The Fund supports networks of state health policy decision makers to help identify, inspire, and inform policy leaders.
A bipartisan group of state health policymakers from both the executive and legislative branches who are focused on improving population health.
Networks of state officials, advocates, and others aiming to invest in and transform primary care.
A program dedicated to advancing state-based efforts to make health care more affordable for residents, employers, and states.
The Milbank Memorial Fund supports two state leadership programs for legislative and executive branch state government officials committed to improving population health.
A leadership development program for early and mid-career state government officials who are committed to improving the health of all people in their communities.
A leadership program for senior state government officials who are committed to improving population health.
The Fund focuses on creating an affordable health care system built on strong primary care and partnerships that improve health outcomes for all.
Improving state leaders’ ability to enact and implement evidence-based health policies.
Advancing policies that create a more prevention- and primary care-oriented health system.
Improving population health through policies that contain health care cost growth.
Our state health policy resources offer relevant data analysis and best practices.
The Fund publishes reports, issues briefs, and case studies on state health policy issues.
Short takes on health policy issues from Milbank staff and guest authors.
Insights from Milbank President Debra Lubar on state health policymaking.
Reported articles and Q&As on timely health policy issues, as well as foundation updates.
Milbank Memorial Fund and Milbank Quarterly webinars featuring state health policymakers and researchers.
Updates and expert contact information for reporters.
The Milbank Memorial Fund is a private foundation that works to improve population health and health equity.
June 2025 (Volume 103)
Quarterly Article
Raquel Burgess
Tanja Srebotnjak
Christine Lin
Lawrence Grierson
Daniel C. Esty
Yusuf Ransome
Nicholas Freudenberg
June 2026
March 2026
September 2025
Back to The Milbank Quarterly
Policy Points:
In the last two decades, the concept of the commercial determinants of health (CDH) has become an increasingly common lens for understanding the causes of adverse health outcomes and their distribution across populations. In a recent Lancet series on the CDH, Gilmore and colleagues defined the CDH as “the systems, practices, and pathways through which commercial actors drive health and equity.”1 The study of these systems, practices, and pathways has been informed by the work of civil society organizations that have tackled these issues for many decades.2, 3 More recently, the CDH concept has been incorporated into public health practice and policy in some jurisdictions, such as within Australia’s National Preventive Health Strategy.4, 5 Efforts to advance the theoretical and practical use of the CDH concept have faced a myriad of challenges that include insufficient funding, a lack of attention to commercial practices within public health education programs, a lack of metrics for measuring commercial activities and assessing impacts, a diverse and complicated commercial sector, and industry opposition and intimidation.2, 6-8 Despite these challenges, the CDH concept has the potential to be a useful tool to overcome some of the key barriers the field of public health has faced in promoting healthier communities and improving health equity (e.g., advancing policies that challenge entrenched interests).9, 10
In this article, we seek to advance discussion on two key priorities related to the CDH: 1) the development of mechanisms to measure and monitor the practices of commercial entities, and 2) the development of effective policy recommendations for addressing the CDH.
Gilmore AB, Fabbri A, Baum F, et al. Defining and conceptualising the commercial determinants of health. Lancet (London, England). 2023; 401(10383): 1194–1213. https://doi.org/10.1016/S0140-6736(23)00013-2
Freudenberg N, Lee K, Buse K, et al. Defining priorities for action and research on the commercial determinants of health: a conceptual review. Am J Public Health. 2021; 111(12): 2202–2211.th
Townsend B, Johnson TD, Ralston R, et al. A framework of NGO inside and outside strategies in the commercial determinants of health: findings from a narrative review. Global Health. 2023; 19(1): 74. https://doi.org/10.1186/s12992-023-00978-x
Parker M. What are the commercial determinants of health, and why do they matter? Intouch Public Health. April 13, 2023. Accessed May 13, 2024. https://intouchpublichealth.net.au/what-are-the-commercial-determinants-of-health-and-why-do-they-matter/e
World Health Organization; Small Island Developing States Health; Pan American Health Organization. 2023 Bridgetown Declaration on NCDs and mental health. December 12, 2023. Accessed June 29, 2024. https://www.who.int/publications/m/item/2023-bridgetown-declaration-on-ncds-and-mental-health
Burgess R, Nyhan K, Dharia N, Freudenberg N, Ransome Y. Characteristics of commercial determinants of health research on corporate activities: a scoping review. PLoS One. 2024; 19(4):e0300699. https://doi.org/10.1371/journal.pone.0300699
Freudenberg N, Crosbie E. Teaching the commercial determinants of health. In: N Maani, M Petticrew, S Galea, eds. The Commercial Determinants of Health. Oxford University Press; 2023. https://doi.org/10.1093/oso/9780197578742.003.0031
Lacy-Nichols J, Nandi S, Mialon M, et al. Conceptualising commercial entities in public health: beyond unhealthy commodities and transnational corporations. Lancet. 2023; 401(10383): 1214–1228. https://doi.org/10.1016/S0140-6736(23)00012-0
Freudenberg N. Framing commercial determinants of health: an assessment of potential for guiding more effective responses to the public health crises of the 21st century. Milbank Q. 2023; 101(S1): 83–98. https://doi.org/10.1111/1468-0009.12639
Friel S, Collin J, Daube M, et al. Commercial determinants of health: future directions. Lancet. 2023; 401(10383): 1229–1240. https://doi.org/10.1016/S0140-6736(23)00011-9