The Commercial Determinants of Health

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In the last few years of the COVID-19 pandemic, many of us have come to appreciate the critical importance of public health.

In honor of National Public Health Week 2023 (Monday April 3 through Sunday April 9), we’re highlighting an emerging public health concern that impacts health outcomes worldwide: the commercial determinants of health (CDoH).

Let’s examine why CDoH is gaining more attention among public health professionals, and how we can address its negative health impacts.

What are the Commercial Determinants of Health?

In the past decade, public health practitioners have noted the growing influence of companies on federal laws and policies.

As a result, companies have gained more power in shaping our social, physical, and cultural environments through business actions that affect our health, such as how a product is produced, marketed, and priced.

Therefore, CDoH refers to the positive and negative health impacts of business and company activities, according to the World Health Organization (WHO).

How Do the Commercial Determinants of Health Negatively Impact Health Outcomes?

Research shows that CDoH can impact various health outcomes, including obesity, diabetes, cardiovascular health, cancer, road traffic injuries, and mental health, according to WHO.

One example of how CDoH affects public health is US food and beverage companies disproportionately targeting Black and Latino consumers with advertising for high-calorie, low-nutrient products, including candy, sugary drinks, and snacks.

The marketing strategies behind ethnically targeted food and beverage advertisements are alarmingly effective in influencing Black and Latino consumers, especially those of a younger age, according to a 2022 study.

For example, advertising campaigns incorporate hip-hop and Latinx music celebrities, which is an effective and well-established way to appeal to youth audiences.

This ethnically targeted advertising contributes to inequities in diet-related diseases, including heart disease, obesity, and diabetes, in communities of color.

Another example of how CDoH affects public health is the availability of flavored tobacco products, which “play a significant role in enticing youth and young adults,” according to the Truth Initiative.

Flavored tobacco products are also often sold in bright, colorful packages and sold individually and cheaply, which can make them even more appealing to youth and young adults.

As a result, millions of middle and high school students nationwide report using tobacco products, with nearly seven out of 10 of these youth using flavored tobacco products, according to the Truth Initiative.

The health impacts of using tobacco products is well documented, with some of the most common consequences being cancer, heart disease, and chronic obstructive pulmonary disease (COPD), according to the Centers for Disease Control and Prevention.

Many of these CDoH issues, like marketing that targets communities of color, also fit under the umbrella of the social determinants of health (SDoH). SDoH are the non-medical factors that influence our health, such as the conditions in which we are born, grow, live, work, and age.

If not addressed, social needs can cause and worsen health conditions.

“SDoH, including the effects of centuries of racism, are key drivers of health inequities within communities of color,” according to the US Centers for Disease Control & Prevention. “The impact is pervasive and deeply embedded in our society, creating inequities in access to a range of social and economic benefits – such as housing, education, wealth, and employment. These inequities put people at higher risk of poor health.”

Who is Most Impacted by the Commercial Determinants of Health?

While CDoH can affect anyone, researchers report that certain populations are especially at risk of negative outcomes, including impressionable young people (like in the examples above).

Low- and middle-income countries are also vulnerable to the negative effects of CDoH.

These countries often face greater pressure to grow their economy, which can lead them to engage in business practices that worsen health inequities on a global scale.

Such business practices that can worsen health inequities include opening a factory that emits air pollution, producing unhealthy products (like processed food and soft drinks), and exploiting workers in unsafe working environments.

For example, agricultural workers, many of which are Latino, were exploited in the workplace early in the COVID-19 pandemic. Some agricultural business owners did not distribute necessary personal protection equipment (PPE), such as N95 masks, to employees.

Instead, the masks were available for purchase.

“The frustration and anger that [the workers] felt, when they asked their supervisor, ‘Why are you wearing a mask that says N95, and you give us these other ones that look, clearly, cheaper and less protective? This virus doesn’t distinguish between you and me, why do you get a better mask and we don’t?’” Rosalinda Guillen, executive director of Community to Community Development, told Spokane Public Radio.

In this case, CDoH and discrimination contributed to the devastating impacts of the coronavirus pandemic on Latino farmworkers, who already faced various health inequities, such as limited access to healthcare.

Additionally, the lack of precautionary measures to keep farmworkers safe threatened the security of our nation’s food supply – potentially impacting many more lives.

How Do the Commercial Determinants of Health Positively Impact Health Outcomes?

While it may seem that companies and businesses often harm our health, they can contribute to positive health outcomes.

For example, Volvo Car Corporation was the first company to introduce the three-point seat belt seen in vehicles today. The three-point seat belt was more effective than previous models (even lifesaving!), so Volvo gave the seat belt’s design to other vehicle manufacturers for free, all in the name of safety.

Also, in 2014, CVS pharmacy stores stopped selling tobacco products.

“Not only did our decision lead to 100 million fewer packs of cigarettes being sold in the first year since their removal, but we also took our efforts beyond our stores, helping 228 colleges and universities become tobacco free over the past five years and committing $50 million to deliver the first tobacco-free generation through our Be The First initiative,” according to CVS.

Companies also promote positive health outcomes by providing workers with competitive, livable wages; paid parental/family/sick leave; access to affordable health insurance; and health promotion initiatives and activities, such as walkathons, sports, and health literacy events.

How Can Activist Groups Address the Negative Impacts of the Commercial Determinants of Health?

If the government persists in allowing companies and businesses to influence laws and policies, our health outcomes will continue to be impacted, many experts say.

Nicholas Freudenberg of City University of New York School of Public Health explained in a webinar that social activist groups hold the most potential for tackling CDoH issues, because they are less likely to have conflicts of interest with commercial actors.

“Social movements and activist groups are driving forces in change,” he said. “They can put pressure on commercial actors to change practices and encourage the government to take more robust action.”

The Truth Initiative is one such example of a driving force for change.

Because of the non-profit’s efforts, teen cigarette use has decreased from 23% in 2000 to less than 5% today.

Additionally, the Truth Initiative has helped positively influence local laws and policies on the sale of flavored tobacco products. The non-profit is currently pushing for more change at the federal level, specifically to eliminate all flavors from tobacco products.

You Have a Voice for Health Equity!

You can visit our “Take Action” web page to push for system change for health equity.

One example is the free Salud America! Action Pack “Help Your City Adopt Smoke-Free Multifamily Housing” to help your city explore a smoke-free multifamily housing policy for apartment units.

Experts say this can protect the health of tenants and staff of apartments, as well as save property owners money in unit maintenance, fire prevention, insurance, and reduced legal liability. People who live in apartments and other multifamily housing share air with their neighbors ─ including secondhand smoke, which can travel through doorways, halls, windows, ventilation systems, and more.

The action pack can help you use model emails, graphics, and policies to explore a local smoke-free multifamily housing policy in your town.

In addition, you can select your county and get a Health Equity Report Card by Salud America! at UT Health San Antonio.

In your report card, you will see maps, data, and gauges to compare public health issues to the rest of your state and nation.

You can email your Health Equity Report Card to local leaders to stimulate community change. Use the data in your materials or share on social media to raise awareness about the importance of addressing the negative impacts of SDoH and CDoH.

Get your Health Equity Report Card!