Conceptualising commercial entities in public health: beyond unhealthy commodities and transnational corporations

Jennifer Lacy-Nichols, Sulukshana Nandi, Melissa Mialon, Jim McCambridge, Kelley Lee, Alexandra Jones, Anna B. Gilmore, Sandro Galea, Cassandra De Lacey-Vawdon, Camilla Maranha Paes de Carvalho, Fran Baum, Rob Moodie

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Abstract

Most public health research on the commercial determinants of health (CDOH) to date has focused on a narrow segment of commercial actors. These actors are generally the transnational corporations producing so-called unhealthy commodities such as tobacco, alcohol, and ultra-processed foods. Furthermore, as public health researchers, we often discuss the CDOH using sweeping terms such as private sector, industry, or business that lump together diverse entities whose only shared characteristic is their engagement in commerce. The absence of clear frameworks for differentiating among commercial entities, and for understanding how they might promote or harm health, hinders the governance of commercial interests in public health. Moving forward, it is necessary to develop a nuanced understanding of commercial entities that goes beyond this narrow focus, enabling the consideration of a fuller range of commercial entities and the features that characterise and distinguish them. In this paper, which is the second of three papers in a Series on commercial determinants of health, we develop a framework that enables meaningful distinctions among diverse commercial entities through consideration of their practices, portfolios, resources, organisation, and transparency. The framework that we develop permits fuller consideration of whether, how, and to what extent a commercial actor might influence health outcomes. We discuss possible applications for decision making about engagement; managing and mitigating conflicts of interest; investment and divestment; monitoring; and further research on the CDOH. Improved differentiation among commercial actors strengthens the capacity of practitioners, advocates, academics, regulators, and policy makers to make decisions about, to better understand, and to respond to the CDOH through research, engagement, disengagement, regulation, and strategic opposition.
Original languageEnglish
Pages (from-to)1214-1228
Number of pages15
JournalThe Lancet
Volume401
Issue number10383
Early online date23 Mar 2023
DOIs
Publication statusPublished - 8 Apr 2023

Bibliographical note

Funding Information:
JL-N, MM, JM, AJ, ABG, SG, FB, and RM contributed to the conceptualisation of the paper and its aims. JL-N, MM, JM, AJ, SG, FB, and RM contributed to the design of the project. RM sourced funding from the Victorian Health Promotion Foundation and the University of Melbourne to support a .4TE (ie, two days a week) position for JL-N to lead this paper and manage the overall Series. JL-N and CdL-V synthesised literature and consulted with expert stakeholders to inform the development of the framework. JL-N and RM contributed to project administration. RM contributed to supervision. JL-N, MM, JM, AJ, SG, CdL-V, FB, and RM wrote original manuscript. SN and CMPC contributed original case studies to a subsequent draft. All authors contributed to subsequent drafts including substantive commentary and revision.

ASJC Scopus subject areas

  • General Medicine

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  • SPECTRUM

    Gilmore, A. & Rutter, H.

    MRC

    1/10/1930/09/24

    Project: Research council

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