Defining and conceptualising the commercial determinants of health

Anna B Gilmore, Alice Fabbri, Fran Baum, Adam Bertscher, Krista Bondy, Ha-Joon Chang, Sandro Demaio, Agnes Erzse, Nicholas Freudenberg, Sharon Friel, Karen J Hofman, Paula Johns, Safura Abdool Karim, Jennifer Lacy-Nichols, Camila Maranha Paes de Carvalho, Robert Marten, Martin McKee, Mark Petticrew, Lindsay Robertson, Viroj TangcharoensathienAnne Marie Thow

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Although commercial entities can contribute positively to health and society there is growing evidence that the products and practices of some commercial actors-notably the largest transnational corporations-are responsible for escalating rates of avoidable ill health, planetary damage, and social and health inequity; these problems are increasingly referred to as the commercial determinants of health. The climate emergency, the non-communicable disease epidemic, and that just four industry sectors (ie, tobacco, ultra-processed food, fossil fuel, and alcohol) already account for at least a third of global deaths illustrate the scale and huge economic cost of the problem. This paper, the first in a Series on the commercial determinants of health, explains how the shift towards market fundamentalism and increasingly powerful transnational corporations has created a pathological system in which commercial actors are increasingly enabled to cause harm and externalise the costs of doing so. Consequently, as harms to human and planetary health increase, commercial sector wealth and power increase, whereas the countervailing forces having to meet these costs (notably individuals, governments, and civil society organisations) become correspondingly impoverished and disempowered or captured by commercial interests. This power imbalance leads to policy inertia; although many policy solutions are available, they are not being implemented. Health harms are escalating, leaving health-care systems increasingly unable to cope. Governments can and must act to improve, rather than continue to threaten, the wellbeing of future generations, development, and economic growth.

Original languageEnglish
Pages (from-to)1194-1213
Number of pages20
JournalThe Lancet
Issue number10383
Early online date23 Mar 2023
Publication statusPublished - 8 Apr 2023

Bibliographical note

Funding Acknowledgments
ABG and AF were supported by the SPECTRUM Consortium
(MR/S037519/1), which is funded by the UK Prevention Research
Partnership (UKPRP). UKPRP is an initiative funded by the British Heart
Foundation, Cancer Research UK, Chief Scientist Office of the Scottish
Government Health and Social Care Directorates, Engineering and
Physical Sciences Research Council, Economic and Social Research
Council, Health and Social Care Research and Development Division
(Welsh Government), Medical Research Council, National Institute for
Health Research, Natural Environment Research Council, Public Health
Agency (Northern Ireland), The Health Foundation, and the Wellcome
Trust. AE, KJH, and SAK were supported by the South African Medical
Research Council/University of the Witwatersrand Centre for Health
Economics and Decision Science (Grant number 23108). AB was
supported by a PhD scholarship funded by University of Bath. JLN was
supported by the Victorian Health Promotion Foundation.
LR was supported by fellowships from the New Zealand Heart
Foundation and a Royal Society Fast Start grant (UOO2028).

ASJC Scopus subject areas

  • General Medicine


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    Gilmore, A.



    Project: Research council

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