BEYOND NON-COMMUNICABLE DISEASES: Expanding The Scope Of Commercial Determinants Of Health Research

In its first decade, research on commercial determinants of health (CDoH) focused heavily on the role of the tobacco, alcohol, and food industries in the rising burden of widening inequities in non-communicable diseases such as heart conditions, diabetes, cancer, stroke, and lung diseases. While these industries do play a powerful role in shaping global patterns of health and disease, this post highlights two recent studies that expand the scope of this work to other sectors and industries. Readers are invited to send notices of other recent (2021) CDoH articles that study outcomes other than NCDs and sectors beyond food, alcohol, and tobacco.

The COVID-19 Pandemic Exposes Another Commercial Determinant of Health: The Global Firearm Industry

Firearms have a significant impact on the health of individuals and societies globally, with a disproportionate burden on low- and-middle-income countries (LMICs). The firearms industry uses strategies to promote the sale and use of their products that are detrimental to health and therefore should be viewed through a commercial determinants of health lens. Coupled with the heightened risks during the COVID-19 pandemic, the threat to health posed by the firearms industry necessitates public health research, intervention, and collaboration. Public health practitioners and policy makers should increase efforts to reduce the burden of firearm violence. Public health researchers should use a commercial determinants of health lens when investigating health risks caused by firearms. When discussing solutions to firearm violence, public health practitioners and policy makers should include perspectives from LMICs and vulnerability.

Citation: The COVID-19 Pandemic Exposes Another Commercial Determinant of Health: The Global Firearm Industry, Adnan A. Hyder, Meghan Werbick, Lauren Scannelli and Nino Paichadze, Global Health: Science and Practice June 2021, 9(2):264-267

Pharmaceuticals As a Market For “Lemons”

Drawing on economic theory and institutional analysis, this paper characterizes pharmaceuticals as a multi-tier market of information asymmetry in which actors in each tier have substantial control over how much they disclose about hidden risks of harm. Such a market rewards the production and sale of “lemons.” Current incentives and institutional practices reward developing a large number of barely therapeutically innovative drugs and ignoring their often hidden or understated harmful side effects. The probability of benefits decreases but the chances of lemons adverse events do not. The details presented here deepen understanding of how markets for lemons thrive on information asymmetry, secrecy, and power.

Citation:  Light DW, Lexchin JR. Pharmaceuticals as a market for “lemons”: Theory and practice. Social Science & Medicine. 2021 ;268:113368.

New Reports on Commercial Determinants of Health

The Science for Profit Model—How and why corporations influence science and the use of science in policy and practice

Major industries, including tobacco, chemical, and pharmaceutical, have long used science to delay progress in tackling threats to human and planetary health by obscuring industry harms, and opposing regulation. A new study in PLOS ONE synthesizes the literature to develop an evidence-based typology and model of corporate influence on science in order to provide an overview of this multi-faceted phenomenon. Their report provides an accessible way to understand how and why corporations influence science, demonstrates the need for collective solutions, and discusses changes needed to ensure science works in the public interest.

Globalization, first-foods systems transformations and corporate power

This report in Globalization and Health synthesizes literature and data on the market and political practices of the transnational baby food industry. The authors found that industry practices are a major impediment to global implementation of the International Code of Marketing of Breastmilk Substitutes, and other policy actions to protect, promote and support breastfeeding. They conclude new modalities of public health action are needed to negate the political practices of the industry in particular, and ultimately to constrain corporate power over the mother-child breastfeeding dyad.

A public health approach to gambling regulation

A Viewpoint in Lancet argues that the United Kingdom lacks a gambling policy system that explicitly tackles public health concerns and confronts the dependencies and conflicts of interest that undermine the public good. Too often, government policy has employed discourses that align more closely with those of the gambling industry than with those of the individuals, families, and communities affected by the harms of gambling. The authors identify elements that need challenging and stimulating debate.

Cristiano Ronaldo rebuff sees Coca-Cola market value fall by $4bn

After soccer star Cristiano Ronaldo removed two Coca-Cola bottles at a Euro 2020 news conference, reports ESPN, Coca Cola saw its share price drop by 1.6%, lowering its market value from $242bn to $238bn — a $4bn drop. Ronaldo, an advocate of a healthy diet, moved the glass bottles out of the camera frame and instead held up a bottle of water and said in Portuguese: “Water!” A few days later, France midfielder Paul Pogba removed a bottle of Heineken beer that had been placed in front of him at a news conference following the 1-0 win over Germany in Munich. Pogba, a practicing Muslim who does not drink alcohol, removed the bottle when he sat down to speak to the media after he was named man of the match.

Time for Public Health to talk About Capitalism?

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A cascade of health crises—from the covid-19 pandemic to our climate emergency, and a rise in “deaths of despair”—are contributing to growing global health burdens, making this the time for health professionals to seek the common causes of these catastrophes. Despite the influence of dominant political and economic structures and health, health professionals are often reluctant to use the word capitalism when analyzing the world’s current health problems and proposing solutions. Is now the time for public health researchers, professionals , and activists to focus our attention on the role of 21st century capitalism in creating these crises, asks Nicholas Freudenberg in a BMJ First Opinion post? Read more.

Air pollution and the noncommunicable disease prevention agenda

Air pollution is a major environmental risk factor and contributor to chronic, noncommunicable diseases (NCDs). However most public health approaches to NCD prevention focus on behavioral and biomedical risk factors, rather than environmental risk factors such as air pollution. In this article, Eloise Howse et al. discuss the implications of such a focus. They urge those in public health and environmental science to work together to acknowledge the shared drivers, including corporate determinants of air pollution; take a ‘co-benefits’ approach to NCD prevention; and expand prevention research through systems thinking and intersectoral, cross-disciplinary collaboration.  Read more.

Beyond nutrition and physical activity: food industry and principles of scientific integrity

In a study published in Globalization and Health designed to assess how food industry actors seek to influence the principles of scientific integrity, Mialon and colleagues present a case study of the International Life Science Institute (ILSI) as a key actor in that space. The authors conclude that the activities developed by ILSI on scientific integrity principles are part of a broader set of industry political practices of industry actors to influence public health policy, research, and practice. They argue that it is important to counter these practices as they risk shaping scientific standards to suit the industry’s interests rather than public health ones.

Corporations, Politics, and Democracy: Corporate political activities as political corruption

Corporate involvement in democratic processes typically takes the form of corporate political activity (CPA). In an article in Organizational Theory, Daniel Nyberg develops a framework of political corruption to explain the corroding influence of CPA on democratic processes. The articles explicates the corporate capture of democratic processes and assesses the role of corruption in Western liberal democracies. Finally, the author suggests ways to halt this process and thereby defend democracy as a system of governance from undue corporate interests.

Corporate versus public control of science and technology: Forging a framework for the 21st Century.

“Science knows no country, because knowledge belongs to humanity, ” Louis Pasteur wrote in 1876. Today it would be more accurate to say that science belongs to the corporations and investors that have the money, power, and savvy to secure patents and bring new developments to global markets, a change that threatens human and planetary health. Nicholas Freudenberg writes  in STAT that the pandemic and the cascade of other global public health crises, including the climate emergency, increasing deaths of despair,  and the growing burdens of chronic diseases and mental health problems demand a new accounting of the costs of the corporate control of science and technology in the 21st century. 

And an upcoming event….  Nicholas Freudenberg discusses Modern capitalism and the future of health: assessing the costs and charting alternatives,  Tuesday April 20, 12:30- 1:30 pm ,  Australian Eastern Standard Time, Australia National University, register here

The Commercial Determinants of Three Contemporary National Crises: How Corporate Practices Intersect with the COVID-19 Pandemic, Economic Downturn, and Racial Inequity

The United States finds itself in the middle of an unprecedented combination of crises: a global pandemic, economic crisis, and unprecedented civic responses to structural racism. While public sector responses to these crises have faced much justified criticism, the commercial determinants of these crises have not been sufficiently examined. In a commentary in The Milbank Quarterly, Maani et al. examine the nature of the contributions of such actors to the conditions that underpin these crises in the United States through their market and nonmarket activities. On the basis of their analysis, the authors make recommendations on the role of governance and civil society in relation to such commercial actors in a post-COVID-19 world.

To protect health, rein in Big Tech: Influential companies must take responsibility for effects


Big Tech is finally getting the scrutiny it deserves. The Federal Trade Commission and 46 state attorneys general are suing Facebook for anti-competitive conduct; the Department of Justice has brought a case against Google, challenging its dominance in search engines; ten Republican attorneys general are suing Google over its ad technology practices. These are important efforts to rein in Big Tech’s economic advantages, but the global technology giants’ increasing harm to our health has not yet attracted the attention it warrants.

Continue reading To protect health, rein in Big Tech: Influential companies must take responsibility for effects

Beyond ‘AI for Social Good’ (AI4SG): social transformations—not tech-fixes—for health equity

Many Artificial Intelligence for Social Good (AI4SG) initiatives are shaped by the same corporate entities that incubate AI technologies, beyond democratic control, and stand to profit monetarily from their deployment. Such initiatives often pre-frame systemic social and environmental problems in tech-centric ways, while suggesting that addressing such problems hinges on more or better data. They thereby perpetuate incomplete, distorted models of social change that claim to be ‘data-driven’.

Continue reading Beyond ‘AI for Social Good’ (AI4SG): social transformations—not tech-fixes—for health equity