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June 2025
Quarterly Article
Raquel Burgess
Tanja Srebotnjak
Christine Lin
Lawrence Grierson
Daniel C. Esty
Yusuf Ransome
Nicholas Freudenberg
March 2024
The Future of Population Health
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
