prioritising commercial profits over people and planet. This has played a key role in driving the rising rates of obesity and non-communicable diseases such as cancer and diabetes, as well as the climate crisis.We therefore need a fresh approach to responding to these ‘commercial determinants of health’. This series outlines the issues and explores how we should respond.Change is urgently needed and, until it occurs, health and equity will continue to be threatened, causing significant economic and social damage. Professor Anna Gilmore University of Bath, SPECTRUM Work Package 2 Lead, and lead author of paper one in the series We all want to be part of a society that's safe, happy and healthy but this will only happen when governments make the health of people and the planet a higher priority than profit.This series isn’t anti-business, it’s pro-health. It’s important that we acknowledge that many businesses play vital roles in society, but we also need to recognise the practices and products of some are making people and the environment sick. Professor Rob Moodie Series Lead and Professor of Public Health Melbourne School of Population and Global Health, University of Melbourne Related linksThe Lancet | Access the full series Publication date 24 Mar, 2023
