Researchers from the University of Bath have contributed to a three-paper Series published in the leading health journal The Lancet 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 inequalities

The Series describes how, although many commercial entities contribute positively to health and society (eg through the creation of jobs or products essential to health), 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 Series authors make key recommendations to improve how healthcare systems in the UK and around the world are managed to ensure health is always prioritised above profit. Resources include a model explaining how inequity happens and how it can be adjusted, and policy briefs with advice for politicians and public health leaders.

Professor Anna Gilmore of the University’s Department for Health contributed to all three papers and is lead author on paper one. Anna Gilmore is Professor of Public Health, Director and founder of the Tobacco Control Research Group (TCRG), and Co-Director of the Beacon for 21st Century Public Health at the University of Bath. Dr Alice Fabbri and Adam Bertscher, also of the Department for Health, were contributing authors on the first paper, which defines and conceptualises the commercial determinants of health.

Professor Gilmore explains:

“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.”

Professor Rob Moodie, Series Lead and Professor of Public Health Melbourne School of Population and Global Health, University of Melbourne, says: "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.”

Cycle of harm

The 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 (eg treating non-communicable diseases or clearing corporate waste) are largely met by the states and individuals affected, reducing 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 needed

The authors argue significant, systemic change is needed, and offer policymakers and practitioners a toolbox to help them respond. As Professor Gilmore says: “Commercial entities need to meet the true costs of the harm they cause; governments 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”.

Some of these changes might include:
- Governments legislating to prevent the 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 using ‘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 their political agendas.
- Improved rules on transparency and ways to address conflicts of interest in policy making.

Professor Gilmore argues:

Change is urgently needed and, until it occurs, health and equity will continue to be threatened, causing significant economic and social damage.