Commercial determinants of health, an emerging theme for research and mobilization

A recent WHO seminar on cancer and a public health thesis in France highlight the importance of what are called the commercial determinants of health. These encompass the impact of companies' commercial strategies on the health of populations, and are as significant as the social determinants of health.

It was in Barcelona that the European branch of the World Health Organization (WHO) and the Association of European Cancer Leagues organized a summer university in September 2023. This brought together for two days around forty youth ambassadors against cancer, all health professionals. The objective was to raise awareness among these young health professionals of the links between the commercial determinants of health and cancers.[1].

Impact of private sector products on public health

According to the definition of a committee of independent international experts, the commercial determinants of health refer to “the systems, practices and pathways through which commercial actors influence health and equity”[2]. They raise the question of the impact of the private sector on public health and take into account in particular all the consequences on the health of populations due to the marketing of certain harmful products such as tobacco and alcohol, whose health burden is well known, but also hydrocarbons and processed foods. These products are mainly manufactured by multinationals which, through lobbying actions, put pressure on public decision-makers when public health measures threaten their interests. The commercial determinants of health thus characterize the practices and strategies deployed by manufacturers to keep harmful products on the market. Cancers are only part of the pathologies caused by exposure to these products.

"The public health community is investing heavily in awareness raising (...), the private sector is investing in lobbying", summarized Mashkur Isa, one of the youth ambassadors against cancer. The health professionals gathered in Barcelona are sorry that their health efforts are constantly invalidated by the products and practices of these manufacturers. However, they do not see this situation as inevitable, and are now campaigning for a reversal of health priorities. It seems paradoxical to them to let these products freely invade the market, and then spend public money to ask populations not to use them. Reducing health risk factors at the source thus appears more effective than fighting diseases or focusing solely on the social determinants of health (gender, age, social category, education, income level, etc.).

Collaboration with certain private sector actors and conflicts of interest that public decision-makers may face here constitute obstacles to prevention policies. According to the participants of this seminar, in order to better discern priorities, health professionals need reliable information that is not influenced by categorical interests that go against the general interest. Research funded by industry, as well as lobbyists and third parties, thus represent as many pitfalls for public health policies.

Boosting research on commercial determinants of health

The topic of commercial determinants of health is also becoming a research topic, as indicated in March 2023 by the launch by The Lancet of a medical journal dedicated to them. In the United Kingdom, the University of Bath has dedicated a research department to it for several years.

In France, this theme is more recent but was the subject of a thesis, defended in September 2023 at the School of Advanced Studies in Public Health (EHESP). Entitled “The impact of commercial determinants of health. The case of alcohol and tobacco industry lobbying in France”, this thesis by Ana Millot, supervised by Professor Karine Gallopel-Morvan, expressly highlights the two main causes of avoidable mortality: tobacco and alcohol[3].

On the subject of tobacco, Ana Millot highlights in particular the lobbying activity of the Confédération des buralistes and its members, in connection with the tobacco industry. In France, tobacconists thus relay the arguments developed by tobacco manufacturers around the world. They present themselves as "local traders", in a context of desertification of certain areas of the territory and place themselves in a victim position to counter public health measures.

Keywords: commercial determinants of health, cancer, WHO, EHESP, Ana Millot

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M.F.

[1] Studying commercial influences on health professionals and the fight against cancer, WHO, published November 13, 2023, accessed November 17, 2023.

[2] Gilmore AB, Fabbri A, Baum F, Bertscher A, Bondy K, Chang HJ, Demaio S, Erzse A, Freudenberg N, Friel S, Hofman KJ, Johns P, Karim SA, Lacy-Nichols J, Paes de Carvalho MP, Marten R, McKee M, Petticrew M, Robertson L, Tangcharoensathien V, et al. (2023). Defining and Conceptualizing the Commercial Determinants of Health. The Lancet, 401(10383), 1194-1213.

[3] The impact of commercial determinants of health. The case of alcohol and tobacco industry lobbying in France., Addict'Aide, published on November 13, 2023, consulted on November 17, 2023.

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